What with terrorists crashing jets into tall buildings, a recession crashing holes into the New Economy bubble and everything from drug resistance to lipodystrophy crashing many a combo-cocktail party, 2001 was for many HIVers the Year of Living Dangerously. Well, out with the old...2002 needn't be another annus horribilus, especially if you orient your New Year's resolutions around a few of the following initiatives that are of special benefit to HIVers. Now, we know it ain't easy. That's why we asked some experts and veterans for advice on getting started. From all of us at POZ, here's wishing you and your loved ones a 2002 free of detectable viral load and undetectable plane hijackers -- and full of health and happiness.
1. Give Your Fridge a Makeover
The whole point of staying alive is to experience the joy of being -- and if that means pigging out occasionally on crème brûlée or Ben and Jerry's Chubby Hubby, here's a spoon. But, says Cal Cohen, MD, of the Community Research Initiative of New England, "immune cells are made of peanut butter and bran flakes, not Twinkies and Diet Coke." So when you down more fat, sugar and salt than protein, you're not doing right by your body, especially because both HIV and HIV meds put you at high risk for everything from heart disease and osteoporosis to high blood pressure and diabetes -- all of which are linked to diet. This year, rethink what you shovel in your gullet.
Honey, you can't afford to look like Calista Flockhart They say you can never be too rich or too thin. We'll gladly concur on the former (until we lose our state health benefits), but when you have HIV, you'd better beware the latter. An unexplained, unintended loss of 10 percent or more of your normal body weight is technically classified as wasting -- a scary sign of HIV progression. But even if you're in robust health and appetite, membership in the HIVer club entitles you to eat more (of the right stuff, of course). Extra muscle weight -- a.k.a. "lean body mass" -- will armor you against HIV.
Loaves and fishes Eat plenty of protein (meat, chicken, fish, beans, seeds and nuts), though if your cholesterol is high, stick to a lean cuisine (skinless white chicken and such). Ditto for carbs: The "complex" ones make up all that cheap, filling, delicious stuff that gives us "time-released" energy -- grains, cereals and veggies. "Simple" carbs are the "quick-energy" sugars in fresh or dried fruit, honey, jam and syrups.
Are you a good fat or a bad fat? In a nutshell (ahem!): Mono-unsaturated fats, found in nuts, seeds, canola and olive oils, and fish are "good" -- you need some for extra zip. The saturated fats lurking in butter and animal products are "bad" and shouldn't loom large on your plate.
No bones about it Low bone density and high rates of osteoporosis are common in viral vixens. So, ladies, it's a must that you get your dairy, the single richest source for bone-boosting calcium. Lactose intolerant? Chow down on leafy green vegetables like kale and broccoli, or legumes like peas and beans. And wash it down with calcium-enriched OJ -- or try Tums (yep!).
The story of eau For med processing, toxin flushing and a host of other bodily benefits, you simply can't beat God's soft drink, H2O. Drink at least six to eight glasses a day, and make sure it's boiled or treated to be free of cryptosporidium, the stomach bug that thrives among the under-200-CD4s crowd. Watch caffeinated drinks like coffee, tea and Coke -- they leave your body needing more water.
A little something extra Even whole-fooders may want to nutritionally enhance their diet with a multivitamin or supplement. Research suggests that certain nutrients and antioxidants -- most notably, B-complex and E vitamins, zinc and selenium -- are of special benefit to HIVers, who may need more than the daily standard. But before picking a pill, powder or root, consult your doctor. Too much of a good thing can clash with certain HIV meds.
2. You Gotta Move It, Move It
Your body, that is -- and no, Miss Thing, wending your cart toward that Fritos display at the supermarket doesn't count. Like eating right, exercising can vastly improve your quality of life: Not only does it up pulmonary and cardiovascular health, immunity, body cell mass, sex drive, appetite, appearance, metabolism, mood, bone density, sleep habits and overall energy -- it downs many of the icky side effects linked to HIV meds. And research shows that it also boosts a key indicator of long-term survival -- your "phase angle," the measure of body-tissue density.
If you're already fierce enough to pose for one of those oh-so-controversial drug ads featuring HIVers rappelling down mountains, skip to No. 3. But if your definition of exertion is singing along with Nell Carter on the Gimme a Break! theme, you're probably wondering where to start:
With your doctor Don't start any exercise regime short of a walk on the beach without an official OK. Your MD knows your medical profile and can tell you what's best to build.
