H.E.A.R.T. PROJECT Progressive Case Studies
THE PROGRESSIVE CASE STUDIES MAKE UP THE PRIMARY TECHNOLOGY METHOD OF THE H.E.A.R.T.
PROJECT'S TRAINING. THREE CASE STUDIES FOLLOW. EACH ONE BUILDS UPON THE OTHER IN
AN EVOLVEMENT OF HIV/AIDS ISSUES RELATED TO THE INTERSECTION OF HIV/AIDS AS A DISABILITY
WITHIN CULTURAL COMMUNITIES. WE SUGGEST THE FOLLOWING PROCESS IN USING THESE CASE
STUDIES.
Form small groups selecting a facilitator and a recorder. Using the module chapter
outline and reference materials where appropriate, and after reading the assigned
case study, in small groups discuss the questions you will be provided and make a
list of your small group discussion highlights for large group discussion. Each
group will be provided a different case study for discussion.
H.E.A.R.T. Case Study #1 - Brad
1. Brad is a 32 year old, married white male construction worker. He has used drugs
on and off since age 14 which is one of the reasons he never finished high school.
He began injecting heroin at the age of 24, shortly after his son was born. He
has been in recovery from heroin use for 3 years and attends Narcotics Anonymous
meetings. He has been a construction worker for the past 12 years. His job was
mostly outdoors and included heavy lifting. He does not have a contractors' license
and works mostly "under the table" in terms of receiving payment. He was
married at the age of 22 to a Latina. They had a child who is now 9 years of age
who lives with them. Brad and his wife were separated shortly after their child
was a year old because of his drug use. He completed a drug treatment program where
he learned he is HIV positive. He and his wife reconciled however he failed to tell
his wife that he has HIV disease. The only medical insurance he has is on his wife's
policy from the day care center where she works. He has not paid into social security,
unemployment, or disability. They rent their apartment in Sacramento. From a physical
standpoint, Brad has swollen glands, intermittent fevers and he has lost about 5%
of his base body weight. He has had frequent bouts of diarrhea which have subsided.
He has thrush and because of this and his swollen glands, he finds eating uncomfortable.
He is fatigued and depressed. These symptoms are similar to a severe bout of the
flu he had 8 years ago. He currently has some upper body muscle weakness. Vocationally,
Brad is able to do some light work, but is finding that he can no longer lift heavy
things, nor work a full eight hour day. He is very worried that he is progressing
to AIDS and is concerned about relapsing since stress is one of the triggers. He
has no one to talk to about his fears because no one knows that he is HIV positive
and he is afraid to tell anyone. He is being treated by a physician who has very
little experience with HIV disease and who has encouraged him to tell his wife about
his condition. Brad is afraid his wife will leave him if she finds out about his
condition. The doctor has not told Brad's wife about Brad's condition (although
by law he can) because he is concerned that Brad will cease treatment. Brad's CD4
count is 409.
Discussion Questions
Case Study #1 - Brad
Using module outlines and reference materials discuss
and answer the following:
Medical
• In what stage of HIV disease is Brad?
• Does he have any condition that constitutes an AIDS diagnosis?
• What could be some of the causes of his symptoms?
Psychosocial
• What psychological/emotional issues have to be dealt with?
• What social issues have to be dealt with?
Vocational Rehabilitation
• Brad comes into your office to apply for services and you as officer of the day
have to take his application.
What can the vocational rehabilitation counselor say or do given the issues you've
raised?
• Knowing Brad's sensitivity in disclosing his condition what would an Rehabilitation
Counselor need to consider in working with him?
• What are the confidentiality issues that must be addressed in working with Brad?
• What are the main vocational rehabilitation issues for Brad?
• What are Brad's functional limitations?
• Having assessed Brad's functional capacities, discuss what services DR could offer
and how these would reduce the impact of these limitations?
• What types of vocational evaluation tools would be useful in assessing Brad's
vocational potential?
• What are Brad's vocational limitations and how do they impact on his vocational
rehabilitation potential?
• Discuss the possibility of return to previous work. If return to previous work
is unlikely, what skills are transferable and to what type of work? What type of
accommodation might be requested?
• If you learned that Brad was considering growing marijuana for sell to increase
income how would you counsel him?
Multicultural
• Do any "cultural "issues need to be addressed? If so, what are they?
• Which is the most important in terms of Brad's rehabilitation?
