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HIV and the Recession: Living Well in Tough Times

Winter/Spring 2010

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Eating and Sleeping Well

HIV and the Recession: Living Well in Tough Times
Your mother was right: Eat well and get enough sleep, and you'll feel better. This is a rule of thumb for everyone, of course. But for people with HIV, these simple daily functions can help maintain health. Plus, they are inexpensive.

"That is, without a doubt, one of the most important aspects of maintaining good health, period," said Johnson. "Eating well [and] sleeping enough hours are linked to a healthy immune system."

But how many of us do that -- HIV positive or not? Johnson admits he's often up late and then awake "as soon as the sun peeks up over the horizon."

For many people, the key to incorporating good basic nutrition into their lives is to make small changes that become a permanent part of their routine, according to Cade Fields-Gardner, director of services for the Cutting Edge, a Chicago-based organization dedicated to improving nutrition for HIV positive people.

"The good news is that the body is a pretty amazing thing. If you take care of it at all, it will take care of you," said Fields-Gardner, who has specialized in HIV care for 22 years. "But, as with adjusting to a pill regimen, it may take a while to adapt to lifestyle changes."

You can do it, and it doesn't have to be painful if you take things a step at a time.

Sleep Well

Let's start with that elusive eight hours of sleep. For everyone, those hours may be interrupted by worry, depression, work, or children. HIV positive people have an added challenge: Some HIV medications can cause insomnia or poor sleep, including the widely used efavirenz (Sustiva, also in the Truvada and Atripla combination pills).

Don't be afraid to speak up about insomnia and ask your clinician about other antiretroviral options that will let you get much-needed rest.

"Many times, you'll get started on a medication and the side effects will be strong," said Fenway's Boswell. "But they usually gradually resolve over a period of weeks. If that doesn't happen, especially if there are more options, your clinician [can] move you off that medication, because of the need for sleep."

It also helps to create a routine. Reyes said staffers at HELP/PSI often work closely with clients to help them develop new bedtime routines that do not include working or playing on computers, watching TV, or other late-night activities. It may be painful at first to give up your evening entertainment, but making small changes -- such as not watching programs that rile you up just before bed, or turning the lights low before sleep -- will eventually take hold and help create healthier sleep habits, she said.

Eat Real Food

Resources for Healthy Eating

Nutrition Works (Boston)

USDA Online Farmer's Market Search

USDA Supplemental Nutrition Assistance Program

Women, Infants, and Children (WIC) Program of the USDA Food and Nutrition Service

For Mike, one of the surprising side effects of losing his job has been that he is eating at home more often and eating fewer fried foods. The changes, though, have mostly been small.

"I gave up french fries and started eating more salads," he said. "Instead of eating donuts, I am eating fat-free licorice."

It's not perfect, of course, but Mike's approach is still a good one, said Fields-Gardner. And there's a good reason to get started today. For HIV positive people, just having the virus changes the body's metabolism.

"HIV is a chronic inflammatory disease, which it has in common with rheumatoid arthritis, Crohn's disease, and others," explained Fields-Gardner. "What chronic inflammation does is change the way muscle and fat are metabolized in your system. These changes affect muscle, bone, and other tissue."

Chronic HIV infection also changes how sensitive your body is to natural hormones, which can lead to increased resistance to testosterone, growth hormone, and, notably, insulin.

Insulin allows glucose from food to enter cells, where it is used as a source of energy. When insulin resistance develops, cells do not respond properly to insulin, allowing glucose to build up in the blood. In other words, the body has to work harder to come down from a "sugar high." Over time, insulin resistance can progress to prediabetes or even diabetes. (For more information, see "HIV/AIDS and Diabetes: Minimizing Risk, Optimizing Care" in the Winter/Spring 2009 issue of BETA.)

Another issue for people with HIV is altered fat metabolism. Chronic HIV infection, antiretroviral drugs, or a combination of the two can lead to abnormal levels of cholesterol and triglycerides in the blood, which in turn increase the risk of cardiovascular disease. While it's good advice for everyone, it is especially important for people with HIV to avoid a high-fat diet and maintain a healthy weight.

Build a New Rut

If you're a fast-food junkie or love an occasional sugary snack, no need to fear: Eating well with HIV does not have to mean resigning yourself to a life of brown rice and raw foods.

