I'm an ex-smoker. When I smoked, I used to meet scores of fellow HIV-positive smokers, especially outside conference doors during breaks. I must admit that I enjoyed the camaraderie, the chance to connect with people, the ritual. I don't miss smoking but I do sometimes miss those often-chilly moments outside conference buildings where I made a lot of friends.
We smoke for a whole range of reasons. I took up smoking at the age of 30 because I had a boyfriend who smoked and I thought it looked sexy. The boyfriend came and went, but my two-pack-a-day habit lasted for a couple of decades. Menthol lights were my thing -- who knows why? I liked the taste for a while, and then the habit took over and it became automatic to light up as soon as I woke up and then anytime my hands were free. I smoked one after the other, mindlessly.
When I was diagnosed with HIV in 1993, my smoking seemed the least of my troubles. Before the advent of effective anti-HIV therapy, people living with HIV typically had poor prospects for long-term survival and smoking offered a handy crutch, a stress reliever to blunt the edge of pain and depression. But with the introduction of protease inhibitors in 1996 and a vastly improved outlook -- in fact, the prospect of many years of life to come -- the rationale for smoking seemed to thin. Then, as more and more research showed strong connections between smoking and a long list of diseases and health conditions, not to mention a shortened lifespan, smoking became even less of a rational activity for people living with the virus, including myself. Nevertheless, smoking rates remain high in people living with HIV: Research indicates that more than 50 percent of people with HIV smoke, compared to 17 percent of the general population.
As I was living on disability support, it was eventually the cost of cigarettes that took my smoking habit down. Cigarettes were cheaper back then, but their cost still blew a major hole in my budget. They had to go. So I tried to stop, and failed. And tried again, and failed. And tried a third time, and failed yet again. Nicotine is highly addictive, so it's not uncommon to try quitting multiple times. But, says the Canadian Lung Association -- and I think they're right -- it gets easier each time.
My strategies for quitting were scattergun -- cutting down gradually, chewing nicotine-replacement gum, using the patch, going cold turkey. ... I tried them all at one time or another. What felt like repeated failure was, of course, frustrating, but in retrospect each attempt helped me see what didn't work for me. By my fourth try, I had what proved to be the winning formula. By exposing what didn't work for me, quitting actually felt fairly easy.
My success finally came with knowing the simple truth that once you have quit, "having just one" doesn't work. The Canadian Lung Association says it's important to incorporate that knowledge into your plan. Pick a date to quit, choose a method (or two) and then "on your quit date, butt out completely. Don't smoke, not even a little. Toss out your cigarettes, other tobacco, and ashtray." No cheating is the golden rule. It worked for me. The first few days were hard, obviously, but I knew I had a winning formula and so I stuck with it -- and started liking how food tasted again. I felt proud.
There are a host of websites that offer other tips for quitting. I like "10 Simple Tricks that Help Smokers Quit" from caring.com, which recommends making your decision to quit public, tracking your progress on a calendar, exercising and chewing gum. The Canadian Cancer Society's Smokers' HelpLine even includes a Quit Meter that lets you track how much money you are saving. And for hand-held devices, there are many apps out there, such as Break It Off, which track your progress while providing supportive messages. In development are smoking cessation programs aimed specifically at people living with HIV -- watch for them.
Whatever method you choose to kick the habit, it goes without saying that motivation is critical. Establish at the outset why you want to quit. We all know that smoking can kill, but did you know that researchers have reported that smoking has a more significant impact on the lifespan of people living with HIV than HIV-related factors do? Or maybe you want to avoid the host of health complications that smokers with HIV are at higher risk for -- heart disease, osteoporosis, lung and other cancers, gum disease, tuberculosis and emphysema, to name just a few. Of course, health problems that may be years away are not always enough to keep your motivation up, so consider the following:
As for determining the best time to quit, there is no time like the present. However, keep in mind that it is best to be fully prepared. Quitting isn't to be taken lightly -- it's a major adjustment to your habits, your health and even how you feel about yourself. So take it seriously. Say "I quit" and mean it.
Ex-smoker Bob Leahy is the editor of PositiveLite.com, Canada's online HIV magazine. He lives in rural Ontario with his partner of 32 years and three dogs, none of whom smoke.