In each issue, POZ publishes a different standard of care, a guide by which people with HIV and their care providers can make personal choices about health care regimens. HIV standards of care differ by region, treatment philosophy and patient population. The following guide to behavioral approaches to immune-boosting was prepared for POZ by Jeffrey M. Leiphart, PhD, clinical director of the AIDS Response Program at the San Diego Lesbian and Gay Men’s Community Center. Dr. Leiphart also developed the center’s Learning Immune Function Enhancement (LIFE) program, on which the standard below is based.

In recent years, dozens of studies with HIV positive people have found that prolonged periods of intense negative emotions and poor health habits can significantly depress immunity, thereby speeding up symptom development and progression to AIDS and death. Conversely, resolving distress and improving those habits may lead to improved immune function, delayed (if not halted) HIV disease progression and longer survival. This blossoming field of research is called psychoneuroimmunology (PNI).

Based on PNI research and PWA input, we developed the LIFE program, in which HIV positive people learn to self-evaluate and improve 19 psychological and physical health habits (also called cofactors) that are key to a good prognosis. Participants attend weekly psycho-educational groups for three months, followed by weekly individual counseling for an additional three months, and then support groups for as long as desired. People may underestimate the power of the often common-sense strategies taught here to improve PWAs’ health. But our program evaluation has found that about 70 percent of participants significantly improve their distress and poor habits, and about 60 percent of the “improvers” experience reduced physical (especially gastrointestinal) symptoms and better lab numbers for some immune markers.

PNI-based clinical programs for people with HIV are now operating at several mainstream medical institutions besides our own, including Harvard and the University of Miami. International interest by clinics and hospitals is growing, and two clinical trials are underway.

The table below presents seven of the 19 identified cofactors, an explanation of how each can cause physical harm, and actions you can take to correct them. The immune-damaging behaviors are often deeply rooted. Changing them may take difficult psychological work and the sweat of personal growth. If you get stuck working on your own, consult a mental-health professional with HIV experience. n

For more information, order the manual The Care and Feeding of Your Immune System from the LIFE Foundation at 619.544.1520.

Strategies for correcting the 12 behaviors not listed below include:

  • developing self-assertiveness
  • building trusted support
  • making plans for crisis-coping
  • ensuring adequate, restful sleep
  • treating any depression
  • obtaining balanced nutrition
  • ensuring adequate, safe water intake
  • reducing intake of toxins (alcohol, street drugs,nonvital antibiotics)
  • practicing safer-sex and infection-avoiding behaviors
  • maximizing self-nurturing routines when sick
  • learning aboutHIV-related health issues
  • forging a partnership with one’s health care provider.
IMMUNE-DAMAGING BEHAVIOR OR HABIT IMPACT ON IMMUNITY AND HEALTH RECOMMENDED ACTIONS AND STRATEGIES
Belief that HIV=AIDS=Death (fatalism) Can trigger fear, panic and hopelessness; through autonomic nervous system (ANS), can directly depress immunity (especially CD4 cells) Read about and talk with long-term HIV survivors about their health strategies; foster belief that “maybe I too can have long-term good health.” Join support group and do readings emphasizing strategies for surviving and thriving.
Internal speediness (consistently feeling anxious, impatient or rushed) Constantly activates sympathetic branch of ANS, which can depress immunity (especially CD4s and CD8s) Develop and practice daily 20-minute “slowing and calming” period, using such techniques as soaking in a hot bath, self- or partner-massage, listening to restful music or meditation. Consult self-help books or tapes on relaxation.
Frequent worries about threats to safety and security (including physical, emotional, financial and career) Triggers the body’s “fight or flight” alarm (including adrenaline), which depresses immunity (CD4s and CD8s) Create and practice daily ritual to foster safety and calm (such as meditating, eating with friends or seeing a movie). Talk out nature of threat with friend or counselor. Develop, write down and follow specific plan to reduce or resolve threat. Learn and practice stress-reduction strategies (such as meditation or visualization).
Inadequate expression of grief and loss Depresses immunity (including CD4s, CD8s and natural killer [NK] cells that can destroy HIV and HIV-infected cells) The key to recovery from loss is the emotional expression of that loss -- alone or with a friend, loved one, counselor or support group. Develop a grief-expressing ritual that fits you; one effective technique is talking aloud to a photo of the person who’s died.
Lack of (or reduced) life purpose and goals Physiological mechanism unknown, but many long-term AIDS survivors report that an exclusive focus on fighting disease is exhausting; thus they strongly pursue one or more life goals Revive goals you may have abandoned after testing positive; create new short- or long-term goals that generate enthusiasm; some form of volunteering or activism often accomplishes this.
Shallow or restricted breathing Reduces overall body vitality and prevents necessary exchange of air at edges of lungs’ lobes where pneumocystis carinii pneumonia often first starts Remind yourself (via stickers on phone, mirror, desk and so on) to observe your breathing. Breathe slowly and deeply many times a day. Consult self-help books and tapes on proper breathing. Attend yoga, aerobic or other exercise classes that focus on breathing.
Lack of physical exercise Moderate exercise increases both number and virility of NK cells; aerobic exercise promotes deeper breathing and overall vitality Any form of moderate physical activity will do. Brisk walking (or its equivalent) for 20 minutes three to five times weekly is sufficient. Avoid extreme and strenuous exercise, which may depress immunity. Develop an exercise partner to help with regular motivation.