Over the past 50 years, Western medicine has revolutionized the meaning of medical care and our understanding of health. Through discoveries in bacteriology and virology, modern medicine enables us to fight illness caused by infections in the body and thus increase our health, well-being and longevity.

Conversely, many of the therapies that are often referred to as either complementary or alternative medicine have for thousands of years focused on preventative medicine. The role of complementary therapies in prevention is often called wellness care. Its purpose is to strengthen the immune system, enhancing the body's natural ability to fight infection in order to maintain health and well-being. Complementary medicine thus parallels the goals of HIV primary care, maintaining health and enhancing immune function.

In most parts of the country, complementary medicine is still not covered by medical insurance. Learning how to integrate complementary therapies into a treatment plan thus requires creative thinking and commitment from both health care providers and consumers. Despite these challenges, HIV-focused complementary services are increasingly being used in the primary care setting, from hospital-based designated AIDS centers, to private practices, to non-Western health care practitioners offering HIV-specialized primary care.

Complementary Therapies in a Hospital-Based HIV Center

At the HIV/AIDS Center of St. Luke's-Roosevelt Hospital in New York City, the biopsychosocial team approach is enhanced by the mind-body-spirit perspective of its Complementary Therapy Program. The director of the HIV/AIDS Center, Dr. Victoria Sharp, implemented the Complementary Therapy Program in 1996, as the use of triple-combination therapy moved the focus of HIV treatment from the acute care setting to the primary care setting. Sharp notes that as the treatment of HIV disease increasingly became an "outpatient" endeavor, HIV service providers needed to develop programs that enhance peoples' well-being at home and promote health-supportive lifestyle choices.

Today, the treatment approach at the St. Luke's-Roosevelt HIV/AIDS Center is enhanced with an array of mind-body medicine services that draw largely from the principles of traditional Asian medicine. By integrating shiatsu (Asian massage), hatha yoga, and treatment and training in Reiki (Japanese energy medicine involving light touch), doctors, nurses and mental health providers bolster their treatment plans with this new set of gentle, humanistic services.

"Learning how to integrate complementary therapies into a treatment plan requires creative thinking and commitment from both health care providers and consumers."

Each patient in the Center has the opportunity to receive one or all three services on a weekly basis. Since the use of complementary therapies in hospital-based programs is new to both patients and health care providers, the integration of complementary therapies at the HIV Center is overseen by a clinical social worker who specializes in mind-body medicine. Patients interested in using complementary therapies receive an initial complementary therapy assessment during which the social worker determines each patient's knowledge and provides individualized education about the appropriate use of mind-body medicine and natural healing. This initial counseling session serves as preparation for referring patients to holistic services both in the Center as well as in the community at large. Patients using complementary therapy services usually receive at least one complementary therapy assessment per month. In this way, the Center strives to assure that complementary therapies are being used effectively and safely, while also documenting ways that these innovative approaches are enhancing patients' health and well-being.

Some of the HIV-related issues most frequently addressed by the Center's Complementary Therapy Program include neuropathy, insomnia, loss of appetite, depression, anxiety and panic attacks. Many of the Center's patients have a history of illegal drug use. The stress management aspects of the complementary services often help these patients reduce their drug-related risk behavior. One patient recently stated, "I used to run to drugs when I'd get stressed out. Now I run to Reiki." The Center's Dr. Nereida Ferran notes that integrating complementary therapy into the treatment plan helps patients adhere to their antiretroviral regimen, as the Asian healing techniques help to reduce the side effects of medications, while enhancing people's ability to deal with the emotional stress of living with HIV/AIDS.

