Table 1.
Overview of Studies on CAM Use among HIV+ Individuals
| First author (year) |
Sample | Method | % CAM Users |
Most Common Types of CAM (% of sample) |
Findings |
|---|---|---|---|---|---|
| Agnoletto, V. (2003) | Convenience sample: n = 632 Europeans (65% male) | Quantitative: Self-administered survey | 100%b | Nutritional supplements (20%) Mind-body (18%) Herbal remedies (10%) Acupuncture (5%) Homeopathy (4%) |
N/A |
| Anderson, W. (1993)a | Clinic sample: n=184 (94% men) | Quantitative: Self-administered survey | 40% | Immune-enhancement agents (83%) Dietary modifications (42%) Imagery (41%) Bodywork (41%) Religious healing (including prayer) (39%) Vitamins (30%) |
CAM use more common in MSM and those with longer HIV disease duration |
| Bates, B. R. (1996)a | Clinic sample: n=287 (76% men) | Quantitative: Self-administered survey | 31% | Vitamins & Minerals (80%) Imagery & Meditation (37%) Herbal therapy (21%) Massage (12%) Non-prescribed prescription medication (8%) |
CAM use more common in women, Caucasians, and those with more than high-school education |
| Bica, I. (2003) | Convenience sample: n=642 (75% male) Surveys completed: n=2000 (unit of analysis was the survey, not the participant) |
Quantitative: Survey completed every 6 months for 4 years | Ingested CAM use reported in 60% of surveys |
B-complex stress formula (28%) Antioxidants (27%) Garlic-based products (18%) Ginseng-based supplements (10%) Glutamine (9%) Protein powder preparation (8%) |
Ingested CAM use more common among MSM, people with more education, and those who have secure housing Prevalence of ingested CAM use decreased from 71% to 52% from 1995 to 1999, whereas prevalence of HAART use increased from 0% to 70% |
| Burg, M. (2005) | Clinic sample: n=226 (100% male) | Quantitative: Method of data collection not specified | 64% | Meditation (32%) Dietary supplements (31%) Faith healing (20%) Massage therapy (18%) Herbs (17%) Megavitamin therapy (15%) Chiropractor (11%) Acupuncture (6%) |
CAM use associated with more disability days in past 4 weeks, more visits to clinician, lower role and social functioning, and higher scores on health-promoting lifestyle profile |
| Carwein, V. L. (1997)a | Clinic sample: n=127 (87% male) | Quantitative: Self-administered survey | 100% | Self-help (63%) Touch Therapies (50%) Relaxation (49%) Spiritual (28%) Ingested CAM (28%) Diet (22%) |
N/A |
| Chang, B. L. (2003) | Clinic sample: n = 182 (60% male) patients receiving HAART | Quantitative: Semi-structured interview | 88% | Religious activities (79%) Herbs, Vitamins, or Nutritional Supplements (67%) Physical/Body-mind therapy (37%) |
Use of physical and mind/body therapies associated with self-reported HIV-treatment related symptoms (e.g. difficulty sleeping, stomach pain, nausea) |
| Colebunders, R. (2003)a | Two community-based cohorts recruited from 8 European countries: 1995-97: n = 1161 1998-99: n = 899 |
Quantitative: Self-administered survey | N/A | Percentage of users for each cohort: Vitamins/minerals (58%; 63%) Herbal products (25%; 20%) Homeopathy (21%; 15%) |
In analyses that combined both cohorts: use of homeopathy associated with longer time since HIV diagnosis and lower CD4+ count and use of herbal products associated with longer time since diagnosis and more advanced disease stage. |
| de Visser, R. (2002) | Community sample: n = 924 Australians (91% male) |
Quantitative: Self-administered survey |
55% | Vitamin, mineral, nutrient supplements (46%) Massage therapy (28%) Meditation (20%) Herbal Medicine (19%) Acupuncture (8%) |
CAM use more common among females, those who have more education, a major co-morbid health condition, read HIV/AIDS media, and spend more time with other HIV+ individuals CAM use associated with more favorable attitudes toward CAM and less favorable attitudes toward HAART |
| Duggan, J. (2001) | Clinic sample: n=191 (88% male) | Quantitative: Self-administered survey | 67% | Lifestyle change (38%) Diet change or dietary supplements (37%) Megavitamins (24%) Massage (24%) Prayer therapy (22%) Acupuncture (19%) Yoga (19%) Chiropractor (15%) |
