Reduce Stress and Substance Abuse in Ex-Prisoner HIV Patients with Yoga

Reduce Stress and Substance Abuse in Ex-Prisoner HIV Patients with Yoga


By John M. de Castro, Ph.D.


“Yoga is an ideal exercise for people with HIV. It not only helps build muscle and energy, but also reduces stress.” – Matt McMillen


More than 35 million people worldwide and 1.2 million people in the United States are living with HIV infection. These include a significant number of children and adolescents. In 1996, the advent of the protease inhibitor and the so-called cocktail changed the prognosis for HIV. Since this development a 20-year-old infected with HIV can now expect to live on average to age 69. Hence, living with HIV is a long-term reality for a very large group of people. People living with HIV infection experience a wide array of physical and psychological symptoms which decrease their perceived quality of life. The symptoms include chronic pain, muscle aches, anxiety, depression, weakness, fear/worries, difficulty with concentration, concerns regarding the need to interact with a complex healthcare system, stigma, and the challenge to come to terms with a new identity as someone living with HIV.


Incarcerated people are 5 times more likely to have HIV infection and also are much more likely to suffer from substance abuse problems. Dealing with these issues upon release from prison is essential for successful reintegration into society. Mindfulness training has been shown to improve psychological well-being, lower depression and strengthen the immune system of patients with HIV infection. Yoga practice has also been found to be effective in treating HIV and with substance abuse.  It is not known whether yoga can help with these HIV patients with substance abuse upon release from prison.


In today’s Research News article “A randomized trial of yoga for stress and substance use among people living with HIV in reentry.” (See summary below or view the full text of the study at:, Wimberly and colleagues recruited adult HIV patients who had a history of substance abuse and who were recently released from prison. The participants were randomly assigned to either treatment as usual or to treatment as usual plus once a week for 12 weeks, 90-minute yoga practice. They were measured before and after training for perceived stress and substance abuse.


They found that in comparison to baseline and treatment as usual the patients who practiced yoga had significant reductions in perceived stress and the percentage of days with substance abuse (20% for yoga participants vs. 41% for treatment as usual). The patients had difficulty attending yoga classes with an average attendance of 35% of the classes.


It is well documented that yoga practice reduces stress and is helpful in controlling substance abuse. The present results are encouraging in that they suggest that yoga practice may be helpful in reducing stress and substance abuse in this vulnerable group of HIV patients who had a history of substance abuse and who were recently released from prison. Finding ways to improve attendance would seem important, perhaps online yoga classes would help. Regardless, participation in yoga appears to improve the likelihood that these ex-prisoners will be able to deal with HIV infection and life outside of prison.


So, reduce stress and substance abuse in ex-prisoner HIV patients with yoga.


Drugs, I believe, are keeping me alive. But yoga,” he says, “keeps my spirit alive.” – Ken Lowstetter


CMCS – Center for Mindfulness and Contemplative Studies


This and other Contemplative Studies posts are also available on Google+ and on Twitter @MindfulResearch


Study Summary


Wimberly, A. S., Engstrom, M., Layde, M., & McKay, J. R. (2018). A randomized trial of yoga for stress and substance use among people living with HIV in reentry. Journal of substance abuse treatment, 94, 97–104. doi:10.1016/j.jsat.2018.08.001



– Compared stress and substance use outcomes of yoga versus treatment as usual.

– Participants included returning citizens with HIV and substance use problems.

– At three-months, the yoga group had reduced stress and slightly reduced substance use.

– Future research with this population can compare yoga with an active intervention.



People in reentry from prison or jail (returning citizens) living with HIV and substance use problems often experience numerous stressors and are at high risk for resumed substance use. Interventions are needed to manage stress as a pathway to reduced substance use.


This study explored the effect of a Hatha yoga intervention as compared to treatment as usual on stress and substance use among returning citizens living with HIV and substance use problems.


Participants were randomized to either a 12-session, 90-minute weekly yoga intervention or treatment as usual. All participants were clients of a service provider for returning citizens that offered case management, health care, and educational classes. Outcomes included stress as measured by the Perceived Stress Scale at the completion of the yoga intervention (three-months) and substance use as measured by the Timeline Followback at one-month, two- months, and three-months.


Seventy-five people were enrolled, two of whom were withdrawn from the study because they did not have HIV. Of the 73 remaining participants, 85% participated in the three- month assessment. At three-months, yoga participants reported less stress than participants in treatment as usual [F (1,59)=9.24, p<.05]. Yoga participants reported less days of substance use than participants in treatment as usual at one-month, two-months, and three-months [X2 (1)= 11.13, p<.001].


Yoga interventions for returning citizens living with HIV and substance use problems may reduce stress and substance use. This finding is tentative because the control group did not receive an intervention of equal time and intensity.


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