People living with HIV/AIDS (PLWHA) smoke cigarettes at a high prevalence. PLWHA experience internalized HIV/AIDS stigma (IHAS) at high rates and smoking and IHAS are associated with negative health outcomes. This study was the first to examine the relationship between IHAS and smoking behaviors (i.e., smoking status, nicotine dependence, motivation to quit smoking) in a sample of PLWHA in the United States (US).
A convenience sample of 287 PLWHA at the Montefiore Center for Positive Living (145 current smokers, 43.9% female, 55% Latina/o) completed a survey on psychological and personality factors and smoking behaviors. IHAS was assessed using the Internalized AIDS-Related Stigma Scale (IARSS). Smoking status was assessed via self-report and confirmed via expired carbon monoxide levels. Nicotine dependence was assessed using the Fagerström Test for Nicotine Dependence, and motivation to quit smoking was assessed using the Contemplation Ladder. The relationship between IHAS and each smoking behavior was examined using direct logistic regressions. Additional analyses adjusted for age, current marijuana use, and self-reported diagnosis of AIDS. Exploratory analyses explored depression as a possible moderator and mediator in the relationship between IHAS and smoking behaviors.
No significant associations between IHAS, smoking status, nicotine dependence, and motivation to quit were found. For the individual IARSS item “I sometimes feel worthless because I am HIV positive,” current smokers were more likely to answer yes to the item compared to non-current smokers [χ2 (1, n = 287) = 6.73, p < 0.01]. For item “I hide my HIV status from others,” non-current smokers were more likely to answer yes to the item compared to current smokers [χ2 (1, n = 287) = 4.28, p = 0.04]. For item “I feel guilty that I am HIV positive,” smokers with high nicotine dependence were more likely to answer yes to the item compared to smokers with low ND [χ2 (1, n = 145) = 4.45, p = 0.04].
Conclusions While overall IHAS was not associated with smoking variables, some specific aspects of IHAS were. Given the high rate of smoking and IHAS experienced by PLWHA, research on other barriers to optimal smoking outcomes in PLWHA is needed.||en_US