H.E.A.R.T. Case Study #2
Sophia is a 29 year old Latina who is married to Brad. She has completed two years
of college. She has a nine year old son, Ricky, who is not HIV positive. Sophia
works at a Catholic day care center for migrant workers. In the early years of her
marriage to Brad, she "kept the books" for his construction work. She
and Brad separated for several years after she learned that Brad was using injecting
drugs. She reconciled with Brad after he completed his recovery program. Sophia
and Brad are practicing birth control, however the only forms of birth control she
uses are the rhythm method and/or withdrawal. These are the only methods acceptable
in her religion. Also, she was reluctant to ask Brad to use a condom. Sophia's
family is unhappy about her choice of husband because he is not the same religion
as her. She brings home the most consistent pay check since her husband's work is
somewhat seasonal. From a physical standpoint, six months ago she had what appeared
to be a very severe bout of the flu that lasted several weeks. This was accompanied
by a very high fever, night sweats, diarrhea, and a rash. Three weeks ago Sophia
went to the doctor because she thought she was pregnant. She found out that she
is pregnant. At the same time as the examination, she had an HIV test at her doctor's
strong suggestion. The results returned positive. At this point she realized that
her husband is probably HIV positive which further explained his current poor medical
condition. Sophia is wondering about her son Ricky and whether should she continue
her pregnancy. She worries about what will happen if her employer finds out about
her antibody status. She worries about what will happen if she loses her job. She
wonders about who she can to and whether she should she try to find another job where
she is not working with kids?
Discussion Questions
Case Study #2
Using module outline and reference materials discuss and answer the following:
Medical
• In what stage of HIV disease is Sophia?
• Does she have any condition that constitutes an AIDS diagnosis?
• What could be some of the causes of her symptoms?
Psychosocial
• What psychological/emotional issues have to be dealt with?
• What social issues have to be dealt with
Vocational Rehabilitation
• What are the confidentiality issues that must be addressed in working with Sophia?
• Given the medical information provided, is Sophia eligible for Department of Rehabilitation
(DR) services?
• What other information would be helpful in assessing eligibility?
• What kind of vocational information would be useful to Sophia?
Multicultural
• Do any "cultural "issues need to be addressed? If so, what are they?
• Which is the most important in terms of Sophia's rehabilitation?
• How should the rehabilitation counselor approach these issues?
H.E.A.R.T. Case Study #3
Phil is a 30 year old African-American gay male. He grew up in a small rural area
near Sacramento where he now lives. From age 19 until last year he lived in San
Francisco, where he received an AIDS diagnosis and his partner of 11 years died as
well as many of his friends and clients. He has been unable to work as an athletic
trainer conducting aerobic work outs. Six months ago he returned home because he
felt he was near death. He moved back home to be near his family and get their support.
Generally, they are supportive of him, but are not supportive in regards to his
sexual orientation. His mother and sister are the only ones at home that he has
told about his illness. At the time he moved back home, his viral load was 250,000
and his CD4 count was 200. He has Kaposi's Sarcoma (KS) lesions on his face and
arms and legs. He has had shingles, some neurological involvement including some
neuropathy of the hands and feet and some memory loss. He is taking prophylactic
medications to prevent PCP. He has lost about 50 pounds and has been unable to work.
His previous job in San Francisco was at a fitness center as an athletic trainer
where his visible KS lesions were not problematic. He went to the Department of
Rehabilitation because he wants to find employment to assist his family financially.
He is being seen by a physician who is an AIDS specialist. This physician has prescribed
a regimen of protease inhibitors and other antiviral agents. His viral load is now
undetectable and his CD4 count has risen to over 400. He is beginning to feel much
better and less fatigued. He wants to work but is not sure he can handle aerobic
workouts. Phil has a Bachelor's degree in physical education.
Discussion Questions
Case Study #3
Using module outline and reference materials discuss
and answer the following:
Medical
• Using manual outline and reference materials answer the following:
• In which stage of HIV disease is Phil?
• What could be some of the causes of his symptoms?
• What is the basis of his AIDS diagnosis?
• Why has his viral load probably decreased and his CD4 count increased? Is it
guaranteed that this improvement in health will continue?
Psychosocial
What psychological/emotional issues have to be dealt with?
What social issues have to be dealt with?
Vocational Rehabilitation
• What type of financial or social services may Phil be eligible for? - What kind
of assessment tools would be helpful in determining eligibility and career choice
for Phil?
• As the Rehabilitation Supervisor your Rehabilitation Counselor reports the lesions
on Phil's face and expresses fear of contracting HIV disease. What do you advise?
What other issues may you need to discuss or assess with your Rehabilitation Counselor?
• What resources might be helpful to access within and outside DR to
assist Phil?
Multicultural
Do any cultural issues impact on Phil's adjustment to his "impairment"?
If there are, what are examples of culturally sensitive responses a rehabilitation
counselor might make to Phil as vocational planning goes on.