The occupational careers of men living with HIV infection in the United Kingdom: Insights into engaging in and orchestrating occupations

Abstract

Background: Human immunodeficiency virus (HIV) emerged as an entity in the mid-1980s. Since that time, medical developments have greatly improved the detection and management of infection and the associated acquired immunodeficiency syndrome (AIDS). As such, HIV infection is now seen as a chronic yet life-threatening condition. Although occupational therapists have worked with people infected with HIV since quite early in the history of the disease, an understanding of living with HIV infection from an occupational perspective has been limited. However, as a chronic condition HIV infection is likely to have significant occupational implications. Methods: Five men living with HIV infection in the UK were recruited through personal contacts and information sent to HIV/AIDS organisations. Each man was interviewed using an extended oral history model, recording detailed individual life histories from early childhood until the time of the interview. Interviews were recorded and transcribed verbatim. A process of narrative analysis was developed and used to analyse each oral history. The result was a story of each man's life, centred around an occupational plot. Results: The narratives are textual representations of each man's occupational career as they reveal the complexity of each man's life as a web of occupations, as well as the individual careers of particular occupations. The production of each man's occupational career made it possible to first explore living with HIV infection from an occupational perspective and provide an example of how an occupational perspective of humans and health can be operationalised. They tell the story of each man's life centred around occupation, and highlight how the men not only engaged in occupations but also orchestrated their engagement over time and within various environments. In addition, the occupational careers give a contextualised insight into the meaning of occupations. Second, this research has enabled an appreciation of the difference between biomedical and occupational views of living with HIV infection. Adopting an occupational perspective illustrated how the twists and turns of life living with HIV infection may not be marked wholly by such markers as blood tests and medication side-effects. For some men in this study, living with HIV infection was marked by occupational engagement; ceasing, commencing, resuming, or requiring more effort to perform occupations. Third, this research has enabled an understanding of each man's response to HIV infection as part of his lifelong process of occupational adaptation. It was possible to appreciate how each man had responded to challenges in the past in order to achieve and maintain occupational adaptation. Although this was not predictive, it did provide a valuable insight into how each man responded to HIV infection.