The potential role of occupational therapy in acute care with clients with HIV/AIDS

Identity Issues for People Living with HIV/AIDS: Humans with Potential or Sexual Victims?

Sexuality issues are important to consider within the practice of occupational therapy. This is especially so when working with people with the human immunodeficiency virus and the acquired immune deficiency syndrome (HIV/AIDS), where issues related to sexuality are both relevant and present. Recent advances in HIV medications have improved the health and life expectancy for many people living with HIV/AIDS (PLWHA). This has been not only a medical and biological change, but also one that has had dramatic impact on the psychosocial issues, including those related to sexuality, relevant for PLWHA.

This shift in HIV context prompted the creation of a new occupational therapy service for PLWHA — Positive Employment Support (PES). This paper describes data from a focus group held with PES clients, conducted to evaluate the client responses to PES and to direct future service provision. While the focus group provided the expected data about client responses to PES, it also provided rich data about the impact of the shifting HIV/AIDS context on notions of sexuality and identity. This paper explores these ideas and the resulting implications for occupational therapists, especially those working within the field of HIV/AIDS.

Advancing research and practice in HIV and rehabilitation: a framework of research priorities in HIV, disability and rehabilitation

BACKGROUND

HIV increasingly is experienced as a complex chronic illness where individuals are living longer with a range of physical, cognitive, mental and social health-related challenges associated with HIV, comorbidities and aging, a concept that may be termed 'disability'. Rehabilitation such as physical therapy and occupational therapy can help address disability and has the potential to improve quality of life in people living with HIV. Hence, the role for rehabilitation in the context of HIV, aging and comorbidities is emerging. Our aim was to establish a framework of research priorities in HIV, disability and rehabilitation.

METHODS

We convened people living with HIV, clinicians, researchers, service providers, representatives from community-based organizations and policy and funding stakeholders to participate in the first International Forum on HIV and Rehabilitation Research. We conducted a multi-stakeholder consultation to identify current and emerging issues in HIV, disability and rehabilitation. Data were collated and analyzed using content analytical techniques.

RESULTS

Ninety-two participants attended the Forum from Canada, United Kingdom (UK), Ireland and the United States. Situated within three overarching themes (episodic health and disability across the life course; rehabilitation; and methodological advances), the Framework of Research Priorities in HIV, Disability and Rehabilitation includes six research priorities: 1) episodic health and disability; 2) aging with HIV across the life course; 3) concurrent health conditions; 4) access to rehabilitation and models of rehabilitation service provision; 5) effectiveness of rehabilitation interventions; and 6) enhancing outcome measurement in HIV and rehabilitation research. The Framework includes methodological considerations and environmental and personal contextual factors (or lenses) through which to approach research in the field. Knowledge translation should be implemented throughout the development and application of research knowledge to inform HIV clinical practice, programming and policy.

CONCLUSIONS

These priorities highlight the emerging priorities of living long-term with HIV and outline a plan for HIV and rehabilitation research in resource-rich countries such as the UK and Canada.

Enhancing labour force participation for people living with HIV: a multi-perspective summary of the research evidence

Labour force participation has been identified as a critical social and health issue facing people living with HIV/AIDS (PHAs). We conducted a scoping study (a form of literature synthesis that summarizes research findings, research activity, and identifies literature strengths and gaps) on labour force participation for PHAs, guided by a community advisory committee. We summarized information from 243 peer-reviewed articles and 42 reports from the grey literature, and synthesized the evidence into a preliminary conceptual framework with five components: (1) the meaning of work, (2) key factors (barriers and facilitators) influencing labour force participation, (3) factors affecting vulnerable populations, (4) strategies and supports for returning to or sustaining work, and (5) outcomes (benefits and risks) of labour force participation for individuals and employers. The framework supports the development of labour force initiatives requiring collaborative efforts in multiple domains (health, employment, community) by PHAs, rehabilitation professionals, employers, insurers, and policy makers.

Patterns of referral and intervention for persons with AIDS

OBJECTIVE

This study identified reasons practitioners receive occupational therapy (OT) referrals for persons with AIDS (PWAs). Frequency of OT interventions and perceived priorities of PWAs at each Centers for Disease Control and Prevention (CDC) stage of the disease's progression were examined.

METHOD

Surveys were sent to practitioners (N = 47) listed with AOTA having current or past work experience with PWAs. Twenty of the returned questionnaires were usable for analysis. Frequencies, ANOVAs, and weighted rank order statistics were used to bring meaning to the data.

RESULTS

Significantly more referrals for OT services were received for PWAs in Stages 3 and 4 of the disease than Stages 1 and 2 (F = 43.99, df = 3, p <.001). Referrals for early stages of the disease focused on role status, and play/leisure activities. In the latter stages, referrals for cognitive/perceptual skills, adaptive equipment, and caregiver training were more frequent. Frequency of interventions used by practitioners tended to mirror referral patterns, as did the perceived priorities of the PWA.

CONCLUSION

Reasons for referral and the interventions used with PWAs throughout the stages of the AIDS/HIV disease were similar to the perceived priorities of PWAs receiving services from OT practitioners, and reflected the typical symptoms experienced by PWAs at each CDC stage.