Hiv and physical activity – How and why to get get started

Hiv och fysisk aktivitet - vad gäller och hur kommer jag igång

The development of treatment for hiv has been fantastic. But despite that, people living with hiv still face worse health outcomes compared to the general population. What can we do to counter this and improve our health and well being? Turns out, quite a lot, and it starts with movement!

In our 30´s our bodies begin to age. The biological aging process makes the cells in our bodies slower and less fit. From the reproductive system to our skin, muscles and senses, most of our bodily functions become affected. The aging process also affects cognitive abilities which can result in changes in mental health. How fast and in which way we age hinges on genetics, our environment as well as way of living.

Today we know that almost any physical activity has a positive impact on our health and slows the aging process, even when physical activity is initiated at an older age. In other words, there is no best before date to get started with some exercise.

Living with hiv and general health

The ability and function of the heart, lungs and muscles is often referred to as cardiorespiratory health. In people living with hiv, cardiorespiratory health is in general worse compared to people not living with hiv (1). The exact reason behind this is not fully known, but there are signs of a faster aging process, commencing earlier, in people living with hiv (2). A number of studies has shown that the aging process starts 5-10 years earlier in people living with hiv, resulting in an earlier onset of common aging disease such as diabetes, cardiorespiratory disease and certain cancers.

The good news is that we do have ways to both slow down the aging process and decrease the risk of early onset of aging diseases.,Whether it’s in a gym or just in everyday life, physical activity is something that most can do and fit into their lives.

What impact does physical activity have on the health of people living with hiv?

Just like with anyone else, physical activity improves the health in people living with hiv. Increased lung capacity, ability to absorb oxygen and mobility are some of the effects that have been proved when people living with hiv start with some form of physical activity. Both aerobic activity (for example brisk walking and bicycling) and resistance training (for example weight training and swimming) has shown to have similar effects(3). Other benefits of physical activity is more of the healthy cholesterol and less of the bad cholesterol. Since certain hiv medications can increase lipids and fat in the blood physical activity works as a great counter measure (4).

Physical activity has also shown positive impact on overall well being and quality of life in people living with hiv. In one study, a group of people living with hiv that currently did not exercise started on a three times a week training regimen. Compared to a group that did not start exercising the group that did exercise showed improved quality of life as well as less anxiety and depression (5).

Even the sleep can be improved by physical activity. Bad, interrupted or too little sleep are often one of the causes of fatigue, which in turn can lead to decreased or no physical activity. However,pPhysical activity should not thou be thought of the holy grail to insomnia. Stress, socio-economic status, mental health, hiv in itself or medications can all impact your sleep (6).

What type of training should I aim for?

All types of physical activities are beneficial, but there are some differences in how and in what way certain types of physical activity improves our health. The best effect however, is a combination between aerobic activity and resistance training and in general, the higher the intensity, the better effect (7). One should of course be cautious to not sustain injuries and gradually increase the intensity.

How do I get started?

Being shameful of our bodies, our health and ourselves can be barriers preventing to get started. But with support, cheers and a sense of everyone started out as at some point, can help.

Studies have also shown that a training buddy, or someone who checks in on the progress, increases the chances to continue sticking to the training. Could a friend with hiv, a neighbor, relative or maybe someone at the gym be your go to person to talk to? Another method is to get a prescription for physical activity from your doctor and let a health professional follow your progress.

Three final advice

  • Find a type of physical activity that feels good for you. Test and try, be brave and experiment to find out.
  • Get together – train, cycle, walk or just talk about your own ambitions and progress with someone to share your experiences and be proud of every small step forward!
  • It’s never too late – if you haven’t started yet you have the most to gain!

If you are having a hard time getting started, or maybe the motivation isnt really there? Get in touch and let’s talk how to get going!For further reading, check this article which summarizes many of the most important points in this article:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6124952/

References:

  1. https://journals.lww.com/aidsonline/Abstract/2019/05010/Cardiorespiratory_fitness_is_associated_with.10.aspx
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3413877/
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5997336/
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6124952/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6323156/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266344/
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5997336/
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6318073/
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7089845/

Free training at Friskis & Svettis for members!

