Have you ever heard someone say, "I don't want HIV to take over my life. My life is more than my HIV status?" Perhaps you've had similar feelings or felt overwhelmed with trying to manage your health. This article provides a different way of thinking about health than what many people may experience at a doctor's office. The goal is to offer a framework for thinking about a big picture of well-being and provide a path for developing a long-term strategy to promote and maintain overall general health.
Studies have looked at similarities among people who are long-term survivors of HIV and other life-threatening conditions. People who have spontaneous remissions from serious conditions or improving outcomes over time are people who are most likely to proactively address health on all fronts. This doesn't contradict findings that people who see an HIV-experienced doctor are more likely to live longer and healthier lives with HIV infection. Nor does it disregard that some people might not progress to AIDS as quickly due to genetic factors, the virulence of the virus they were initially infected with and other factors. Yes, sometimes outcomes in HIV infection might just come down to luck. In the biggest picture, however, people who proactively address health on all fronts have a tendency to do better than people who do not.
What Is Health?
What is health and how does someone address health on all fronts? Is it possible to come up with strategies to address health on all fronts without it becoming a full time job? Sometimes health crises arise and managing them can take over a large part of a person's life. Part of the goal of a general health maintenance strategy, however, is finding the right balance. It's not about health maintenance interfering with life -- it's about healthy living.
Project Inform ascribes to a model of health as it concerns the whole being -- a biopsychosocial model of health. This includes physical (biological), mental (psychological), spiritual and social health and assumes that each of these areas of health impacts the others.
At the biological level, health is freedom from disease or injury and any limitations these might impose. Merely avoiding disease; having healthy bones, skin and teeth; and staying out of harms way doesn't reflect the complexity of our lives. We are more than the sum of our parts and we can be healthy without being perfect. As the definition of health expands to include how our whole body is functioning, a picture of health that includes a mind-body connection emerges. It doesn't stop there. Health includes a state of mind, a peace and harmony with ourselves and our physical and social environments.
Developing a Strategy: Building a Strong Foundation
A general health maintenance strategy addresses the mind, body, spiritual and social connections of who we are and how we live. By viewing health this way, the idea of a general health maintenance strategy being something that overwhelms one's life begins to fade away. Through both action and inaction people make choices daily about their health. You likely have general health strategies that you are implementing all the time. Taking a moment to look at what those strategies are, name them, refine them and explore ways to improve them is the very foundation of health.
No single strategy works best for everyone. Rather, the best answers are those that fit you best. There are resources, tools and some basic principals to consider. A good strategy includes goals you can achieve, is tailored to your needs, fits into your life and makes you feel better as you implement it. That doesn't mean that your strategy is failing if you come down with the common cold or if you have a bad day. A general health strategy is not something one achieves or completes, it's an ongoing process that needs to be revisited periodically and adjusted as your life changes -- as you change.
Your basic biological health is something that a doctor can help you to understand and develop tailored strategies for promoting and improving. While people living with HIV often see a doctor four times each year, many times both HIV specialists and patients can forget about basic health screening and maintenance. This includes physical examinations, vaccinations, other preventive health measures as needed and age-appropriate health screening.
For information on what is looked for in a routine physical examination, what's meant by age-appropriate screening, general recommendations on vaccinations and a list of special health considerations, call the Project Inform hotline. Also available is information on standard tests, vaccines and issues to deal with during a first visit to a doctor after finding out that you're living with HIV.
Taking care of your biological health includes more than seeing a doctor. The following are a few examples:
The body needs nutrients in order to work effectively. Often when people are really hungry they'll get a headache, feel dizzy or may find themselves in a bad mood. How often and what do you typically eat in a day? What does good nutrition mean to you and what can you do to improve your nutrition? Realistic nutritional goals that fit with your life and lifestyle are key to success. What this often means is incremental improvements. For example, if a normal breakfast for you is a cup of coffee and a pastry on your way out the door, is it possible also to add a glass of juice? While it's great to consult with a nutritionist (especially one who specializes in HIV), there are probably ways you can improve on your general nutrition now. For some this means eating more, for others eating less and for others it's about eating different foods. For more information on these publications, "Nutrition and Weight Maintenance" and "Food Safety," call the Project Inform hotline.
A few pounds of muscle mass (lean body mass) can make a difference in whether someone recovers from a severe life-threatening infection. There are many reasons why exercise is good for us, from helping muscles and bones remain strong to improving the function of our heart and lungs. Are there ways you can improve how you exercise or the amount of exercise you get each day? Some people love to go to the gym and workout; others wouldn't set foot in a gym if someone paid them. If you typically don't set aside any time for exercise, consider taking a walk for twenty minutes each morning and/or at the end of the day. Perhaps you'll never go to the gym, but you may enjoy going for a hike, bike riding or simply taking the stairs in your building. What can you do to improve the kind or quality of exercise you get each day?
When we sleep, our bodies heal. In general, it's recommended that people get eight hours of sleep each night. The amount of sleep needed differs to some degree between individuals and can also vary based on other things going on in a person's life. When someone is depressed they might sleep more or have trouble sleeping. Often when someone is fighting an infection their body demands more rest. Do you get enough sleep each night? If you are sleeping too much it is important to figure out why -- are you depressed, fighting an infection, do you have low red blood cell counts (anemia)? If you are sleeping too little it's also important to figure out why -- are you depressed, drinking coffee or other caffeinated beverages too late at night, or is something else going on? If you find your life is just too busy to find time for sleep, strive for incremental improvements. If you're sleeping only five hours a night, is it possible to make time for five and a half or six hours?
