In 1990 River Huston was a kick-ass fitness trainer in New York City. Her workouts were about pain,
tight buns, and thousands of stomach crunches. Pushing herself beyond physical limits was her
modus operandi. "I was mainly into having the perfect body, and it became an obsession,"
"I had to work out every day, and my clients were the same. They were people who cared about
their bodies and not about their spirits."
That same year, Huston, now 40, found out she was HIV positive. That news flooding her with
emotion, she shed her in-your-face abs, butt, and thighs philosophy and embraced a more mellow
approach that incorporated yoga and meditation. Soon she lost her hard-core clients. "It was so
funny—when I tested positive, my classes really changed," she says. "That time in my life was
really the beginning of my journey of love, forgiveness, and service."
Huston is now an AIDS activist, published poet, and author of the photography book A Positive Life:
Portraits of Women Living with HIV (Running Press, 1997). She is one of thousands of HIV positive
people around the country who have incorporated yoga into their wellness program. While there is
only preliminary research stateside that suggests yoga improves the health and quality of life
for people with AIDS (PWAs), studies in Spain, India, Germany, and Africa have shown yoga can
slow disease progression, improve mental health, body image, and even help prevent spread of the
virus, encouraging a more pro-active approach to care and treatment. There are, however, dozens
of published studies in America that show yoga benefits the ailments some PWAs experience,
such as substance abuse, depression, anxiety, heart disease, high blood pressure, high
cholesterol and blood sugar, headaches, and chronic pain.
Huston has used yoga during the course of her illness to subdue the panic during emergency room
visits, ease the pain of a hysterectomy, and most recently, to combat fatigue, headaches, and
nausea from a weekly dose of intravaneous drug treatment (similar to chemotherapy) that treats
an AIDS-related auto-immune condition attacking her bone marrow. But ultimately she feels the
value of yoga goes well beyond the physical benefits.
"It's about going deep under the waves—the hurricane that's HIV—and finding a stillness. As
debilitating and emotional as HIV is, yoga helps me transcend it so that I can rediscover myself.
Then I remember I am not HIV; I am not the face of AIDS. I am me."
Like many in the aids community, Huston is a survivor. During the 10 years she has known her
positive status, she has lost friends to the disease and endured her own bouts of illness. And she
is far from alone. The Centers for Disease Control and Prevention estimate that more than 800,000
U.S. residents are living with HIV and approximately 40,000 new HIV infections occur in the
country each year. The epidemic is spreading most rapidly among minority populations, and
one-half of the newly infected are under 25 years old. AIDS is now the fifth leading cause of
death among people aged 25 to 44.
Global statistics are perhaps the most daunting. It's estimated that approximately 36 million
people are infected around the world, and nearly half of the adults are women—and around 70 percent
of these are living in sub-Saharan Africa. In 2000, more than 6,500 people worldwide aged 15 to 24
became infected with HIV every day—that's about five every minute.
Despite these staggering numbers, estimated AIDS-related deaths in the United States dropped about
68 percent from 1995 to 1999—from 50,610 to 16,273—according to the Centers for Disease Control in
Atlanta. Increased survival in the developing world is directly related to the advent of—and
access to—new AIDS drugs called "protease inhibitors," which interrupt late stage HIV virus
replication. These drugs were introduced in 1996, and when used in conjunction with other AIDS
medications, this treatment called "combination therapy" can make HIV, the virus that causes
AIDS, virtually undetectable in most positive people. Subsequently, blood T-cell counts
stabilize and ensure the immune system is up and running. The result? Improved health and
quality of life.
While this success cannot be belittled, people who work and live with HIV never forget these drugs
are not a cure. In fact, researchers know the virus has not been eradicated from its host;
instead, it's just hiding in hard-to-find places like the lymph nodes, testes, brain, and the
retina of the eye. And perhaps the greatest rub of all—these drugs are, in and of themselves,
toxic solutions with side effects that can be at the least uncomfortable and in the worst cases
even deadly; some of the more serious side effects include increased blood pressure and/or
cholesterol levels, which have led to fatal heart attacks.
Western medical conventions continue to dictate AIDS research and treatment protocols, but because
of the insidious nature of the virus and the chronic illness it causes, in the United States more
than 70 percent of people with HIV have used some kind of alternative therapy to enhance their
treatment. One of the increasingly popular methods is yoga.
"Healing does not come only out of little bottles, as many people want it to," says Jon Kaiser,
M.D., a San Francisco HIV specialist and author of Healing HIV: How to Rebuild Your Immune System
(HealthFirst Press, 1998). "Healing comes from inside. That's why I strongly recommend that
patients with HIV take time each day to practice deep relaxation. Yoga quiets the mind, improves
breathing and circulation, and reduces stress. Daily practice can help support the immune system
in conjunction with a comprehensive HIV treatment program."
