Yoga for people living with HIV -- Michael Solis Michael is a yoga teacher from Yoga Vidya Gurukul. This is an article Michael wrote as a part of his assignment for the Yoga Teacher training course. Michael is a very sincere yoga aspirant and he was one of the top students in the course.	Print This Page
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Yoga for People Living with HIV/AIDS

For many people, yoga has proven to be a useful practice for healing ailments, sickness, disease, abdominal illness, and muscle problems, among other issues. While yoga cannot reverse the effects of certain illnesses, particularly terminal illnesses such as AIDS, yoga can help to reduce the effects of people ’s symptoms and extend the lifespan. Understanding how yoga can be used to benefit people living with HIV/AIDS in particular is critical in the search for ways to assist and empower such people.

The Human Immunodeficiency Virus (HIV) is the cause of the Acquired Immunodeficiency Syndrome (AIDS), a condition in humans in which the immune system begins to fail, leading to life threatening opportunistic infections. Such infections can be caused by a variety of factors, including bacteria, virus, fungi, and parasites. HIV infection occurs by transfer of blood, semen, vaginal fluid, pre-ejaculate, or breast milk. The four main routes of infection are unsafe sex, contaminated needles, breast milk, and mother-to-child transfer from pregnancy to birth. From 1981 to 2006, AIDS killed more that 25 million people, with 2.5 to 3 million people dying per year.

When HIV enters the human body, it attaches to CD4 white blood cells, also known as T4 cells, which are the body’s main disease fighters. CD4 cells are responsible for fighting infections and helping to prevent the body from falling sick. The damage of these cells can affect a person’s disease fighting capability and general health, which are consequences of the battle between the replicating HIV virus and the CD4 cells.

Most people living with HIV/AIDS experience a symptom free period that can last 10 years or more, during which they appear and feel healthy while the HIV virus attacks their systems. People with HIV often experience a flu-like symptom 3 to 6 weeks after acquiring HIV, which is often treated or misdiagnosed. Possible symptoms that develop after the symptom-free period include rapid weight loss, dry cough, recurring fear or profuse night sweats, profound/unexpected fatigue, swollen lymph glands in the armpits, groin, and/or neck, diarrhea lasting more than one week, white spots and blemishes on the tongue, mouth, and throat, pneumonia, red, brown, pink, and purple blotches of the skin under the mouth, nose, and eyelids, and memory loss, depression, and neurological disorders. Later symptoms include further rapid weight loss, easy bruising, long-lasting diarrhea, shortness of breath, pelvic inflammatory disease, severe and frequent infections, vaginal/yeast infections, unexplained bleeding from growths on the skin, rashes, numbness, and/or pain in the hands and feet, paralysis or loss of muscular stretch, and altered states of consciousness.   

Because regular asana practice can help contribute to a healthy immune system, it is important to understand how yoga can strengthen the immune system of people living with HIV/AIDS. Primarily, certain asanas can elicit a relaxation response that is good for countering the physical and psychological stress response that HIV/AIDS can place on the immune system.

A few precautions are necessary before people living with HIV/AIDS begin the practice of yoga. First, they must consult with a healthcare provider before practicing. Second, because fatigue can further weaken the immune system, it is important not to overextend the students and to avoid overheating. Third, if the students have a red rash, itching, or redness of the eyes, they should avoid overheating, full inversions and backbends. Fourth, students with CMV retinitis should avoid full inversions. Finally, students who have experienced pneumocystis should avoid unsupported backbends and the staff pose, as they may be stressful for the lung tissue.
Classical poses should be modified so that the muscles remain quiet and can relax easily. Classical, free-standing poses keep the body in alignment but require muscle action. To help students’ muscles to become more relaxed, props such as blocks, benches, towels, bands, belts, eye bags, and sandbags should be used.
Inversions (handstand, forearm balance, headstand, and shoulder stand) are particularly useful because they work on the immune system, particularly the endocrine glands. Another important gland these poses target is the thymus, which regulates the immune system and produces the hormones thymosins. Thymosins regulate white blood cells, particularly T-cells, control other hormones, and are important to the growth and aging process. The diagnostic tool for reading the effect of HIV on the body is the T-cell count. In the thymus, T-cells are transformed into fully functional thymus-derived T-cells. Open chested poses such as konasana (reclining bound angle pose) or setu bandha (bridge pose) over bolsters or a bench can help stimulate the thymus gland.

