2013 – The Human Experience – AIDS

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By a Student, Massage Therapy Institute (The author of this article will remain anonymous to protect the identity of the patient interviewed.) Human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) are so much in the news – so much in our daily consciousness – that finding out that you’re infected with the virus can seem like a knell of doom. That may have been true back when AlDS first became a public health threat, but it isn’t anymore. Powerful medications now keep many people with HIV and AIDS in good day-to-day health, living better and longer. Another positive force for living with HIV and AIDS today is the easy availability of support groups, where people affected by the disease receive caring support and learn creative ways of dealing with problems that arise. DESCRIPTION The letters “H IV” stand for “human immunodeficiency virus” – the virus that causes immunodeficiency syndrome (AIDS). If you’ve been diagnosed with HIV infection, you’re “HIV-positive” – that is, your blood shows the presence of type 1 (HIV-1) – the most common type in the U.S. and Europe – or type 2 (HIV-2) virus. Both types can cause the chronic illness AIDS. AIDS makes the immune system – the body’s natural defence against infection – increasingly less effective, so the body is less able to ward off disease. HIV is considered to have progressed to AIDS after the infected person develops an “opportunistic” infection or tumour (one that might not have developed if HIV had not been present) or a “helper” T-cell count in the blood of less that 200. “Helper” T-cells help infection-fighting antibodies to form in the blood -and are the cells that kill or weaken the HI Virus. A healthy “Helper” T-cell count is 600 to 1000. You may not know how you became infected with HIV, which is transmitted through contact with the blood of an infected person. People who have the highest risk of getting AIDS includes anyone who has unprotected sex and/or multiple sex partners, regardless of sexual preferences; intravenous drug users who share needles; people with the blood disease haemophilia who were given so called “clotting-factor” preparations between 1977 and April 1985, when screening of donated blood began; anyone who received a blood transfusion before April 1985; and new-born babies whose mothers are HIV positive. SYMPTOMS Many people who are infected with HIV have no symptoms at first. In addition, the length of time between HIV infection and the development of AIDS varies greatly. According to the Centre for Disease Control (CDC), the following may be warning signs of HIV infection: Rapid weight loss Dry cough Recurring fever or profuse night sweats Profound and unexplained fatigue Swollen lymph...

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Research Round-up: Therapeutic massage for HIV / AIDS – More than anecdotal evidence

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For more than a decade now research into the role of massage in supporting HIV/AIDS patients has been done. In an article discussing the benefits of massage, Delaney notes that it is more that merely anecdotal 1. The author refers to studies conducted by the Touch Research Institute of the University of Miami and highlights three that are of specific interest to people living with HIV/AIDS: In 1996 a study involving 29 HIV-positive men indicated that a majority of the individuals receiving massages showed an improvement in immune system function, both in the number of natural killer cells and in the activity of those cells. As a result of this evidence, two more studies into massage and the working of the immune system were done. The second study was done on nine healthy female medical students in the middle of exam time. “Not only did the students report reduced anxiety, but blood samples taken before and after the massage showed that five had a substantial increase in white blood cell numbers and in the activity of natural killer cells”, writes Delaney. The third study involved 20 breast cancer patients, divided into two groups. One group watched relaxation tapes and the other received massage therapy three times a week for five weeks. The patients who had received massage therapy showed an 80 percent improvement in immune system function. Of the group who watched the tapes, only 30 percent had any improvement. That massage can facilitate the improvement of immune system function is clear from these studies but exactly how it happens is the subject of different theories. Some believe that massage works by reducing stress, and thereby alleviating the wear and tear inflicted by stress hormones, in particular, cortisol. According to Delaney, studies indicate that up to 80 percent of illness is stress-induced, “so it stands to reason that if massage therapy can reduce stress, it can also improve the body’s defense system against illness”. 2 Gnanakkan 3 refers to more research on the efficacy of massage on HIV/AIDS patients: Scafidi & Field studied HIV-positive babies who were massaged by their mothers and who gained significant weight in comparison to the control group babies. They also presented with lower stress behaviours and so did the mothers. Seventy three HIV-positive men were studied by Antoni, et al., to determine how cognitive-behavioral stress management (including massage therapy) affected anxiety, T-cytotoxic/suppressor cells and 24-hour urinary norepinephrine output. The results showed significant reduction in anxiety, anger, total mood disturbance and perceived stress, and lowered norepinephrine output. Even after six to 12 months, there was a significant increase in T-cytotoxic/suppressor (CD4+CD8+) lymphocytes. 1. Delaney M.T. Jr. (1999). A Healing Touch: Massage Therapy and HIV/AIDS, thebody.com, http://www.thebody.com 2. Ibid. 3. Gnanakkan, J....

