Tobacco Smoking and Associated Factors Among People Living With HIV in Uganda

Abstract

Introduction This study aimed to assess smoking patterns, behaviours and associated factors among people living with HIV (PLWH) in Uganda. Methods A cross-sectional survey was conducted among adults in HIV care in Uganda. Descriptive statistics were used to describe smoking patterns and behaviours. Logistic regression was used to identify factors associated with current smoking status. Results We recruited 777 participants between October and November 2019: 387 (49.8%) current smokers and 390 (50.2%) non-smokers. 60.9% were males, and the mean age was 40.5 (SD 10.7) years. In multivariate logistic regression, the following increased the odds of being a current smoker: being male (OR 6.60 (95%CI= 4.34 to 10.04)), having at least two smokers among five closest friends (OR 3.97 (95%CI= 2.08 to 7.59)), living in smoking-permitted households (OR 5.83 (95%CI= 3.32 to 10.23)), alcohol use (OR 3.96 (95%CI= 2.34 to 6.71)), a higher perceived stress score (OR 2.23 (95%CI= 1.50 to 3.34)), and higher health-related quality of life (OR 5.25 (95%CI= 1.18 to 23.35)). Among smokers, the mean Fagerstrom Test for Nicotine Dependence score was 3.0 (SD 1.9), and 52.5% were making plans to quit. Self-efficacy to resist smoking and knowledge of the impact of smoking on PLWH’s health were low. Conclusions Being male, having at least two smokers among five closest friends, living in smoking-permitted households, alcohol use, higher perceived stress scores and higher health-related quality of life were associated with being a current smoker. Smokers had low to moderate nicotine dependence, high willingness to quit, and low self-efficacy. Implications Future behavioural smoking cessation interventions for PLWH should address co-consumption with alcohol and comorbid mental health conditions that are common among PLWH such as stress. In addition, they should take into account the lack of knowledge among this population of the impact of smoking on their health, and low self-efficacy. Given the relatively low levels of nicotine dependency and high levels of willingness to quit in our sample, smoking cessation interventions, if offered, are likely to support this population in achieving long-term smoking abstinence.

Tobacco Use among HIV-Positive and HIV-Negative Women and Men in Zambia—Demographic and Health Survey, 2018

“…Alternatively, the lack of association noted in these measures may indicate that current smokers living with and without HIV are not significantly different in terms of the frequency and intensity of tobacco smoking. Few studies have assessed the frequency or intensity of tobacco smoking among PLWH who smoke; Asfar et al (2021) found that in the US, the number of cigarettes smoked per day by PLWH was lower than by PLWOH (9.9 vs. 18.2, respectively) [ 5 ], while Mdege et al (2021) found that PLWH in Uganda reported an average of 5.2 manufactured cigarettes smoked per day [ 22 ]. It is known that the number of cigarettes smoked per day does not fully capture the intensity of smoking, given interindividual differences in the depth of smoke inhalation and related measures [ 23 ].…”

HIV healthcare providers’ perceptions on smoking behavior among PLHIV and smoking cessation service provision in HIV clinics in Uganda

“…Evidence suggests a high prevalence of tobacco smoking among PLHIV in Uganda 4 . Our finding that HIV care providers had a low knowledge on the prevalence and magnitude of tobacco use among PLHIV could be attributed to the fact that healthcare providers do not routinely screen for, or ask about, tobacco smoking.…”

“…One study reported that up to 24% of AIDS-related deaths were attributable to smoking 6 . Collectively, these findings suggest that smoking is a big public health challenge among PLHIV and call for smoking cessation integration in HIV care services 4 .…”

“…This study was a cross-sectional, qualitative study in which interviews were conducted with HIV healthcare providers. It was carried out alongside a survey of HIV clinic participants on tobacco use 4 and a qualitative study with PLHIV 16 .…”

“…In Sub-Saharan Africa, studies show high smoking rates among people living with HIV (PLHIV) 2 , 3 . For example, for Uganda, the prevalence of smoking among men living with HIV is two-fold that among general population men (20% vs 10%), and threefold in women living with HIV when compared to general population women (6% vs 2%) 4 . Smoking is associated with a two-fold increase in mortality in PLHIV 5 .…”