PositiveLite.com and the Ontario HIV Treatment Network (OHTN) are partnering in a project to try to reduce smoking rates in people living with HIV. I invite you to watch our new video which features a person living with HIV, a smoking cessation expert and the OHTN’s Sean Rourke talking about the project.
Just why do many people living with HIV smoke? We’d like to turn to the research but there is none specific to that question, but we can listen to the people who do smoke. Or did. Quite a few have given up now.
Adrian Betts, Executive Director of the AIDS Committee of Durham Region (you'll meet him below) mentions several reasons why he smokes. “There are things I love about smoking. I love the reward part of smoking. When I’m working and doing a task which is particularly onerous - when it’s completed, that reward smoke? Fantastic! There’s the calm that comes with smoking. And then there’s the after-dinner cigarette I can’t tell you how good that one is either.”
I can vouch for that. After dinner-cigarettes were one of my favourites too. I used to smoke - and it sort of made sense at the time, at least for a while. Way back in 1993 I was stressed out by work and a new HIV diagnosis and I thought (knew?) I wouldn’t be around for long, so what difference would a two pack a day habit make? (You can read more of my smoking story here if you want the sordid details.)
It took a while for the penny to drop that after going on antiretroviral therapy in 1996, smoking suddenly made less sense. Miracle of miracles, it became clear I would likely survive HIV and, later I would learn, have a good chance of living a normal life span. But not, the research here and here suggests, if I continued smoking.
So to cut a long story short, I quit.
But I feel for and can identify with those that have yet to make that step despite the knowledge that it’s hurting them. Adrian says while he loves smoking there are some aspects he hates, quite apart from the health aspects. He finds the smell on his clothes “so gross” he says and hates the way the smoke discolours his moustache. He’s tried to quit three times; once he quit for two years but has always eventually fallen off the wagon.
How many people living with HIV smoke ?The OHTN responded to an information request as follows:
Smoking rates have been found to be significantly higher among people living with than the general population with some estimates in the U.S. finding prevalence rates of 50-70% among PHAs (three times the national average). Similar levels have been found among PHAs in Canada. For example, the smoking rate among patients visiting the HIV clinic at The Ottawa Hospital is estimated to be between 43-49% compared to a smoking rate of 12% in Ottawa’s general population. In addition, the OHTN cohort study found that 54% of PHAs living in Ontario smoke which is much higher than smoking rates among HIV-negative adults in Canada, which have fallen below 20%.”
Here is a graphic from the OHTN which explains some of the regional disparities that exist in Ontario:
It does appears that many PHA smokers would like to quit. No good Canadian data is available but, reports the OHTN. “75% of (PHA) respondents in a recent survey in New York indicated they had an interest in quitting while 64% had tried to quit at least once in the past year.”
Shannon Carney, who is with Toronto Public Health and knows smoking cessation issues well, is working with PositiveLite.com, the OHTN and a multi-disciplinary team in an effort to reduce PHA smoking rates. She’s a former smoker herself. And, she says, she still experience cravings so she knows well what smokers trying to quit face.
Shannon, talking directly to PHAs on the video, below pulls no punches. “You do need to quit smoking. Quitting smoking is one of the best things you can do to improve your health". She echoes Adrian in saying you need to do it for yourself, because you want to. But she’s a realist. “It’s so difficult to quit smoking because it’s a powerful addiction – as addictive as heroin and cocaine. Plus smoking quickly becomes part of a person’s everyday life, so there’s a biological component as well as a behavioural component." She says that on average it takes people between seven and nine attempts to quit. But, she says, “the main thing we want people to learn here is that from each quit attempt you learn something that can help with the next one – and make it easier.”
How does the OHTN/PositivelIte.com project Positive Quitting aim to help? I’m co-chair of that project with the OHTN’ s Executive and Research Director Sean Rourke, so I can answer that.
Firstly we are involving a cross-sectoral panel of experts to help guide us - researchers, people living with HIV, both smokers and non-smokers, people like Shannon from Public Health, addiction experts, clinicians. ASO staff and funders are all involved. We are working together to devise strategies which are definitely not coercive and recognize the particular pressures, stressors and history people living with HIV who use tobacco face.
So . . we will be in the business of highlighting the importance of the issue to our community. We will offer to connect smokers with existing services which provide free smoking cessation products and support services. We will offer professionals who interact with people living with HIV – in ASOs and positive care clinics, for instance - training in smoking cessation issues. And eventually we want to test innovative programs geared specifically towards people living with HIV, delivered in part by their peers. Plus we want to work with health care professional who see people living with HIV regularly to make sure that smoking cessation is on their collective agendas.
All of this work will help to narrow the gap between smoking rates in people living with HIV and the general population. More importantly, all of this work will contribute to people living with HIV who currently use tobacco to live longer, healthier lives, with more money in their pocket to boot. (We’ll discuss the research on the impact of tobacco use and what interventions are out there in more detail in a future PositievLite.com feature.)
The OHTN’s Sean Rourke sees great potential in this project. “We want to help people to make healthy choices” he says. ”I’m not sure it's taboo” he says “but (PHA smoking) Is something that people just don’t talk about. We just need to get it out in the open. I think a lot of people want to stop smoking but they don’t know how or don’t have the resources to do so and our job is to connect them into those resources and those opportunities to help them make healthier choices.”
Adds Sean “This is something very dear to our heart at the OHTN in providing the evidence for this, and it’s part of a wider strategy here in Ontario that will improve the health and wellbeing of people living with HIV.”
It’s an exciting project and I’m happy to be part of it. As an ex-smoker who understands why people living with HIV smoke smoke, I want to make sure people with HIV who use tobacco currently are respected and treated with dignity, and understanding and with a total lack of coercion as they are presented with the opportunity to choose a healthier future and to truly realize the life preserving benefits of antiretroviral therapy.
I'm also pretty proud of this video which provides an overview of where we are at, but also incidentally marks the start of a collaborative process between PositiveLite.com and the OHTN teams to produce informative videos of a higher standard as we move forward.
So watch the video – and watch PositiveLite.com for more news about Positive Quitting!