In the first issue of POZ (April/May 1994), "Touch Me, Heal Me" described the benefits of massage for PWAs. Five years later, as this update indicates, the treatment looks better than ever.

To Chicago PWA Derek Worley, the results speak for themselves: After a year of biweekly massage, his CD4 count skyrocketed and his viral load plummeted. Just a fluke? Worley is convinced that his regular rubdowns are the special ingredient in a protease-based recipe for shining health—especially since his meds haven't changed in three years. But his original goal in getting massaged was quite different: to treat his  peripheral neuropathy. "And it has," Worley says. "The pain in my foot and leg is much reduced, and I get my best night's sleep after
a massage."

Stress reduction or relief from backaches and muscle knots are what most often drive people to a massage therapist. "One of its greatest benefits is simply being touched, especially when facing an illness that can be so isolating," says B.J. Green, director of the Shi'atsu Institute in San Francisco. "And it can be a powerful complement to psychotherapy in helping purge stored-up emotional garbage."

Lest all this seem too New Agey for you, know that massage also has proven clinical benefits, including increased circulation of blood and of lymph, the fluid that carries immune cells and collects pathogens. The past five years have seen more and more evidence supporting a role for massage in HIV care.

Doctors at the Touch Research Institute (TRI) at the University of Miami Medical School have had their hands especially full. In one study, 20 men with HIV who received daily massage for a month had notable increases in the number and activity of natural killer cells (destroyers of virus-infected and tumor cells) and significant decreases in anxiety and levels of cortisol, a hormone associated with

In another, 10-day TRI study, 28 newborns of HIV positive mothers were randomly assigned to receive either three daily massages or none at all. The massaged group showed greater daily weight gains and faster development.

Preliminary results of a third TRI study show that 10 HIV positive adolescents receiving biweekly massage have had increases in CD4 counts and numbers of natural killer cells. And at the New York Hospital/ Cornell Medical Center, five of seven PWAs receiving massage for peripheral neuropathy not alleviated by
medication reported decreased intensity of pain.

Except for the adolescent trial (which involves seated massage), these four studies each used a composite of several forms of massage. In fact, it is common for  therapists to be trained in multiple techniques. The following are among the most widely practiced: Swedish uses long strokes, lubricated with oil or lotion, to increase circulation and move body fluids. Deep tissue manipulates soft tissues to release tension. Chinese massage is one tool among several—acupuncture, herbs, heat therapy and exercise—that comprise the 3,000-year-old system of Traditional Chinese Medicine, aimed at unblocking the flow of energy (chi) to internal organs. Each method manipulates the skin sites where energy pathways surface. A specialized Chinese form of deep tissue massage called tui na is an MD-administered treatment for conditions ranging from headache and eye problems to gynecological disorders. Shi'atsu, a Japanese form based on Chinese medical principles, applies pressure using fingers, palms, elbows, knees and feet, and is also aimed at getting the chi going.

To make the most of massage, sample a variety before deciding which suits you best. And find a therapist you're comfortable with. Green offers the following four tips when in the massage market:

1. Look for a therapist who individualizes each session, understands HIV and its complications, and knows when to refer you to an MD or other practitioner.

2. Check credentials: 27 states license massage therapists, while other states offer a less rigorous, but still recognized, certification.

3. Stick with the same practitioner, with the hope that he or she will learn your body's sore spots and tight areas and keep track of your health.

4. Seek out programs (available in some cities) offering quality inexpensive or free massage to people with HIV. Student massage, though affordable, may not always offer sufficiently skilled care for your particular needs.

A final thought: Not everyone responds to massage the way Derek Worley does. Despite biweekly massage, Chicago PWA Greg Knepper says his peripheral neuropathy has not lessened, and he still can't get a good night's sleep. So why continue it? "Massage reduces stress and makes me happier," Knepper says. "It's a good thing."