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Research Round-up: Does therapeutic massage benefit patients with HIV / AIDS?

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Type the phrase HIV/AIDS + massage in the search line of any search engine and you will be guided to a number of sites that serve as resources for patients who suffer from these conditions. Therapeutic massage is discussed as one of many complementary therapies available to these people. However, narrow your search down to South Aftrican sites and the picture looks very different. Despite the talk of an HIV/AIDS pandemic in this country, the majority of references that pop-up relate to massage parlours or massage as a safe substitute for sex. The health-related sites merely log massage as a method of stress relief for patients. Thus a very effective and wide-reaching treatment option is not available to the majority of people with HIV/AIDS. The Therapeutic Massage Therapy profession’s lack of assimilation into the national healthcare system due to official inattention and therapists’ apparent complacency and lack of involvement in the management of the profession, has trapped it on the periphery of public health. Consequently massage is still seen as a luxury treatment associated with spas and the beauty industry instead of a legitimate treatment option that can play an active role in contributing to the battle against HIV/AIDS. In countries such as the USA the importance of understanding HIV/AIDS in massage therapy practice is reiterated by its inclusion in the curriculum for continuing education and maintenance of a license1, in South Africa there exists no requirements for continued professional development related to the one condition that affects so many of our people. It is essential for massage therapists to understand the benefits as well as cautions and considerations of this disease. Guidelines for treating patients with HIV / AIDS Some general guidelines for therapeutic massage therapists to follow when working with HIV/AIDS patients include: Being educated about HIV’s aetiology and pathology. Perform a thorough personal and medical history prior to each treatment. Since HIV/AIDS encompasses many types of infections and each infection calls for a different form of treatment, each treatment must be planned in accordance with the presenting problems. Surveying the patient to ascertain there are no cuts, open wounds or bleeding Keeping your nails short so they don’t accidentally scratch the patient Washing your hands thoroughly with warm water and soap before and after massage Rescheduling with an HIV patient if you are sick, since their immune system is extra vulnerable to catching your own illness Refraining from direct pressure on any open lesion, inflamed area or on a patient with a circulatory system infection. Instead, choose point specific massage and avoid the affected area. Monitoring your patient for dizziness, nausea or lightheadedness, as they may be experiencing a large toxin release. In this case, gentler...

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2013 – Working with HIV/AIDS: A personal journey