Treatment of HIV/AIDS has come a long way since the epidemic surfaced in the late 1980s. During
that time, Denise Johnson was a new yoga teacher working in Denver, Colorado. As more and more
students came to class suffering from AIDS, Johnson and a group of dedicated teachers formed a nonprofit organization called the Yoga Group, which has continued to teach free classes to students with HIV and AIDS since 1992. "When we first started teaching, people were coming to class in wheelchairs," says Johnson. "We had to lift them out of their chairs onto the floor, and we were losing students all the time. They were dying, and it became almost a support group atmosphere."
Johnson and other Yoga Group teachers—with recommendations and supervision from B.K.S.
Iyengar—developed a regimen for HIV/AIDS designed specifically to stabilize and boost the immune
system. The practice focuses on inversions and supported backbends like Sirsasana (Headstand),
Salamba Sarvangasana (Supported Shoulderstand), and Adho Mukha Vrksasana
(Handstand), as well as backbends like Salamba Setu Bandha Sarvangasana (Supported Bridge Pose)
and Supta Baddha Konasana (Reclining Bound Angle Pose).
While there is no scientific evidence to back up the inversion theory, the hypothesis is based
on improving the efficacy of the thymus, an endocrine system gland that helps regulate immune
system necessities like T-cells. PWAs, who often have dangerously low T-cell counts that compromise
their immune system, can become vulnerable to opportunistic infections that healthy people can
fight. So the logic is that inversions increase circulation to the thymus gland, and backbends
open the chest and stimulate thymus activity.
Like Johnson, Shanti Shanti Kaur Khalsa, Ph.D., began working with PWAs early in the epidemic in
Los Angeles and has since gone on to become executive director of the Hacienda de Guru Ram Das
Center for Medicine and Humanology near Santa Fe. "In the beginning the medical community couldn't
help my students, and a lot of the emphasis was on alleviating fear and helplessness," she says.
"We used yoga and meditation to help people feel more safe with the unknown because we know fear
is the biggest immune suppressor."
Reasons Not to Stress
Kaur Khalsa's intuition was astute. Fear causes stress, and those who study HIV know that the most
significant benefit of yoga for PWAs may be stress reduction. A May 1999 study at the University of
North Carolina at Chapel Hill found that PWAs with more-than-average amounts of stress got sick
two to three times faster. And a study released last summer from the University of Miami, Florida,
reported that the stress hormone norepinephrine was significantly lower in PWAs who attended
weekly stress-management group sessions. Even better, the study also showed that the same group
had higher levels of CD8 cells, which are known to help control the HIV virus.
Even before there was scientific evidence of its benefits, the mind-body program for HIV/AIDS at
Beth Israel Deaconess Medical Center at Harvard University had been using yoga for 14 years. Ann
Webster, Ph.D., who directs the program, touts yoga as a great way to achieve the "relaxation
response," a physiological state defined more than 25 years ago by Harvard Medical School Professor
Herbert Benson, M.D.
Stress wreaks havoc on our nervous system and sets off the body's state of emergency, the "fight or
flight" response: Blood pressure rises, metabolism speeds up, blood sugar levels spike, and the
immune system is not as efficient. But conscious acts of relaxation counteract this state of alarm
and allow the body to return to its normal level of functioning. "Relaxation is a state of quiet
in the mind and the body," says Webster. "Yoga is a way for people to learn to self-regulate the
body. For example, when I put my students in Child's Pose, which is how little babies sleep, it
relieves anxiety, and it's almost impossible to worry in that position."
Anxiety, stress, and depression also increase levels of the hormone cortisol. Cheryl Koopman,
Ph.D., an associate professor in the Department of Psychiatry and Behavioral Sciences at Stanford
University, who specializes in HIV/AIDS, points out that everyone has stress, but PWAs generally
have additional factors. "We know too much cortisol is harmful to people with HIV infection,"
she says, adding that "while everyone has stresses in their lives, people with HIV tend to have
additional stress like discrimination, disclosure, racism, homophobia. These kinds of stresses
are associated with subgroups that are more likely to have HIV." Koopman also points out that
elevated cortisol levels impair the immune system and notes that a 1998 study published in the
Journal of the Association of Nurses in AIDS Care indicates that higher levels of cortisol may
even increase replication of the HIV virus.
It seems quite obvious that a less anxious person is a healthier person, but achieving a
stress-free life is easier said than done. For Gurudas Phillips it took yoga to drive that point
home. Yoga, he says, gives him the peace of mind to endure the anxiety of chronic health
challenges. He discovered this a year ago when he enrolled in an HIV class at the Integral Yoga
Institute in San Francisco at a time in his life when complications from hepatitis C were causing
him emotional distress and physical ailing. "On some level, I knew my overall anxiety would be
more detrimental to me than the virus," says Phillips, who now teaches yoga to others with HIV.
"Beyond the physical benefits have been the raja benefits—not identifying with the mind—and
learning not to live in absolute fear of when my viral load will come back. Instead, yoga has
been a real gift that has forced me to live my life in a more meaningful way."
