Enjoying Life

KEEPING WELL: ENJOYING LIFE MENTAL HEALTH

HIV can be a lot to deal with. It is not uncommon for people to experience unhappiness, distress, anxiety or depression at some point. Sometimes medication can be useful or necessary, but fortunately there are a lot of other things you can do to look after your mental health and wellbeing.

You may experience periods of fatigue or constant tiredness. The cause could be psychological or physical. Stress and depression are common causes of fatigue, however, constant tiredness may be related to your HIV or other illnesses, diet, or lack of sleep or exercise. If you are feeling more than usually fatigued or the onset of tiredness is sudden or extreme, talk to your doctor.

It’s important to be proactive. Keep doing things you enjoy — things which make you feel good about yourself. Take some time to really look after yourself.

EATING

Think:

Am I eating well?

It is important to eat well and enjoy food to help your immune system stay healthy. This means eating a balanced diet that includes fresh fruit, vegetables, grains and protein. Avoid low calorie diets or ‘fad’ diets that are excessively restrictive.

Women with HIV may need to eat a diet higher in protein than HIV-negative women in order to conserve lean muscle mass. Some women need specific help to maintain normal blood lipids and sugar. You may want to talk with a dietitian to help manage your specific nutritional needs. A dietitian may be able to recommend ways to manage stress, fatigue, diarrhoea, nausea, or changes in body shape or weight loss.

If you are thinking about taking extra vitamins or nutritional supplements, talk to your doctor or HIV specialist to ensure they won’t interact with any other medication or medical conditions.

Nutrition is really important to both your physical and mental health but food can play a more important role than that. You might need to eat on the go now and then but taking some time to sit down and enjoy a meal can give you a moment to catch your breath. Sitting down and eating a meal with someone you like can also feel really good.

SLEEPING

Am I sleeping enough?

Sleep is fundamental to both physical and mental health. Not getting enough sleep can trigger emotional and mental health issues. Conversely, too much sleep can make you feel tired and reduce motivation to do things. Talk to your GP about different options to address sleeping issues. There are many possibilities aside from medication, including specific breathing and relaxation techniques.

EXERCISE

Am I doing enough exercise?

Regular physical exercise will keep you fit and it can also help you manage stress, improve your mood, increase your energy levels, decrease symptoms of anxiety and mild depression, maintain your lean muscle mass and can help you sleep soundly at night. A daily walk in the fresh air can help you feel and sleep better. Exercising with someone else can make it more enjoyable as well as increasing your social contact. Exercise is good but enjoyable exercise is really good! And if you enjoy it, you’re more likely to keep doing it.

WORK

Am I dealing with work?

Work has the potential to affect your health and wellbeing in both positive and negative ways. Work can be boring, stressful or just an economic necessity. If you’re lucky, it can also be interesting, fulfilling, and a great reason to get up in the morning. If you have a choice whether to work or not (or whether to work full-time or part-time) it is a good idea to think about the role of work in your life before you make any decisions.

Your ability to work may be compromised by your health, and it can be difficult to balance the demands of work and family/personal life. Perhaps you are experiencing periods in which you are unwell or need regular time off for medical care. Taking antiretroviral treatments can also be an issue impacting work, particularly if you are experiencing side-effects (such as diarrhoea). Take some time to make sense of your options. You may want to talk it through with your partner, your doctor, a counsellor or peer support worker.

If you feel you need to have time off, think about how you will talk to your employer before you ask to see them. Remember, you do not have to tell them you have HIV. You may want to tell them or you may prefer to explain that you have a medical condition. You may find it easier just to discuss the symptoms you are managing.

It is useful to remember that the nature of the workforce is changing all the time. You may find there are opportunities for part-time work or work with flexible working hours.

Some women with HIV who are not working find it rewarding to get involved in activities such as volunteer work or study in order to keep busy and to develop or maintain skills and social networks.

DRINKING & RECREATIONAL DRUGS

Am I drinking too much or taking drugs that are doing me no good?

Drinking too much alcohol and excessive use of recreational drugs increase emotional and mental health issues, as well as damaging your physical health and interfering with your HIV antiretroviral treatment. Think about your alcohol and drug use and whether they’re really helpful (beyond the moment).

A little alcohol can help you relax, feel good and increase your appetite. A glass of wine or beer or a single measure of spirits should do you no harm (unless you are pregnant). Heavy drinking increases your body’s requirements for certain nutrients, such as vitamin B6, and places a strain on your liver. A healthy liver is needed to process HIV antiretroviral treatments. Some women on treatments find they become increasingly likely to experience a ‘hung over’ feeling following even small amounts of alcohol.