Positiva Gruppen Syd offers all members free training at Friskis & Svettis. Choose whatever activity you would like, for example swimming, gym och a group session, and train whenever you like!

You can access any of the 7 facilities owned by Friskis & Svettis in Malmö. If you are living elsewhere, let us know!

Get in touch with us and we will arrange the membership needed at Friskis & Svettis, after that you are good to go and can start training!

Not yet a member in Positiva Gruppen Syd?

Read here how to become a member for only 100 kr per year and get more benefits: https://www.pgsyd.se/en/become-a-member/

Update of pgsyd.se – Welcome to our new website!

After four years it was time for a change. With the new website we hope to be able to deliver knowledge and information for all people living with or affected by hiv in southern Sweden. We have created a whole new design and layout, which hopefully makes it both easy intuitive to find whatever you are looking for in terms of hiv, regardless if you are reading this from a mobile phone, tablet och desktop computer.

Compared to our old version, all the content has been either updated or replaced by new content. We also hope the themes and topics we choose to include feels relevant and provides an image to what hiv is in 2020. A major new feature is the addition of English language, all pages in Swedish are also available in English.

The coming months will be spent to tweak, update and iterate where needed. If you have feedback or just want to ask something, feel free to reach out. We hope you enjoy the site and finds answers to your questions, otherwise we are available on the chat or just send us an email info@pgsyd.se

Moving to Sweden with hiv – what you need to know

Moving to a new country can be taxing, moving countries with hiv can be even more difficult and require additional planning and knowledge. In this article we will present a broad overview of what you need to know when moving to Sweden with hiv. The article starts with a general background of hiv and healthcare in Sweden, laws related to hiv in Sweden and finally immigration to Sweden with hiv, including work and studies.

The information in this article is accurate as of 30th of April, 2020. If in doubt, always consult a legal party to gain up to date information or contact us. (Article updated july 2019 in wake of the new announcement from Folkhälsomyndigheten/Swedish public health authority)

The Swedish healthcare system and hiv

Sweden offers universal healthcare. In practice this means healthcare is available as a right to all citizens, and in many instances also for people permanently or temporary residing in Sweden (more on this later). Hiv testing, treatment and care is generally incorporated in the division of infectious diseases at hospitals and Hiv care is offered at most major hospitals in Sweden’s 21 counties.

For persons living with hiv in Sweden, check ups on eg. viral load and cd4 is usually done every 6 months for stable patients, and in some cases even less frequently. The infectious disease doctors, who normally treats persons living with hiv, can together with the patient decide the frequency of checkups. Normally lab work is done a couple weeks ahead of the appointment with the infectious disease doctor, thus every checkup round requires two visits to the hospital. Both visits are by appointment only.

All hiv medicine are prescription only in Sweden, and persons living with hiv usually receives a one year prescription and are able to refill once every 3 months. Medicines needs to be pre-ordered as they are rarely kept in stock in smaller local pharmacies, and can be either sent to a nearby postal service or to the nearest state run pharmacy (Apoteket).

Healthcare in Sweden is governed through a separate legislative county level body called ”Landsting”. In Sweden there are 20 of these and all run their own budgets. Local management, governance, doctors mandate and differences in county interpretation of laws might cause some differences in how patients experience hiv care.

Laws regarding hiv in Sweden

According to the Swedish Communicable Diseases Act, individuals who might suspect they contracted hiv are obliged to consult a doctor and test for hiv. Sweden also requires all persons living with hiv to adhere to a set of rules which in practice means that when there is a situation, even theoretically posing a risk for transmission, persons living with hiv needs to disclose they are living with a “blood borne infection”. These situations includes dental work, drawing blood, getting a tattoo, using syringes and all forms of sex, even while using a condom. (New rules as of July 2019, see further down)  The rules should be thought of in conjunction with the level of prosecution for hiv-related offences in Sweden, which historically is and has been very high compared to other western countries.

Although these laws still are in effect, increased understanding of transmission while on treatment and the concept of TasP (Treatment as Prevention) has incurred changes. Since 2013 infectious disease doctors has the mandate to void the need to disclose when engaging in sex. This applies for individuals following treatment guidelines, meaning taking their medicines as prescribed, showing an undetectable viral load for at least six months and being free of other sexually transmitted diseases. Condom use is still required, and only the need to disclose is voided.

