Disabilities Related to HIV Infection

Technical Assistance Brief (September 1996)

Contents

• Overview
• Planning Services
  • Eligibility
    • Evidence of HIV Antibodies
    • HIV Illness
    • AIDS
  • Disability Determination
    • Primary Disability
    • Secondary Disability
  • Developing an IWRP
  • Confidentiality
    • Handing HIV Information
    • Exchange of Information
  • Reasonable Accommodations

Overview

The Human Immunodeficiency Virus (HIV) produces a deficit in the human immune system which reduces a person's resistance to certain types of infections and cancers. HIV is transmitted through sexual contact with an HIV infected person, direct contact with infected blood, needle sharing with an infected person, transplanted organs from an infected donor or from an infected mother to her child from breast milk, across the placenta or during delivery.

The virus may remain in a dormant state in some infected individuals with no significant signs or symptoms for years. When activated, persons infected with HIV may exhibit symptoms that vary in severity and duration which include persistent fever, night sweats, cognitive deficits, fatigue, malaise, weight loss, oral candidiasis and/or diarrhea not due to exercise, diet or other illnesses. HIV may cause intermittent compromises to health at any point.

Acquired Immune Deficiency Syndrome (AIDS) is caused by the HIV. The diagnosis of AIDS is made when an HIV infected person develops one or more specific opportunistic illnesses. The most prevalent illnesses are Pneumocystis Carinii pneumonia, a severe type of parasitic pneumonia; Kaposi's sarcoma, a rare type of rapidly progressive cancer; encephalitis, inflammation of the brain or spinal cord; severe infections of yeast; cytomegalovirus; neurological impairments; herpes virus; parasites, such as toxoplasmosis or cryptosporidia; and invasive cervical cancer.

An individual's ability to maintain or become employed may be affected by HIV infection. Physical manifestations of the infection as well as emotional aspects of the disease must be considered when an individual is applying for VESID services. VESID staff should be sensitive to the fear of disclosure many individuals may experience and how that may impact the person's ability to secure and maintain employment. Referral to AIDS counseling and service programs should be considered for anyone who may request information about HIV/AIDS.

Individuals who are at risk of acquiring HIV infection or are suspected of being at risk cannot be required to submit to any tests related to HIV infection. Under no circumstances should concern or suspicion about the health or at risk condition of any consumer result in a request that the individual be tested for HIV.

Planning Services

Eligibility

Impairment - When a person tests positive for HIV infection, he/she is considered to have a physical impairment.

Impediment - The question of Does the impairment substantially impede that person's ability to enter, engage in or retain employment" will have to be answered, considering the presenting functional limitations. Some people with HIV infection have no functional limitations, while for others a broad spectrum of functional limitations can occur that may impact a person's ability to work, such as low work endurance levels, vision loss and diminishing strength and energy over time.

Ability to Benefit - There is a presumption that all persons with disabilities can benefit from vocational rehabilitation services in terms of an employment outcome. A person can only be determined incapable of benefitting when there is clear and convincing evidence that no employment outcome is possible, even with the provision of vocational rehabilitation services. Each case should be evaluated on an individual basis. Before individuals are determined ineligible because of the severity of their disability, the individual must be provided with an extended evaluation to determine if he/she can benefit from services. An example of when persons may be determined incapable of benefitting is when persons with AIDS are too sick to avail themselves of VESID services at the time.

Requires Services - Determining whether an individual requires vocational rehabilitation services should involve the consideration of a variety of factors related to his/her HIV status and possible secondary disabilities. VESID staff should review the individual's skills, education, work history, aptitude and abilities, motivation and access to formal or informal support networks as well as treatment factors and diagnostic information specific to work limitations. At times, such intervening factors as medical issues, work stamina, diet, and intact abilities may impact persons' with HIV/AIDS need for VESID services.

When people become infected with HIV/AIDS, the impact and disabling condition may begin, become dormant, or resurface at any point in the following continuum or cyclical pattern:

Evidence of HIV Antibodies only (Asymptomatic)

These individuals have tested positive for HIV antibodies in their blood stream without symptoms of any type of disease or psychological disorder.

Eligibility Considerations - These individuals are not eligible for vocational rehabilitation services solely on the basis of testing seropositive because there are no work-related functional limitations associated with only the presence of antibodies. Persons who test HIV positive can remain symptom free for prolonged periods before developing HIV illness or active AIDS.

