Evaluating the relative impact of State Vocational Rehabilitation and American Job Centers on contributing to the goals of the National HIV/AIDS Strategy

BACKGROUND: In the recent decades, there has been an emerging population of people living with HIV/AIDS (PLWH) participating in vocational rehabilitation services to become gainfully employed. OBJECTIVE: The purpose of this study is to apply the Behavioral Model for Vulnerable Populations to gain a better understanding of (a) the characteristics of people living with HIV who reported use of vocational rehabilitation (VR) and/or American Job Centers (AJC), (b) factors that contribute to use of these services, and (c) the effects of use of federal employment services on access to care and reduced health-risk behaviors. METHODS: Survey research methods were used to collect data from a diverse sample of volunteer respondents. RESULTS: The majority of respondents were from low-income backgrounds and many had experienced significant barriers to employment such as homelessness, drug abuse, and incarceration. Chi-square tests of independence, factor analysis and structural equation modeling were used to address the research questions. The fit of the final structural equation model was good (RMSEA=0.063, with 90% upper bound of 0.061, CFI=0.95, TLI=0.94). Overall, the findings indicate that the extent to which barriers to employment are experienced differs among those who used federal employment services and those who do not use either of these services. CONCLUSION: Although use of VR is associated with a reduction in health-risk behaviors, an important outcome associated with reduced onward HIV transmission, no such relationship was found with respect to use of AJC services. However, use of VR or AJC services was associated with increased access to care, indicating that both of these federal employment programs play an important role in achieving goals of the National HIV/AIDS Strategy.