Chinese Healing in the Bay Area

The Quan Yin Healing Arts Center in San Francisco provides full-service traditional Chinese medicine to people with HIV/AIDS. As a nonprofit organization, it receives public funding to serve those in need, regardless of their social status or ability to pay. In 1996, Quan Yin received Federal funding, as California is one of the states where complementary medicine is supported by the Ryan White CARE Act. The center's core services include acupuncture and electro-acupuncture, moxibustion (an herbal heat therapy), massage therapy, qi gong classes (Chinese exercise and meditation), herbal medicine, and Western medical consults. While all clients at Quan Yin receive Western medical consults, Western medicine is used here to support Chinese medicine, the primary approach practiced there. Most of the clients at Quan Yin also work with a Western medical doctor outside of the clinic, and 35% of the center's referrals are made by outside physicians.

The center also collaborates with other health care organizations worldwide to develop and implement scientific research that assesses the efficacy of integrating Chinese and western medicine in HIV treatment. Finally, Quan Yin has an HIV-specialized clinical training program where practitioners of Chinese medicine receive advanced training in the treatment of HIV-related illness.

Misha Cohen, OMD, LAc is a doctor of Asian medicine and chairperson of research and education at Quan Yin. She has been treating people with HIV for 16 years. Cohen notes that with the integration of Western and Chinese therapies, "we are creating a new form of medicine. Chinese medicine is about harmony and balance, and anything that promotes this (i.e. antiretroviral therapy) is in line with the principles of Chinese medicine."

Cohen remembers that people used Chinese medicine less frequently for the first few months after protease inhibitors became widely available. This quickly changed, however, as people sought out Chinese medicine to help them reduce the side effects of their medications, promote their natural healing process and use fewer pharmaceutical medications. Cohen states that some of the HIV-related issues most helped by Chinese medicine are fatigue, diarrhea, lowered appetite, digestive disorders, anemia, sinusitis, and hormonal problems contributing to problems with menopause and PMS.

"With managed care we don't have a lot of variability in our work ... but complementary therapy is one way that we can be open-ended and creative in developing a plan that really helps people."

Supportive Care on the Hudson

Supportive care services, such as day treatment programs, nursing home services, hospice programs and supportive residential settings are increasingly integrating holistic and natural healing into their standard of care.

In Yonkers, New York, the Greyston Foundation sponsors two HIV-supportive service programs, an independent housing program called Issan House, and an adult day treatment program called Maitri Day Program. Located on two acres of land overlooking the Hudson River, the Foundation has developed an innovative program of integrative care that views inner peace and feelings of well-being as primary goals of treatment. The program's beautifully renovated turn-of-the-century buildings have windows and terraces facing flower gardens and vistas of the Hudson Valley. Such attention to detail demonstrates the Foundation's commitment to promoting a spirit of tranquility and harmony for both staff and clients.

Clients at Issan House and Maitri Day Program are called members rather than clients, as they are viewed as members of a healing community. In this way the program aims to create a new form of family for people who, for various reasons, have been alienated from more traditional support networks. While this non-hierarchical structure may be viewed as a challenge to the standard Western medical model, it promotes an atmosphere of cooperation and co-responsibility between members and health care providers.

In addition to the standard constellation of Western medical services provided by doctors, nurses and social workers, the program integrates massage therapy, Reiki, meditation, acupuncture, herbology, tai chi, hatha yoga, creative arts therapy and gardening into its standard of care.

All services are provided on an individualized basis to reflect members' needs and interests. Massage therapy, for example, is one of the program's more popular complementary therapy services due its role in stress management, pain management and immune stimulation. Many of the program's members, however, do not feel comfortable receiving full-body massage due to histories of physical and sexual abuse. For these members, the program has developed a chair massage option, which is less invasive, and feels safer to abuse survivors.

Staff and members appreciate the individualized nature of the integration of natural healing modalities, such as the use of acupuncture to relieve the pain of neuropathy. Dale Rascoe, the program's physician assistant, states, "With managed care we don't have a lot of variability in our work ... but complementary therapy is one way that we can be open-ended and creative in developing a plan that really helps people."