Moreover, a ruling by the Supreme Court in 2018, acquitting a person living with hiv on the count of “creating a danger to another”, despite having unprotected sex, in effect established that the risk of transmitting hiv while on treatment is too low to be considered a risk judicially.

As of 2019 new rules are under revision and is expected to decrease the legal burden on persons living with hiv and generate greater freedom.

Update July 2019:

Folkhälsomyndigheten (Swedish public health authority) announces  that there is no risk of transmitting hiv, when people living with hiv are undetectable and on a stable treatment regimen, when engaging in unprotected sex. The infectious disease guidelines that are given to people with hiv whom are undetectable and on a stable treatment regimen has been revised. The new guidelines does not include an obligation to disclose status, even when having unprotected sex. Hence, the use of a condom is no longer required.

For more information:

Announcement from Folkhälsomyndigheten:

https://www.folkhalsomyndigheten.se/nyheter-och-press/nyhetsarkiv/2019/juni/ingen-risk-for-hiv-via-samlag-om-behandlingen-ar-valinstalld/

Infectious disease guidelines for hiv:

https://slf.se/smittskyddslakarforeningen/app/uploads/2019/07/hiv-pat-med-valinstalld-behandling-190703-korrekt-titel.pdf

Children with hiv

Childcare is a right for all children in Sweden and they can start pre-school from the age of one. For children living with hiv, the status does not affect this right whether it is preschool or higher education. Regarding possible disclosure of hiv status eg. “blood borne infection”, it is not required by law to disclose this information prior to entering preschool. When entering preschool, healthcare journal requisition is optional and the guardians can opt out of having it transferred when entering preschool. However, it is the responsibilities of the guardians to see that your child adheres to the guidelines set by the Swedish Communicable Diseases Act, thus to prevent transmission.

Nonetheless, for children entering  preschool it is a common recommendation for guardians to inform the preschool manager about the status. If further personnel is to be informed it is in consultation with guardians and  your doctor. When starting school it is the school health team, thus the school doctor and nurse who should be informed. Regarding disclosure of status it is always you as guardian who decide who, or if to inform.

For children living with hiv there are a number of hiv related educational activities and social gatherings such as ”Barnhiv Centrum”. With the aim of providing an inclusive environment for children living with hiv where knowledge, social development and friendships can be gained. 

Immigration to Sweden and hiv

Sweden does not ban entry or stay based on hiv status, and your hiv-status will not influence your immigration process, whether you are visiting for a few weeks, moving for work, or immigrating to stay with a Swedish spouse.

For individuals seeking asylum in Sweden, a basic healthcare check will be offered, inclusive of hiv testing. The outcome of the test does not influence the immigration process or the decision by the Swedish Migration Board, irrespective of granting asylum or not.

Access to treatment and costs

For eu-citizens moving to Sweden

Hiv treatment for eu-citizens residing in Sweden is regulated by the European Union and is generally free of charge. If you misplace or lose your medication you are entitled to substitution medicine. However, all hospitals might not stock all brands of hiv medicine,so getting ahold of your hiv medicine on the spot might become an issue.

For non-related hiv issues that are deemed ”non-essential”, care might not be offered for free. If visiting a health care facility, the practitioner will assess how essential the need for care is and depending on the circumstances care might be offered free of charge. The objective with the guidelines of providing essential care is to make visitors feel safe and medically taken care of while they are staying in Sweden. Essential care should ensure that a planned stay in Sweden is not cut short because of a medical need.

As a eu-citizen you should carry and be able to present your European healthcare insurance card at health care facilities and hospitals. This is to avoid having to pay any medical fees upfront. In the case you are not carrying the card you might have to pay a fee, although these fees would be reimbursed by your EU-country, nontheless you would still need to claim the cost back by yourself. A check will also be performed to make sure that the care given in Sweden is covered by your healthcare plan policy in your home country.

