Managing your health: a guide for people living with HIV


4. Healthy living

One of the best ways to live well with HIV—other than taking anti-HIV drugs—is to work toward achieving a healthy, happy and relaxed you. Like the old saying goes: “Living well is the best revenge!” This chapter focuses on proactive strategies, options and ideas to help you get and stay healthy, reduce harm and take control of your personal well-being. Finding the right balance for your body and lifestyle can make living well with HIV a reality.

Eating well

Eating a balanced diet based on fresh, unprocessed foods is essential for health.

Eating a balanced diet based on fresh, unprocessed foods is essential for health.

So what does eating well actually mean? To help you understand how to make healthy food choices, Canada’s Food Guide recommends that you eat the following servings daily from each food group:

  • at least seven servings of vegetables and fruits;
  • six to eight servings of grain products;
  • two to three servings of milk products and alternatives;
  • two to three servings of meat products and alternatives.

At first, this may seem like a lot of food! However, you only need one piece of bread or half a cup of cooked rice to make up one serving of grain products. Similarly, half a cup of fresh, frozen or canned vegetables or half a cup of fruit juice is all you need to make up one serving of vegetables or fruits. One serving of meats or alternatives can mean two eggs, two tablespoons of peanut or nut butters or just half a cup of cooked meat or fish.

Canada’s Food Guide points the way to good nutrition for all Canadians, but it may not adequately take into account particular foods that you are accustomed to eating, especially if you are from an ethnocultural community. And it doesn’t take into account special dietary considerations you may have as a person living with HIV. Talk to your doctor, nutritionist, naturopath, dietician, nurse or other healthcare provider if you have questions or concerns related to HIV, food and nutrition.

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Maintaining a healthy weight

Maintaining a healthy weight can be a challenge. Some people with HIV find it hard to keep enough weight on. Others tend to gain weight—often in the unhealthy form of fat.

Maintaining a healthy weight can be a challenge. Some people with HIV find it hard to keep enough weight on. Others tend to gain weight—often in the unhealthy form of fat. Fat redistribution associated as a side effect of certain anti-HIV drugs makes this issue even more complicated.

You deserve to look and feel your best, but you also need to make sure you are getting all the nutrition you need. Look for healthy ways to lose or gain weight. Any weight-loss diet that places too much emphasis on a small range of foods, or deprives you of vital nutrients, is a no-no! Likewise, if you are trying to gain weight you should include a wide range of foods in your diet and avoid saturated and trans fats. In most cases, attention to your diet should be combined with an exercise routine. Discuss any weight loss or weight gain plans with your doctor, dietitian, nutritionist, naturopath, nurse or other healthcare provider.

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Carbohydrates, fats and proteins

Carbohydrates, fats and proteins are the building blocks of a nutritious diet. They are also needed to give your body the energy it needs to carry out daily tasks. Calories are the common measure of the energy in various foods. Learning more about the number of calories in different foods will help you understand how much food energy your body needs each day depending on your age, weight, gender and other factors.

Carbohydrates or carbs are a primary source of healthy food energy and should be eaten with every meal.

Carbohydrates or carbs are a primary source of healthy food energy and should be eaten with every meal. There are two kinds of carbohydrates: simple carbs and complex carbs.

Complex carbs include whole grains, beans and peas, vegetables and fruits. These foods are considered healthy because they take some time for your body to process, raising your blood sugar (or glucose) levels gradually and giving you a steady source of energy. Complex carbs also tend to be great sources of fibre, vitamins and minerals.

Simple carbs include sugars, fruit juices and white starchy foods such as white rice and white bread. Found in most processed foods, simple carbs raise your blood sugar rapidly and give you instant energy. This rapid rise is followed by a dramatic drop in blood sugar that can leave you feeling drained. Unlike complex carbs, simple carbs are usually not a good source of nutrients, vitamins, minerals or fibre.

As much as possible, you should try to eat complex carbs and limit your intake of simple carbs. Some easy ways to include complex carbs in your diet include replacing white rice with brown rice, white bread with whole wheat and using grain or spinach pastas.

Make sure your diet contains the healthy type of fats. Unsaturated fats, monounsaturated fatty acids and omega-3 fatty acids are all good for heart health.

We have all heard bad things about fats over the years. In fact, fats are a vital part of your diet because they provide the most concentrated form of energy that is available from food. There are different kinds of fats, some that are healthy and some that are not, especially for some people with HIV. Make sure your diet contains the healthy type of fats.