Community-Based Organizations

Since the beginning of the epidemic, people with HIV and AIDS have creatively developed community-based organizations (CBOs) to address needs which have often been poorly served by standard medical and social service programs. Due to their independence from mainstream health care, CBOs developed the first wave of holistic and natural healing opportunities for people with HIV/AIDS in the mid-1980s. They continue to be an important source of complementary and alternative medicine for people with HIV/AIDS.

Alive and Well

The mission of Alive and Well , a CBO in Glendale, CA, is to provide education and holistic services to people with HIV/AIDS. Nancy Rez, RN, the program's clinical coordinator, states that, "As people get involved in their healing, they usually develop an increased sense of well-being. It helps them feel they have some control over what happens to them. People...feel they can take charge of their bodies and their life. They feel empowered."

Alive and Well's core services consist of chiropractic, massage therapy, acupuncture, acupressure, shiatsu, polarity therapy, t'ai chi, hatha yoga, qi gong, Reiki, meditation, pranic healing and guided imagery. The center also has a bookstore and lending library.

Rez notes that people usually come to the center seeking symptomatic relief from either the side effects of their medication or the illness itself. She states, "Most people use a combination of modalities ... they move around and do different things." The wide range of healing traditions reflected in the services at Alive and Well illustrate how the independence of CBOs enables them to develop innovative treatment paradigms that reflect the needs and interests of people with HIV/AIDS. Happily, these "alternative" services empower people to maximize the benefits of Western medicine, as Rez states, "When people are able to manage their nausea, diarrhea and neuropathy, and sleep better, they have an easier time staying on the cocktail."

Friends In Deed

With its mission to provide emotional and spiritual support to people dealing with life-threatening illness, Friends In Deed in New York City offers an environment of serenity and support to people with HIV/AIDS and their loved ones. While the center provides an array of educational and holistic services, the heart of the program is called the "Big Group" -- a type of support group that strives to help people develop a solution-focused perspective, empowering them to see all of life's challenges, even life-threatening illness, as opportunities for healing and growth.

Friends In Deed also sponsors ongoing educational workshops on natural healing and mind-body medicine. Some recent workshop topics included: "Dealing with Medical Side Effects of Protease Inhibitors"; "Yoga: A Journey into Healing," "Finding the Balance Between Eastern and Western Medicine," "Body and Soul Cooking for One" and "Outliving Ourselves: Long-Term Survivors."

In addition to educational services, Friends In Deed provides hatha yoga classes, Reiki treatment and training, psychotherapy and holistic pharmaceutical counseling for people with HIV/AIDS. Most group activities are concluded with a home-cooked meal served in the center's Manhattan loft. With the meal, Friends In Deed fosters the sense of community which is at the center of all holistic healing.

What We've Learned

In the early stages of the AIDS epidemic, many people turned to what we then called "alternative" medicine in an effort to suppress the virus, boost the immune system, and most importantly, avoid the toxic side effects associated with early antiretroviral monotherapy. As with mainstream medicine, however, the alternative therapy movement lacked experience addressing the complex array of medical and non-medical issues associated with HIV-related illness. Consequently, treatment outcomes were often disappointing.

Despite these early challenges, it is the very complexity of HIV-related disease that lends itself so naturally to the holistic philosophy of complementary medicine. In the more than 15 years that have ensued since the beginning of the epidemic, the use of complementary medicine in HIV-related care has been refined so that now, as with mainstream medicine, it offers many effective and safe treatment options for people living with HIV/AIDS. Increasingly, the desire for improved treatment outcomes, decreased side effects to medication and enhanced well-being are making health care providers realize why some 70 percent of their patients with HIV/AIDS are turning to complementary therapies.

With this understanding, many medical providers are integrating complementary therapies into their practice. As Dr. Bruce Lockhart, MD, the medical director at Harlem United Community AIDS Center, Inc., says, "The best choice of therapy shouldn't be determined on the basis of its origin ... but on what works best."

Robert Schmehr is the manager of complementary therapy at the HIV/AIDS Center of St. Luke's-Roosevelt Hospital, and is a psychotherapist in private practice in New York City.