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Targeted work readiness training is an important approach to help people living with HIV (PLHIV) to overcome their unique barriers to work, while addressing social determinants of health needs. This study assesses the psychosocial impacts of a work readiness training and internship program among HIV peer workers in New York City. From 2014 through 2018, 137 PLHIV completed the training program, and 55 individuals completed both the training and the six-month peer internship. Depression, HIV internalized stigma, self-esteem, HIV medication adherence, patient self-advocacy, and safer sex communication apprehension were used as outcome measures. Paired t-tests were performed to determine if significant score changes occurred at the individual level before and after each training. Our results show that participating in the peer worker training program significantly decreased depression and internalized HIV stigma, and significantly increased self-esteem, medication adherence, and patient self-advocacy. The study underscores that peer worker training programs are important tools to improve not only the work readiness of PLHIV, but also psychosocial and health outcomes. Implications for HIV service providers and stakeholders are discussed.

Advancements in HIV medicine have led to an increased desire and/or need to work for many people living with HIV. Despite the importance of work, relatively little attention has been devoted to specifically examining employment status as a social determinant of health. Unemployment/underemployment are associated with societal circumstances known to increase both the risk for acquiring and prevalence of HIV and other co-morbidity. Research indicates that being employed and use of vocational services is associated with positive physical and mental health outcomes. However, these positive outcomes can dissipate under poor or unstable work conditions. Transitions into or out of the workforce can also increase the risk of poor health associated with stress and potential disruptions or loss of access to critical health care. Given that individuals disproportionately impacted by HIV are also impacted by labor market discrimination, social exclusion, and poverty, there is an emerging sense of urgency to better respond to the employment needs of people living with HIV. This book chapter (a) reviews research related to employment as a social determinant of health, (b) provides an overview of the client-focused considering work model, (c) highlights key employment services, and (d) discusses implications for policy, service delivery and research.