At Stanford, Koopman is part of a group that has conducted studies about the possible
health-enhancing benefits for PWAs who have experienced the spiritual shift Phillips talks about.
While she has yet to publish her findings, her preliminary impressions indicate that peaceful
states of mind do indeed enhance well-being. "People who endorsed more spiritual actions and views
were associated with more active coping and less resignation or passivity," she says. "A
worldview that incorporates a spiritual component creates balance and harmony and improves
mental health. The principles of yoga practice should help enhance access to those positive
states of mind more frequently."
In Chicago, Michael McColly turned to yoga because he felt it was something that would help him
deal with the spiritual crisis he faced living with a potentially fatal disease. It also became a
positive way for him to reconnect to the body he had given over to doctors and drugs once he was
diagnosed with HIV five years ago. Yoga's breath work, stretching, muscle strengthening, and
meditation not only helped him work through his depression, it also opened his eyes to the idea
that his body was, indeed, his temple. He has since begun teaching yoga to PWAs at Illinois
Masonic Hospital's alternative clinic. "We need to be in charge of our own health," he says.
"In yoga, you automatically take charge. It changes the whole way you look at your body, and it
makes you more invested and conscious of your health. It's also a great way to do something to
manage HIV drug toxicity."
Relief for Side Effects
The side effects of HIV drug treatment have become a necessary evil in the AIDS community. While
the drugs are literally saving lives—enabling PWAs to go back to work and resume normal lives—they
are also wreaking havoc on bodies taxed by side effects like diarrhea, neuropathy, liver
dysfunction, high blood pressure, high cholesterol, diabetes, nausea, digestive problems, and fat
redistribution disorders that sometimes cause limb wasting, obesity in the torso, and fatty humps
on the back of the neck.
In fact, this past February federal health officials recommended that treatment for the AIDS virus
begin later in the course of the disease rather than sooner in patients who show no symptoms. The
revised guidelines acknowledge the "hit early, hit hard" philosophy risks creating toxic
situations for HIV positive people who may be required to take the drugs for the rest of their
lives. This is particularly disturbing because when drug therapy is stopped, the virus spreads
rapidly, and long-term use can result in virus drug resistance. However, these new guidelines
only affect positive people with no signs of opportunistic AIDS-related infections.
Steve McCeney intimately knows the downside of HIV medication. He has been practicing yoga with the
Yoga Group since 1993, and for the past year yoga has been instrumental in helping him manage some
of his chronic drug side effects. "Sometimes I don't know what it's like to feel normal anymore,"
he says. "But I do know that after an hour of restorative poses, I feel like a new person
mentally, spiritually, and physically."
McCeney's trouble began when chronic digestive problems he blamed on drug side effects evolved into
an insidious gastro-intestinal crisis that caused excruciating pain, bloating, and terrible
constipation. After medication adjustments, he ended up in the hospital with severe diarrhea. He
lost 30 pounds, and even small amounts of food made him feel full. Whether his colon trauma is
attributed to HIV or damage from the medication is hard to pinpoint by even his physicians—though,
intuitively, McCeney believes the medication probably triggered the problem. "We're not going to
survive if we stay on these meds the rest of our lives," he says. "They are harsh on the body,
though I know they have stopped the virus's progression. Even with all I've been through, I
would be fearful of going off medication altogether."
Yoga is an oasis that McCeney can go to even when he's feeling lousy. His practice is primarily
dictated by his physical condition. If he's fatigued, McCeney does rejuvenating poses like
Paschimottanasana (Seated Forward Bend), Viparita Karani (Legs-up-the-Wall Pose),
Supported Downward-Facing Dog, Headstand, and Shoulderstand with a chair. For immediate relief
from digestive pain, he does Supta Baddha Konasana with a strap, Supta Virasana (Reclining Hero
Pose), and Salamba Setu Bandha Sarvangasana (Supported Bridge Pose). Standing poses
are reserved for times when he feels stronger and more energetic.
In addition to yoga, McCeney sees a Chinese medicine practitioner. This multi-faceted approach is
becoming more and more prevalent among progressive AIDS treatment providers. "Ten years ago we
were doing yoga to help stabilize and boost the immune function," says Kaiser. "Now we're trying
a holistic approach. We can no longer use drug therapy at the exclusion of other natural
therapies. The best programs are combination programs."
There's no question that, anecdotally, PWAs who practice yoga feel tremendous relief from various
ailments. Dennis Israelski, M.D., chief research officer and chief of Infectious Diseases and AIDS
at San Mateo County Health Center in northern California, says a good scientific case can be made
to conduct yoga and HIV research, though he admits getting the funding is a challenge. "After all
, yoga does not sell drugs," he says. Nonetheless, he believes yoga is a superb practice.
"Medicine doesn't have all the answers, and I'm convinced by practicing Pranayama, meditation,
and asanas, PWAs will survive longer. Even though we don't have the hard data, I believe that
when people believe in a system that is spiritual and physical, there is power. The path is as
important as the end result."
Stacie Stukin is a freelance journalist based in Los Angeles.