Some recreational drugs also interact with HIV antiretroviral treatments so it’s important to talk honestly to your doctor about any drugs that you use, whether regularly or occasionally. Using recreational drugs while you are on antiretroviral treatment can be harmful because:

each person’s body has a different reaction
your immune system may be damaged through long-term use of some drugs
some recreational drugs lower the levels of HIV treatments in your blood so less of the dose is absorbed
some HIV treatments raise the blood levels of amphetamine-based drugs to possibly dangerous levels.

If you do inject recreational drugs, do not share needles or injecting equipment — even with other HIV-positive people. Use your own injecting equipment or use a new fit every time. This is important to reduce the risk of infection with HIV, hepatitis C or other blood borne viruses.

If you use drugs, you may want to reduce your use or stop altogether. You can seek advice and support through your doctor, community health service, or HIV support group.

Methadone and other opiate substitute therapies may interact with HIV antiretroviral treatment. Negative drug interactions can be managed by adjusting the dosage of methadone and/or HIV medications. Talk to your doctor as soon as possible so they can work out optimal therapy for you. Do not stop taking HIV treatment without talking to your doctor.

For information about interactions between HIV antiretroviral drugs and recreational drugs, see VAC’s Touchbase site. It lists more than 20 drug types and their interaction with HIV and HIV treatments (under the ‘Living with HIV’ section heading). Alternatively, check out ACON’s Stimcheck site or NAPWHA’s Get Smart with Substances webpage.

SMOKING

Should I be smoking?

If you are HIV positive, stopping smoking is one of the most important steps you can take to improve your health. Smoking affects blood supply to your heart and other parts of your body. It reduces the amount of oxygen in your blood and damages blood vessel walls. Smoking increases your risk of heart attack, stroke and peripheral artery disease (which can lead to gangrene and limb amputation) as well as lung disease (emphysema). It also increases the risk of many types of cancer and of osteoporosis.

Smoking is particularly damaging for people with HIV because it will further weaken your immune system. Stopping smoking improves your health within hours, with significant improvement in the following weeks and months. Your risk of cardiovascular disease will decrease rapidly within a year, and within two to six years it will be similar to that of a non-smoker. The risk of having a stroke begins to fall soon after quitting smoking, with most benefit experienced within two to five years.

Giving up smoking is challenging. Remember:

Not everyone is successful the first time. It may take several attempts before you are smoke free. Each attempt brings you closer to your goal.
There are many strategies (including acupuncture and hypnosis) to help you quit and you may decide to use more than one. Get advice and support from Quitline (Tel: 13 78 48).
The more support and help you receive the more likely you will succeed.
Talk to your GP and your friends for emotional support. Having good people around you can only increase your chances of giving up.
There are now medications available to help you stop smoking (NRT — nicotine replacement therapy). Talk to your doctor about whether these are suitable for you.
Most people will need to try to quit smoking a number of times. It is important you don’t stop trying. If you are determined, you will eventually succeed.

For more information, see AFAO’s Giving Up Smoking factsheet.

HEALTHY RELATIONSHIPS

Is my relationship doing me harm?

Healthy relationships with friends and family are a major source of support for many women living with HIV. Unfortunately, not all women have partners who are respectful and supportive. Some women, including women with HIV, experience domestic violence. Domestic violence is about power and control. There are many ways it can be expressed: physical violence or social and emotional control.

Whether or not you have HIV, no one has the right to be violent or abusive towards you. It can be hard to know what to do about abuse while you are caught up in the many complexities of a relationship. Fortunately, there are people out there who can help. If you would like to speak to someone, call the National Sexual Assault, Family & Domestic Violence Counselling Line on 1800 RESPECT (1800 737 732). It is a free telephone and online confidential service for anyone who is experiencing or has experienced domestic violence or sexual assault. It is available 24 hours a day, 7 days a week.

AGEING

Is HIV affecting me more as I get older?

Thanks to improvements in HIV antiretroviral treatments, people with HIV can now generally expect to live long lives. Consequently, the number of people with HIV who are entering their 50s, 60s and 70s is growing. With longer life expectancy, older women with HIV are beginning to experience many of the illnesses and conditions that come with ageing including changes in physical and cognitive abilities and managing more than one chronic disease.

