Yesterday the Network co-hosted a great webinar with the National Youth Advocacy Coalition, examining the relationship between HIV and tobacco. With over 50 participants, the information disseminated and discussions articulated was a fascinating opening dialogue.
- Smokers are contracting HIV faster than the general population: About two-to-three times faster actually, with 50-70% of HIV-positive individuals using tobacco. HIV-positive men-who-have-sex-with men (MSM’s) are two times more likely to smoke than HIV-negative MSM’s. This can be contributed to oral ulcerations caused by tobacco use, more minority-related stress, and the higher incidence of risky behaviors with smokers generally.
- Smokers are developing AIDS faster than HIV-positive individuals overall: With anti-retrovirals (ART’s) today, HIV is considered to be a chronic illness rather than a death sentence. But if you use tobacco, that notion decreases. Smoking can interfere with the processing of anti-retrovirals (ART). The liver processes the 4,000 chemicals ingested from cigarette smoke as well as the ART medications…and the liver always chooses the tobacco first. Tobacco also reduces immune function, increasing the susceptibility to opportunistic infections (OI’s). One of the OI’s, Mycobacterium Avium Complex or MAC, is actually found IN the cigarette paper, active even when it burns down to the filter.
- HIV-positive smokers are dying from tobacco-related illnesses rather than AIDSl: Consequences of smoking such as cardio-vascular disease and liver issues can kill you before AIDS can, influencing 53% of all AIDS moralities. Studies have shown that quitting smoking does more to reduce cardiovascular attack risk in HIV-positive patients than ANYTHING else, including changes in ART regimens. You can also be on less ART ‘s because your liver will have to digest less chemicals. Less tobacco and less medications means you will be saving your body and a combined total of $5500 a year to be a smoker on ART’s.
- HIV-positive smokers have a harder time quitting than tobacco users overall: Not only do HIV-positive people face increased tobacco use and effects, but their ability to quit is compromised as well. HIV-positive individuals have higher relapse rates and lower quit attempts…even though they need to quit and want to quit! Providers frequently have the perception that people living with HIV have enough on their plate as is, so why try and get them to quit if the self-medicating helps them with the stress of the disease. In turn, the provider feels uncomfortable addressing the issue. However, if patients don’t know the negative impacts of tobacco, how can they make educated decisions about whether or not they want to quit?
Helping to Quit: Lessons Learned
Danielle Grospitch, a certified tobacco treatment specialist and HIV educator, gave some great insight on how to aide HIV-positive smokers in quitting. There seems to be a success in numbers when it comes to cessation in positive communities rather than individual support. Be careful if you use nicotine replacement therapy (NRT) in treatment. While it is covered by Medicaid in most states, cessation medications like Zyban can interact with protease inhibitors. For longer-term success, behavioral modification techniques such as cognitive behavioral therapy are more effective than NRT.
An example of a program that has all the above components is the first east-coast LGBT/HIV-positive support group to address tobacco cessation overall. Apart of the LGBT center of New York City for 22 years, presenter and psychologist Barbara Warren helped to find all mental health and social services for the center, including the LGBT Smokefree project. The most interesting component of the case study I found was supporting the ambivalence of cessation. If your client is not ready to quit, that’s okay. Videos like the one below featuring “Mercedes Maybe” allows individuals to explore their ambivalence about quitting, aiding them to quit when they feel its right and increasing their ability to quit successfully.
Videos are also great ways to get youth and young adults to think about quitting as well.
While incentives were found to be helpful to recruit and maintain people in the group, extrinsic motivations were replaced with intrinsic motivation by the end. 50% of the individuals who graduated from the program wanted to donate their final incentive back to the center because they were so grateful for being able to quit. Barbara found that the most important attribute for a group facilitator is to be an ex-smoker, proclaiming that status allowed her to connect with the group members even though she was not HIV-positive or LGBT-identified.
Suggestions on what you can do to help:
- Ask, Advise, Refer: Providers need to be asking and advising HIV-positive smokers, and feel comfortable doing so. Three simple steps will send the person in the right direction: ask if they use tobacco, advise them to quit, and refer them to the appropriate program.
- Collaborate: Collaborating with other local tobacco efforts can decrease costs and resources. If you are interested in funding opportunities, make sure to sign-up for our discussion listserv on our homepage, http://www.lgbttobacco.org, to learn about new tobacco RFP’s in your state.
- Accessibility: If you are going to start a peer-led support group, providing the meeting at an easily accessible location by public transportation and in a comfortable environment like an LGBT center is helpful.
- Following the leader: Howard Brown Health Center and the University of Chicago have just finished four focus groups examining smoking cessation in HIV-positive, African-American MSM’s. The major theme that emerged was that being an ex-smoker was the most deterimental factor for the group make-up. (Click here to request more information on the Chicago Study…) If you cannot have an ex-smoker facilitating, videos sharing success stories of HIV-positive individuals quitting can be used for motivation, like “Ready Rico.”
- Address the whole individual: In cessation, examine the physical, mental, and emotional factors that influence a person’s tobacco use and ability to quit. Having information on nutrition is also pertinent because of the food limitations with ART medications and the use of snacking as a coping mechanism in cessation.
MORE RESOURCE INFORMATION NOW AVAILABLE FROM NYAC!
As I prepare for my departure from the Network to participate in my field internship at AIDS Action Committee, I will make sure to know my resources and to always ask if tobacco is used by my clients. Just a quick ask, suggestion, and resource referral can at least get the ball rolling and educate my clients so they can make the best decision for themselves possible!