CAM use associated with income greater than $15,000 per year and discontinuation of HIV medication for any reason |
| Fairfield, K. M. (1998) | Clinic sample: n=180 (87% male) | Quantitative: Structured Phone Interview | 76% | Supplements (68%) CAM providers (45%) Marijuana (24%) |
CAM provider use more likely among respondents who have a college and those who experience HIV-related fatigue Marijuana use associated with HIV-related weight loss Supplement use associated with HIV-related memory impairment |
| Foote-Ardah, C. E. (2003) | Convenience sample: n = 62 (74% male) | Qualitative: Semi-structured interview | 65% | Not specified | Reasons for CAM use included management of HIV-symptoms, HAART side effects, and need to increase sense of control over HIV treatment |
| Furin, J. F. (1997)a | Community sample: n=26 (100% MSM) | Qualitative: Semi-structured interviews | 65% | Not reported | AIDS activism identified as a major force in disseminating information about CAM in HIV+ MSM |
| Furler, M. D. (2003) | Canadian clinic sample: n =104 (53% male) | Quantitative: Semi-structured interview | 89% any CAM or vitamin 77% not including vitamins |
Vitamins & Minerals (89%) Activities (64%) Naturopathic products (39%) Practitioners (38%) |
Use of any CAM is more common among female respondents Use of CAM activities is more common among respondents who are female, unemployed, receiving disability benefits, and report more overall drug use Use of CAM providers is more common among respondents with more education and higher viral load |
| Gillett, J. (2001) | Community sample: n=46 (78% male) | Qualitative: Semi-structured interview | 100%b | Not specified | Social background characteristics and stigmatizing experiences related to sexual identity and HIV status, cultural background, gender, and drug use history were identified as important themes guiding decisions to use CAM and conventional HIV treatments. |
| Gore-Felton, C. (2003) | Community and clinic sample n = 179 (54% male) |
Quantitative: Self-administered survey | 67% | Multivitamin (50%) Acupuncture (31%) Meditation (28%) Massage (23%) Mineral Supplements (17%) Chinese herbs (12%) |
CAM users more likely to be female, Caucasian, and less depressed (CES-D) |
| Hsiao, A. (2003) | HCSUS sampled n = 2466 (78% male) | Quantitative: Computer-assisted interview | 53% | Non-Ingested: Relaxation (22%) Spiritual Healing (21%) Self-help (16%) Massage (14%) Acupuncture (6%) Ingested: Herbal Medicine (15%) Megavitamins (13%) Unlicensed drugs (5%) Folk remedy (4%) Homeopathy (3%) |
Ingested CAM use (22%) more common among participants who are white, male, and more educated Use of CAM as a substitute for traditional treatment (2.5%) associated with a greater desire for involvement in medical decision-making and belief that antiretroviral medication is “definitely not worth taking” |
| Jernewall, N. (2005) | Community-based sample: n=152 (100% Latino MSM) | Quantitative: Self-administered survey | 80% | “Asian” CAM (72%) Plant-based CAM (42%) “Latino” CAM (13.5%) |
Use of Latino and plant-based CAM associated with having AIDS diagnosis Users of Latino CAM were less likely to attend medical appointments, follow physician advice, and had lower rates of adherence for past 3 days Users of plant-based CAM also had less overall adherence to traditional HIV medication |
| Kirksey, K. M. (2002) | Convenience sample: n = 422 (71% male) | Quantitative: Self-administered survey | 36% | Mind-body interventions (54%) Biological-based therapies (53%) Alternative medical systems (40%) Exercise/Yoga/Tai Chi (34%) Manipulative and body-based methods (7%) Energy Therapies (<1%) |
CAM use more common among respondents who were female or African-American (compared to Caucasians and Hispanics) |
| Knippels, H. (2000)a | Community and clinic sample: n=70 (100% MSM) | Quantitative: Self-administered survey | 71% | Food supplements (63%) Homeopathy (21%) Herbal medicine (17%) Yoga, meditation, imagery, massage (16%) Acupuncture (6%) |
CAM use associated with disease stage (symptomatic patients use more CAM), use of active coping, use of emotion-focused coping, and lower levels of self-reported pain (MOS- pain) |