There is evidence that living long term with HIV can accelerate the aging process in some people. As a person living with HIV it can be very difficult to untangle whether symptoms are related to HIV or not. Regardless, it is important to talk to your healthcare practitioner if you are concerned about any aspects of your physical or mental health.

While HIV treatments have greatly decreased the likelihood of women with HIV developing AIDS-defining illnesses, there are a number of non-AIDS conditions that are more common in older women with HIV than their HIV-negative counterparts. These conditions include cardiovascular disease, lung disease, certain cancers, and hepatitis B and C.

AIDS-related dementia (once common) is now rare, however some people with HIV develop HIV-Associated Neurocognitive Disorder (HAND). HAND may include reduction in attention, language, motor skills, memory, and other aspects of cognitive function. People may also experience depression or psychological distress.

Some people in the general community become more isolated as they age, including people with HIV. It is important to stay connected and seek support if you are experiencing any loneliness or depression. Given the ‘greying’ of the HIV-positive population, some people have begun looking into retirement plans, including nursing homes or aged care facilities. This is an area the HIV sector is currently working on to ensure facilities are able to offer appropriate care, free from any discrimination. If you would like to speak to someone about your options, contact your local PLHIV organisation.

With or without HIV, your long term health is strongly influenced by how well you look after yourself in daily life. Staying active and socially connected, eating well, not smoking, and moderating consumption of alcohol can significantly improve your long term health.

TRAVEL

Should I travel?

Many people with HIV travel whether for work, study or pleasure. To avoid problems, it is often best not to disclose your HIV status unnecessarily while travelling to other travellers, work colleagues, immigration or customs. HIV continues to be heavily stigmatised in many places, and frankly, your HIV status is none of their business.

If you’re planning on travelling overseas, be aware that some countries continue to restrict entry and residence to people with HIV, although many do not. The Global Database on HIV-specific Travel and Residence Restrictions provides up to date information for all countries in the world. If you’re planning a holiday, refer to the section on ‘Countries with restrictions for short term stays (90days)’. If you remain uncertain about your legal rights, you can contact the country’s embassy to ask them directly.

Usually, bringing (importing) HIV antiretroviral treatments for your personal use will not pose a problem but if you are worried you may want to check each country’s specific customs regulations by ringing their embassy before you go. If you are using a drug substitution treatment (such as methadone or buprenorphine) you should definitely check country regulations as some countries consider substitution treatment to be illicit drug use.

When travelling, keep your medication in its original packaging (labelled with your name) and also your doctor’s prescription or a letter (to show the medication was prescribed) but make sure the prescription does not mention HIV. It is usually best to carry your medication in your hand luggage as checked luggage can be lost or delayed. It is also useful to take some extra medication with you in case your return is delayed for some reason. Looking for prescription medicine in another country can be time consuming and expensive, and your medication may not be available. Your doctor can also provide a letter (not mentioning HIV) to say you are carrying prescribed medication for personal use.

Many people take their antiretroviral treatment at the same time every day which can be tricky when crossing time zones. If you are on a complicated schedule or if you are concerned about managing the time change, ask for advice from your doctor. If you are concerned about how your health will be while travelling, you may want to find out where the local HIV clinic is or get the address of a specialist physician before you travel.

It is very important to have health insurance when travelling, particularly if you are travelling with an existing medical condition. For advice on finding a travel insurance company that offers affordable insurance for people with HIV, contact your local PLHIV organisation.

Last word of advice …. Have a great trip!

ASKING FOR HELP

Do I need some help?

Are things starting to pile up? It is important to deal with issues as soon as you can. Whether it’s about work, relationships, family, money, housing, etc., avoiding them can increase your levels of stress while things linger ‘in the back of your mind’. Also, many issues don’t resolve themselves and not addressing the problem early on can actually make things worse.

Sometimes life can seem overwhelming, or perhaps just one issue has got the better of you. Asking for help is not a sign of weakness. Asking for help means you’re taking action to think things through and sort things out. Asking for some expert help is increasingly common. There are a lot of agencies that are set up specifically for this purpose.

Remember:

Be kind to yourself
Don’t judge yourself harshly
Don’t bottle up worries or concerns
Don’t isolate yourself
Join in with activities
Try something new
Ask for help when you need it

For more tips on keeping well, check out the Top Tips website, Your Body Blueprint’s Staying Social page, or visit Pozhet’s Living Well page.

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