Chemicals produced by the body when people experience stress can weaken the immune system, leaving cells more susceptible to infection and crippling the ability of the immune system to rebuild itself. It's virtually impossible to completely avoid stress, but efforts to minimize and manage stress are important to our physical and mental health. Can you identify things that cause you stress that you could eliminate from your life? When the things that cause you stress are unavoidable, are there things you can do to minimize or manage that stress better? Some find that exercise decreases stress levels. Getting a massage, taking a hot tub, talking with friends, laughing, getting out of the house and going to a movie, spending time with people you love, reading a good book, finding a good support group and/or finding a good therapist are all possible ways to decrease and better manage stress. Keep trying different methods until you find what works best for you and then find ways to incorporate it into a daily, weekly or monthly routine.
Psychological (Mental) Health
Each of the issues discussed above, nutrition, exercise, rest and relaxation can affect mental health. By highlighting this, perhaps it's easier to see how health is more than just healthy bones, teeth and skin, and how it is that our physical, social, spiritual and mental health are connected. It's great to seek counsel and guidance from a therapist who is experienced in dealing with HIV issues. General mental health ranges from self esteem to addiction issues, from your emotional outlook to the relationships you have with other people. The paths to examining these issues and developing strategies that are right for each individual are varied.
Is addiction a mental or a biological health issue? Some people are genetically predisposed to alcoholism and other forms of addiction, because of the way that their body processes (or doesn't process) certain chemicals. Regardless of genetic predisposition to alcohol addiction, there is evidence of chemical changes in the brain that leaves people alcohol-dependent after consuming alcohol for a long period of time over days, months and/or years. Addiction comes in many forms. Alcohol and drug addiction are perhaps the most commonly spoken of. There are also people with addiction to food, sex, the Internet, video games, gambling, nicotine, shopping and the list goes on and on. Whatever the case, anyone with an addiction who is speaking candidly about it can tell you how the addiction interferes with their life, their relationships and their health. Depending on the addiction there may be medical interventions, twelve-step programs, one-on-one therapy options, inpatient programs and harm reduction programs to explore. In many instances the first step is recognizing that you have an addiction and then seeking support, guidance and expert advice on plotting a course of action.
Studies show that the most common psychiatric diagnosis among people living with HIV is depression. As in the general population, some studies suggest that it is most common among women. Depression can be caused by chemical imbalances and it can be a side effect of some medications used to treat HIV and related conditions. Depression can be caused by HIV infection itself, HIV-related conditions and even changes in the body (such as menopause and/or decreases in testosterone production). The key to successful treatment of depression is identifying the possible causes. Another step is recognizing depression in the first place. When someone is depressed they may experience extreme fatigue, sleep disturbances, changes in appetite, and generally lose an interest and enjoyment in participating in life. Some of these conditions are interrelated as extreme fatigue can cause depression, sleep disturbances can also cause fatigue and depression, not eating well can impact mental and biological health and be associated with fatigue. Especially when you're depressed, finding the strength to pay attention to sleep, nutrition and exercise is important to avoiding a cycle of ever-worsening problems. If you experience depression, seeking strategies to deal with it is critical. For some this might include anti-depressant medication and for others this might simply involve spending time with people who they love or doing things they enjoy.
Self Esteem and Emotional Outlook
Another common theme that unites many people who are long-term survivors with HIV disease is that they have a philosophy of well-being. Often they believe that what they are doing today will make a difference for their tomorrow. They have a hopeful approach to the future. The road each of us must travel to believe in ourselves and the value of our voices and choices is unique. For some, a strategy to improve self esteem and emotional outlook might include seeking a therapist. For others it might include spiritual soul searching. For still others it might include going to the gym to improve body image. For those who feel like they have a positive outlook and good self esteem, what are you doing to maintain that? A philosophy of well-being doesn't mean that when you feel bad you ignore it or that when you're angry, depressed or upset that you're supposed to think positively. It's about experiencing those feelings, working through them and finding a way to embrace them as part of the picture, but not the whole picture.
Defining what spirituality means to most people is nearly impossible because it means something different to every person. For those who embrace forms of spirituality in their lives, most would contend a discussion of health without a discussion of spirituality is incomplete. Others, particularly those who have had negative feelings about spirituality and religion may be offended by any discussion.
Each person's path to exploring spiritual health is unique and very personal. Spirituality is not necessarily religion. A few examples: for some spirituality is the religion they were raised with, for others spirituality is founded on a harmony with nature, a notion of a Higher Power, The Goddess and/or a balance with the energies of the universe. Spiritual health involves exploring your spiritual beliefs and examining your life, your actions and inactions, accordingly. What matters isn't what your personal spiritual choices are, but that you're living your life consistent with your beliefs.
Social health is not only having healthy personal relationships with others, but also includes one's relationship to their communities and the health of the community.
While some people enjoy and are energized by social and group activities, others are not. Social health doesn't always mean participating in large group activities or even attending large-scale social events. It does mean, however, cultivating deep, rewarding and meaningful relationships and includes contributing to and participating in community. Social health is about giving and receiving support from community and loved ones.
The paths to promoting and maintaining social health are varied. Sometimes it starts with simply sitting down and thinking about personal relationships, identifying which relationships are most meaningful and why. Are you happy with your friendships and what might you do to strengthen those you have and/or cultivate new ones? Are you being the kind of friend you want to be and do you have the kinds of people in your life who support you? What kinds of things can you do to participate in community? Volunteer to help teach children to read? Write a letter to an elected official advocating for an issue of importance to your community? Help your neighbor with his or her groceries?
Developing a strategy for good general health provides a strong foundation upon which to build strategies for dealing with HIV disease. There is a difference between medications, health and healing. Medications treat specific biologic conditions, health is an experience and healing is a process. Medications have their place in an overall strategy for health, but they are merely one piece of a much larger puzzle.
Back to the Project Inform Perspective January 2004 contents page.