Unstable housing and unemployment have been identified as major structural barriers to optimal HIV treatment outcomes among people living with HIV (PLWH). One solution is to provide integrated services that combine medical, employment, housing, and other psychosocial services to address the complex needs of PLWH. This program evaluation reports outcomes of the Foundations for Living program: an integrated employment and housing services program designed for PLWH. Employment and housing outcomes of participants who completed at least one 6-month reassessment were reported by frequency analysis. HIV immune health (CD4 count and viral load) are examined using a matched paired t test. HIV prevention outcomes were assessed by examining changes in the percent of participants with an undetectable viral load. Our findings indicate that among the participants who completed reassessments, 44.8% gained or maintained employment, 86.2% achieved viral load suppression, 75.9% achieved undetectable at the final reassessment. There was no statistical difference between the mean of CD4 count and viral load reported at intake and those reported during the final reassessment. Over half of the participants experienced unstable employment during the program, indicating that significant barriers to employment remain for this population. Implications for rehabilitation counseling practice and research are discussed.
Despite medical advancements that have significantly improved the health outcomes of people living with HIV (PLWH), many do not achieve optimal health outcomes due to psychosocial barriers. This 5-year retrospective longitudinal study draws upon the International Classification of Functioning, Disability, and Health (ICF) framework to conceptualize the relationships between personal and environmental factors and health and retention outcomes among a sample of 704 PLWH in Pennsylvania. A generalized estimated equations (GEE) model was used to model retention in care outcomes (at least one medical visit every 6 months) and a general linear mixed (GLM) model was used to analyze immune system health outcomes (CD4%). This exploratory study reveals that gender, age, race, use of antiretroviral (ARV) medications, use of case management service, mental health diagnosis, and alcohol use were significantly associated with retention in care, whereas race, ethnicity, gender, mental health treatment, use of ARV medications, use of case management services, and retention in care status were significantly associated with the immune system health outcome of CD4%. The results suggest a need for rehabilitation interventions to address key psychosocial issues, as rehabilitation counselors have a unique skill set to address the medical case management needs of individuals with HIV. Implications for rehabilitation counselors and educators are discussed.
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