With a friend Doing 50 reps with dumbbells is more tolerable and sustainable when palling up. If you can afford it, join a health club and hire a trainer. Ask your local ASO if it sponsors a running, aerobics or fitness club. If not, DIY -- it's great date bait.
With attitude (a good one) The only do's for your exercise goals are: Do at least 20 to 30 minutes of cardio (heart beaters) three to five days a week; do resistance and strength training (working specific muscle groups, as in weightlifting) two or three days a week; do as much flexibility-oriented exercise as possible. If that seems daunting, keep in mind that yoga, Pilates and plenty of other exercise options incorporate all three do's and feel so good that you just might forget you're not supposed to have fun.
Still daunted? Go to personal trainer Timothy Brewi's excellent, illustrated website at www.tbrewi.com/hivfitness. Try out some of the at-home exercises for about 10 minutes. Tomorrow, do them for 15. What or how much exercise you do isn't half as important as that you stick with it. "Just Do It"? Hell, just enjoy it.
3. Cut the Butts
Smoking is glamorous -- but no more so than cancer, heart disease, emphysema and loose teeth. And for us "virally gifted" folks, one of tobacco's gifts is the toll it takes on the immune system -- suppressing CD4 cells and surprising you with yucky mouth diseases like thrush.
But many HIVers concur with former smoker Mark V., 32: "The chief joy of smoking for me was its calming ritualistic comfort -- Lord knows it wasn't the phlegm, stained teeth or reeking sweaters." So how to stop (or cut down) when a nicotine fix seems like the only thing that will get you over the hump at hand and going cold turkey just won't cut it?
Relax, you have options. First, there are medical smoking-cessation aides like patches, gum or the prescription pill Zyban. (Consult your doc -- Zyban can interact with Norvir and other HIV meds.) Combine this with a 12-step or similar quit-cigs support group. Contact your local ASO or the American Lung Association at 800.LUNG.USA or www.lungusa.org. And from Nancy Wongvipat, MPH, health-ed specialist at AIDS Project Los Angeles, come these smart tips:
Keep a diary of your smoking habits -- when you light up, how you feel -- to track what "triggers" you to smoke. Then focus on avoiding or undoing these triggers. For example, drop that morning cup of coffee, or switch to tea.
Make rules that increasingly limit your smoking boundaries -- like no smoking when in the car or after dinner or when in the car after dinner. You get the idea.
Don't go cold turkey when stress is high. When you do commit to quit, fill in the vacuum left by cigarettes with self-caring destressors such as exercise, massage or good, old-fashioned safe sex.
4. Lose the booze
Sure, the girls on AbFab and Sex and the City can't live without their drink and drugs, but they also people a parallel universe free of HIV, which thrives on toxically challenged immune systems. You probably already know that booze is bad for you -- high cholesterol, liver disease, depression -- but did you also know that three or four drinks a week can inhibit your combo therapy and decrease your CD4s? And don't even get me started on the damage done by illegal party favors like cocaine, Ecstasy and crystal meth.
If you can erase Cosmos and coke lines from your life with a resolute Barbara Eden-like nod of your head, more power to you, Jeannie. If not, join the club: Misery loves a self-help group.
Wherever you turn for help -- be it a shrink, a treatment center or AA meeting -- make certain it is a milieu where you can freely discuss your HIV status and the role it plays in your addiction. Some cities have AA meetings specifically for HIVers. (Click on the official AA website at www.alcoholics-anonymous.org.) Or contact your local ASO to track down the best starter meeting for you or other resources for HIVers with a drinking or drug problem.
5. Adjust Your Pillbox (not Your Hat)
Five years into the cocktail era, we're all familiar with adherence. It's the important task of taking all our doses of all our meds at all the right times and with the requisite snack or gallon of water, lest we give our wily little HIV the five-second respite it needs to mutate into Supervirus. Here are some tips to help make your adherence as perfect as humanly possible:
Be honest with yourself Today there are better (simpler) options in terms of HIV meds, combos and dosing strategies than when HAART debuted, and study after study has found that HIVers with easier-to-adhere-to regimens are more successful in achieving undetectable viral load. So, if you're about to start or switch HAART, think hard about your daily schedule and fess up to what you cannot realistically adhere to.
