Article Abstract Online ISSN: 1099-176X    Print ISSN: 1091-4358 The Journal of Mental Health Policy and Economics Volume 9, Issue 2, 2006. Pages: 71-86 Published Online: 10 June2006 Copyright © 2006 ICMPE

* Correspondence to: Christopher J. Conover, PhD, Assistant Research Professor of Public Policy Studies, 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
Tel.: +1-919-613 9369
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E-mail: conoverc@hpolicy.duke.edu

Source of Funding: This work was supported by a cooperative agreement for the ``HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study,'' (see Appendix) a collaboration of six Federal entities within the U.S. Department of Health and Human Services (DHHS): The Center for Mental health Services (CMHS), which had the lead administrative responsibility, and the Center for Substance Abuse Treatment, both components of the Substance Abuse and Mental Health Services Administration; the HIV/AIDS Bureau of the Health Resources and Services Administration (HRSA); the National Institute of Mental Health, the National Institute on Drug Abuse, and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), all parts of the National Institutes of Health (NIH). The views expressed are those of the author(s) and are not to be construed as official or as reflecting the views or policies of the Substance Abuse and Mental Health Services Administration, the Health Resources and Services Administration (HRSA), the National Institutes of Health (NIH) or any other agencies of the U.S. Department of Health and Human Services (DHHS).

Abstract

We sought to determine sources of money income for HIV triply diagnosed adults, receipt of transfer income and financial support from others, and their employment status.  Average self-reported money 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.  Blacks were more likely than others to rely on public assistance and married individuals were less likely. 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 relative to their counterparts in the general population.  The relative probability of current full-time/part-time employment was lower among females; such employment also was lower among those in the worst physical health and those in moderate physical health.

Background: This 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 Study: We 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. Methods: We 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. Results: Average 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 Use: This population represents an important opportunity for better health and labor market outcomes through prevention and improved treatment adherence. Implications for Health Policies: Despite 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 Research: Future 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.

Received 18 May 2005; accepted 17 April 2006

Copyright © 2006 ICMPE