While headlines about HIV tout long-shot but possible cures and very real pharmaceutical treatments, there’s something missing when experts talk about that so-called treatment cascade. It’s something critical to treating HIV, says Mark Misrok, president of the board of directors for the National Working Positive Coalition, and it’s not something a doctor can give you. It’s a job.
“In developing effective treatments for HIV, we’ve found that what was most effective was combination therapy and not monotherapy,” says Misrok. “The same applies to improving HIV health outcomes and to reducing health disparities and new infections. Medically focused interventions alone will not achieve our treatment and prevention goals. Employment plays a powerful role in the social and economic lives of almost everyone. Addressing employment needs of people living with HIV is essential to our success in facing down HIV now in the U.S.”
Misrok’s group hears from people all over the country who have “a desperate need for help and information to get or keep a job” as well as service providers trying to help poz clients with their employment needs. The NWPC was started in 2003 by people living with HIV and committed allies to connect “the few but passionate HIV employment service providers, researchers, educators, and advocates in the U.S.”
The group advocates at all levels of government for measures that would expand opportunities for employment and access to employment services for people living with HIV, and it also seeks to link poz people with existing vocational rehab and “transition-to-work” programs.
“This has long been an underdeveloped and underexplored area of service for the needs of people living with and at greatest risk of HIV,” he says. “Pharmaceuticals are capable of profound benefits in HIV care and prevention, but key social and economic determinants of health — including poverty, unemployment, and underemployment — present equally powerful barriers to optimal engagement in care and adherence to treatment and prevention medications.”
NWPC, he says, has also built alliances with advocates for populations “disproportionately struggling for stable, healthy, living-wage employment, all of which include people living with HIV. Structural barriers and discrimination in employment intersect with challenges to staying HIV-negative and achieving viral suppression for people living with HIV, including inequities based on race, sex, sexual orientation, gender identity, disability, poverty, mass incarceration, immigration status, religion and geographic location. In our social and economic contexts, many of us need help to approach leveling the playing field related to employment.”
Employment is a “major challenge for so many of us,” Misrok says, “yet it’s one that can be addressed.” While some areas have HIV-specific employment services available, like New York City, HIV service organizations are often unaware of what local employment programs are available to their clients. This has led many people with HIV to feel like they have to drop out of the workforce, further jeopardizing their health and economic future.
“What we regularly hear from people living with HIV is how much they need and want to work…and [inquiring] where to get the information, training, and employment assistance needed to get the jobs they need,” he says. Often folks don’t even realize the range of jobs they could do, careers they could have even with their disability.
With some help from high up, NWPC is seeing positive change, both with providers seeking information and with policy leaders deciding to “address employment needs as a social and economic determinant of health.” Douglas Brooks, director of the White House Office of National AIDS Policy, has recently said that expanding access to employment and employment services for people living with HIV is among the top priorities for achieving the goals of the National HIV/AIDS Strategy.
Brooks and Misrok, with the help of other HIV organizations such as the Positive Women’s Network-USA, NMAC, and the HIV Prevention Justice Alliance (who collaborates on the group's HIV Economic Empowerment Campaign), have been working with leaders at the U.S. Departments of Labor, Education, and Housing and Urban Development as well as other federal and state agencies to focus resources on the employment needs of people living with HIV.
“There’s simply never been a priority on ensuring that fundamental information about existing employment assistance programs or the ‘transition-to-work’ policies of SSI/SSDI, Medicaid/Medicare, HOPWA, and Section 8 are made accessible, either to people living with HIV or to their service providers,” Misrok says. But if his group has a say, all that is going to change.