Make sure there's always something there to remind you HIVers have come up with a hatfull of handy tricks to help with adherence. Set the alarm on your digital watch or cell phone. "Harness" doses to certain daily ritual activities like brushing your teeth or your lunch break by putting Post-Its on the bathroom mirror or your work computer. San Diego HIVer John T., 47, shares his never-fails, "forgetful Granny" trick: "I have a vitamin travel case into which I place four days' supply of my a.m. and p.m. meds. That way, taking the correct pills is a no-brainer."
Be honest with your doctor If you're still missing more than a dose or three a month for any reason at all, tell your doctor the whole story. "Work with him or her on revising your med regimen to something easier for you to live with," says HIVer Michael Shernoff, a longtime AIDS therapist.
6. Sex It Up
If ever there were a disease designed to screw up your sex life, it's HIV. But as painful as it may be, 2002 is the perfect year to take an honest inventory of the role sex plays in your life. First, ask yourself: Did any of the sex you had in the past year possibly put you at risk for ill health? If so, get your ass to your doc for an STD screen. While there, why not also get vaccinated for hep A and B? You can further minimize your risk by breaking out more of the latex and telling all of your sex partners about your status.
Is HIV standing in the way of sexual intimacy between you and a neggie lover? If it is, you're not alone: One study of "serodiscordant" couples found that they had dramatically higher than average rates of depression and anxiety; another found that the HIVer in the duo often felt fear and guilt even when practicing safe sex. Initiating conversation about this stuff can be hard, so ask your local ASO about support groups or therapists that focus on these issues. Or type "serodiscordant" in the search window of HIVInsite.com -- you'll find plenty of feedback from similar couples.
And if HIV has been holding you back from opening either your legs or your heart, take a chance on love again in 2002:
Get in touch with touch (See No. 2.) Or just get a massage or a makeover.
Put yourself out there Grab your best girlfriend and go check out an HIVer social group or dating service.
Learn to flirt again Allow yourself the liberty of forgetting your HIV status when you meet someone. (It's as much about sizing up him or her as vice versa.) Spend the night dancing or holding hands at a movie. If by the end of the second date you want a third, disclose your status in a straightforward way. You might be pleasantly surprised by the reaction. But if someone who had seemed gaga for you suddenly recoils, remember: They don't deserve you.
7. Revive Your 9-to-5
Nancy Breuer of WorkPositive, a consulting firm focusing on HIV in the workplace, says that after September 11 many Americans are rethinking what's important, making the New Year "the ideal time for HIVers to raise the subject of cutting back at work or making a career change." She suggests that the employed-but-frazzled start with a few basic self-queries: Which do you value more: eye-popping achievement or a humming high-quality life? What's your goal in switching careers? How does it fit with your values? Studies now support working as a life-extending activity for HIVers, "but," cautions Breuer, "only if you reap as much as you sow." What if you're a protease Lazarus considering a workplace return after a long absence? Breuer says to start with:
Your doctor Get a medical reality check on how many hours a week you can healthily invest in a job.
The Internet Go to www.aidsfund.org, the National AIDS Fund website. It has a workplace resources center where you can learn your rights before finding yourself face to face with a pre-employment physical or a health history questionnaire. It also covers the basics of the Americans with Disabilities Act. And the workplace forum on TheBody.com will clue you in on the different challenges back-to-work HIVers have to deal with, and how best to do it.
HIVer friends and support group Troll for tips on how to take meds at work, whether they've disclosed at work and why, and how to respond when your boss asks why you've been out ill. ("A family illness" ends the discussion. Plus, it's the truth.)
8. Free Your Heart, Feed Your Soul
Not to get all Oprah on you, but if you're going into 2002 with old resentments -- against an ex, family or fallen-out friend -- either patch things up or let the anger go. According to Everett Worthington, a psychologist who studies the health effects of forgiveness, "By giving an unwarranted gift to someone who doesn't deserve it, we find paradoxically that it is we ourselves who are freed from that bondage." That can mean lower levels of stress, depression, blood pressure -- all coups for HIVers.
So that leaves just you and the universe. How do you talk to each other? Whether it's through an organized house of worship, some form of meditation or prayer, volunteering your time to others or even just a conscious gratitude that every day is a gift, reaching out to something bigger than yourself may greatly enhance all those pills, powders and protein shakes. (Studies correlate more prayer with more CD4 cells -- honest!) And keep in mind these words from HIVer Mark V.: "Any experience -- be it sex, nature, art or hilarity -- can be spiritual if you are present for it."