For non-eu-citizens moving to Sweden

In general, if you have received a permission to stay that is less than 1 year, you won’t be able to obtain a personal identification number and receive healthcare as citizens or people insured in the Swedish social security scheme. However, hiv-treatment due to its importance for sustaining life and lowering transmission will be offered once in country, there might be shorter prescriptions than 1 year, and refills might be only monthly due to the temporary nature of the stay. For non-eu citizens that has received a permission to stay longer than 1 year, a personal identification number can be obtained and healthcare is offered on the same level as citizens.

For asylum seekers and non-documented immigrants

Non-documented and non-eu immigrants with a permission to stay is entitled to hiv treatment free of charge according to the law. Some differences, such as shorter refills and pickup at hospital might occur.

It should be noted that the county level management of hospitals and interpretation of the law does influence the level of care and procedures surrounding hiv-care for immigrations, especially asylum seekers, non-documented immigrants and non-eu citizens.

Moving to Sweden for work

There is no mandatory hiv testing in Sweden to obtain a work permit but for certain professions persons living with hiv are barred from taking up employment, this relates mainly to work in the military branches. Other professions such as flight attendants, surgeons and police officers, although not explicitly excluding persons living with hiv has at least anecdotally direct or indirect discriminated against people living with hiv.

As a rule of thumb, even if employers are asking for health information, it does not relate to ones legal right to work in Sweden. Discriminating people living with hiv based on hiv-status alone is illegal.

Moving to Sweden for studies

Hiv does not pose a barrier to study or obtain a visa to stay based on studies.

In summary: Hiv does not pose a barrier moving to Sweden and hiv treatment will be offered, if its needed, to anyone, regardless of immigration status. However, obtaining a personal identification number can make the experience living with hiv in Sweden better and easier. Whether this is done through a longer permission to stay, work or other arrangements, the personal identification number grants clarity for both the health care staff in how to service you as the healthcare offered would be on par with what a Swedish citizen receive. The laws concerning hiv and people living with hiv, can be tricky, there are several rules to adhere to, and although there are signs of change, Sweden still has a history of prosecuting and criminalizing hiv. Thus, living well with hiv in Sweden requires one to stay on top of both rules, and one’s own health.

New reports of hiv and Covid-19 from New York and Barcelona

In the city of New York data has been compiled for 5 700 patients admitted to hospital with confirmed Covid-19 between March 1st and April 1st. 0,8% of the admitted where confirmed to also be living with hiv. I the city of New York approximately 1,3% lives with hiv, which suggests that people with hiv is not any more likely than the general population to contract or get severely sick from Covid-19. The outcome of the admitted patients with hiv was not reported, for the full read see: https://jamanetwork.com/journ…/jama/article-abstract/2765184

A study from Barcelona reports five people in the ages 29-49 living with hiv in a study among 543 patients admitted to hospital with confirmed Covid-19. One person was living with undiagnosed hiv (cd4 levels just north of 100) and two were living with additional underlying disease. After care, where two of the admitted were considered severe cases, four of the five were released from hospital. One person remains in hospital. The person with undiagnosed hiv, which had the lowest cd4 cell count were one of the released. Researchers underlies the need for more data and studies for older people with hiv as knowledge about older people living with hiv and Covid-19 is lacking. .
Read the full study here: https://www.thelancet.com/…/la…/PIIS2352-3018(20)30111-9.pdf

The reports confirmed what has earlier been documented by IAS and the cases with hiv and Covid-19 in China and Switzerland, hiv does not seem to be a riskfactor to contract nor develop a more severe illness due to Covid-19. However, future studies might show otherwise so take precautions and protects yourself and others. Feel free to reach out to us if you have the need to talk or want to know more.

Does people living with hiv get more sick with Covid-19?

Many are worried about how the novel coronavirus might affect people living with hiv. To sum up, at this stage there are few reports and the data is fairly thin, but nothing points to people living with hiv becoming more severely sick compared to people not living with hiv. This conclusion is based on data from IAS(International Aids Society) presented yesterday. The cases reported were people living with hiv and being admitted to a hospital with confirmed corona infection were as follows:

– 4 people in Switzerland aged 55 to 79. Three out of four had underlying risk factors in addition to hiv. One out of the four were in need of intensive care, the others received standard care. Two (including the person previously in intensive care) have been released from the hospital and two remains in care.

