Following a career-ending injury as a firefighter captain, I embarked on a new adventure as a doctoral student, attending the University of Georgia’s counselor education and student personnel services program. In a leap of faith, my wife and our three small children moved from Rochester, New York, to Suwanee, Georgia, where we quite literally knew no one. I remember thinking at the time that trying to make a career change like this made running into a burning building look easy. Fortunately, I was assigned to a rural HIV/AIDS clinic. The people I was about to meet there would welcome me and ultimately change my life.
As I stepped nervously through the clinic door and my eyes adjusted to the small, dimly lit room, I was greeted by a friendly man seated behind a makeshift desk. During the months that followed, I came to know him — and the important role that work played in his life while living with HIV/AIDS — well. For him, I think that returning to work by answering phones and greeting new visitors to the clinic represented a way to contribute to his community. His bright smile and warm sense of humor made him perfect for the job.
As we shook hands, he jokingly pointed to a piece of tape that stretched across the back of an office chair. On the piece of tape, his name was proudly displayed in handwritten marker. “This is my chair. … They let me work here!” he exclaimed.
Reflecting on that first day, I’ve come to realize that this was more than just an office chair — it symbolized his success in reclaiming a professional identity. What I learned from this inspiring man has since helped me reclaim my own sense of professional identity as I shifted from being a firefighter to a mental health counselor. This article is dedicated to his memory.
Each of us possesses many intersecting identities. Some of these identities are obvious, and others not so much. For example, if I didn’t share with someone my disabled status, it is unlikely that they would be able to tell because my injuries are internal, and I go about my day doing everything possible to keep it this way. But when I do share my story, people usually thank me for my service because for many, firefighters are like heroes.
I think everyone should enjoy this type of validation because we are all living courageously with different challenges. Some of these challenges include health problems or sudden loss of employment. In managing the complexities of HIV/AIDS, both of these factors are compounded, and the very real threat of social stigma can discourage a return to work, compromising personal and professional identity.
In all honesty, I can tell you that I’m still affected by a passing fire engine because firefighting is such a deeply internalized identity for me. Similarly, during initial intake and screening, vocational counselors may explore the meaning of work in the lives of their clients with HIV/AIDS, paying special attention to differences before and after infection, and any existential questioning in the wake of serious illness.
For some of these clients, HIV/AIDS was the impetus for them leaving work in the first place, resulting in changes to personal and professional identity. This means that counselors should help these clients explore feelings of loss in social and financial capital associated with their former work environments, as well as strategies for establishing new supports. Other important concerns include management of strict medication routines, side effects resulting from medications, fatigue, exposure to work-related stressors and the risk of contracting outside infections occurring in the workplace. By carefully exploring a range of vocational challenges with these clients, and the role of work in their lives, counselors can facilitate the process of forming new professional identities.
Situating vocational needs
Re-entering the workforce is increasingly possible for clients with HIV/AIDS, thanks in large part to continued advances in highly active antiretroviral therapy. These medications are used in combination to reduce the progression of HIV by preventing the virus from making copies of itself.
Thanks in part to such promising medical advances, vocational counselors can begin work with these clients by exploring myriad career opportunities and matching them with each client’s unique skills, interests and health needs. I should note that although returning to work may reflect a significant victory for people living with HIV/AIDS, counselors still need to understand the potential challenges facing these clients related to workplace discrimination, insurance denial and managing health care while working and caring for loved ones. Overlooking these realities risks setting up your clients for possible failure and, even worse, interruptions in health-sustaining insurance coverage.
Meeting basic needs
President Obama’s National HIV/AIDS Strategy (2010) explicitly called for increasing career development for people living with HIV/AIDS and using innovative employment strategies to expand potential career options. However, most AIDS service organizations and their clients depend on federal funding provided under the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, including for life-sustaining medications. This leaves many clients feeling threatened under the current Trump administration and the possibility of budget cuts.