| Langewitz, W. (1994)a | Clinic sample: n=100 (76% male) | Quantitative: Self-administered survey | 56% | Supportive counseling (23%) Homeopathy (22%) Vitamins (13%) Herbs (9%) Meditation (9%) Relaxation therapies (9%) Massage (8%) |
CAM use associated with higher anxiety and depression scores and lower ratings of perceived efficacy of conventional treatments |
| London, A. S. (2003) | HCSUS sampled n=2864 (78% male) | Quantitative: Computer-assisted interview | 15% | Types of alternative therapists were not specified |
Use of alternative therapist more common among gays/lesbians, higher income earners, and residents of northeast and west (compared to south) |
| Mikhail, I. S. (2004) | Clinic sample: n=391 (100% women) | Quantitative: Self-administered survey | 59% | Vitamins (36%) Religious Healing (27%) Dietary Supplements (22%) Herbs (16%) Bodywork (10%) |
CAM use associated with higher education, no health insurance coverage, longer disease duration, higher number of HIV-related infections |
| Nicholas, P. K. (2002) | Patients with HIV-related peripheral neuropathy: n=49 (71% male) | Quantitative: Self-administered survey | 69% | Massage, Acupuncture, Reflexology, Meditation, or Vitamins (69%) Exercise (12%) Recreational Drug Use (8%) |
N/A |
| Nokes, K. M. (1995)a | Convenience sample: n=145; 97% male | Quantitative: Self-administered survey | 100% | Vitamins, relaxation, humor, spirituality, and meditation |
N/A |
| Ostrow, M. J. (1997)a | Clinic sample: n=657 (94% male) | Quantitative: Self-administered survey | 39% | Dietary Supplements (22%) Herbal Therapies (22%) Tactile Therapies (22%) Relaxation Techniques (20%) |
CAM use more common among respondents who are younger, more educated, earn higher incomes, report greater pain, and report spending less time out of bed during the day |
| Owen-Smith, A. (2007) | Clinic sample: n=366 (100% female) | Quantitative: Self-administered survey | 60% | Oral CAM: Immunity Boosters or Vitamins (40%) Body/Healing CAM: Religious or psychic healing, bodywork (30%) |
CAM use more common among respondents who are older, more educated, and earn higher incomes Use of Oral CAM associated with greater nonadherence to HAART in past 30 days |
| Pawluch, D. (2000) | Community sample n=66 (83% male) | Qualitative: Semi-structured interview | 100%b | Not specified | CAM is construed by HIV+ respondents as a: Part of a health maintenance strategy Alternative to Western medicine Way to mitigate side effects of HAART Strategy for improving quality of life or coping with stress Way of resisting mainstream medical care which is seen as oppressive and untrustworthy |
| Risa, K. J. (2002) | Clinic sample: n=118 (99% male) patients receiving HAART | Quantitative: Self-administered survey | 38% | CAM use prior to HAART use: Megavitamins (14%) Relaxation (10%) Spiritual Healing (8%) CAM use + HAART use: Megavitamins (9%) Massage (7%) Herbal Remedies (5%) |
CAM use associated with higher levels of distress, problem-focused coping, lower belief in efficacy of HAART, and being Caucasian CAM users who started using CAM after initiation of HIV meds were more likely to be African-American and have higher income compared with prior users |
| Singh, N. (1996)a | Clinic sample: n=56 (100% male) | Quantitative: Self-administered survey | 30% | Meditation (47%) Herbs (29%) Special Foods (29%) Vitamin therapy (29%) Imagery (24%) Acupuncture (12%) |
CAM users more likely to be over the age of 35 and use recreational drugs |
| Smith, S. R. (1999) | ACSUS samplec n=1385 (81% male) |
Quantitative: Structured interview | Not reported |
Vitamins (68% of full sample) Nonprescription drugs (54%) Herbs (10%) Recreational drugs (5%) |
Vitamin, herbal product, and recreational drug use more common among Caucasians Herbal product use more common among those with more than high-school education and those receiving psychological care |
| Sparber, A. (2000)a | NIH HIV/AIDS clinical trial sample: n=100 (98% male) | Quantitative: Structured interview | 84% | Mind-body (38%) Structural or energetic (35%) Lifestyle, diet, nutritional (35%) Traditional medicine (10%) Pharmacologic or biologic (6%) |
