Pre-fix: A guide for people with Hep C or HIV who inject drugs

Living as healthy as you can with Hep C or HIV

Get connected, get care

There are different reasons you might want to connect with other people or services. Emotional support, practical help and spiritual support from friends, family, counsellors and spiritual leaders such as Elders and ministers can make living with Hep C (hepatitis C) or HIV easier. Other people with Hep C or HIV can tell you about how they live with the virus on a day-to-day basis.

You should also see a doctor or other health worker regularly. Hep C and HIV are serious health conditions that require medical care. Hep C damages your liver and you cannot live without your liver. Severe damage, called cirrhosis, can lead to liver failure or liver cancer. HIV weakens the immune system, making it harder for your body to fight off infections. These infections can kill you.

Though you may not feel sick for many years with Hep C or HIV, the virus is still damaging your body. Having Hep C or HIV also puts you at risk for other health problems, including heart problems, diabetes and thyroid and bone problems.

The good news is that there is a cure for Hep C that works for many people and there are medicines for HIV that control the virus. By seeing a doctor or other health worker regularly you can live a long and healthy life.

If you want more info on services in your area, check out CATIE’s website www.catie.ca or call us at 1-800-263-1638 (we accept collect calls from prisons in Canada).

Eating healthy

Eating a healthy diet is one key way you can support your health. This can be hard if you don’t have a lot of money or if you don’t have a safe place to live, but there are some cheap ways to get the food you need.

  • Try to eat some fruit or vegetables every day. Fruits and vegetables are cheaper when they are in season. For example, apples and carrots are in season in the fall, and spinach and plums are in season in the summer. For some people, picking berries is part of their culture and a great way to eat more fresh fruit.
  • Try to eat some protein every day.  Inexpensive kinds include peanut butter, beans, eggs, tofu and canned fish like tuna. If hunting and fishing is something you do where you live or is a part of your culture, this can be a good way to get protein.
  • Bread and pasta are cheap and give you energy; look for whole-grain products, such as brown bread or whole wheat or rice pasta.
  • No fridge or stove? There are lots of foods that are healthy, keep for a while and don’t require much cooking, such as bread and bagels, peanut butter and nuts, granola bars, powdered milk, canned tuna or salmon, canned beans, raisins, bananas and apples.
  • When you are using drugs, drink high-calorie drinks like milkshakes, chocolate milk or soy milk. Eat as well as you can.
  • Plan ahead. Try to buy groceries that last a long time like oatmeal, peanut butter, canned soups and stews before spending money on drugs.
  • Ask friends, health workers and counsellors about food sources—they may know about soup kitchens, food banks, food share or food box services that give out free groceries.

If you’re having health problems like losing weight, feeling sick, throwing up or having diarrhea, check out A Practical Guide to Nutrition for People Living with HIV for practical tips. The guide also has a section on addiction and recovery.

“I eat really well. I sleep. I don’t go out and use every day. I saw a lot of my friends die – full-blown AIDS and they were still going out and using every night. All the people I used to hang out with are dead. So you come to the conclusion that eating, sleeping and not using every day is going to make you live longer.” Silke

Drinking water

Try to drink lots of water every day, especially if you’re drinking alcohol or taking ecstasy, cocaine or speed. This may not be easy if you do not have access to clean drinking water. Healthy juices or milk are good options in this case. Water can help your body process nutrients and makes getting rid of waste less work for your liver. Not getting enough water (dehydration) can make you feel tired. Alcohol, coffee and other drinks with caffeine (such as soda pop) don’t count because they actually make your body lose water.

Multivitamins

Multivitamins can give your body extra vitamins when you can’t eat healthy all the time. Check with your doctor before you start taking them. To save money you could buy a cheap store brand or check with a community health organization, clinic or pharmacy to see if they give them out for free. In some cases, vitamins are covered by public or private health insurance.

Exercising

Exercise increases your energy level and reduces stress. Start with something simple that you know you enjoy doing, like going for a walk, dancing or swimming in a public pool.

Sometimes people taking Hep C or HIV treatment feel really tired. If you feel this way, do simple stretches while sitting down or walk for a few minutes. Every little bit helps.

Some people already get lots of exercise every day. This is often true if you are homeless and walking a lot just to get around.

Sleeping

Sleep helps your body heal and fight infections. Drugs like crack, cocaine, speed and crystal meth make you feel more alert and good about yourself for a while, but they can also make it hard to sleep. Some Hep C or HIV meds can also affect your sleep. The stress of living with Hep C or HIV may cause sleep problems, too. Finally, people with Hep C who have severe liver damage tend to have more problems sleeping. Here are a few things that might help you sleep better.

  • If you are out partying, consider stopping your drug use a few hours before the party is over so you can sleep after.
  • If you are using for a stretch of time, try to limit the number of days you go without sleeping.
  • Try to go to sleep at the same time each night; this will help your body get into a rhythm of sleeping.
  • Try to create a ritual before you go to sleep, such as drinking a glass of milk, listening to relaxing music or reading a book. This will help remind your body that it is time to go to sleep.
  • If you have trouble sleeping for long stretches, take naps.
  • If you are sleeping outside, try to stay warm, dry and out of the wind. Try to keep your head, feet and hands covered.
  • If you are sleeping in a shelter, try to get there early enough to get a spot in a quieter area.
“Even if you are going to use, still take time out to eat and sleep, shower, right? Take care of life’s responsibilities, too.” Nancy

Drugs, alcohol and smoking

Drugs, alcohol and smoking are hard on your body. They can harm your liver and weaken your immune system. Living with Hep C or HIV means your body is already strained by the infection, so it’s especially important to take care of your liver and your immune system. Some people decide to change their drug use, drink or smoke less, or quit altogether once they find out they have Hep C or HIV.

