Lonely Men with HIV are More Likely to Smoke

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Tobacco smoking by people living with HIV is higher than in the general population. This association, likely due to stress and depression, is even higher in middle- and low-income countries where the spread of HIV is worse.

AIDS-related deaths are also higher in tobacco smokers with HIV and there is a difference in life expectancy of about 12.3 years between smokers and non-smokers.

To identify which types of people living with HIV are the most likely to smoke and to find ways to address this issue, researchers completed a systematic review of previous research on smoking and smoking cessation of people living with HIV. Researchers — led by Thanh H. L. Hoang a doctoral student from the School of Public Health and Community Medicine at the University of Gothenburg, Sweden — combed through data published on PubMed, Scopus, PsycINFO and Web of Science and settled on 80 articles with a total of 131,854 participants. Results were published in Aids and Behavior earlier this month.

Researchers found that lonely, HIV-positive men with existing substance abuse issues living in high-income countries were the most likely to smoke tobacco. They were also more likely to abuse cocaine, crack, marijuana and alcohol. Loneliness was defined as being divorced, widowed or not in a stable long-term relationship. As a result, depression was frequently reported. Men were 3.26 times more likely to smoke than women, which may be due to the societal stigma against women smoking in some countries. This is especially true in low-income countries like Uganda where HIV rates are high and smoking is socially acceptable and common for men, but not for women.

Their findings also indicate that to address this issue, there should be smoking cessation interventions with mental health services and increased social support. Researchers found that HIV-positive smokers were 3.34 times more likely to consider quitting after speaking to a healthcare provider.

They also determined smoking habits should be addressed alongside comorbid conditions such as chronic obstructive pulmonary disease, cardiovascular diseases and tuberculosis, which are common in smokers.

There are currently many smoking cessation campaigns, but none that specifically address people living with HIV, a population that is less likely to quit and therefore may benefit more.

People living with HIV who have “regular contact with the healthcare system presents an important opportunity to intervene,” Hoang writes. “Given the essential role of HIV care providers, professional training that enables them to effectively assess and assist patients in smoking cessation should be offered.”