Unsaturated fats, monounsaturated fatty acids and omega-3 fatty acids are all good for heart health. These types of fats come mainly from plant sources. They can be found in olive oil, canola oil, flax oil, nuts and avocados. Salmon is also an excellent source of omega-3 fatty acids.

Saturated and trans fats are not good for the health of your heart because they can clog your veins and arteries and raise your risk of heart disease. Avoiding saturated and trans fats is important for some people with HIV because some anti-HIV drugs may increase their levels of cholesterol.

Saturated fats are found mainly in animal fats and dairy fats and should only be eaten in very small amounts. Trans fats are found in processed fast foods and snacks. They are also known as partially hydrogenated oils. Most baking shortenings and shortenings used for deep fat frying in restaurants are major sources of trans fats. Since significant health risks have been associated with trans fats, it is recommended that you avoid them completely.

Food labels contain important information about what is contained in the foods we eat. Read the fine print on cans, bags and bottles in order to know more about what you are eating. This information will help you to avoid or reduce the amount of saturated fats, trans fats, simple carbohydrates and other things that are not healthy in your diet.

Protein is another important part of your diet. Protein helps your body produce hormones, enzymes, cell structures and parts of the immune system. Protein also helps build and maintain lean muscle mass. Proteins are found in all meats, fish and shellfish, eggs, legumes (beans and peas), peanut and nut butters, nuts and seeds, milk products, including cheese and yoghurt, and soy products such as tofu and soy milk.

It is important to note that certain medical conditions such as kidney disease can be made worse if you eat too much protein, so be sure to talk with your doctor or nutritionist about his or her recommendations for the amount of protein you should be eating.

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Food safety

Untreated HIV disease makes your body more susceptible to disease-causing bacteria found in food or water.

Untreated HIV disease makes your body more susceptible to disease-causing bacteria found in food or water. In the years before effective anti-HIV drugs, many people living with HIV experienced life-threatening illnesses caused by contaminated food and water. Though serious illnesses are less of a problem now that effective anti-HIV drugs are available, it is still very important to observe safe food preparation rules:

  • make sure that your hands and the surfaces that you are preparing the food on are clean;
  • ensure that meat and seafood is thoroughly cooked;
  • carefully peel or wash fruits and vegetables;
  • avoid foods that are past their “best before” dates or are spoiled;
  • keep raw meat, poultry and seafood separate from ready-to-eat foods, such as fruits or salads, and keep raw meat, poultry and seafood separate from cooked foods. This includes paying attention that you don’t reuse your cutting board for ready-to-eat foods after it has been used for raw meat or seafood;
  • don’t let food sit out at room temperature for long if it is prone to spoiling. Keep hot things hot and cold things cold;
  • pay attentions to warnings about food contamination.

You have better control over these things if you are preparing your meals at home. When you are dining out, it may be better to avoid raw or undercooked foods, especially fish, poultry and meats.

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Food and anti-HIV drugs

Some anti-HIV drugs are meant to be taken without food. It’s important to know about special food instructions so your anti-HIV drugs work as well as they can.

Some foods interact with anti-HIV drugs. This means certain foods can change the way your body absorbs the drugs you are taking. Make sure to ask your doctor or pharmacist about any special food considerations for each anti-HIV drug you are prescribed. Also, ask whether or not you are supposed to take your drugs with or without food. It’s important to know about these special food instructions so your anti-HIV drugs work as well as they can.

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Getting the vitamins and minerals your body needs

A healthy diet should provide all the vitamins and minerals your body needs. However due to lifestyle factors or medical ones, people with HIV may have a difficult time getting all the nutrients they need from their food alone. This means your body may lack certain vitamins and minerals that help it function well.

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Vitamin and mineral supplements

Due to lifestyle factors or medical ones, your body may lack certain vitamins and minerals that help it function well. Taking a daily multivitamin is highly recommended.

HIV disease and some of the side effects of anti-HIV drugs can make it hard to absorb vitamins and minerals from your food, so taking a daily multivitamin is highly recommended.

Your doctor, nutritionist or naturopath can determine if your diet is not providing you with adequate vitamins and minerals. If this is the case, supplementing your diet with vitamins and minerals is a good idea. Talk to your doctor, nutritionist, naturopath, nurse, dietitian or other healthcare provider about the value of supplements in HIV. Be sure to choose supplements that match your body’s needs and that don’t interact with your other drugs.

Some HIV organizations provide limited funds so that people with HIV can purchase supplements, or they may have bottles of supplements available for their clients.