Like Mike, you can take small steps toward better-for-you treats. If you love sugary soda and eat fast food every day, maybe start by choosing beverages with less sugar and switching to some of the healthier items on the menu, suggested Fields-Gardner. If you crave steak, reduce the portion size while adding a side dish of healthier (and more budget-friendly) foods such as beans or lentils. This can help you get accustomed to new flavors while you learn to prepare and enjoy unfamiliar foods.

"I like the idea that people don't live nutrition," said Fields-Gardner. "You figure it out, you build a good rut with healthy foods, and then you move on with your life."

To build that new rut, you have to stick with small changes over a period of time. It can take three days for your body to establish a new pattern, but months for your brain to adjust to those changes and for them to become ingrained, she said. During that time, don't sabotage yourself by attempting unsustainable major changes to your diet.

Try Home Cooking

HIV and the Recession: Living Well in Tough Times
"Not everyone is going to want to take the Julia Child approach," Fields-Gardner said. "If someone is used to visiting a restaurant for dinner every day for the last ten years, asking him to make his own stock from scratch is kind of crazy."

But there is a happy medium. Some organizations, like HELP/PSI, offer cooking classes for HIV positive people, so they can learn inexpensive ways to prepare nutritious meals at home.

One of the best options, said Shane Convery, Program Director for San Francisco's Immune Enhancement Project (IEP), is stews. His program teaches people how to cook a flavorful and healthful stew, even if all they have to work with is a hot plate in a single-room-occupancy hotel. Stews, he added, end up being nutritious and cheap because they're mostly made from beans and inexpensive cuts of meat.

If even this seems like too much effort, there are plenty of healthy options that don't require any cooking at all, for example homemade sandwiches of lean meat and vegetables, or whole grain cereal with low-fat milk.

In addition, preparing food at home puts you in control of what ingredients go into your meals, rather than leaving those choices up to restaurant chefs and fast-food cooks. "The side effect of eating at home is that, yes, it's less expensive, but you make better food choices, as well," Convery said.

Go Farm Fresh

Farmer's markets can be a cornucopia of healthy foods. But it turns out they can also be cost effective, said Convery. In a survey conducted recently by IEP, produce cost slightly less at farmer's markets than at supermarkets. And because they weren't shipped across the country and stored in warehouses for weeks or even months, the fruits and vegetables offered at farmer's markets are fresher and tastier.

Many farmers are willing to negotiate prices, especially if you visit their stalls late in the day as they're packing up. That way, they don't have to haul unsold produce home and you don't have to pay full price.

And you can use food stamps at many farmer's markets. Food stamps and food pantries were created for people who need healthy food and cannot afford to buy it on their own. People who are permanently disabled are automatically eligible for the U.S. Department of Agriculture's (USDA) food stamp program, but must not earn more than 165% of the federal poverty level. Visit the USDA's searchable farmer's market database (listed in the table above) to locate markets that accept food stamps and other vouchers for nutritional assistance.

Assemble Your HIV Dossier

If you have never accessed the HIV health services system before, you will learn that signing up for services requires an intake visit where you present documentation of your diagnosis, income, and residency -- among other things -- in order to get connected and start receiving care.

Before you seek services, do yourself a favor and put together a notebook with the required documentation, including:

  • A photo ID
  • Proof of residency (such as utility bills with your name and address on them)
  • Letter of HIV diagnosis from your health care provider
  • Lab results from the past six months
  • Proof of income (pay stubs from the past three months if you are currently working, or a W-2 form from the previous year)
  • Rent receipts, if you are seeking assistance with rental expenses said. During that time, don't sabotage

Complementary Therapies

Despite Michael's challenges, he's kept up one thing: his yoga practice.

"I like a particular type of yoga called hatha yoga," he said. "It's very meditative, slow, quiet." Although Michael also enjoys other, more rigorous forms of exercise, he finds that yoga offers extra benefits. "It's not only good for you physically; it's great mentally, as well. It can be a way to calm your mind. There are so many benefits other than physical."

For years, yoga has been shown to counter chronic stress, depression, and anxiety. Emerging research is beginning to suggest that the flood of the hormone norepinephrine (also known as noradrenaline) that comes with intense stress allows HIV to replicate more rapidly in the body. And studies suggest that yoga may help staunch the flow of norepinephrine throughout the body.

