http://informahealthcare.com/dre ISSN 0963-8288 print/ISSN 1464-5165 online Disabil Rehabil, Early Online: 1–8 ! 2014 Informa UK Ltd. DOI: 10.3109/09638288.2013.837968 RESEARCH PAPER Examining the role of vocational rehabilitation on access to care and public health outcomes for people living with HIV/AIDS Liza Conyers 1 and K. B. Boomer 2 1 Department of Educational Psychology, Counseling and Special Education, Penn State University, University Park, PA, USA and 2 Department of Mathematics, Bucknell University, Lewisburg, PA, USA Abstract Purpose: The purpose of this study is to examine the role of vocational rehabilitation services in contributing to the goals of the National HIV/AIDS strategy. Three key research questions are addressed: (a) What is the relationship among factors associated with the use of vocational rehabilitation services for people living with HIV/AIDS? (b) Are the factors associated with use of vocational rehabilitation also associated with access to health care, supplemental employment services and reduced risk of HIV transmission? and (c) What unique role does use of vocational rehabilitation services play in access to health care and HIV prevention? Method: Survey research methods were used to collect data from a broad sample of volunteer respondents who represented diverse racial (37% Black, 37% White, 18% Latino, 7% other), gender (65% male, 34% female, 1% transgender) and sexual orientation (48% heterosexual, 44% gay, 8% bisexual) backgrounds. Results: The fit of the final structural equation model was good (root mean square error of approximation ¼ 0.055), with 90% upper bound of 0.058, Comparative Fit Index ¼ 0.953, TLI ¼ 0.945). Standardized effects with bootstrap confidence intervals are reported. Conclusions: Overall, the findings support the hypothesis that vocational rehabilita- tion services can play an important role in health and prevention strategies outlined in the National HIV/AIDS strategy. ä Implications for Rehabilitation  Vocational rehabilitation services can play a unique role in contributing to the goals of the National HIV/AIDS strategy by increasing access to care, increasing use of job support services and reducing health-risk behaviors.  Increased job confidence and more positive health perception reduced HIV stigma, which is a key mediator to use of vocational rehabilitation services.  The Behavioral Model of Vulnerable Populations is a useful framework to evaluate the impact of vocational rehabilitation services on access to health care and health-risk behaviors. Keywords Chronic illness, HIV/AIDS, public health, US National HIV/AIDS Strategy, vocational rehabiltiation History Received 25 March 2013 Revised 19 August 2013 Accepted 21 August 2013 Published online 7 January 2014 Introduction Implementation of the National HIV/AIDS Strategy (NHAS) [1] raises important questions regarding the role of vocational rehabilitation in this major public health initiative. The primary objectives of the National HIV/AIDS Strategy are to (a) reduce new HIV infections, (b) increase access to care and (c) improve health outcomes for people living with HIV/AIDS (PLWHA). The National HIV/AIDS Strategy Federal Implementation Plan [1] specifically directs federal agencies to ‘‘consider ways to increase supports for employers to hire and maintain employment of people with HIV and how to integrate them in broader employ- ment initiatives for people with disabilities’’ (p. 25). This inclusion of employment and vocational services in the National HIV/AIDS Strategy reflects an increased interest in examining structural factors (such as reducing poverty) on HIV health and prevention outcomes [2] as well as the increased need for these services among people living with HIV/AIDS. With the improved health outcomes associated with advance- ments in medical treatments, many PLWHA want or need to work, yet many also face significant barriers to employment and could benefit from vocational services [3,4]. The most compre- hensive employment initiative for people with disabilities within the United States is the State Federal Vocational Rehabilitation System (VR) [5]. Within this system, rehabilitation counselors provide a range of services designed to facilitate the employ- ment of people with disabilities. Rehabilitation counselors can also authorize medical referrals and supportive rehabilitation services, including mental health counseling, if these services will remove barriers to employment [6]. Research findings indicate that use of VR services increases the chances of successful employment [7]. Address for correspondence: Liza Conyers, Associate Professor of Rehabilitation and Human Services, Department of Educational Psychol- ogy, Counseling and Special Education, Penn State University, 302 CEDAR Building, University Park, PA 16801, USA. Tel: (814) 863-6115. E-mail: Lmc11@psu.edu Disabil Rehabil Downloaded from informahealthcare.com by SUNY State University of New York at Stony Brook on 02/04/14 For personal use only.