Consumers with HIV/AIDS: application of theory to explore beliefs impacting employment

Journal of Rehabilitation,  Jan-March, 2008  by Kenneth C. Hergenrather,  Scott D. Rhodes

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Despite some success in behaviorally focused HIV prevention, the pandemic continues to spread and a vaccine for HIV infection is many years away (Anonymous, 2001; Centers for Disease Control and Prevention, 2007; Girard, Osmanov, & Kieny, 2006). Advances in medical treatments have dramatically changed the course of HIV infection to a chronic disease requiring lifetime management. With the advent of protease inhibitors and non-nucleoside reverse transcriptase inhibitors in 1996, combination treatment of antiretrovirals to suppress HIV viral replication and improve immune function became available. The treatment is termed highly active antiretroviral therapy (HAART), and commonly known as the treatment cocktail and enhanced the longevity of persons living with HIV/AIDS (PLWHA). Between 1990 and 2003, the number of PLWHA in the US increased 519.1% and the annual number of AIDS-related deaths in the US decreased approximately 75.2% (Centers for Disease Control and Prevention, 2003; Karon, Fleming, Steketee, & DeCock, 2001; National Center for Health Statistics, 2002; Vittinghoff, Scheer, O'Malley, Colfax, Holmberg, & Buchbinder, 1999).

In 2007, there were nearly 1 million PLWHA in the US, of which 97% were between the working ages of 20 to 64 years (CDC, 2007). Because of HAART and the increased longevity of PLWHA, the number of PLWHA seeking employment has increased (Brooks & Klosinski, 1999; Fesko, 2001; Glenn, Ford, Moore, & Hollar, 2003; Hergenrather, Rhodes, & Clark, 2004; 2005; Hergenrather, Rhodes, & McDaniel, 2005; Hunt, Jaques, Niles, & Wierlis, 2003; Kalichman et al., 2000; Massagli, Weissman, Seage, & Epstein, 1994; McReynolds, 2001).

During the past two decades, the Americans with Disabilities Act (ADA) of 1990 has enhanced opportunities for persons with disabilities to participate in society. The ADA reflects Congressional intent to prohibit discrimination against persons with disabilities. Under the ADA, PLWHA that meet defined disability criteria are eligible for specific services, including job placement, through public vocational rehabilitation services (Americans with Disabilities Act, section 3: Definitions, 1990; McCarthy, 1998). Research suggests that successful job placement services for persons with disabilities, including those with HIV/AIDS, is influenced by the attitude of public rehabilitation placement professionals (e.g., job placement specialists, rehabilitation counselors, employment specialists) employed by state and federal vocational rehabilitation agencies to place individuals with disabilities into jobs (All, Fried, Ritcher, Shaw, & Roberto, 1997; Hergenrather et al., 2005; Mullins, Roessler, Schriner, Brown, & Bellini, 1997). Attitudes of public rehabilitation placement professionals toward persons with disabilities (i.e., consumers) have been correlated with the consumer's self-concept, consumer's self-efficacy, and consumer's level of job-seeking skills (All, Fried, Ritcher, Shaw, & Roberto, 1997; Millington, Asner, Linkowski, & Der-Stepanian, 1996). Although federal legislation addresses the placement for persons with disabilities, there is limited knowledge of the influences on rehabilitation placement professionals to place PLWHA into jobs from an emic or insider perspective. Successful placement of PLWHA may be enhanced by exploring and understanding the salient beliefs of public rehabilitation placement professionals toward the behavior of placing consumers with HIV/AIDS.

The Theory of Planned Behavior (TPB) suggests that a person's behavior is a function of his or her beliefs toward performing a specific behavior (Ajzen, 2001; Ajzen, 1988). The TPB is a widely applied social cognitive behavioral theory utilized to elicit and identify beliefs and develop interventions to enhance behaviors that include: HIV prevention among adolescents in the UK (Sutton, McVey, & Glanz, 1999), the effect of organization-based self esteem (Hsu & Kuo, 2003), research dissemination among addictions counselors (Breslin, Li, Tupker, & Sdao-Jarvie, 2001), the placement of consumers with a disability of substance abuse (Hergenrather & Rhodes, 2006), technology training adaptation in the workplace (Morris & Venkatesh, 2000), enrollment in distance education courses (Becker & Gibson, 1998), and the influences of intrinsic motivation on behavior (Chatzisarantis, Hagger, Smith, & Luke, 2006).

Theory of Planned Behavior

Theory of Planned Behavior (TPB) posits that one's behavior is a function of his or her intention to perform a particular behavior (Ajzen, 1985, 1988, 2001; Ajzen & Fishbein, 1980; Ajzen & Madden, 1986). Intention is correlated with actual behavior and predicted by the determinants of attitude, subjective norm, and perceived behavioral control (see Figure 1). Each determinant consists of a set of beliefs elicited from persons most likely to perform that behavior, and an evaluation of each elicited belief.