Smoking Among HIV Positive New Yorkers: Prevalence, Frequency, and Opportunities for Cessation

Abstract

Tobacco use presents unique health risks for persons living with HIV/AIDS (PLWHA). There is an urgent need to characterize tobacco use among PLWHA, and to assess the capacity of HIV/AIDS service providers to deliver smoking cessation interventions. Questionnaires were administered to PLWHA in care in New York State (n = 1,094) and to State-funded HIV/AIDS service providers (n = 173) from 2005 to 2007. Current PLWHA smoking prevalence was 59%, three times the general population rate. Over 50% of current smokers were moderately or highly dependent on nicotine. Three-quarters of smokers indicated an interest in quitting, and 64% reported a least one quit attempt during the past year. Less than half of HIV/AIDS service providers reported always assessing tobacco use status, history, dependence, or interest in quitting at intake. Medical care providers were more likely to conduct assessments and provide services. Although 94% of providers indicated a willingness to incorporate tobacco cessation services, 65% perceived client resistance as a barrier to services. HIV/AIDS service providers are inadequately addressing the high smoking rate among PLWHA, despite being uniquely suited to do so. Efforts are needed to educate providers about the need for, and interest in, tobacco cessation.

Smoking Cessation for People Living With HIV/AIDS: A Literature Review and Synthesis

“…1 By contrast, between 50% and 70% of PLWHA smoke cigarettes daily. 3,5,[10][11][12][13] On a positive note, one longitudinal study showed that smoking rates may be declining among women with HIV (to 39% in 2011 in the Women's Interagency HIV Study). 14 Although the reasons for this high prevalence are not well understood, there are some factors that appear to distinguish nonsmoking from smoking PLWHA.…”

“…32 Further, there is evidence that a majority of HIV health care providers advise their patients to quit smoking, but these interventions are not universal. 4,5 Among those who provide cessation services, the most frequent interventions include brief advice to quit, recommending nicotine replacement, and providing print self-help materials. 32 Treatment providers cite both patient resistance to smoking cessation interventions, as well as systemic barriers (eg, lack of reimbursement for pharmacotherapy, lack of time, and lack of provider confidence in their abilities to provide smoking cessation) as barriers to effective implementation of smoking cessation treatments in HIV care.…”

“…32 Treatment providers cite both patient resistance to smoking cessation interventions, as well as systemic barriers (eg, lack of reimbursement for pharmacotherapy, lack of time, and lack of provider confidence in their abilities to provide smoking cessation) as barriers to effective implementation of smoking cessation treatments in HIV care. 5,32 Importantly, however, PLWHA who smoke are significantly more likely to engage in a quit attempt if a treatment provider provides smoking intervention. 33 …”

“…Recent studies reveal that nearly two-thirds of HIV+ smokers wish to quit smoking. [3][4][5] However, despite the high-risk nature of smoking among PLWHA, relatively few studies have systematically examined treatment efforts to reduce smoking in this population. This dearth of studies might be a result of the nature of HIV/AIDS as an illness.…”

HIV infection, aging and cardiovascular disease: epidemiology and prevention

“…19,24 Current smoking has been reported in 40% to 70% of HIV-positive patients, two-to three-fold greater than the general population. 4,22,[25][26][27][28][29][30][31] Compared with non-smokers, smokers have a two-fold or greater increased risk of MI 19 and CVD. 24,32 Although two studies have reported decreasing rates of smoking over time, in part suggesting that in an aging cohort, smoking rates are decreasing, 4,5 few data are available on actual rates of smoking as HIV-positive patients age.…”