Vitamin and mineral supplements can be costly because, for the most part, they are not covered by health plans. Some HIV organizations provide limited funds so that people with HIV can purchase supplements, or they may have bottles of supplements available for their clients. In larger cities, some health food or supplement stores offer a discount to people with HIV.

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Eat your veggies! Chicken soup

This soup is a great way to use up leftovers.

Bring some chicken broth (you can buy this in cartons, cans or cubes, or you can make your own) to a boil in a large pot. Add a wide variety of colourful vegetables, fresh and frozen: corn, green or yellow beans, peas, cabbage, broccoli, onions, spinach, kale, Swiss chard, bok choi, carrots, potatoes… the list is almost endless. If they don’t give you problems with gas, pre-cooked or canned beans such as lentils, kidney beans or chick peas can be added to increase the protein in this soup. You can also add some leftover chicken pieces and a few spoonfuls of olive oil to really boost the taste and the nutritional value. Salt, pepper and other herbs like parsley, cilantro, oregano or basil can be added to taste. From start to finish, this soup shouldn’t take more than 15 minutes to make.

If you are vegetarian, you can modify this recipe by starting with a vegetable broth and omitting the chicken. You could add cheese or tofu to boost the protein content and some sesame oil to give it a hearty flavour.

Croutons, parmesan cheese, nuts or whole grain crackers can top off this nutritious soup.

Make a big pot and freeze some of it for a day when you feel too tired to cook but want to feed your body and soul!

Adapted from Lark Lands’ KISS Chicken Veggie Soup, The Positive Side, Spring/Summer 2004.

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Made naturally by the body, antioxidants are also found in some foods and supplements. Antioxidants are important because they neutralize molecules called free radicals inside your body. Free radicals start a process called oxidation, which damages healthy cells in the body. HIV can intensify this process of cell damage. Antioxidants protect against cell damage.

As we come to understand more about the role that inflammation and oxidative stress play in health conditions of people with HIV as we age, such as cardiovascular, liver and kidney disease, the possibility of moderating these effects through a diet rich in antioxidants deserves attention.

Foods that are rich in antioxidants include blueberries, red peppers and spinach, as well as black and green tea, red wine and dark chocolate. You can also find antioxidants in supplements, including vitamin C and E supplements, coenzyme Q10, selenium, zinc, alpha-lipoic acid and N-acetyl cysteine (NAC).

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B Vitamins

B vitamins are great for increasing your energy. B vitamins are found in potatoes, bananas, lentils, liver, turkey and tuna, among other things. If your diet is not providing you with enough B vitamins, you might consider supplementing with vitamin B1, B2 and B3.

Low levels of vitamin B12 are associated with anemia, low energy and the inability to think clearly. Your doctor can check your levels and, if they are low, you can get a B12 injection from your doctor, which provides B12 in a way that your body can use that is better than oral or liquid B12 formulations.

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Vitamin C

Vitamin C is one of the best antioxidants available. If you feel that you are not getting enough vitamin C in your diet through fruits and vegetables such as citrus fruit, broccoli, parsley and red peppers, you may consider supplementing with vitamin C. In high doses, vitamin C can cause diarrhea.

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Vitamin D

Many of us in Canada experience harsh winters where we do not get as much sun as our body needs to make vitamin D.

Vitamin D helps our bodies use calcium properly, and has many other functions as well. Our skin makes its own vitamin D when exposed to the sun. However, many of us in Canada experience harsh winters where we do not get as much sun as we would like or as much as our body needs to make vitamin D. Since it is difficult to get vitamin D from food, many common foods such as milk, bread and margarine have vitamin D added to them.

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Vitamin E

Vitamin E is another great antioxidant. It is found in such foods as avocados, nuts and seeds, leafy green vegetables and vegetable oils such as canola, corn or sunflower. High doses of vitamin E may increase your risk of heart disease, so don’t overdo it if you are supplementing with vitamin E.

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Calcium is essential for healthy bones. It is found in dairy products such as milk, cheese or yoghurt. Certain anti-HIV drugs can affect your bone health, leading to thinning bones. People who are older, especially menopausal women and people with thinning bones, should especially ensure that they have sufficient calcium intake. If you are concerned that you are not getting adequate calcium from your diet, consider calcium supplements. Some people find calcium supplements can be constipating. A small amount of magnesium can ease this effect.

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A diet low in iron, which is often the case with the typical North American diet, can make you prone to infection.

