Employment is a major factor in maintaining income levels and living conditions, especially among persons with long-lasting chronic diseases. In addition, unemployment has been shown to be an independent predictor of morbidity and mortality both in the general population and among HIV-infected people.
HIV infection most often occurs in early adulthood, and the majority of HIV-infected individuals are of working age. Therefore, employment constitutes a major dimension in the life of HIV-infected people, and understanding the ways by which the disease interferes with employment may provide insights into strategies for limiting the burden of HIV disease for individuals and society. This requires the availability of longitudinal datasets documenting both clinical, biological and socio-occupational aspects. Information on socio-occupational characteristics are generally not routinely collected in hospital databases; as a result, studies on the impact of HIV infection on employment have remained limited.
Several reports, based on data collected earlier in the era of combined antiretroviral therapies, i.e. in the years 1996-2004, found that HIV infection weighted on the chances of maintaining in employment through various mechanisms including disease severity and experiences of HIV-related discrimination. Since 1996, the impact of HIV infection on employment may have changed as a result of the dramatic changes occurred with the sustained use of cART. Namely, as suggested in a recent paper (Dray-Spira et al, AIDS 2012, 26:207–215), the burden of HIV disease characteristics themselves on chances of maintaining in employment may have decreased. In contrast, comorbidities frequently associated with HIV disease including diabetes, hypertension and depression seem to substantially affect the chances of maintaining in employment during the course of HIV infection. Given the importance of employment issues among HIV-infected people, a predominantly working-age population, such changes are important to be documented in order to be accounted for in the implementation of comprehensive care programs, especially in the current adverse socio-economic context in Europe marked by increased unemployment and job insecurity.
In order to correctly inform individuals’ employment status, information needs to be collected not only on situation regarding labour but also, for those employed, on the type of employment contract which constitutes a major predictor of maintain in employment. Thus, we propose to include 2 questions (see below) in participating cohorts. These questions are based on data collected by EuroStat in the various EU countries (thus allowing comparisons with the general population), and adapted to be easily informed in the context of clinical settings. Ideally, we propose to collect this information on a yearly basis.