• Christopher J Conover, Peter Arno, Marcia Weaver, Alfonso Ang, and Susan L Ettner.
• Center for Health Policy, Law & Management, Terry Sanford Institute of Public Policy, Duke University, Rubenstein Hall-Room 126, Box 90253, 302 Towerview Road, Durham, NC 27708-0253, USA. conoverc@hpolicy.duke.edu
• J Ment Health Policy Econ. 2006 Jun 1;9(2):71-86.

BackgroundThis paper examines the labor market outcomes of HIV triply-diagnosed adults having a combination of HIV, mental illness and substance abuse problems.Aims Of The StudyWe sought to determine the sources of money income for HIV triply diagnosed adults (public or private), receipt of transfer income (e.g., welfare) and financial support from others. We further sought to ascertain their employment status and analyze the characteristics associated with full- and part-time employment.MethodsWe use self-reported money income during the past 30 days and self-reported employment status. We calculate earnings losses due to illness by subtracting self-reported earnings from average earnings for all U.S. workers based on 5-year age and gender categories. We provide descriptive statistics to show how income and employment vary by patient characteristics and logistic regression analysis to examine correlates of income and employment.ResultsAverage income is below the poverty level for single individuals, with more than two-thirds coming from public income sources. The likelihood of receiving disability/retirement income was lower among those with the worst mental health (RR=0.80; 95% CI=0.64, 0.97). Blacks were more likely than others to rely on public assistance (RR=1.24; 95% CI=1.02, 1.55) and married individuals were less likely (RR=0.60; 95% CI=0.41, 0.79). While most private income comes from employment, less than 15 percent of this population is employed full- or part-time. On a monthly basis, the average individual in our sample lost $2,726 in income when compared to the earnings of individuals of the same age and sex in the general population. The relative probability of current full-time/part-time employment was lower among females (RR=0.56; 95% CI=0.34, 0.83); such employment also was lower among those in the worst physical health (RR=0.39; 95% CI=0.26, 0.65) and those in moderate physical health (RR=0.55; 95% CI=0.34, 0.81) relative to those in the best physical health.Implications For Health Care Provision And UseThis population represents an important opportunity for better health and labor market outcomes through prevention and improved treatment adherence.Implications For Health PoliciesDespite its relatively small size (at least 100,000), this population merits closer attention due to a combination of their high medical and companion social costs (e.g., income transfers) and the large potential for improving their ability to earn income.Implications For Further ResearchFuture research should determine the marginal contribution of mental health conditions or substance abuse on income or labor market outcomes relative to individuals having only HIV/AIDS. This would allow policymakers to better understand how much of income and employment can be attributed to HIV/AIDS, mental health or substance abuse. Future work also should examine the impact of integrated treatment services on income and employment for this population.

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