With the advent of Web 2.0 technologies, websites have evolved from static pages to dynamic, interactive Web-based applications with the ability to replicate common desktop functionality. However, for blind and visually impaired individuals who rely upon screen readers, Web 2.0 applications force them to adapt to an inaccessible use model. Many technologies, including WAI-ARIA, AJAX, and improved screen reader support, are rapidly evolving to improve this situation. However, simply combining them does not solve the problems of screen reader users. The main contributions of this paper are two models of interaction for screen reader users, for both traditional websites and Web 2.0 applications. Further contributions are a discussion of accessibility difficulties screen reader users encounter when interacting with Web 2.0 applications, a user workflow design model for improving Web 2.0 accessibility, and a set of design requirements for developers to ease the user's burden and increase accessibility. These models, accessibility difficulties, and design implications are based directly on responses and lessons learned from usability research focusing on Web 2.0 usage and screen reader users. Without the conscious effort of Web engineers and designers, most blind and visually impaired users will shy away from using new Web 2.0 technology in favor of desktop based applications.