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HIV/AIDS Blog Central

Turning a Blind Eye to Smoking No Longer

By Bob Leahy

June 7, 2012

It's time, I'm afraid, to turn a critical gaze on those with HIV who smoke -- but more importantly those service providers who ignore that life-threatening issue. Because where we are now as a community on this issue, a community who should be leaders in promoting healthy choices is, frankly, third-rate.

There, I've said it. Stop reading, unfriend me. Call me a bore. But no matter, I'm joining the painfully thin ranks of those who say our community's lack of action has to be addressed. Simply put, we need to put smoking cessation programs front and centre. Turning a blind eye on smoking is destroying prospects of healthy living. Let's be big boys and girls. Let's be brave, be strong, acknowledge our vulnerabilities, individually and collectively, and care for each other and our community in ways we haven't tried before.

At one time I was more tolerant. We had excuses, lots of them. But some of those excuses seem weaker now. So I've become tired of AIDS service providers -- your local ASO may be one of them -- whose wellness problems ignore the biggest threat to wellness of all. There may be a place for acupuncture, massage therapy, wellness retreats and the A-Z range of therapies that crop up on the agenda of most ASO's , but don't include smoking cessation programs, or routine referrals to same, and ASO credibility suffers.

It's well known that smoking rates in people who live with HIV are high. A 2010 study of 1,094 people living with HIV in New York found an alarming 59% smoking prevalence rate. Interestingly, three quarters of those HIV+ smokers wanted to quit. But less than half of the 193 AIDS service providers surveyed indicated intake processes that include tobacco use questions, nor provided cessation programs or even referrals.

Why are smoking cessation issues so often ignored by ASOs? The same study suggests 65% of those agencies surveyed "perceived client resistance as a barrier to services." That's lame! I concur with the study authors who say "HIV/AIDS service providers are inadequately addressing the high smoking rate among PLWHA, despite being uniquely suited to do so. Efforts are needed to educate providers about the need for, and interest in, tobacco cessation." The need is described as "urgent."

It's important to contextualize all this and try to understand why smoking rates amongst people living with HIV are so high, though. One can't ignore, for instance, that smoking incidence in gay men is twice that of the national average, a consequence in part of bar culture which used to position smoking as a cultural norm. Everybody smoked in bars once, and some of us got addicted. I did.

The pressures of living with HIV which sometimes enhance the appeal of smoking can't be ignored too. Many HIVers perhaps need a crutch of some kind to get them through, to make the hurt feel less bad, to lower their stress levels, to provide pleasure in a world short of pleasurable experiences. One could argue that with advances in treatment and improving heath generally, that crutch is less of an essential for some. One way or another, HIVers are too often left with an unwelcome addiction to deal with -- and a strong one at that.

I know about nicotine addiction. I smoked two packs a day for years, including the first decade or so of my diagnosis. At first it didn't seem to matter -- I was going to die anyway. But things changed, and I wanted to quit. My early efforts were unsuccessful .But it's possible, I found, to learn from your mistakes. I found once I analyzed where my quitting efforts went wrong -- in my case it was the mistaken belief that "just one is OK" wouldn't result in more -- and omitted that behavior from my next attempt at quitting, it was in fact much, much easier. I quit cold turkey. So yes, I absolutely know that quitting can be hard, but with the right learned behaviors, tools and mindset, eminently do-able. My take -- and this is where we started -- is that AIDS service providers need, at the very least, to provide an entry point to the variety of programs available.

I'll be brutally honest. I'm alarmed by support workers who smoke along with their clients outside their building. Commitment to client wellness includes, I think, being a bit of a role model. Demonstrating to clients that smoking is OK just doesn't seem right.

I mean aren't agencies supposed to be sex positive? When was impotence -- a common side effect of smoking -- sex positive?

Wellness programs for HIVers should, I'm suggesting, always include smoking cessation. But look at most ASO websites and smoking cessation programming is largely missing in action. So we should laud the few shining exceptions, like the UK's GMFA where a clickable banner "Stop Smoking Help" is right there on their front page.