Perceived benefits of CAM included: relief from HIV-symptoms, improved coping, increased sense of control, and enhanced treatment outcomes. |
| Standish, L. J. (2001) | Community and clinic sample: n=1675 (79% male) | Quantitative: Self-administered survey | 100%b | Lifestyle change (Vitamin use, exercise; 93%) Mind/Body medicine (prayer, meditation, support groups, psychotherapy; 89%) Herbal medicine (87%) Manual healing (e.g., massage: 53%) CAM Providers (e.g., acupuncture: 45%) Bio-electro magnetic (e.g., crystals: 11%) |
CAM users who also use HAART (63%) were less likely to be employed and more likely to have an AIDS-diagnosis, lower CD4 counts, more HIV symptoms, and lower MOS scores (indicating poor quality of life, physical functioning, and emotional well-being) |
| Suarez, M. (1996)a | Clinic sample: n=76 (67% male; 100% Hispanic) | Quantitative: Semi-structured interview | 66% | Prayer (52%) Use of healing items: Candles (38%) Holy water (34%) Oils or Incense (22%) Herbs (18%) Consult spiritualist (16%) |
Use of folk healing practices more likely among individuals with symptomatic HIV |
| Suarez, T. (1997)a | Clinic sample n=73 (100% male) | Quantitative: Self-administered survey | 63% | Meditation, Imagery, Relaxation (19%) Mega-dose vitamins (17%) Spiritual/Religious healing (15%) Homeopathic remedies (7%) Special Diet (5%) Acupuncture/Acupressure (4%) |
CAM use associated with appraisal of HIV-related stress as controllable and as a challenge Greater # of CAM procedures associated with being Caucasian, having been diagnosed longer, and use of planning and humor coping strategies |
| Suarez, T. (2000) | Convenience sample: n=127 (82% male) | Quantitative: Self-administered survey | 69% | Exercise (27%) Spiritual/Religious healing (20%) Mega-dose vitamins (12%) Meditation (10%) Herbs (9%) Special Diet (5%) Chiropractic Care (4%) |
Greater use of CAM among MSM and Caucasian males CAM use associated with use of a number of adaptive coping strategies, appraisal of HIV-related stress as controllable, and greater life satisfaction |
| Sugimoto, N. (2005) | HIV+ support group participants: n=132 (27% male; 100% Thai) | Quantitative: Self-administered survey | 34% | Not Specified | Use of herbs associated with better general mental health, especially among women who were widowed, symptomatic, have low social support and receive government subsidies |
| Tsao, J. (2005) | HCSUS sampled n=2466 (77% male) | Quantitative: Computer-assisted interview | 53% | Mind-Body (39%) Biological (26%) Manipulative/Body-Based (17%) Alternative Medical Systems (10%) Energy Healing (4.2%) |
CAM use more likely among Caucasians and individuals who are older, more educated, report HIV-related pain, and experience depressive symptoms |
| Woolridge, E. (2005) | Clinic sample: n=523 (92% male) | Quantitative: Self-administered survey | 27% | Cannabis | Use of cannabis more likely among those with longer disease duration and higher degree of disability |
| Wutoh, A. K. (2001) | Clinic sample: n=100 (78% male) | Quantitative: Structured interview | 21% | High-dose megavitamins (8%) Garlic (5%) Spiritual healing (4%) Herbal teas (4%) |
None |
Notes. Parenthetical percentages in the ‘Most Common Types of CAM’ column reflect the portion of identified CAM users who endorse specific types of CAM, as opposed to the portion of the entire sample. Primary results from bivariate and multivariate statistical analyses are reported in the ‘Findings’ column. N/A, not applicable; MSM, men who have sex with men; HAART, Highly-active antiretroviral treatment.
a
Indicates that all or some of the data were collected before 1996, prior to the advent of HAART. All other studies use data collected after 1996 or eligibility criteria required current receipt of a treatment regimen that includes at least one antiretroviral medication.
b
Participants were selected on the basis of their CAM use, thus, 100% of the sample were CAM users.
c
AIDS Costs and Services Utilization Study, a panel survey of patients from 1991-1992.
d
HIV Cost and Services Utilization Study, a nationally representative sample of patients who received conventional HIV care in 1996.