Characteristics associated with employment among HIV-positive New York City ryan white clients

Unemployment is widespread among persons living with HIV (PLWH) who access publicly-funded service programs. Survival and quality-of-life gains due to effective antiretroviral regimens place more PLWH in a position to join/re-join the workforce. Using client data reported by New York City (NYC) Ryan White HIV service providers, we assessed baseline characteristics associated with current employment status. For 16,358 HIV-positive NYC Ryan White clients served in 2012, we examined employment status as of January 2013 against baseline measures for gender, age, race/ethnicity, birth country, education, marital status, housing status, CD4 count and viral load (VL). We constructed multivariate logistic regression models to identify predictors of employment. The sample at baseline was largely male (64%), >45 years old (61%), black or Hispanic (86%), US-born (60%), ≤high school-educated (73%), never married (39%), and stably housed (62%). Of those reporting clinical data, 58% had VL ≤400 and 59% had CD4 count ≥350. As of January 2013, employment status was full- or part-time for 1,979 (12%); "out of workforce" for 1,985 (12%); "unpaid volunteer" for 143 (1%); unemployed for 9,607 (59%); and missing/declined for 2,644 (16%). In multivariate logistic regression, modifiable factors associated with lack of employment included unstable housing (AOR: 3.76, CI=3.03-4.66), VL >400 (AOR: 1.14, CI=1.01-1.29) and CD4 <350 (AOR: 1.18, CI=1.04-1.33). Client baseline characteristics, including housing and clinical status, predicted employment. In a context of improved health outcomes, limited resources and healthcare systems change, it is important to understand subgroup differences in employment, and shape programs supporting employment and self-sufficiency among PLWH.