A possible consequence of this fear of lost benefits is that many people living with HIV/AIDS may feel pressure to find work that provides private health coverage. At present, federal funding is allocated for housing, medication and legal assistance, leaving very few clinics with the resources or vocational expertise to address the challenges associated with returning to work. For outside agencies that do offer career or vocational counseling services, most are not familiar or equipped to serve the unique needs of the HIV/AIDS community. This leaves many clients afraid to access these services when having to negotiate work accommodations, maintaining a strict medication schedule and coping with episodic symptoms that require frequent and unexpected leaves of absence.
For these reasons, vocational counseling in the HIV/AIDS setting is inherently complicated. This reflects the need to include such specialized services in the familiar and trusted space of AIDS service organizations, where professional networks and community partnerships are already in place.
The role of legal services
In addition to these formidable challenges, HIV criminalization laws currently exist in roughly half of the 50 U.S. states, leaving clients at risk for further marginalization in the workplace following intimate partner complaints and subsequent arrests and convictions. In some cases, these arrests have even resulted in prison sentences and mandated sex offender status, making a return to work exceedingly difficult.
This unfortunate reality is even more problematic for women, who are often diagnosed with HIV/AIDS before a male partner due in large part to having regular gynecological exams. This means that women are at additional risk for legal prosecution for “knowingly infecting their partners” despite the possibility that the virus originated from an accuser. This perpetuates a veil of secrecy, adding to the complexity of HIV/AIDS treatment options, particularly among infected mothers who may face persecution for passing the virus on to their children. Not surprisingly, such discriminatory practices become disincentives for HIV screening and follow-up care. Furthermore, surveillance reports from the Centers for Disease Control and Prevention (2014) reflect that African American women represent a disproportionate number of newly infected cases.
Given that more women than men are responsible for the care of children and elderly family members, vocational counselors should explore flexible work opportunities that align with individual needs. This should include legal counsel from the local community that is available for clients who wish to make informed decisions about returning to work.
Exploring career interests and abilities
In the wake of my firefighting injury, and facing a lifelong disability, I can attest to the significance of vocational counseling as an integral part of the healing process. This is a familiar narrative among people living with HIV/AIDS, who sometimes struggle to explain why they have not returned to work given their outward appearance of health. Counselors can help these clients respond to any concerns involving gaps in employment history, the need to update work skills, résumé writing, professional attire and preparation for job interviews.
This need for personalized vocational counseling remains largely unmet, however. The counseling profession can respond to this increasing demand for career-related services by attending HIV/AIDS conferences and workshops to learn more about living and working with the virus. Community-based partnerships are also invaluable. Many AIDS service organizations provide internship opportunities in which counseling students can gain field experience and insights into the process of cultivating new personal and professional identities.
Flexible career opportunities
Many individuals must manage episodic symptoms associated with HIV/AIDS. In response, vocational counselors can expand these clients’ career opportunities by helping them connect with employers that offer flexible scheduling or the possibility of working from home.
In dealing with HIV/AIDS, episodic symptoms may remain dormant for years, only to reappear and become disruptive to work scheduling and the person’s ability to perform routine tasks. Many clients are fearful that under such circumstances, employers will expect them to share personal information when they are absent from work. Managing personal privacy surrounding any chronic illness is challenging, and in the case of HIV/AIDS, an added threat of stigma remains.
It is important for counselors to share information with their clients concerning extended Medicare and Trial Work Period programs, which are designed with flexibility for people who have disabilities. This may help to alleviate concerns about losing Social Security disability benefits, which is a common theme among people living with HIV/AIDS when contemplating a return to work.
Michael B. Drew is a retired firefighter captain from upstate New York. Following a career-ending injury, he completed a bachelor’s degree in advanced fire administration and a master’s degree in mental health counseling and is currently a doctoral candidate in counselor education and student personnel services at the University of Georgia. Contact him at firstname.lastname@example.org.
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