Quality of life of unemployed HIV

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Quality of life of unemployed HIV

• Olga Urbánková

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Reflection on a quarter century

• Last year, HIV/AIDS celebrated its 25th
  anniversary
• Since its discovery, the image of HIV/AIDS has
  changed significantly.

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Quantity or Quality?

• During the 1st decade, the focus of sciences had
  been devoted to more medical and pharmaceutical
  aspect of HIV/AIDS.
• Since the current prophylactic and therapeutic
  strategies were developed, one of the goals,
  prolonged longevity has been achieved.

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Quality!

• Longevity brings about other issues it becomes
  necessary to shift attention to more
  psychological, social and economic aspects of
  HIV/AIDS.
• Quality of life (QoL) among PLWHs appears as one
  of the important areas of current scientific (and
  human) interest.

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Aspects of QoL

• QoL is a complex phenomenon consisting of several
  aspects
• Physical functioning
• Emotional and cognitive functioning
• Social functioning
• Economic functioning
• HIV/AIDS represents a threat to all these
• 
  
  
  

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Coping with HIV Influences QoL

• Difficulty in coping with HIV/AIDS mostly appears
  among PLWHs who
• Feel guilty about their past behavior
• Have low quality of habitation
• Are not accepted by peers or colleagues
• Are unemployed
• Have family backgrounds full of conflicts or that
  are poor

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Meanings of Work

• Employment as a source of
• Financial support
• (Higher level of habitation)
• Structure
• Social support
• Role identity
• Self-esteem and self-efficacy
• (Provides oneself with) meaning of life
• (Contributes to) improved health

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HIV/AIDS Limits to Employment of PLWHs.

• HIV/AIDS represents several obstacles for
  employment of PLWHs
• Need for a frequent adaptation to an
  unpredictable illness course
• Fear and anxiety how HIV will affect career
• Episodic illness, fatigue, physical or cognitive
  limits, pain, frequent medical appointments
• Fear of disclosure of HIV status
• Fear of prejudices and social stigmatization

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Long-term unemployment of PLWHs

• Long-term unemployment and emotional stress
  together are associated with
• Poverty
• Substance abuse
• Homelessness
• risky behavior and habits sexual service
• Low social support

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Situation in the Czech Republic

• HIV positive people are mostly young people who
  just started their career. After infection most
  find it difficult to enter the job market,
  moreover lots of them have poor employment
  history or they have not established themselves
  yet.
• Some of PLWHs belonged to marginalized groups
  before infection (e.g. prostitutes) thus they
  have not developed their working skills yet and
  it becomes more difficult to develop such skills
  after infection.
• They need assistance entering the workforce.

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To work or Not to Work?

• PLWHs who enter or re-enter job market must
  weight their costs and benefits from work
• For some PLWHs it is more convenient to retire
  and live on social welfare but after health
  improvement they may feel need for re-entering
  the workforce.

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For Those Who Like Research

• Employment was found to be an important factor
  associated with improved QoL
• Employed PLWHs report higher level of self-worth
  autonomy. Their immunological parameters are
  significantly better than those of the
  unemployed
• Unemployed VL mean 66,86 CD4 299
• Employed VL mean 17,65 CD4 364
• Unemployed PLWHs generally show more depression,
  anxiety and lower self-esteem
• Unemployment belongs to important factors
  associated with suicidal ideation in PLWHs

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Czech pilot study on QoL of 50 HIV positive people
Mean of QoL using SEIQoL (in centimeters) Unemployed Employed Total
HT men 5,50 7,53 6,37
HT women 5,58 7,50 5,83
HS men 4,96 7,09 6,18
Total 5,29 6,26 5,72
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Work and Group Psychotherapy

• 23 PLWHs attending group therapy since 1st Sept
  2005
• The most frequent topics
• habitation, social situation 17
• work, (un)employment 17
• relationships 15
• health condition 12
• Alcohol 4
• Who infected whom 2
• Suicidal ideation 3
• Role of group therapy encourage people in
  searching for job and accompany them in
  remaining at work. 7 of them successfully
  (re)entered the job market.

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Results

• Unemployment represents a threat to QoL of PLWHs
• AIDS as a threat to world economics young people
  stop to be economically active use their
  savings on a treatment, this increases the
  chances of poverty setting in
• Big need for education of
• Students
• Possible employers not to bring prejudices

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Conclusion

• The third decade of HIV/AIDS is approaching its
  end, that means
• We have to do more about fighting with AIDS
• We should ask ourselves how we can influence the
  direction of fighting HIV/AIDS.
• Our greatest opportunities lie in education and
  our children.

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Thank you for your attentionemail
olga_at_urbankova.com