Iron plays an important role in supporting your immune system. A diet low in iron, which is often the case with the typical North American diet, can make you prone to infection. It is important for people with HIV to ensure they are getting enough iron, which is found in meats, dried peas and beans, some cereals and some fruits and vegetables. You should only take an iron supplement if it is prescribed by your doctor or nutritionist.

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Selenium is an essential micronutrient and plays a role in how the thyroid gland works. It is found in foods such as nuts (especially Brazil nuts), cereal, meat, fish and eggs.

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Zinc is important for the health of your immune system. Foods that contain zinc include most meats, poultry and shellfish. If you are a vegetarian, a great source of zinc is pumpkin seeds, as well as milk and cheese, beans and brown rice.

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Other supplements for people with HIV

Other supplements that may benefit people living with HIV include:

  • alpha-lipoic acid;
  • carnitine;
  • N-acetyl cysteine (NAC);
  • L-glutamine;
  • probiotics;
  • coenzyme Q10.

To get more information on these supplements and the role they play in your health, check out CATIE’s Practical Guide to Nutrition for People Living with HIV.

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Rainbow Fruit Smoothie

Put a sliced, ripe banana in a blender. Since colour is where the nutrients are, add a whole rainbow of fresh or frozen fruits to your blender till it is about three quarters full. Add orange juice—fresh-squeezed if possible—to the level of the fruit. Blend the mixture till it is smooth, then add a couple of spoonfuls of plain yoghurt and blend a little longer.  This is a delicious way to start your day!

There are lots of variations to this basic recipe.  You can add cranberry juice concentrate, frozen mango purée, pomegranate juice concentrate or some grated ginger. Ginger and pomegranate boost the antioxidant, anti-inflammatory and cancer-protecting nutrients in the smoothie. If you need extra calories in your diet, add coconut milk in place of some of the juices. If you need extra protein, add a little protein powder. Experiment and make this basic smoothie your own.

Adapted from Lark Lands' KISS Fruit Shake, The Positive Side, Spring/Summer 2004.

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Not only is a strong body better equipped to fight HIV, but achieving a level of physical fitness can help you fight stress.

Many people living with HIV find that exercise helps their overall health and well-being. Not only is a strong body better equipped to fight HIV, but achieving a level of physical fitness can help you fight stress. Physical fitness is also important because it reduces your risk of depression, and people living with HIV have high rates of depression. Last but not least, exercise will help you maintain your ideal body weight in the form of muscle rather than fat. Running, walking fast, biking, skating, swimming and other similar aerobic activities all promote a healthy body. Be careful though! You don’t want to overdo an exercise plan, especially when you are just starting out. Check with your doctor before you start in a workout program and consider meeting with a personal trainer who can demonstrate how to get the most from your workout. Exercise can also be a part of a rehabilitation program. For more information about exercise in the context of rehabilitation, see Chapter 14, HIV and rehabilitation.

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On the move

Exercise can lead to:

  • more energy;
  • less stress;
  • an improved mental outlook;
  • improved heart capacity and lung function;
  • sound sleep;
  • more regular bowel function;
  • enhanced self-image and self-esteem.

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Building lean muscle

To put on weight that will stay on, you need to lift weights and increase the amount of protein and complex (healthy) carbs in your diet.

Gaining weight and building lean muscle mass can be especially important if you have experienced rapid weight loss with HIV disease. To put on weight that will stay on, you need to lift weights and increase the amount of protein and complex (healthy) carbs in your diet. Eating high-fat foods is not the answer! For weight training, use machines at a gym, free weights or do push-ups, sit-ups and squats, which use your own body weight to build muscle.

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Training Tips

When working out, don’t forget to:

  • breathe;
  • wear comfortable clothing;
  • drink lots of water before, during and after you exercise;
  • include a warm-up and cool-down period as a component of your workout;
  • listen to your body;
  • eat a nutritious, well-balanced diet with adequate calories and protein to fuel your body;
  • give yourself a break, such as days off between workouts, to let your body recover.

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Coping with stress

Make time in your life for the things you love to do.

Finding time for yourself is an effective stress buster, so make time in your life for the things you love to do. Go dancing, cook a healthy meal, bake bread, go for a walk in the park or woods, go swimming, listen to music, or do some gardening. And, of course, spend time with the people you love.

There are other ways to deal with stress.

