Emory Report

June 26, 2000

 Volume 52, No. 36

Health Sciences

Study looks at HIV, employment

By Lillian Kim

Emory researchers at the Grady Health System are studying how employment status affects the quality of life, psychological health and role identity of people with HIV.

The study is headed by Emory psychiatrist Stephen McDaniel, project director of the Center for AIDS/HIV Mental Health Services, part of the Grady Health System's Infectious Disease Program. Andrew Blalock, a postdoctoral fellow at the center, is the study's co-investigator.

Four years ago, when AIDS was almost invariably a terminal illness that slew swiftly, AIDS-related psychotherapy largely focused on coping with death.

The introduction of protease inhibitors and combination drug therapies changed that, just as it dramatically changed the overall face of AIDS in industrialized countries such as the U.S. Now, many people with HIV are healthy enough to resume many of the activities they enjoyed before becoming ill.

In some ways, though, attempting to regain some semblance of a normal life can be as psychologically challenging for people with HIV as their physical battles against the virus itself.

"It's a common story these days," Blalock said. "People say, 'There I was, ready to die, and I was making plans around that, and now I'm not dying, I'm doing fine. What does that mean?'"

One of the most daunting yet desirable goals for people with HIV is to return to work. Anecdotal evidence has long shown that many HIV-positive people who quit their jobs and go on disability suffer boredom and depression.

But returning to work may not be feasible or practical, however, for numerous reasons. Many HIV-positive people may be relatively healthy, but not quite vigorous enough to cope with a demanding job.

"Returning to work obviously has potentially tremendous benefits," McDaniel said. "But it takes a lot of courage and stamina to take that initial step, especially not knowing how their immune systems will hold up. It doesn't always work out. That can be deva-stating."

Another complicating factor is that for many HIV-positive people, returning to work may be financially disadvantageous. Those supported by disability payments and Medicaid may become ineligible for health coverage if they return to work and exceed maximum income criteria for these programs.

Many studies have assessed the relationship between work and mental health, but the study at Grady is among the first to look at this relationship in the context of chronic illness such as HIV infection.

McDaniel and Blalock hope to learn more about the relationship between the emotional and physical health of people with HIV and their employment status by studying disease progression, mental and psychological functioning and occupational history. The researchers also will measure role salience, or how strongly individuals identify themselves by the role of worker.

"People whose work has been very important to them but now can't work are vulnerable to a lot of problems, both medical and psychological," Blalock said. "If they're able to develop other kinds of meaningful activities, that's a good way to take care of themselves. But there's a group of people who haven't done that."

Funded by the Emory Medical Care Foundation, the study will enroll about 200 people from the metro Atlanta area.

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