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  Briefing Document
28
HIV and Alternative and Complimentry Therapies

This Briefing Document explores issues surrounding HIV/AIDS and Alternative and Complimentary Therapies, such as What they are, Who uses them, Deciding to use them, Stress Relief, HIV and Herbs, HIV and Marijuana, Chinese Traditional Medicine, Hands-on Therapies, Spiritual Healing, Mind-body Treatment, Cautions, and the Global Context.

Briefing Document #28 is one of an on-going series. Visit the catalogue of Briefing Documents.

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What Are Alternative and Complimentary Therapies?

 Therapies considered alternative or complimentary to "Western" - or allopathic - medicine can include ingested natural substances or extracts, physical manipulation systems, culturally-based medicinal systems, religious healing methods, and philosophical/meditative practices. Examples of alternative therapies can be found in acupuncture, ayurveda, environmental medicine, homeopathy, naturopathy, Latin American rural practices, Native American healing practices, shamanism, Tibetan medicine and Traditional Chinese Medicine (Hanna 1998b).

"Alternative systems of medical practice refers to types of health care ranging from self-care according to folk principles, to care rendered in an organized health care setting based on alternative traditions or practices" (Hanna, 1998b).

 

Who Uses Alternative Treatments?

Complimentary and Alternative Therapies are both highly praised and staunchly denounced. Sceptics often cite the lack of standardized testing, while adherents point to the thousands of years of beneficial use of such therapies. Despite the controversy, complimentary and alternative medicine is used by nearly half of all US adults, including HIV positive individuals. Data is lacking on the utility of such therapies, particularly for people living with HIV/AIDS (Hanna 1998b).

 

Deciding on Alternative and Complimentary Therapies

Alternative treatments should be undertaken only after gathering information and discussing the treatment with your primary care provider. One should collect information from objective sources, such as published studies in reputable journals. If possible, one should discuss the treatment with others in similar circumstances who have utilized that therapeutic method, both recently and in the past - although be aware that anecdotal information may be deceiving. One should determine procedures used, advantages, disadvantages, risks, side effects, costs, and the time span over which results can expected. When considering costs, note that alternative treatments may not currently be covered under health care insurance. The training and expertise of the person administering the treatment should also be ascertained (CDC 1994). When discussing issues with the primary care provider - usually a family physician or HIV specialist - symptoms should be described as accurately as possible. Frequency and severity of symptoms, efficacy of any pharmaceutical medications taken, and the alternative treatments being considered should be discussed in full before beginning new alternative treatments. Interactions between any standard pharmaceutical medications and the proposed alternative treatment should be assessed. Progress in alternative treatment should be discussed on an ongoing basis with the primary care provider, so as to maximize the benefits experienced by both alternative and standard treatments (Hanna 1998b).

 

Alternatives to Stress

Stress and anxiety disorders are diagnosed in up to 38% of HIV-positive individuals (Elliot 1998). Fear, loss, grief, and financial trouble can all contribute to these disorders. Symptoms of excessive anxiety include chest pain, headache, numbness, and insomnia and can be exacerbated by some HIV treatments (ddl, d4T, AZT, fluconazole, foscarnet, and isoniazid) (Elliot 1998). Fortunately, it has been shown that HIV-positive individuals benefit from alternative therapies aimed at relaxation. Yoga, music therapy, deep breathing, muscle relaxation, meditation, and tai chi can decrease depression, improve attitudes, and improve immune function (Project Inform 1999).

 

HIV and Herbs

People living with HIV or AIDS are among those most likely to utilize herbal remedies to improve their health. Although some studies have been conducted on herbal remedies, few tests have been rigorous, standardized clinical trials, and even fewer have examined the use of herbal medication by HIV-positive individuals. Herbal treatments can be used by people with HIV to attack the virus, support the immune system, treat or prevent secondary infections, and to relieve side-effects of HIV pharmaceuticals. Herbs should always be utilized with the knowledge that they are drugs which can cause side-effects and drug interactions as readily as can pharmaceutical drugs (Hanna 1998a).

 

Marijuana: The Politics of Alternatives

The report, entitled "Marijuana and Medicine: Assessing the Science Base" made six recommendations:

  1. Physiological effects of cannabinoids (including THC - the active ingredient in marijuana) should be more thoroughly researched.
  2. Rapid-onset, reliable, and safe delivery systems should be developed.
  3. Psychological effects such as anxiety reduction and sedation should be further studied.
  4. Health risks related to smoking marijuana should be analysed.
  5. Clinical trials should be utilized to test the use of marijuana for medical purposes.
  6. Use of smoked marijuana for patients for debilitating symptoms should meet specific conditions.