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By Julia Griss It was a late Friday afternoon, when I stood buzzing a doorbell to one of the apartment blocks in Sea Point. A voice answered, sounding American. “Hi Juliaaah, come up.” I am almost certain that you have had a massage intervention with a client  who has deeply touched and moved you. In some way you have learnt something about yourself and your practice as a therapist. My client, Damian (fictitious name), was such a person. That first treatment in the confines of his apartment brought me face-to-face with HIV/AIDS and the impact regular massage can have on a person living with the disease. At our first session I took a detailed account of his medical history. He claimed to have ‘cancer’, yet I suspected that he was HIV positive. Interestingly he truly believed the cancer theory until he died. According to him HIV/AIDS was a conspiracy by drug companies. Had he admitted the possibility that he had HIV, he might still be living today. But I digress. My experience with Damian supported what research has pointed out, that with massage his serotonin levels increased and he was able to manage the pain. I would spend at least 15 minutes before each session talking to him and allowing him to talk about his ‘cancer.’ This seemed to calm him. During the massage he relaxed completely and allowed me to use deep pressure strokes. Over a period of eight months I saw his muscles begin to waste. He got thinner and thinner, yet I continued to massage him on a weekly basis. SOMATIC APPROACH I used a somatic approach to my massage treatments. Let me explain. Somatics involves awareness of the whole self – body, mind, spirit and emotions. During our sessions we spoke about his body and what it represented in his life. Through describing some of his symptoms, I was able to find effective ways of working with his chronic pain. He would candidly express his feelings to me. The level of trust between us was profound. He had a mountain of information on a wide variety of organic foods and supplements. He religiously followed a strict vegan diet. Yet Damian refused conventional medical treatment. In our time together I was aware of my presence in hearing him and listening to his accounts of his illness. I was present, yet able to maintain a professional boundary. In many ways I was ‘there’ for him- able to offer support without being an intrusion. STIGMA Damian had isolated himself from society and had virtually become a recluse when I first started seeing him. However, as our weekly sessions progressed, he seemed to come out of his shell and...

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2013 – HIV/AIDS RESEARCH ROUND-UP: SA physio’s review massage research for people with HIV/AIDS

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What do we know about the effects of massage for people with HIV/AIDS? A group of physiotherapists from the University of Stellenbosch and the University of Southern Australia have undertaken a systematic review with the Cochrane HIV/Aids and South African Cochrane Centre to find out. Authors Susan L Hillier, Quinette Louw, Linzette Morris, Jeanine Uwimana and Sue Statham are currently about halfway through the review. According to Dr Susan Hellier of the Centre for Allied Health Evidence, School of Health Sciences , University of South Australia in Adelaide who is working in Cape Town for six months, the group is reviewing trials already done, rather than doing their own. “We have found four quality studies that have studied this question for adults and children,” she says. The idea for the topic came from one of the team members who is from and has extensive experience working with people with HIV/AIDS. “It was felt that the literature would benefit from more understanding about things that can improve quality of (patient’s) life etc. as a balance to the spotlight always being on medication and cure (which are obviously vital),” Dr Hellier explains. The team has promised to let InTouch have a copy of the final results once it is published. Below follows an extract from the review protocol kindly provided by Dr. Hellier. Massage therapy for people with HIV/AIDS: Protocol information Authors  Susan L Hillier, Quinette Louw, Linzette Morris, Jeanine Uwimana, Sue Statham Background  The Human Immunodeficency Virus (HIV) and Acquired Immunodeficency Syndrome (AIDS) is a threatening pandemic that has eroded many lives and affected millions of people globally. The 2007 AIDS epidemic update report from WHO/UNAIDS highlights that an estimated 33.2 million [30.636.1 million] people are living with HIV/AIDS (PWHA) worldwide, of which about 95% are living in the developing world (Stjernswärd 2002). More than two out of three (68%) adults and nearly 90% of children infected with HIV live in sub-Saharan Africa (SSA) and more than three in four (76%) result in AIDS deaths (UNAIDS/WHO 2007).  There has been some decline in HIV infection and deaths in SSA in the past two years partly due to effective prevention interventions and availability of antiretroviral treatment services (ART). However, AIDS remains a leading cause of mortality worldwide (UNAIDS/WHO 2007). Moreover, the increasing HIV infection rate and lack of good treatment options in some areas has been negatively affecting the quality of life (QoL) of PWHA. Description of the condition  The main symptoms reported by PWHA include opportunistic infections (OIs), night sweats, fatigue, weight loss, Pneumocystis carini pneumonia, Kaposi’s sarcoma, cytomegalo-virus lymphadenitis, depression, anxiety, poor sleep quality and pain. Peripheral neuropathic or nociceptive pain is a unique form of chronic pain that...

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