– 6 people from China. Several had low CD4 counts and also underlying health complications/risk factors in addition to hiv. All presented only with mild symptoms and have been released from hospital after successful recovery.

Anecdotal cases from Sweden has also shown successful recoveries. However, any official data on people living with hiv and confirmed corona has yet to be public.

We continue to monitor the situation and will update our channels as soon as more information becomes available. We recommend everyone at this point to follow precautions outlined by the health authorities and protect their own and others health.

For more information from the IAS:

https://www.iasociety.org/…/Cross…/COVID-19-and-HIV-Webinars

Living with hiv in southern Sweden

Are you living with HIV? If you just found out or have been positive for some time – Welcome to Positiva Gruppen Syd! We are an organization for people living with or affected by HIV in the south of Sweden. 

We are based in Malmö and arrange monthly activities for those of us with HIV in southern Sweden. We serve Malmö, Lund, Helsingborg, Kristianstad, Halmstad and other communities in the regions of Skåne, Halland, Blekinge and Småland.

Besides our activities it can be nice to just know there is someone to talk to and having a friend living with hiv can feel good. We have a network of people living with hiv so through us you can meet and interact with other people living with hiv. You might want to talk about your experience or just listen to gain the advice from someone else, you decide! If you have specific questions, great, if you just want to get to know us, thats great too. Feel welcome and free to be whomever you are!

To give you an idea of what we are offering in terms of activities, below is a list of some of the events we arranged last year and a few of the most frequently asked questions.

Example of previous activities in 2019

Christmas dinner – Thursday 19th december

Eat and be merry together in true Christmas spirit! We host a Christmas dinner starting at 5pm until the food is finished or everyone has gone home. Feel free to drop in anytime, to drink we serve the classical Julmust! Drop us a message to let us know you are coming and notify if any food-allergies so we have time to prepare alternatives.

Beauty and the Beast – Wednesday 11th december

Join us for an evening at Malmö Opera, we have 5 tickets up for grabs for the show starting at 19:00. Sign up by contacting us!

World Aids Day – Sunday 1st december

Public lecture by a famous Swedish TV personality on the theme overcoming obstacles, followed by debate where we discover similarities and differences between hiv and diabetes and cancer. Starts 15:00 at Scandic Triangeln, Malmö. Reserve seat by contacting us.

“Whats your experience with hiv?” – Saturday 9th November

Workshop in our office in Malmö to develop a message to use in campaigns aimed at increasing the knowledge of hiv among the public. Share your thoughts in what should be included and addressed. Following the workshop we jointly walks to a nearby spa and gets a professional massage. The day ends with dinner at a nearby restaurant.  Only 5 slots due to capacity constraints, grab your seat by contacting us.

Visit to Kafé Knud in Copenhagen -Friday 25th October

We meet at 16:30 and hop on the train to Copenhagen to visit HIV Denmark for a joyful “open house”. Mingle, network or just relax, usually there’s some entertainment (singer-songwriter etc) to check out. We cover the travel expenses and cost for dinner. Let us know if you would like to join by contacting us October 22 at latest.

Since we are in the midst of the corona pandemic, most of our group activities for 2020 are however on hold. We do keep our meeting space open if you would like to drop by for a coffee and chat. Feel free to reach out, we are always open to connect.

Frequently asked questions

I don’t live in Malmö, can I still join one of your activities?

Positiva Gruppen Syds office and meeting space is in Malmö but caters to everyone living with hiv in southern Sweden. The area in which we operate spans from Trelleborg in the very south all the way to the border of Småland in the north. We also cover Blekinge and Halland districts. We offer to cover travel expenses paid for people not living in Malmö as a way to ensure the support we provide is accessible regardless of home address.

What type of people can I expect to meet in your organization/activities?

We are open to all people, regardless of nationality, ethnicity, gender, sexual identity or any other differences. Our activities largely attracts a rather diverse group of people. We mostly speak Swedish, but if you don’t speak Swedish or just starting to learn, don’t hesitate to join, we often have other non-Swedish speaking participants!

Can I visit you in private and talk one-on-one?

Absolutely, let us know and we’ll try to accommodate and set up a meeting. Peer-support is a central part of who we are and what we do.