| Summary: | Background
In high-income countries, being HIV positive is associated with higher rates of smoking. This is
important to public health because evidence suggests that HIV/AIDS patients who smoke have
poorer treatment and survival outcomes. Moreover, both smoking and HIV are risk factors for
comorbidities such as tuberculosis, which is highly prevalent in some low-and middle-income
countries. The HIV-smoking relationship is understudied in sub-Saharan Africa, where tobacco
use patterns and HIV prevalence differ greatly from other world regions. This study is an effort
to fill this gap in the literature.
Methods
This study examined cross-sectional data from the Demographic Health Surveys (DHS) and
AIDS Indicator Surveys. Data from 25 sub-Saharan African countries were pooled (n=286,850),
and the association between cigarette smoking and HIV status was analysed through hierarchical
logistic regression models. As a secondary aim, this study also examined the relationship
between smokeless tobacco use (chew and/or snuff) and HIV status.
Results
Overall, men who had HIV/AIDS had a significantly (p < 0.0001) higher smoking prevalence
(25.90%) than men who did not (16.09%), as did women who had HIV/AIDS compared with
women who did not (1.15% vs. 0.73%; p < 0.001). Multivariate logistic regression analysis
revealed that people living with HIV/AIDS were 12% more likely to smoke than people living
without (OR = 1.12, 95% CI=1.04, 1.21; p < 0.001) when adjusting for socioeconomic,
demographic, and sexual risk factors. Similarly, multivariate logistic regression revealed that HIV-positive individuals were 34% more likely to use smokeless tobacco than HIV-negative
individuals (adjusted OR = 1.34, 95% CI = 1.17, 1.53).
Conclusions
This study complements evidence from other world regions showing that HIV infection is
associated with a higher likelihood of cigarette smoking as well as smokeless tobacco use in subSaharan
Africa, even when controlling for demographic, socioeconomic, and sexual risk factors.
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