Finding out you have Hep C or HIV might lead you to think about changing the way you use drugs. You might use less. You might switch to less harmful drugs, like marijuana (pot). You might talk to your doctor about substitution therapy, like methadone or buprenorphine. You might decide to stop using. Whatever your choice, know that there are people who can help you.

Drinking less alcohol is one of the best things you can do for your health, especially when you have Hep C. Not drinking also improves the chances of Hep C treatment working. If you want to make this change in your life, try different strategies to discover what works for you. You might:

  • Set a drinking goal you think you can manage and try to stick to it.
  • Space out alcoholic drinks with non-alcoholic drinks such as water.
  • Switch to smaller drinks or drinks with lower alcohol content (a three percent beer instead of five percent, for example).
  • Water down hard alcohol by mixing it with juice, soda pop or water.
  • Seek support through a support group, addiction treatment or counselling.
“Going down on alcohol is number one. It really kills your liver. I almost drank myself to death.” Nancy

Smoking is also very hard on your body. It can be hard to stop or cut back because nicotine in cigarettes is very addictive, but it is an important thing you can do to improve your health. If you want help to quit smoking or cut down, you can contact the Smokers’ Helpline, 1-877-513-5333.

Complementary therapies

Some examples of complementary therapies are acupuncture, massage, meditation and Aboriginal traditional healing practices, such as sweat lodges and medicinal herbs. Complementary therapies cannot cure your Hep C or HIV but they can help your liver and your immune system, reduce stress and help you manage the side effects and symptoms of the infection.

Some complementary therapies may be offered for free at community health organizations, networks for people who use drugs, or harm reduction programs.

If you want to take medicinal herbs or other supplements, check first with your doctor or pharmacist because some may interact with your Hep C or HIV medications. Your medications may stop working or the side effects might become worse.  

For more information check out Hep C and Complementary Therapies or  A Practical Guide to Complementary Therapies for People Living with HIV.

Taking care of your emotional health

Using drugs can cause emotional highs and lows. You may also face other things in life that upset your emotional health. Depression and anxiety happen to many people. Also, side effects from Hep C and HIV treatment can make people feel low (depressed) or anxious. There are ways to make the lows from using drugs easier to manage and ways to treat depression and anxiety. The most important thing is to know that you are not alone. Help is available. Talk to someone you trust.

Making the lows less hard. Some people who use drugs recommend preparing for the lows so that when you feel anxious or depressed you have a few things ready to take care of yourself. Apart from your dope kit, you could also create a “down kit” containing things that help you relax such as calming music, a funny movie, a recording of a meditation exercise or a special item that gives you strength. For some people, being in nature helps them to relax. Getting enough sleep, eating as healthy as you can, spending time with people who care about you and getting some exercise on a regular basis can also make the lows easier to manage. A peer or harm reduction worker can also talk with you about strategies for dealing with the lows.

Sometimes the lows can be really bad. If you are really down or feel like hurting yourself or killing yourself, talk to someone you trust about how you are feeling. Visit a doctor, community health organization, harm reduction program, emergency department, social worker or other place you feel safe to talk about your thoughts and feelings. It takes courage, but you can cope better with these feelings with a bit of help. You can also call the emergency phone number in your area (often 911).

Dealing with the mental health effects of treatment. Some HIV drugs can affect your mood. If you are on HIV treatment and you think it is affecting your feelings and mental health, talk to your doctor about what is happening. You may be able to switch to other HIV medications that don’t cause these side effects. Some people find that talking to a counsellor or social worker on a regular basis (talk therapy) can be helpful for treating depression and anxiety.

Depression is a potential side effect for Hep C treatment that includes peg-interferon. Treatments that include only direct-acting antiviral medications (DAAs) do not cause depression or anxiety. If you are going to take a Hep C treatment that includes peg-interferon and you have had depression, talk to your doctor. Treatment guidelines for Hep C suggest starting antidepressants before treatment with peg-interferon if there is a risk of depression

Dealing with pain

People with Hep C or HIV often experience pain at some point. Treating pain when you use drugs can be tough because you may have a high pain tolerance or because some doctors don’t want to give pain medicine to people who use drugs.

People who use heroin or who are on methadone or buprenorphine may have a higher pain tolerance and may need a higher dose of pain medication. Some doctors may assume that if you are on either methadone or buprenorphine you don’t feel pain, so they won’t give you enough pain medicine. If a doctor assumes that your pain is related to your drug use or thinks you are just looking for pain medicines to get high, he or she might not treat it.

If you are having trouble working with your doctor to manage your pain, try to talk to your doctor clearly and openly about the pain and your drug use. You might bring a friend, peer or healthcare worker with you for support. Take notes about what the pain is like, such as:

  • Where is the pain?
  • How bad is it on a scale of 1 to 10?
  • When does the pain happen?
  • When does it feel better?
  • Does it stop you from doing your daily tasks—for example, getting dressed, cooking or working?

If you have Hep C, be careful with acetaminophen (Tylenol). It can be hard on your liver and large doses could be a problem if you have a lot of liver damage. Talk to your doctor about what pain medications are right for you.