Everyone deals with a certain amount of stress every day. But if you are a woman living with HIV (HIV+), stress can become overwhelming. Long periods of high stress can damage your immune system and cause physical and emotional illnesses. Research has shown that stress can accelerate the progression of HIV.

In the US, recent studies have shown that HIV+ women are five times more likely to have post-traumatic stress disorder (PTSD) and two times more likely to have survived domestic violence than women in the general population. In addition, HIV+ women who experienced recent trauma were four times more likely to fail to adhere to their HIV drug regimens and have higher viral loads than HIV+ women who did not.

You will be able to manage stress better if you recognize the symptoms. Below is a list of some common symptoms. It is important that you tell your health care provider if you experience any of these symptoms, since some may have causes other than stress (e.g., side effects of medications or HIV).

• Allergies
• Change in appetite
• Back pain
• High blood pressure
• Breathlessness
• Chest pain
• Clammy hands
• More colds than normal
• Constipation
• Diarrhea
• Dizziness
• Fatigue
• Headaches
• Racing heartbeat
• Muscle tension
• Nightmares
• Rashes
• Restlessness
• Sleeping problems
• Stomach aches

• Anger
• Anxiety
• Denial of a problem
• Difficulty making decisions
• Loneliness
• Nervousness
• Feeling powerless
• Feeling rejected
• Feeling trapped
• Feeling unhappy for no reason
• Being easily upset
• Worrying frequently

• Increasing use of alcohol, tobacco or other drugs
• Neglecting your physical appearance
• Arguing with friends or family
• Avoiding tasks and responsibilities
• Difficulty concentrating
• Crying easily
• Being late to work
  
• Eating too much or not enough
• Snapping at people
• Watching more TV
• Withdrawing from family and friends

What are some of the things that can make you feel stressed?

• Health problems in the family
• Dealing with HIV drugs
• Financial difficulties
• Children and childcare issues
• Substance use (also often used to manage or deal with stress)
• Social isolation
• Disclosure issues
• Insurance worries
• Housing concerns
• Fatalism (focusing on death and dying)
• Chronic impatience
• Grief
• Absence of purpose and goals
• Lack of self-assertiveness
• Lack of support
• Poor coping skills
• Poor eating habits and nutrition
• Sleep disturbances
• Inadequate exercise
• Limited ability to care for yourself when sick
• Limited understanding of HIV-related health issues
• Poor relationship with your health care provider

Stress often results from feeling that things are out of control. While you may not be able to remove what stresses you, it can be very helpful to begin to accept that you are human (not ‘superwoman’), understand that you need help, and find the resources that can help. That way, even if you have a lot on your plate, you will feel better able to cope with it. Make a list of the following:

• Areas in which you feel overwhelmed and need help
• Who or what can help
• How to get available services

Some cities publish books on resources and agencies that are available to the public. Some towns have an information and referral service that can help. Often a caseworker or advocate at an AIDS service organization can help you sort through the information.

What kinds of free or low cost services can help with stress? It depends on where you live, but some of them include: medical services, counseling and psychological help, child care, taxi rides, bus passes, acupuncture, yoga classes, community college classes, massage, support groups, HIV+ dating services, free computers, legal services, drug and alcohol programs, etc.

Apply to as many programs, agencies, or services as you can, and do not feel guilty about accepting money or services. That is why they are there. If there are limits to the number of services you can receive from a certain agency, choose the most important or necessary services first. It may take some time to fill out and process all the paperwork, but it will be worth it in the long run.

It is important not to forget about friends and family. If someone offers help or asks you what you would like for a holiday or your birthday, speak up! If what you really need is someone to watch the kids for a weekend or help pay your rent, ask. The worst that can happen is they will say no.

Another key to dealing with stress is learning the value of self-care. Sometimes women consider it ‘selfish’ to take time to exercise, get a massage, or talk with friends when there are so many other important things to do. But if you become overwhelmed by stress, who will tend to your responsibilities? Many HIV+ women are too busy caring for kids or partners to notice that they are “burning out” mentally, physically, or emotionally. Try to find a balance between giving and receiving help. (Note: We also encourage you to visit A Girl Like Me, an online support community for HIV+ women.)

Long periods of high stress can lead to depression. Sleep problems, changes in appetite, low sex drive, decreased energy, loss of interest in activities, feelings of guilt or worthlessness, difficulty concentrating, and thoughts of killing yourself are all symptoms of depression. Depression is often undiagnosed and untreated in HIV+ people because many of the symptoms are common to HIV disease or HIV drugs.

Over half of all people living with HIV experience depression at some point in time. Women are twice as likely as men to become depressed, regardless of their HIV status. Making sure you are mentally healthy is important, as depression can be a major reason that HIV+ people do not take their HIV drugs regularly. Depression can be treated through therapy (individual or group), medications, or alternative therapies. If you think you are depressed, talk to your health care provider.

Everyone has different stressors in their lives and everyone finds different methods effective in dealing with those stressors. Look for stress-reducing techniques that work for you. Here are some ideas:

• Talk about it: a friend or family member may help you sort out your feelings and get a new perspective on problems
  
• Join a support group (also visit A Girl Like Me, our online support community for HIV+ women)
• Get regular physical activity
• Change your own outlook and actions, rather than trying to change others
• Keep a journal
• Practice assertive communication (learn how to say no to things you do not want to do and yes to things you do want to do)
• Get enough sleep: most people need about six to nine hours of sleep at regular times
• Take a break and treat yourself
• Practice hypnosis, biofeedback or massage to relieve tension
• Listen to music
• Try relaxation techniques such as meditation, deep breathing, or visualization: recent studies suggest that mindfulness meditation may prevent CD4 cells from decreasing when an HIV+ person is under stress.
• Eat healthfully: fuel your body with good foods that will help it to remain strong; for more information, see Nutrition and HIV
• Remind yourself of your accomplishments
• Try to find the positive aspects of change
• Try to look back on a crisis as a learning opportunity

See your health care provider to talk about stress and how it affects you. It is not a sign of weakness to care for yourself, mentally or physically. Consider seeing a therapist or counselor if stress gets out of hand.