HIV/AIDS as an emergent disability: The response of vocational rehabilitation

It is with great pleasure that I welcome you to this special issue on HIV and employment. Since the onset of the HIV pandemic in the early 1980s, the nature and course of this illness has changed in dramatic ways. As such, the response of the field of vocational rehabilitation has also grown to meet the ongoing needs of individuals with HIV/AIDS, especially as the need for employment and vocational rehabilitation has become a primary concern for many living with this illness. Within the past several years, there has been a groundswell of interest in the vocational rehabilitation of individuals with HIV/AIDS among a wide range of diverse professionals. In April of 2003 the Matrix Research Institute (now the Matrix Center at Horizon House, Inc.) organized the Working Positive Summit conference [endnote] to bring together leading HIV and employment researchers, educators, and service providers from across the nation to share knowledge and provide recommendations for next steps. Uniformly, conference attendees recommended the formation of a national organization to facilitate ongoing exchange regarding the best practices for employment research, education, services, and advocacy. From this effort, the National Working Positive Coalition (NWPC) was established. In my role as chairperson of the NWPC Research Working group, I have had the pleasure of sharing many ideas with other group members and it was through such a dialogue that the idea for this special issue materialized. One of the most helpful ways to understand many of the current advances and challenges regarding the vocational rehabilitation of individuals with HIV/AIDS is to view this illness from the perspective of an emergent disability. Emergent disabilities are defined by two main characteristics: the disorder has either newly appeared in the population, or it has previously existed but is rapidly increasing in geographical range or incidence [8,38]. HIV/AIDS meets both these criteria. When HIV first appeared in the United States in the early 1980s, little, if anything, was known about this disease except that many people were dying. Since HIV was first recognized, the CDC has continued to note new or emerging demographic patterns of this disorder [7]. The most prevalent feature of HIV/AIDS as an emergent disability is its constant evolution and the need for ongoing adjustment in services as medical advancements are made. A review of the vocational rehabilitation literature reveals the response of rehabilitation and AIDS service professionals to these changes. During the very early period of HIV emergence, many people were not aware of their illness until they became seriously ill and were not able to work. Consequently, there was little attention paid to HIV/AIDS in the field of vocational rehabilitation. However, as early as 1988, the Journal of Applied Rehabilitation Counseling published one of the first manuscripts providing an overview of AIDS for rehabilitation professionals, highlighting counseling interventions and vocational implications [40]. As we gained a better understanding of HIV/AIDS and improved medical man-