Date on Master's Thesis/Doctoral Dissertation

8-2009

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Social Work

Committee Chair

Faul, Anna

Author's Keywords

HIV/AIDS; Neuropsychology; Neuropsychiatry; Social work; Occupation; Persistence

Subject

HIV-positive persons--Employment; HIV-positive persons--Mental health; AIDS (Disease)--Patients--Mental health; AIDS (Disease)--Patients-- Employment

Abstract

It is well established that HIV (human immunodeficiency virus), the virus responsible for AIDS, directly attacks the central nervous system, altering cognition, behavior, and affect, and can result in a full dementia syndrome. HIV-associated neurocognitive complications, along with a myriad of other health threats, resulted in significant disability and unemployment for those infected. However, the advent of more effective antiretroviral medications used in combinations, along with homologous improvements in morbidity and mortality, have allowed for people living with HIV/AIDS to return to work, albeit not without challenges. Even mild cognitive impairment has been shown to affect employability and level of occupational functioning. The focus of this dissertation was to develop an understanding of the impact of HIV-associated neurocognitive challenges, the most common neuropsychiatric expression of HIV, on occupational persistence. This study analyzed existing data from a parent study conducted in New York City. The sample consisted of 116 community dwelling HIV positive men and women who were actively seeking employment after being unemployed subsequent to learning of their HIV status. The research design was a longitudinal prospective cohort study testing a multilevel growth model with a two- nested-level structure. The growth model examined individual differences in occupational persistence over a two year time period, testing multiple potential neuropsychological predictors and covariates. Changes in individual growth profiles were investigated, and possible explanations for observed differences were tested. The analysis found that memory is the most potent neuropsychological predictor of occupational success, both in terms of returning to work in the first six months of the study (event), as well as persisting on the job over time (two years). The second most influential neuropsychological predictor was executive functioning, which significantly influenced occupational persistence over time and an accelerated growth trajectory. These central findings along with other significant control interactions are discussed. The study limitations are discussed, along with opportunities for future research. The relevance of these findings is explored, specifically addressing the implications for social work practice and social work education.

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