Rehabilitation in the context of HIV

From a clinical perspective, although medicine was best positioned to help contend with disease processes, it was the rehabilitation community (e.g., physical therapists, occupational therapists, speech-language pathologists and physiatrists) who brought expertise in dealing with the life-related consequences of the illnesses [4].

Furthermore, it was rehabilitation and disablement frameworks to which scholars and activists turned for insight into how to reconceptualize HIV beyond the level of disease. The World Health Organization's (WHO's) International Classification of Impairments, Disabilities and Handicaps (which was updated in 2001 and renamed the International Classification of Functioning, Disability and Health, or ICF) provided a framework that could highlight the challenges related to living with HIV at the level of the body structure or function (e.g., painful knee or congested lungs), the level of the individual (e.g., difficulty walking or getting dressed), and the level of involvement in life situations (e.g., difficulty with one's job or in parenting roles) [5, 6]. This reframing provided the basis for both programming and policy advocacy.

For instance, the Canadian Working Group on HIV and Rehabilitation (CWGHR) was founded in 1998 by HIV activists, rehabilitation professionals, government policy makers and representatives from the insurance industry to examine and respond to the emerging needs of people living with HIV in this new context. Guided by the WHO framework, the organization's research and policy work has focused on such issues as work and employment, HIV education and mentorship for rehabilitation professionals, and the facilitation of a prevalence study to assess the level of disablement among populations of people living with HIV [7, 8].

In 2005, Worthington et al advanced a conceptualization of rehabilitation in the context of HIV that was informed by these efforts and based directly on the ICF [9].

This HIV Rehabilitation Conceptual Framework heightens understanding of rehabilitation domains, services and issues in the context of HIV. Using the ICF, the framework outlines the multiple life domains affected by HIV and associated treatments, provides a working definition of rehabilitation in the context of HIV, and highlights the expanded role that health providers and services have in the rehabilitation of people living with HIV, including their role in enhancing their labour forces and overall social participation. Although this framework is being taken up in certain environments in wealthy countries, it has had only limited application in resource-limited settings [10].

A new concept- episodic disability

Along with advocacy efforts geared solely to HIV, the CGWHR also brought together likeminded individuals and organizations from outside of the HIV world that were facing similar concerns. An early outcome of this "cross-disability" initiative was the creation of a model, which helped identify areas of shared concern across the groups and sparked the notion of "episodic disability". The model uses medical diagnoses as the basis for illustrating the intersection of issues related to- HIV; "permanent" or static disabilities; and "episodic" disabilities, which refer to experiences of disablement that are unpredictable and intermittent in nature.