  • Learn more about meditation and relaxation breathing techniques - Take a course or buy or download meditation guides. Most naturopaths will have more information for you.
  • Start taking yoga or Tai Chi - Check for free or pay-what-you-can yoga classes at yoga studios, community centres or HIV organizations.
  • Get a massage - If you work, the cost of massage may be partially or completely covered through your insurance plan. Massage may also be available free at your local HIV organization. Some massage schools offer free or pay-what-you-can massages from their students.
  • Take breaks - This includes small breaks such as having a nap or taking a sick day from work or school, as well as longer breaks such as going out of town for a vacation.

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Tips to help you de-stress

Drink lots of water - Our bodies are made up of 75 per cent to 90 per cent water, and water flushes out toxins from the body and keeps us hydrated. Try to drink at least eight glasses of water a day.

Eat fresh fruits and greens, whole grains and soy products - Try juicing fruits and vegetables, which is a great way to get lots of nutrition from fresh foods. Think of how good your body feels when you feed it a fresh, colourful salad and compare that to how you feel when you eat over-processed and overcooked food. Avoid the centre aisles in your grocery store as much as possible because this is where most processed foods are located.

Slow down, savour the moment. Be mindful and present. Rest and relax. Get a massage to boost your body’s circulation and immune system.

Trust yourself - Listen to your inner voice. Keep a journal. Dare to fulfill a dream. Learn the power of intent. Put out a wish or prayer and don’t be surprised if you get what you ask for. Remember to give thanks.

Rejoice - Celebrate by doing one of your favourite activities or discovering a new one. Learn how to knit. Join a choir. Try salsa dancing or African drumming.

Exercise - Get your heart pumping and blood circulating. And don’t forget to breathe! Walk, swim, dance, cycle… pick your favourite. Not only will it benefit you physically, it will also lift your spirits. Sex counts as exercise!

Speak sweetly to yourself - Your words to yourself can either heal or harm you. Speak and think positive thoughts. Respect yourself and your contribution. Each of us is unique and holds different gifts and perspectives.
Seek out help - Utilize your local HIV organization. They may have resources or programs that make your life easier. Opportunities may exist that you are unaware of. Connect with others. If you live in a remote area, reach out by e-mail, on the Web or use toll-free numbers. Communicating with other people with similar issues is an invaluable resource of support and information. Accept support from family and friends. Celebrate your relationships.

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Tattoos and piercings

People with HIV can get tattoos and piercings. But if you are considering getting a tattoo or piercing, be aware that if the instruments used are not sterilized or disinfected, the risk of hepatitis B or C transmission to you does exist. As well, reused or unsterilized equipment can transmit HIV. Single-use, disposable needles and ink cups should be used. Any reusable instruments or devices that penetrate the skin and/or come in contact with blood should be thoroughly cleaned and sterilized between uses. Look for a clean, hygienic shop, with staff who can speak knowledgeably about what procedures they use to prevent the transmission of blood-borne infections.

In prisons, tattoos are a part of the subculture, where prisoners who are tattoo artists create their equipment from available materials. Because this equipment is reused and not sterile, it can easily transmit blood-borne infections from one person to another. Prisoners and their advocates are attempting to promote safe tattooing projects within prisons to protect both prisoners' and public health.

Harm reduction as a tool to healthy living

You may find it strange that information about drug use and harm reduction is in a chapter about healthy living. But people with HIV may be at very different places with regards to healthy living practices and decisions. Some of us are risk-takers and party people, while others prefer calm pursuits that keep us close to home. Some of us are people who have always prioritized our health and cared for our bodies, while some of us have learned how to do this in a way that suits our character and temperament over time. Any commitment to healthy living with HIV, no matter how big or small, begins with where we are at now in our lives.

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Drugs, drug use and harm reduction

The terms “drug” and “drug use” have specific meanings in this section of the book. They do not refer to the drugs used to treat HIV as in the rest of Managing your health. Instead they refer here to a wide range of substances and activities, from the occasional use of drugs for pleasure or fun through to dependence and addiction. When we refer to drugs in this section we are including substances that are often referred to as party drugs, street drugs or recreational drugs.

The term harm reduction refers to an approach to drug use that provides options or choices to help you live as healthily as possible, even if you are using drugs. Drug use can put you at risk for many health problems. But you can take steps to reduce those risks.

Drugs can include stimulants or “uppers,” like cocaine and methamphetamines, depressants or “downers,” like methadone or oxycontin, and hallucinogens, like LSD. Drugs can be smoked, as in the case of cigarettes, marijuana or crack. They can be swallowed, as with ecstasy or oxycontin. They can be drunk, as in the case of alcohol or methadone. They can also be snorted as with cocaine or injected as in the case of heroin.

