3.2 What are the rehabilitation interventions that can address the activity limitations and participation restrictions common among people living with HIV?

The impairments described in Section 3.1 may result in a variety of activity limitations and restrictions to an individual’s participation in education, vocational, family and social pursuits.

A broader and more holistic rehabilitation approach should take into account the activity limitations and participation restrictions faced by people living with HIV. Rehabilitation providers have important roles to play in addressing these challenges at multiple levels. For example:

• Clinical interventions
• Education to family and community
• Advocacy efforts to address the circumstances that create these challenges

It is vital that rehabilitation providers see that they have a role across the spectrum of the disease process from acute hospital care to long-term follow-up in the community. When rehabilitation providers are working with people living with HIV, they should consider both the individual’s personal characteristics (e.g., age, gender, economic status), as well as the environment in which they live, socialise and work.

Rehabilitation providers should also, where possible, be involved in advocacy efforts to ensure the efficient and effective provision of rehabilitation services to people living with HIV, particularly those from marginalized groups (e.g., people who are experiencing financial instability, people from racialized communities, people with disabilities). Advocacy efforts can be strengthened by active involvement in community-based research initiatives focusing on rehabilitation for people living with HIV.

This section is organized according to the categories of activity and participation in the World Health Organization’s International Classification of Functioning, Disability and Health (see Section 1.3).

Potential causes of these impairments and rehabilitation interventions are shown in the table below.

Table 3.2: Rehabilitation Interventions for Activity Limitations and Participation Restrictions

Activity Limitations and Participation Restrictions	Rehabilitation Interventions(for details, see Section 3.3)
Learning and applying knowledge	Adult-based education programs Assistive devices Environmental adaptation Provision of visual or auditory education materials
General tasks and demands	Energy conservation and pacing Environmental adaptation Exercise prescription – aerobic Exercise prescription – strength Home-based rehabilitation Assistive devices – scooters, jar openers, sock donners Return to work/activity strategies
Communication	Adaptation of communication environment Articulation, fluency, resonance, language advice and exercises Augmentative communication devices e.g. text-to-voice output device Education on managing conversations and communication Environmental adaptation Psychosocial rehabilitation
Mobility	Assistive devices Community-based rehabilitation Energy conservation and pacing Environmental adaptation Ergonomic interventions Exercise prescription – aerobic Exercise prescription – strength Exercise prescription – balance/neuromotor skills Exercise prescription – stretching and passive movement Home-based rehabilitation
Self-care	Advice on personal hygiene Advice/training and exercises related to transfers Assistive devices (e.g. grab bars, raised toilet seat) Energy conservation and pacing Environmental adaptation Ergonomic interventions Home-based rehabilitation
Domestic life	Advice on meal preparation and nutrition Assistive devices Energy conservation and pacing Environmental adaptation Home-based rehabilitation
Interpersonal interactions and relationships	Couple counseling Family support groups and parenting programs Involvement and education of family and friends Psychosocial rehabilitation
Major life areas including work and employment	Accessibility awareness and promotion Education and advice on social grants/ employment/accessibility legislation Energy conservation and pacing Environmental adaptation Ergonomic interventions Extramural education and activities for learners Involvement and education of employers, colleagues and educators Psychosocial rehabilitation School education programs School feeding programs Vocational rehabilitation
Community, social and civic life	Community-based rehabilitation Education and advice on human rights Energy conservation and pacing Involvement and education of spiritual, political and community leaders Advocacy group participation