Other studies have found that yoga may be helpful in coping with medication side effects such as peripheral neuropathy. This makes yoga particularly beneficial, as research shows that persistent side effects from medications are a good predictor of poor treatment adherence.

Complementary Therapy Resources

American College of Traditional Chinese Medicine (San Francisco)

Desert AIDS Project (Palm Springs)

Immune Enhancement Project (San Francisco)

Links to information on low-cost or free yoga classes for HIV positive people in several states

Other complementary therapies, such as acupuncture and massage, may offer similar relief. "The basis of all this is to achieve a balance," said IEP's Convery. "And because each thing you do is up to you, complementary therapies really empower individuals to make their own decisions. At a time when it seems like so little is up to the individual, a sense of control can be very healing."

But how can you find yoga, acupuncture, and other complementary therapies that you can afford? After all, at $15 per yoga class and more than $100 per acupuncture session, the cost can be prohibitive.

Ask Your One-Stop Shop

Many one-stop HIV/AIDS centers such as HELP/PSI and Gay Men's Health Crisis offer complementary therapies to their clients. If they don't, they may be able to direct you to local agencies or groups that do offer those therapies for low rates or free.

For instance, the Desert AIDS Project in Palm Springs, California, provides yoga classes tailored to the symptoms and immune health of its HIV positive clients. In San Francisco, the Integral Yoga Institute offers affordable classes for people with HIV/AIDS, and offers work exchange. Call your local organization and ask if they offer something similar.

Work it Out

Acupuncture is usually expensive, but not at IEP's drop-in clinic. Three days per week, the organization offers acupuncture for a donation -- anywhere from $5 to $20. "But no one will be turned away if they can't afford it," said Convery. "We'll gladly accept $4, $3, $2."

"Some of us are willing to create work exchange plans with people who'd like acupuncture but can't afford to pay for it," Convery said. "We're certainly thrilled to have the volunteers -- and I think every organization right now is thrilled to have that. What you do when you volunteer can be tailored to your energy levels, and it's a great way to get new skills, be active, and get out."

As with newly trained mental health service providers, many senior-level acupuncture students and massage therapists are looking for practice. In San Francisco, the American College of Traditional Chinese Medicine has student clinics that offer the same services others charge full-price for, but at discounted rates. Students are supervised by experienced practitioners to ensure high-quality care.

Getting Help: Dispelling the Myths

Myth: "My needs aren't as important as the needs of others."

Fact: If you're HIV positive and have never needed services before because you were employed and received health insurance through your employer, you may think that services offered through the San Francisco AIDS Foundation, AIDS Legal Referral Panel, Positive Resource Center, or even ADAP are designed for people who have less money or more advanced HIV disease than yourself. You might feel guilty for accessing services. Don't, said Steven Boswell. They're for you as much as anyone else.

Myth: "I don't qualify because I make too much money."

Fact: If you earned a lot last year but have been laid off this year, you may still qualify for many services. ADAP, for example, covers people with incomes several times the federal poverty level. Don't let past income get in the way of seeking the help you need today.

"What I tell people is that the services are here for people just like you," said Ellen Novogrodsky. "Especially when it comes to medical costs, it can be so expensive, and that's why the AIDS Drug Assistance Program exists. You shouldn't feel uncomfortable accessing services."

Myth: "If I am seen entering an HIV clinic, people will know that I'm HIV positive. Keeping my HIV status private is more important."

Fact: If you're struggling with the stigma of an HIV diagnosis, you might feel like avoiding public clinics and other centers that offer low- or no-cost HIV services. That may be a preference you can't afford, however, if your current finances make your private doctor too expensive, said Phil Johnson.

"The fact is, you may meet someone who has already had experience with obtaining services and is successfully tapped into available resources," he said. "And you may find it easier to navigate the health care maze or obtain the quality of care you need by working with people who have the same diagnosis."

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This article was provided by San Francisco AIDS Foundation. It is a part of the publication Bulletin of Experimental Treatments for AIDS. Visit San Francisco AIDS Foundation's Web site to find out more about their activities, publications and services.
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