Why do people with HIV smoke so much?
Rob Olver: What does this tell us about people living with HIV and what are the health implications as the population ages? The Ontario HIV Treatment Network Cohort Study has some sobering answers.
At the beginning of last August I quit smoking for the last time, after having smoked for roughly half my life, but in spells of about seven years on and seven off. An odd pattern, I know. It wasn’t planned, it just worked out that way.
And so I got lots of experience at giving up the habit, sometimes successfully, sometimes not. And at times it was easy to quit, while at others it was incredibly hard and sometimes downright impossible.
For instance, one day fairly early in my smoking career, I got very angry indeed about the fact that I was killing myself with smoke and paying through the nose for the privilege. I quit cold turkey then and there for seven years. And it was easy. That time, my anger was enough to see me through the ordeal of stopping nicotine consumption. That time.
But at other times, anger was nowhere near enough. Worse; unresolved anger was a major factor impelling my addiction in the first place. Fire with fire? Not a recipe for success. And Oh the guilt and inward–pointed rage that would follow the failed attempts! The self examination, the self recrimination and self flagellation, the feelings of failure and uselessness as I would wrack my brain to learn where my discipline had gone and why, why, why I just couldn’t seem to break the cycle right now, not today, maybe not ever, I’ll let you know. Move along now, nothing to see here.
After one of these failed attempts, a year could easily pass before my confidence would recover enough to allow me to try it again.
I succeeded this time as part of the MATCH study, using Champix. It made me want to vomit but it did the job. I ended up stopping Champix a month early (it was a three month course) because of the vomit feature, but it’s ok; the cycle was broken. I no longer smoke and I don’t want to go back to it. But why did I do it in the first place?
Once again I found a treatment that worked for me. But as a person living with HIV, I was far from alone in this struggle. Available data suggest that nearly three times as many people living with HIV smoke cigarettes than in the general population. We all know it's bad for us. So what is it with us? Why do we do it? And what do we have in common? What impact does smoking have on us?
The Ontario HIV Treatment Network Cohort Study (OCS) has been looking at, among many other things, the trends and correlates of cigarette smoking and its impacts on health-related quality of life among people living with HIV. This month they published those findings in a research article entitled Trends and Correlates of Cigarette Smoking and Its Impacts on Health-Related Quality of Life (HRQOL): Findings from the Ontario HIV Treatment Network Cohort Study, 2008-20014.
It makes for interesting reading.
The study sought to examine the trends of cigarette smoking, identify correlates of smoking, and examine the impacts of smoking on health-related quality of life among people living with HIV in Ontario, Canada.
The study sample included 4,473 individuals receiving care and enrolled in the Ontario HIV Treatment Network Cohort Study. Self-reported data on cigarette smoking, health-related quality of life, and demographic and socio-behavioral variables were collected between 2008 and 2014 through annual face-to-face interviews and correlated with medical data.
At first interview, 1760 participants (39.3%) were current cigarette smokers. It's gratifying that smoking prevalence declined annually by 1.6% between 2008 and 2014, but it remained much higher than in the general population.
Cigarette smokers were more likely to be younger, male, white or indigenous, Canadian-born, single, unemployed with lower education, heavy drinkers, non-medicinal drug users, and to have current depression than former cigarette smokers or those who never smoked.
Cigarette smokers also had significantly worse physical and mental health symptom scores than those who never smoked.
The authors' conclusion? "To reduce the burden of cigarette smoking, cessation interventions that take into account the complex social, economic, and medical needs of people living with HIV are needed urgently."
The authors say, "“The higher prevalence of smoking in this population is concerning, given that smoking has been linked with several adverse health outcomes, including chronic obstructive pulmonary disease, lung cancer, cardiovascular disease such as myocardial infarction and stroke, progression of AIDS, all-cause mortality, increased HIV symptom burden, worse antiretroviral adherence, and worse health-related quality of life.
“While the prevalence of smoking in the general Canadian population has decreased steadily, it is not known whether this trend holds in people living with HIV. It is important to examine the trend and understand the reasons for the elevated smoking prevalence in this sub-population."
"People living with HIV have complex socioeconomic and medical needs that may influence smoking behavior. For example, some groups of the population (e.g. men who have sex with men, indigenous people, racial and ethnic minorities, and those who are economically disadvantaged) that are disproportionately affected by the HIV epidemic also have higher prevalence of smoking than the general population. In addition, individuals with HIV experience higher burdens of mental health and substance use disorders than the general population."
“While substance use and depression are strongly correlated with cigarette smoking and increased nicotine dependence, they are also linked with lower readiness and decreased motivation to quit smoking. Therefore, it is critical to understand correlates of smoking behavior in this population to design tailored and successful smoking cessation interventions."
For me the study paints an eerily familiar picture of smoking addiction -- my own struggles with it as well as with depression. And although I'm so very glad I don't smoke any more, the picture is still quite a disturbing one.
My brothers and sisters in HIV, diverse as we are, who would have thought we'd all have so many points in common? Like all these social co-determinants of health.
The marginalized truly do walk a gauntlet in this world. That's what this study tells me.
Love to all.
P. S. - I've skipped the study methodology for the purpose of this highly readable article but trust me, it's all there. You can check it if you like in AIDS PATIENT CARE and STDs Volume 31, Number 2, 2017 .
Note: Quitting smoking is one of the best things that people living with HIV can do to protect their health. The OHTN's website, www.positivequitting.ca, is full of information for HIV clinics, AIDS service organizations and people living with HIV.
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