HIV Illness

Individuals with HIV illness have tested positive and have symptoms such as persistent fever, night sweats, diarrhea and fatigue, which may vary in intensity and duration on an individual basis.

Eligibility Considerations - Individuals with HIV illness may have functional limitations that meet eligibility requirements. Individual circumstances should be reviewed to determine the extent of the limitations, the treatment plan and job implications of the treatment plan. Some individuals may be eligible for services if the HIV infection results in vocational limitations and their intact abilities allow for the development and completion of the goals of an IWRP.

AIDS

Individuals with active AIDS have tested positive and have one or more opportunistic diseases, such as Pneumocystis Carinii pneumonia, invasive cervical cancer and Kaposi's sarcoma, because of the breakdown in the body's immune system caused by HIV.

Eligibility Considerations - Each person's situation should be reviewed to determine the severity of the illnesses, his/her resulting functional limitations, the treatment plan, job implications of the treatment plan and the ability to maintain employment. Some people with AIDS may be able to work while others may be so limited by the frequency, duration or severity of their infections or other symptoms that they are unable to function in employment or services leading to employment, and, therefore, may not be eligible for vocational rehabilitation services. Extended evaluation is required before determining that a person's disability is too severe for the individual to benefit from services.

Disability Determination

Primary Disabilty

Individuals may request services from VESID because they have HIV/AIDS. If existing documentation to determine eligibility and vocational rehabilitation service needs is not available, the consumer should request testing for HIV which is available at no cost through the New York State Department of Health. The individual, with appropriate consent, should be referred to the testing facility that is equipped to provide the tests and the necessary pre and post test counseling. The New York State Department of health can provide information to determine the closest testing facility.

Individuals are obligated to provide information to VESID about their HIV status only when it will affect their employability. If the individual is applying for services because of HIV infection, VESID must be able to document the conditions of the disability and other relevant medical issues to evaluate the individual's need for services. If the refusal of the applicant to allow VESID staff access to relevant medical information results in VESID's inability to establish eligibility or to develop the IWRP, the case should be closed.

Secondary Disabilty

Individuals may request or receive services because of another disability, such as substance abuse, but may also disclose having a secondary disability of HIV infection or AIDS. The impact of HIV/AIDS should be considered as any other disability for those consumers who apply for or have been determined eligible for VESID services because of another disability.

Developing an IWRP

The IWRP for an individual with HIV infection should be flexible and reflect changes that may occur in an individual's physical and mental condition. An individual with HIV infection has the potential for periodic opportunistic illnesses that may affect his/her ability to participate in services and to achieve and maintain employment. No specific job is inappropriate for a person who is HIV positive.

Persons with HIV may be more likely to have successful outcomes if they are able to gain and maintain employment with accommodations in hours worked per week, flexible sick leave and work schedules, work-at-home and modifications in jobs requiring extensive physical activity. Placement with employers sensitive to these job accommodations should be sought. Community support groups should be used as resources for job development. The impact on the person's existing and future benefits should be considered as well as the availability of family and support groups.

Some independent living programs can offer services that are vital to the well being of persons with HIV/AIDS. Peer counseling, social support services, referral to community resources, locating attendants, and the provision of transportation services are several key programs that some centers may be able to assist persons with HIV infection.

Confidentiality

Any information related to an HIV test, test results, HIV infection, HIV related illness or AIDS, or information which could indicate that a person has been exposed to HIV, is confidential and protected by State statute and regulations. The statute provides for both civil and criminal penalties for violations; extreme penalties apply in cases of willful misconduct.

Handling HIV Information

Recognizing that persons with HIV infection may face discrimination, confidentiality is of the utmost importance to protect the rights of the individual. Only those VESID staff who require HIV/AIDS information for the necessary functions of their job requirements can have access to HIV-related information. VESID District Office Managers are responsible for ensuring that existing and new staff receive training and information provided by this policy and other resources, as available. HIV-related records, including those handled electronically, must be maintained securely, used only for the purpose intended and accessed only on a need-to-know basis.

Exchange of Information

Reasonable Accomodations

The Americans with Disabilities Act (ADA) requires businesses to make reasonable accommodations consistent with the needs of the business and consumer unless the accommodation would pose an undue hardship on the business. Examples of reasonable accommodations that may be appropriate for persons with HIV/AIDS, especially in situations to maintain or regain employment include, but are not limited to flexible schedules, part-time work, job-sharing, locations near bathrooms, clean air environment, job restructuring, better lighting, work at home, securing a location to rest and other individually determined creative solutions.