GENEVA, Switzerland — People living with HIV who are employed are almost 40 per cent more likely to stick to HIV treatment than those without a job, says a new ILO study released ahead of World AIDS Day.

The report — The Impact of Employment on HIV Treatment Adherence — analyses the findings of 23 studies on the relationship between employment and HIV treatment, and covers more than 6,500 people living with HIV. The analysis was supplemented by a series of surveys and telephone interviews carried out by the ILO.

The study found evidence that people living with HIV maintain treatment more successfully when they have a job than when they do not. This is mainly because they have regular financial means to pay for related health services, medications and support, and to afford sufficient food.

“While access to treatment has increased dramatically in recent years, ensuring that people living with HIV are able to keep to treatment regimens remains a challenge. It is clear from the report that employment, and the role of the workplace more broadly, are vital to meeting the goal of treatment for 15 million people living with HIV by 2015,” said Alice Ouédraogo, Chief of ILOAIDS.

The report includes findings from low, middle and high-income countries in Africa, Asia and North America. It found that unemployment, particularly in low and middle-income countries, affects people’s ability to afford treatment, which can lead to interruptions, low viral suppression and ultimately treatment failure.

Joblessness may also result in depression, and in behaviours and situations that have been shown to be factors in non-adherence, including low self-care, substance abuse and homelessness. In some cases it could lead to criminal activity that results in imprisonment.

Women are more likely to have access to anti-retroviral therapy (ART) in most regions of the world, especially those areas with high HIV prevalence. As a result treatment adherence is stronger overall for females. However, employment is a key factor in helping men keep to treatment regimens as they experience better financial and food security and may have access to ART services at their workplace.

People living with HIV, who are in informal work, tend to experience difficulties keeping to treatment regimens. A woman living with HIV interviewed for the study said: “Workers in the informal sector or in small and medium size companies with no insurance or health policy are less likely to adhere to ART because the salary is not high enough or is paid on an irregular basis.”

In certain countries such as the USA, where safety nets are in place to provide people living with HIV with access to a disability grant, the impact of unemployment on treatment adherence is less severe.

But stigma was found to affect those with jobs, with some people not revealing their HIV status because of fear of stigmatisation and therefore not accessing ART, while others miss doses because they are concerned colleagues will see them taking treatment at work.

Currently, only 34 per cent of the more than 28 million people who are eligible for treatment in low and middle-income countries are accessing it, according to the latest figures from the World Health Organisation. Furthermore, UNAIDS estimates that around half of all people living with HIV globally do not know their status, and therefore are not accessing treatment.

The ILO and UNAIDS have combined efforts to increase the number of workers who know their HIV status and can access HIV treatment if needed, through a Voluntary Counselling and Testing at Work (VCT@WORK) initiative.

The partnership aims to reach five million working women and men with voluntary and confidential HIV counselling and testing by 2015, and ensure that people who test positive are referred to HIV services for care, support and treatment if needed.

Progress has been made: 1.6 million people started HIV treatment for the first time in 2012 — the highest figure ever recorded for a single year.

Helping those with HIV maintain anti-retroviral therapy

The report makes several specific recommendations to help improve ART adherence, including:

* Prioritising actions that promote the economic independence of people living with HIV.

* Improving national efforts to develop new anti-discrimination policies and enforcing existing anti-discrimination laws in the workplace.

* Offering direct incentives to keep up ART, including food distribution and economic incentives.

* Expanding opening hours of health facilities offering ART to ensure wider access.

* The adoption of measures by employers to provide flexibility for people living with HIV who may need to change their work arrangements. This includes time off to visit health facilities to receive medication and support to help adhere to treatment.

* Strengthening of health systems by governments, including the provision of training and retention measures to benefit health workers and ensure sustainability of treatment delivery.

* Ensuring that social protection schemes are sensitive to the needs of people living with HIV and provide them with the necessary support to remain on treatment.