It is clear that marijuana does relieve nausea and vomiting (side-effects of certain HIV medications) and it is a promising treatment of pain, anxiety, appetite loss, and wasting for those with HIV. Inhalers or vaporizers which heat cannabinoids but do not involve combustion may make marijuana use smokeless, and thus, safer. The report conceded, however, that these drugs and their associated delivery systems (i.e. Inhalers) may not be available for years, "and may never happen due to the politics and economics of this issue" (James 1999).

A report produced by the Institute of Medicine of the US National Academy of Sciences has found "substantial consensus that certain cannabinoids (a class of chemicals found in marijuana) may have important symptom management uses for some patients -- but that marijuana smoke, like tobacco smoke, is harmful" (James 1999).

 

Chinese Traditional Medicine and Acupuncture

Traditional Chinese Medicine may have benefits in strengthening immune function and inhibiting the HIV virus. Chinese herbal remedies can act both as immune enhancers and anti-viral agents. Acupuncture - placing small needles at specific points on the body - can increase pain-relieving endorphin levels, increase T-cell count and natural killer cell activity, as well as inducing the body to form virus-inhibiting interferon (Wang 1994). The American College of Traditional Chinese Medicine has identified "seven HIV-related conditions which appear to be most responsive to Chinese medicine: weight loss, diarrhea/loose stools, abdominal pain, nausea, headaches, enlarged lymph nodes, and neuropathy" (AIDS Treatment News 1995). Other symptoms relieved by acupuncture include night sweats, diarrhea, vomiting, digestive difficulty, insomnia, anxiety, and muscle pain (Huson 1996). Chinese Traditional Medicine has the added advantages of cost effectiveness and lack of side-effects. It is vital, however, to recognize when allopathic medicine should be introduced to protect the health of the patient (Wang 1994).

 

Hands-On Therapies

A multitude of hands-on therapies are used by HIV-positive individuals, including acupressure, the Alexander technique, deep muscle therapy, polarity therapy, Reiki, Rolfing, Shiatsu, Rubenfeld Synergy, Swedish massage, and therapeutic massage (National Institutes of Health 1994).

Massage provides relaxation, improved circulation, a heightened sense of well-being, and more specifically to HIV, it has also helped with the oedema (accumulation of fluid in the tissues) associated with Kaposi’s Sarcoma. In addition to the physical benefits, massage often provides the experience of being touched again after developing

an untouchable disease. Massage can also become a venue through which issues such as isolation, loss, and shame are dealt with. Chiropractic manipulation offers similar benefits to massage. The emphasis on spinal manipulation and alignment is believed to help with structural problems which cause pain (Project Inform 1999).

On another level, the hands-on practice of Reiki is an Asian theory which takes as its base the assumption that humans are energy and that the manipulation of that energy by the practitioner’s hands can bring about healing. Reiki is said to result in detoxification of the body which in turn eliminates headaches, fatigue, or mild flu-like symptoms (Kovalik 1995).

Though there is little data on any of these hands-on approaches to HIV, individuals tend to show improvement in quality of life regardless of the effect on longevity (Project Inform 1999).

 

Spiritual Healing

Spiritual therapy can occur in any formal or informal religious context and can involve spiritual support, counseling prayer, visualization, worship services, memorial services, celebrations of life, education and workshops on caring, and community education to prevent the spread of HIV infection. Examples of such practices include prayer, spiritual meditation, healing models specific to religious congregations (i.e. yogic practices in Indian traditions, laying on of hands in Christianity, healing prayer by Sufi masters), cooperation between faith communities and public health agencies, and any form of personal or social spiritual activity which leads to improved well-being (http://www.icg.org/ihpnet/models).

 

Mind-body Therapies

Mind-body therapies are based on the idea that the mind can affect the body’s ability to fight disease. Meditation uses deep breathing and focusing techniques to allow a person to centre his or her thoughts. Tension, fatigue, anxiety, and stress can be reduced by meditating. Visualization "is the process by which a person is directed to see himself or herself in some other physical, emotional, or spiritual state" (National Institutes of Health 1994). Through mental images of a strong body and a weak disease organism, patients attempt to boost their immune systems. Yoga, a system of breathing exercises, postures, and meditations, aims to balance the body’s energy centres and aid in detoxification, strengthening of organs, and improved stamina (National Institutes of Health 1994).

 

Cautions Around Alternative and Complimentary Therapies

Until recently, there was no federal regulatory board monitoring the manufacture and sale of alternative and complimentary medicines. This meant that there were no avenues though which to verify the effectiveness or validity of alternative or complimentary treatments. The lack of regulatory guidelines can lead to misleading or blatantly false claims regarding the effectiveness of such therapies, particularly when the person advertising is benefitting financially from the sale of such therapies.

