Background. As a result of the success of Antiretroviral Therapy (ART) reducing Human Immunodeficiency Virus (HIV) associated morbidity and mortality, many employed persons with HIV infection will be able to continue working, and, among patients who could not work because of their diseases, health and functioning may improve to levels that allow them to return to work. However, little is known about how working affects adherence among those who are employed and taking ART. Using data from a multi-site adherence intervention study conducted in Massachusetts between 2002 and 2005, we described the experiences of workers living with HIV and examined possible employment-related barriers to antiretroviral treatment (ART) adherence. This study's aim was to describe the relationship of ART adherence to the psychosocial demands and the decision latitude of the work (job strain), accommodations in the work place, HIV disclosure at the work place, and ART side effects affecting worker performance.

Methods. Patients who were on ART with detectable viral loads were enrolled. Survey items about patients' work were longitudinally administered up to five times over an 18-months period. Adherence was assessed using the Medication Event Monitoring System Cap. We constructed simple and multiple regression models with adherence as the dependent variable, and the employment related variables as the independent variables.

Results. Of the 156 patients participating in the trial, 69 (44%) were employed either part-time or full-time. These 69 patients and their 201 visits were used for our analysis. Our study showed four main findings. First, neither job strain nor its constituent variables job control or demand, were associated with ART adherence. Next, the presence of work place accommodations (reported by 20% of the workers) was significantly associated with higher rates (13%) of adherence to ART (this association held even after adjusting for race, drug use, job strain, side effects affecting work performance and physical and mental health). Third, patients who disclosed their HIV status were more likely to obtain job accommodations without experiencing negative consequences related to the disclosure. Finally, having side effects affecting work performance was not significantly associated with ART adherence.

Conclusions. Relatively circumscribed, even temporary accommodations at the workplace may have a positive impact on ART adherence. These potential benefits of requesting modifications need to be weighed against the possible risks of workplace disclosure.