I think the solution lies in part with us. ASOs aren't providing these services, the research suggests, because they think we don't want them. Tell them -- smokers and non-smokers alike -- we DO want them.

We need hardly mention why and I'm not going to dwell on it. Let me just repeat what CATIE says: "Addiction to tobacco can cause devastating health problems, including cardiovascular disease, lung disease and cancer. Also, smoking harms nearly every organ in the body." Stopping smoking is often quoted as the best thing an HIVer can do for their health. If that argument isn't powerful enough, perhaps it's the social factors that will tip the scale -- the stigma of smoking today, for instance (why deal with more stigma?), or the cost, which I think was the tipping factor for me. But everybody is different and programs need to reflect that. has had a large number of articles on smoking in the past. You can access a selection of them here.

In any event, it really is time to get serious about our response to smoking in our community. No ifs ands and definitely no butts.

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See Also
More on Cigarette Smoking and HIV/AIDS

Reader Comments:

Comment by: Devan (Toronto ) Fri., Jun. 15, 2012 at 11:37 am UTC
Bob -awesome article. The work needs to start at the ASO level and the PHA community to ask "Why do PHAS including gay men have such smoking rates and continue inspite of adverse health outcomes."
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Replies to this comment:
Comment by: Anonymous Wed., Jul. 18, 2012 at 4:20 pm UTC
We've set the wheels in motion, Devan. We are now, through, working with the the OHTN to answer questions just like yours, and as imnportantly to turn the recommendations of the existing research in to programs and interventions designed to reduce smoking rates in people living with HIV in our province.

Comment by: Wayne Stump (Toronto, Ontario, Canada) Thu., Jun. 14, 2012 at 3:00 pm UTC
Hi Bob:

Great article and commentary! Yes, it is important to recognize the well-established and well-characterized health risks of tobacco. And yes, I have seen studies that report very high tobacco use rates in the gay/lesbian communities and among people living with HIV infection. I haven't seen the latest Health Canada CTUMS survey but the overall smoking rate among adults in Canada is about eighteen per cent.

When I went through elementary and secondary school in the 1970's we enjoyed very good anti-smoking education from our teachers. As I recall a few fellow teens did take up smoking in spite of this, and I now recognize that it was probably because of peer pressure and the desire to be accepted in a particular social circle, e. g. the "cool" kids.

Later on when I began my association with the gay community, I noticed that a large proportion of the men in particular were smokers. At first this turned me off, but then because of repeated exposure and the association of smoking with hot, masculine men, my perception changed somewhat, and for a while I saw smoking itself as "sexy." If you go to, you can see literally hundreds of if not thousands of videos of gay-identified men doing nothing but smoking a cigarette (or cigar) for several minutes to titillate their audiences.

Back to reality--that the fact is that there are not only severe health risks from smoking for people not living with HIV, but even higher risk of certain cancers for people living with HIV. So in the best interests of the health and longevity of people living with HIV we need more leadership in the community to explore the social and cultural influences specific to the LGBT/HIV communities and to formulate anti-smoking messages that will reach these communities.

Thank you again for drawing attention to this important topic, and

Best regards,

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Replies to this comment:
Comment by: Bob Leahy (nr Toronto) Wed., Jul. 18, 2012 at 4:23 pm UTC
Let's end the pussyfooting. Perhaps we should start with posters in ASOs that say "HIV won't kill you. Smoking will."

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Northern Lights

Bob Leahy

Bob Leahy

A banker turned AIDS activist, Bob Leahy is the busy Editor of, Canada's globally read online HIV magazine by and for people living with HIV. Diagnosed with HIV in 1993, Bob has held almost every volunteer position in the HIV community imaginable, including chairing his local ASO and serving on the boards of the Ontario HIV Treatment Network and the Canadian AIDS Society. Recognized on the Ontario AIDS Network's prestigious Honour Roll, his interests lie in social media, gay men's sexual health and making HIV research intelligible for all. A long-time blogger, this ex-Torontonian lives the rural life with his three dogs and partner of thirty-one years.

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