Smoking and HIV in sub-Saharan Africa: a 25 country analysis of the demographic and health surveys

• Main Authors: John Murphy, Benmei Liu, Mark Parascandola
• Format: Article
• Language: English
• Published: European Publishing 2018-03-01
• Series: Tobacco Induced Diseases
• Subjects: WCTOH
• Online Access: http://www.journalssystem.com/tid/Smoking-and-HIV-in-sub-Saharan-Africa-a-25-country-analysis-of-the-demographic-and,83905,0,2.html

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.