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Reasons for using drugs

People have different reasons for using (or not using) drugs. Some people use drugs recreationally, which means that they take drugs or alcohol in social situations or on special occasions for fun. Some experience problems associated with drug use, such as loss of inhibition, hangovers, blackouts with memory loss and overdoses. Some people become addicted to drugs.

Drugs can be used as a coping mechanism. Some people use drugs to help deal with problems such as emotional pain, anxiety, stress or low self-esteem. Drugs may help to cover up these problems, but they interfere with figuring out ways to deal with these underlying problems. In these cases, drug use can become a problem.

Maintaining a balance

Many people are able to keep a balance between their drug use and the other things in their lives. For other people, this balance can be hard to maintain. In some cases, getting and using drugs becomes a main focus of our lives. In these cases, drugs become more important than our friendships and our interests, and we may find ourselves doing things we don’t really like doing in order to get drugs: spending too much money on them, missing work, borrowing money and not paying it back, exchanging sex for drugs. This is a sign that drug use has changed to dependence or addiction.

Drug dependence is very complex and can involve physical, psychological and emotional changes, where you don’t have control over the drugs you’re taking—they have control over you. If you think that you’re having problems like this, there are ways to take back control: cutting back, taking a break, switching the amount or type of drug you’re taking or trying addiction treatment. You can also get help to explore your options—talk to a doctor or healthcare provider that you trust.

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Loss of inhibition

One way that drugs can affect us is by lowering our inhibitions.

Inhibitions are the little warning bells in our heads that go off telling us we’re about to do something dangerous or risky. One way that drugs can affect us is by lowering our inhibitions. For example, cocaine can lower your inhibitions by making you feel confident and almost invincible, so you don’t have to listen to the warning bells. Alcohol can suppress the part of our brain that holds the warning bells and make it easier to take risks. Crystal meth can increase your sex drive to the point where nothing seems more important than having sex. Lowered inhibitions may make it more likely for you to make choices you would not normally make.  Depending on the circumstances, these choices could put you or the people around you at higher risk of negative consequences.

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Stimulants, depressants and hallucinogens

There are generally three types of drugs—stimulants, depressants and hallucinogens—and they are classified based on the general effects they have on the body.


Stimulant drugs speed up the body and body processes and are sometimes called “uppers.” They can increase heart rate, breathing rate, energy, sex drive, confidence and sometimes aggression. Stimulants include caffeine (in coffee), guarana and taurine (in energy drinks), nicotine (in cigarettes), cocaine (coke and crack) and methamphetamines (speed, crystal meth and ecstasy).


Depressant drugs cause body processes to slow down and some are painkillers. Depressant effects include slower heart rate, slower breathing rate, reduced pain, feeling calm or relaxed and sometimes even unconsciousness. They are called “downers” or “downs” and this category of drugs includes alcohol, opiates (heroin, methadone and oxycontin), GHB (G) and ketamine (K).


As the name suggests, these types of drugs can cause hallucinations and change the way we perceive the world, with effects ranging from mild to severe. Some of these common effects include paranoia, hearing voices, seeing things or making us think we can do impossible or dangerous things without getting hurt. Examples of hallucinogens include magic mushrooms and LSD.

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Interactions between anti-HIV drugs and recreational drugs

Recreational drugs have unpredictable interactions when combined. This increases the possibility of overdose or of an effect that you did not plan for, such as getting too high when you mix alcohol with hallucinogens or getting an erection that lasts for too long when mixing crystal meth with erectile dysfunction drugs. The interactions between anti-HIV drugs and various recreational drugs are also not well defined. Anti-HIV drugs often increase the activity of recreational drugs in the body—this means that you need less of the recreational drug to get the same effect when you’re also taking anti-HIV drugs along with it. In some cases, interactions can occur which makes your anti-HIV drugs less effective, leading to the possibility of drug resistance. Or certain drug interactions may lead to symptoms of withdrawal. It is best to talk openly and honestly with your doctor about possible interactions between your anti-HIV drugs and the substances that you take.

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Having a few drinks can relieve stress and give you a chance to catch up with friends, but living well is about finding a healthy balance. Excessive alcohol consumption can be dangerous. It can deplete important vitamins and minerals from your body. It can also be very hard on your liver. Too much alcohol can lead you to make errors in judgment, and since sex and alcohol often go together, alcohol can lead you to make choices you may regret.

Alcohol is also a well-known depressant and depression is an issue with which many people with HIV struggle. Proceed with caution when it comes to alcohol and if you feel that alcohol is affecting your decision making and your quality of life, speak to your doctor about ways that you can regain control of your alcohol use.