In developing and refining poses for people living with HIV/AIDS, Mary Pullig emphasizes relaxation. Breathing during the asanas should not compress the throat, hyperextend the neck, or hold tension in the abdomen. Students can use an elastic band to block light and sound, they should look downward to relax their eyes when their eyes are closed, and they should dress warmly. The teacher should assemble the props for the asanas. The poses should be held for 1 to 2 minutes, but they should gradually increase to 10 to 15 minutes each. Each pose should begin with a deeper level of relaxation that the proceeding one. Pullig recommends four poses. First is the reclining thunderbolt pose (supported supta vajrasana), which involves the person sitting back with his or her knees bent on a wooden block. Second is the bridge pose (supported setu bandhasana), which utilizes a low-bench, wooden blocks, a belt, and a blanket. The third and post powerful pose in the restorative process is viparit karani, or the inverted pose with the legs resting flat against the wall, the back supported by blocks, the shoulders supported by a towel, and a cloth folded over the head. This pose should not be practiced by those with glaucoma, high blood pressure, or those who are menstruating. The final pose is the shavasana (relaxation pose) with the head resting comfortable on a bolster and towels so that there is absolutely no tension in the neck. When teaching shavasana to students with terminal illnesses, it is preferable not to refer to it as “corpse pose,” as a reminder of death during yoga could prove to be a stressor.

The AIDS Alternative Health Project offers two types of sequences for supported and/or non-supported asanas. The first consists of the 1) handstand, 2) peacock pose (optimal only if student is strong enough), 3) supported downward dog (head supported by block), 4) headstand, 5) inverted staff pose, 6) supported bridge pose, 7) simple cross leg pose, 8) supported shoulder stand, 9) supported plow pose, 10) legs up the wall with the buttocks supported by blankets or bolsters, 11) supine bound angle pose (back and head supported by blankets), and 12) the supported relaxation pose. The second series includes asanas that are not full inversions:  1) supported downward dog, 2) supported head/knee forward bend (with the head supported by blankets), 3) 3-part forward bend, 4) supported half-bound lotus forward bend, 5) seated forward bend, 6) supported plow pose, 7) supported shoulder stand, 8) supported bridge pose, 9) legs up the wall, 10) supine bound angle pose, and 11) supported relaxation pose.

The purpose of the HIV sequence is to create a sense of empowerment and independence. Repeating the same program week after week minimizes confusion for students who come regularly and provides them with an idea of how they will feel at the end of a class. Past students of Paula Kout have reported the benefits of yoga to include listening more closely to the body, focusing on life rather than death, seeing results and positive changes from the beginning to the end of a class, feeling good about taking part in one’s own health, and gaining a sense of control and comradery. One student in the asymptomatic stage stated that “Yoga is the main thing that makes me feel good, besides emotional things I can do with a partner or being in love. I really feel it if I don’t have it every week. It is a big security blanket. Yoga does more for me than anything else I do. It helps me to slow down and look at life week by week, day by day, using what I have, not always wanting more, and learning to live in the moment.”
Yoga can be a useful tool for improving the quality of life for people living with HIV/AIDS. Past students have experienced transitions from fear, rigidity, and a sense of holding back to participation, fearlessness, and openness. Their sluggishness can disappear, as yoga facilitates their function and helps to release their tension. For people who are undergoing the parallel process of death, falling under any one of the stages of denial, anger, bargaining, depression, or acceptance, yoga can provide them with the power, energy, and release they need to live out the rest of their lives with significantly minimized stress and enhanced comfort. For someone facing something as serious as HIV/AIDS, such a development could amount to true bliss.

References:
Mary Pullig Schotz. Restorative Asanas for a Healthy Immune System.
Paula Kout. Yoga and AIDS.
AIDS Alternative Health Project.

Note - The views expressed in this article are solely the views of author and does not reflect the views and style of Yoga Vidya Gurukul.