R Dray-Spira1, A Gueguen, F Lert. 1. INSERM U687, Hôpital Paul Brousse, 16 av. Paul Vaillant Couturier, 94807 Villejuif Cedex, France. r.dray@creteil.inserm.fr
Abstract
OBJECTIVES: Evidence for the existence of a harmful effect of chronic disease on employment status has been provided. Although this effect of chronic illness on employment has been reported to be higher among the groups with the lowest position on the labour market, the mechanisms of such inequalities are poorly understood. The present study aimed at investigating social inequalities in the chances of maintaining employment during the course of HIV infection and at examining the correlates of such inequalities. METHODS: The authors used data from a national representative sample of people living with HIV in France (ANRS-EN12-VESPA survey). Retrospective information on social trajectory and disease characteristics from the time of HIV diagnosis was available. The risk of employment loss associated with indicators of disease severity and HIV-related workplace discrimination was computed over time since HIV diagnosis according to sociodemographic and occupational factors, using Cox proportional hazards models. RESULTS: Among the 478 working-age participants diagnosed as being HIV-infected in the era of multitherapies and employed at the time of HIV diagnosis, 149 experienced employment loss. After adjusting for sociodemographic and occupational factors, disease severity and self-reported HIV-related discrimination at work were significantly associated with the risk of employment loss in a socially-differentiated manner: advancement in HIV disease was associated with an increased risk of employment loss among women (HR 4.45, 95% CI 2.10 to 9.43) but not among men; self-reported experience of HIV-related discrimination at work was associated with an increased risk of employment loss among individuals with a primary/secondary educational level (HR 8.85, 95% CI 3.68 to 21.30) but not among those more educated. CONCLUSIONS: Chronic HIV disease affects the chances of maintaining employment in a socially-differentiated manner, resulting in increasing inequalities regarding workforce participation. Disease severity and workplace HIV-related discrimination, particularly affecting the employment status of the most socioeconomically disadvantaged, may play a major role.
OBJECTIVES: Evidence for the existence of a harmful effect of chronic disease on employment status has been provided. Although this effect of chronic illness on employment has been reported to be higher among the groups with the lowest position on the labour market, the mechanisms of such inequalities are poorly understood. The present study aimed at investigating social inequalities in the chances of maintaining employment during the course of HIV infection and at examining the correlates of such inequalities. METHODS: The authors used data from a national representative sample of people living with HIV in France (ANRS-EN12-VESPA survey). Retrospective information on social trajectory and disease characteristics from the time of HIV diagnosis was available. The risk of employment loss associated with indicators of disease severity and HIV-related workplace discrimination was computed over time since HIV diagnosis according to sociodemographic and occupational factors, using Cox proportional hazards models. RESULTS: Among the 478 working-age participants diagnosed as being HIV-infected in the era of multitherapies and employed at the time of HIV diagnosis, 149 experienced employment loss. After adjusting for sociodemographic and occupational factors, disease severity and self-reported HIV-related discrimination at work were significantly associated with the risk of employment loss in a socially-differentiated manner: advancement in HIV disease was associated with an increased risk of employment loss among women (HR 4.45, 95% CI 2.10 to 9.43) but not among men; self-reported experience of HIV-related discrimination at work was associated with an increased risk of employment loss among individuals with a primary/secondary educational level (HR 8.85, 95% CI 3.68 to 21.30) but not among those more educated. CONCLUSIONS:Chronic HIV disease affects the chances of maintaining employment in a socially-differentiated manner, resulting in increasing inequalities regarding workforce participation. Disease severity and workplace HIV-related discrimination, particularly affecting the employment status of the most socioeconomically disadvantaged, may play a major role.
Authors: M Goldberg; J F Chastang; A Leclerc; M Zins; S Bonenfant; I Bugel; N Kaniewski; A Schmaus; I Niedhammer; M Piciotti; A Chevalier; C Godard; E Imbernon Journal: Am J Epidemiol Date: 2001-08-15 Impact factor: 4.897
Authors: Rajaram Nagarajan; Joseph P Neglia; Denis R Clohisy; Yutaka Yasui; Mark Greenberg; Melissa Hudson; Michael A Zevon; Jean M Tersak; Arthur Ablin; Leslie L Robison Journal: Cancer Date: 2003-05-15 Impact factor: 6.921
Authors: Sergio Rueda; Janet Raboud; Michael Plankey; David Ostrow; Cameron Mustard; Sean B Rourke; Lisa P Jacobson; Tsegaye Bekele; Ahmed Bayoumi; John Lavis; Roger Detels; Anthony J Silvestre Journal: AIDS Behav Date: 2012-11
Authors: Jenni M Wise; Andres Azuero; Deborah Konkle-Parker; James L Raper; Karen Heaton; David E Vance; Adaora A Adimora; Gina Wingood; Elizabeth Golub; Susanna Levin; Tracey E Wilson; Daniel Merenstein; Ed Yelin; Kathleen M Weber; Margaret Fischl; Mirjam-Colette Kempf Journal: J Assoc Nurses AIDS Care Date: 2022 Jan-Feb 01 Impact factor: 1.354
Authors: Jack E Burkhalter; Sean Cahill; Elyse Shuk; John Guidry; Geoffrey Corner; Alexandra Berk; Norman Candelario; Mark Kornegay; Erica I Lubetkin Journal: Health Educ Behav Date: 2012-10-04
Authors: Ashley A Gorman; Jessica M Foley; Mark L Ettenhofer; Charles H Hinkin; Wilfred G van Gorp Journal: Neuropsychol Rev Date: 2009-05-27 Impact factor: 7.444