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Smoking tobacco has been shown to lead to heart disease and cancer and can make breathing-related conditions, including asthma and emphysema, much worse. The nicotine in cigarettes is highly addictive.

If you smoke, quitting may be one of the single best things you can do for your health and well-being. Many strategies can be found to help cut back or quit altogether, from government-sponsored smoking cessation programs to nicotine substitutes (like gum or the “patch”) to prescribed medications. Talk to your doctor, naturopath or even friends who have quit to learn more about these options.

Smoke-free: Things to look forward to:

  • After a few days: Taste and smell improve;
  • After a few weeks: Circulation improves;
  • After one year: Risk of heart disease is cut by half;
  • After a few years:  Risk of heart disease is the same as someone who never smoked;
  • After 10 years: Risk of lung cancer is cut in half.

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Marijuana (pot or weed)

Marijuana is the most commonly used recreational drug in Canada. It is a controversial drug, with some people claiming it is a “gateway” drug to “harder” substances like crack or heroin and others claiming it has health benefits.

For many years, people with chronic diseases like cancer, hepatitis C and even HIV have used marijuana to manage treatment side effects and disease symptoms. It can stimulate the appetite and promote weight gain. It can also help with general pain management, anxiety, stomach upset, sleep and relaxation.

Health Canada runs the Marihuana Medical Access Division to allow people with grave or debilitating illnesses access to medical marijuana legally. There are forms that you and your doctor fill out and, if approved, you then have the legal right to use marijuana. Many people use buyers’ clubs or “compassion centres” as their source of marijuana. Compassion centres sell clean, safe marijuana to anyone with written proof of a relevant medical condition such as HIV.

More recently, marijuana dispensaries have begun to open in a number of locations in Canada, though they are illegal (as of mid2017). If you buy your marijuana from a dispensary, try to assess the level of responsibility of the dispensary operator in adopting strict policies such as not selling to minors and maintaining a professional and open approach. The Canadian Association of Medical Cannabis Dispensaries operates a certification program.

THC, the active ingredient in marijuana that is responsible for its medicinal effects, is also available by prescription in a drug called Marinol (dronabinol).

Some people use marijuana recreationally and never suffer any negative consequences. Other people may develop depression from regular use. Smoking marijuana, like smoking cigarettes, can also increase the risk for cancer, so some people choose to consume it by vapourizing it or eating food made with it (edibles).

If your marijuana use is causing you to feel depressed or you are experiencing negative consequences from it, talk to your doctor about strategies for quitting or reducing your use.

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Crack, crystal meth or cocaine

Using crack, crystal meth or cocaine can put you at risk for a number of health-related problems. If you are living with HIV and using these drugs, there are things you can do to maintain your health and to protect the health of those around you. These include:

  • not sharing your filters, straws, pipes and other drug-using equipment. Talk to workers at your local needle exchange program about safer drug-use equipment;
  • planning ahead so that you have a safe place to use, new equipment, condoms and lube for sex, your anti-HIV drugs (so you don’t miss a dose), food and a place to crash;
  • learning how to avoid overdosing and how to detect overdose symptoms in others;
  • practising safer sex by keeping your viral load undetectable and using condoms for vaginal and anal sex;
  • getting tested and, if necessary, treated for TB (tuberculosis) and hepatitis A, B and C;
  • getting vaccinated annually against the flu and getting a hepatitis A and B vaccination.

Basic harm reduction strategies that you can put in place for yourself include taking your anti-HIV drugs as prescribed, eating regularly, drinking lots of fluids and getting enough sleep. Try to set yourself limits on how much and how often you use and stick to these limits as much as possible.

If you are feeling like your use of these drugs is getting out of your control and negatively impacting your life, you might consider discussing this with your doctor or a healthcare worker. They can provide you with information on harm reduction strategies such as drug substitution (replacing your drug of choice with something less harmful, such as methadone instead of heroin). If you are having trouble taking your anti-HIV drugs as prescribed and you are missing doses, talk to your doctor or a healthcare worker. They can help you to come up with strategies to help you remember to take your anti-HIV drugs, or they may be able to prescribe a combination that is easier for you to take regularly.

Injection Drugs

If you are HIV-positive and inject drugs—heroin, crack, crystal, cocaine, pills or steroids—you can take steps to stay healthy, even if you don’t want to or can’t quit.