Fortunately, on March 26, 1999, Health Minister Allan Rock announced the creation of the Office of Natural Health Products, responsible for assessment, licensing, monitoring, and compliance to regulations of natural health products. The Minister also announced $3 million in research funding for natural health products and complementary medicines (Health Canada 1999). Though monitoring may improve the consumer’s position with regard to natural health products, alternative or complimentary therapies involving non-ingested healing mechanisms remain unregulated and should be approached with caution.

 

"Alternative", or "The Only Alternative"?

When is a medical treatment called "alternative" and when is it called "primary care"? "Alternative" treatments, as referred to for these purposes, is alternative to allopathic, scientifically based medical models and treatments. Many of the therapies considered to be ‘alternative’ in North America and Europe are the primary mode of medical care in countries around the world.

For example, in countries with minimal or non-existent health budgets, HIV antiviral therapy is difficult or impossible to obtain. Positive Awareness has presented evidence from cases in India that counseling and adopting healthy lifestyles may delay the progression of AIDS. Such counseling encouraged positive attitude, yoga, a balanced vegetarian diet with vitamin supplementation, minimum medication use, and elimination of tobacco use. In one study, doctors reported that of 460 HIV positive individuals counseled on lifestyle, 85% had CD4 counts over 500 (Positive Awareness 1998).

In Mozambique, allopathic medical care is being used in tandem with curandeiros (traditional healers) for people living with HIV and AIDS. These healers provide advice from everything to diet maintenance to abstaining from sex. The curandeiros are trusted advisors in the country and are able to utilize culturally appropriate education about HIV and AIDS (Fleming 1995).

Efforts are being made to ‘bridge the gap’ between allopathic, scientific medical treatments and traditional medicinal systems which have been in use for hundreds or thousands of years. Kaiya Montaocean, PhD, and John Rutayuga, PhD, have established the Center for Natural and Traditional Medicines to study "traditional medicine as primary health care, with a particular emphasis on HIV/AIDS" (Montaocean 1996). Dr. Montaocean also focuses on collaboration between providers of traditional health care and care-givers in the biomedical profession. Allopathic, scientific medicine "is not economically feasible or appropriate for the entire world, and is better suited for crises and short-term intervention (Montaocean 1996). Since the majority of people living with HIV or AIDS live in countries where culturally-based traditional medical systems are relied upon more heavily than allopathic medicine, it is important to determine the utility of these systems with regard to HIV/AIDS. It is increasingly difficult to achieve genuine collaboration between the two schools of medicine due to dwindling economic resources and the lack of respect for traditional medicine on the part of many biomedical practitioners. The CNTM is planning utilize the World Wide Web to encourage communication and collaboration among medical practitioners from all schools of medicine and all areas of the globe (Montaocean 1996).

 

Literature Cited

AIDS Treatment News
1995 "Chinese medicine: where does it work best in HIV/AIDS?". Jun 2;(no 224):8.

Elliot, A
1998 "Anxiety and HIV infection". STEP, Winter;98(1):11-4.

Fleming, J
1995 "Mozambican healers join government in fight against AIDS". Journal of the International Association of Physicians in AIDS Care. Mar;1(2):32.

Hanna, Leslie
1998a "Herbs for HIV". Bulletin of Experimental Treatment for AIDS, San Francisco AIDS Foundation, April: 36-42

Hanna, Leslie
1998b"Complementary and Alternative Medicine: Exploring Options and Making Decisions". Bulletin of Experimental Treatment for AIDS, San Francisco AIDS Foundation, January edition.

Health Canada
1999 "Minister Rock accepts all 53 recommendations made in the Standing Committee report on natural health products, establishes new Office of Natural Health Products and announces funding for research". News Release, March 26, 2024

Huson, C
1996 "Acupuncture and traditional Oriental medicine in the treatment of HIV and AIDS". STEP, Spring;8(1):2-3.

James, John S.
1999 "Medical Marijuana: AIDS Related Information in the New Federal Report". AIDS Treatment News, Issue #319

Montaocean, Kaiya
1996 "World medicine and Western medicine: the missing dialog". Interview by John S. James, AIDS Treat News. May 17;(no 247):1-5.

National Institutes of Health
1994 Fact Sheet #7: HIV/AIDS and Alternative Therapies. CDC National Prevention Information Network. June edition

Positive Awareness
1998 "Complementary therapy". Sep-Oct;9(5):23

Project Inform
1999 "Alternative and Complementary Therapies". Discussion Paper, Updated May 1999

Wang, Jin-Lin
1994 "Using Chinese Herbs and Acupuncture to Treat HIV/AIDS: an Analysis of 201 Cases". Being Alive; January 1994

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