Corey Prachniak is an LGBT rights, HIV policy, and healthcare attorney. He serves on the Steering Committee of the Network for LGBT Health Equity and tweets @LGBTadvocacy.
Dr. Donna Shelley explained that ending smoking among people living with HIV is especially important because “smoking increases the risk of HIV-related infections” and leads to “poorer adherence to HIV meds, higher viral load,” and other health problems. NAM, an HIV/AIDS organization, notes that HIV-positive “smokers are approximately three times more likely than non-smokers to develop the AIDS-defining pneumonia PCP” and that “oral thrush, a common complaint in people with HIV, is also more common amongst smokers.” Dr. Shelley’s study focused on testing cessation strategies among people with HIV in New York.
When it comes to quitting smoking, it could be seen as a positive or negative that people living with HIV are already likely to have complicated medical adherence needs. On the one hand, adding smoking cessation interventions and medications adds to the burden that many people living with HIV already face. But on the other hand, many people living with HIV have found success at incorporating medication regimens into their lives and are used to managing their care, either on their own or with the support of a medical adherence team. For people who are doing well adhering to their HIV-related medications and treatments, they may well be able to incorporate tobacco cessation measures with a high level of adherence.
In fact, that is what Dr. Shelley’s preliminary data suggested. “Adherence at baseline to HIV meds,” meaning how well people remembered to take their HIV medications at the start of the study, “was closely correlated to adherence to cessation medications” by the study’s sixth week, she said.
Dr. Shelley also noted that the people for the study were recruited from healthcare clinics, which often are in more regular contact with their patients than are other types of medical providers. That’s because these settings tend to offer multiple, highly coordinated services. So, for example, if a client comes in to see her therapist but has missed an appointment with her primary care doctor, the staff person checking her in can make sure she reschedules with her doctor or gets the prescription refill or referral that she might need.
The research tested three adherence regimens: smoking cessation medication alone; medication and adherence text messages; and medication, text messages, and adherence counseling phone calls. Interestingly, the research found that the group with the best adherence were those who received the medication and text messages, but not the phone calls, which many people reported as being “too much.” People also stressed that they liked texts with positive reinforcement – like “stay on track” or “look how much money you’ve saved this month” – versus messages that just reminded them to take their medication.
It’s unclear whether the results are unique to people living with HIV, or would have been the same for others, as well. But it’s worth noting that people who are already managing HIV-related care preferred quick positive reinforcement on quitting smoking rather than lengthy counseling on taking their meds or daily messages telling them to take their pill.
It’s true that HIV is not just a problem for the LGBT community. But given that 63% of new HIV infections in 2010 were among men who have sex with men, and that LGBT people smoke at a rate that is 68% higher than the population in general, the intersection of smoking and HIV is a critical topic for LGBT health advocates to keep in mind.