It’s important to know that every time you inject a hit, you make a direct, open path to your bloodstream. This makes it easy for you to get other viruses such as hepatitis B and C, which, like HIV, are passed on through infected blood. All the drug equipment you use—needles, syringes, rigs, spoons, cookers, filters, water—can spread these viruses.

To avoid transmitting HIV, or getting and transmitting hepatitis B and C and other infections, it’s important to shoot safely.

  • Visit your doctor and take your anti-HIV drugs as prescribed to ensure that your viral load remains undetectable.
  • Use a brand-new clean needle/syringe/rig every time you shoot.
  • Try not to share needles, syringes or any other drug use equipment—filters, spoons, cookers, water, ties, pipes.
  • When shooting with others, make sure you have your own needles, syringes and other equipment. Mark yours so you can tell them apart.
  • Talk to the workers at your local needle exchange program about safer injection practices and how to prevent abscesses and other infections.
  • Before you shoot, clean your hands and the injection site. This will help keep germs from getting into your bloodstream.
  • Use a different injection site (rotate) each time you shoot—it helps save veins. Go back to sites you’ve already used only after they’ve healed. Try to avoid dangerous injection sites on your body: groin, thighs, breasts, wrists, neck.
  • After you shoot, recap the needle and put it in a sealed puncture-proof container like a soft drink bottle so nobody can use it again. Bring it to a needle exchange or give it to an outreach worker. If there is no needle exchange near you, put the needle in a sealed container and throw it in the garbage. Do not dump it where someone could find it and get hurt.

Injection drug use has a negative impact on your overall health, and as a person with HIV you need to be especially careful to keep yourself and the people around you as healthy as possible. Some things that you can do to reduce the harms that are associated with injection drug use include:

  • when you know that you are going to be using drugs, plan ahead and get a safe place to use, new equipment, condoms and lube for sex, some food, a place to crash and a supply of your anti-HIV drugs so you don’t miss a dose;
  • talk to the workers at the needle exchange program to find out what you can do to avoid overdosing, how you can recognize overdose symptoms in others and what to do if someone is overdosing;
  • get vaccinated annually for the flu and ask your doctor for a hepatitis A and B vaccination;
  • get tested, and (if necessary and advisable) get treated for TB (tuberculosis) and hepatitis A, B and C.

If you are feeling that your use of injection drugs is getting out of your control and negatively impacting your life, you might consider discussing this with your doctor or a healthcare worker. They can provide you with information on harm reduction strategies such as drug substitution that doesn’t have to be injected (replacing your drug of choice with something less harmful, such as methadone instead of heroin) or on treatment for your dependency on injection drugs. Though it may not be your first priority, it is important to make time to deal with your HIV infection. Many services that support injection drug users also provide support, care and referrals related to HIV. You should:

  • take your anti-HIV drugs as prescribed to keep your viral load undetectable.
  • if you are having problems taking your anti-HIV drugs regularly, talk to your doctor or healthcare worker. They may be able to help you to come up with solutions to the challenges you are experiencing;
  • use condoms for vaginal and anal sex. Condoms protect you and your partners against sexually transmitted and other infections.

To find a needle exchange program near you, where you can get new syringes and other drug use equipment for free, call your public health department or local HIV organization. Needle exchange programs also offer information and support about harm reduction and drug use.

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The Positive Side – Health and wellness magazine containing articles about health living.

A Practical Guide to Nutrition for People Living with HIV – Comprehensive book covering healthy eating, vitamins and supplements, managing symptoms and side effects through nutrition and more

Canada’s Food Guide

Food Safety For People with Weakened Immune Systems– Practical tips from Health Canada

Safe Food Handling: Your Interactive Guide – From Health Canada

Canadian Food Inspection Agency – This federal government agency, responsible for food safety in Canada, posts up-to-date information on contaminated food products

Pre*fix : Harm reduction for + users – Booklet about maintaining health and well being for people who use injection drugs and their care providers

Tips for Preventing Overdoses – Booklets on preventing overdoses from downers, uppers and crystal meth

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About the author

Derek ThaczukAlex McClelland has been involved in many Canadian and international civil society organizations and NGOs working toward and advocating for the support, care and rights of people living with HIV. Alex has been living with HIV since he was 19 years old and for five years he coordinated Positive Youth Outreach, a peer support program for young people living with HIV in Toronto. Alex has since continued to work toward the HIV response with such organizations as the AIDS 2006 XVI International AIDS Conference, the Canadian AIDS Society, UNAIDS, the World AIDS Campaign and the Global Network of People Living with HIV/AIDS.

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