Smoking & Tobacco Use

HIV and Smoking

Tobacco use is the leading cause of preventable illness and death in the United States, causing nearly one out of five deaths in the United States each year. 

Smoking increases your risk of developing lung cancer and other cancers, heart disease, chronic obstructive pulmonary disease (COPD), asthma, and other diseases, and of dying early.

For these reasons, smoking is a significant health issue for all individuals, but it is even more of a concern for people living with HIV, who tend to smoke more than the general population. According to the U.S. Centers for Disease Control and Prevention (CDC), approximately 19% of adults in the United States are smokers. However, the smoking rate is two to three times higher among adults who are HIV-positive.

If you smoke and you HIV, you’re more likely to get HIV-related infections, including:

• Thrush (a mouth infection, also called oral candidiasis)
• Hairy leukoplakia (white mouth sores)
• Bacterial pneumonia
• Pneumocystis pneumonia (a dangerous lung infection)

Smoking when you have HIV also makes you more likely to get other serious illnesses than nonsmokers with HIV. These illnesses can make you too sick to work (disabled) or even lead to early death. They include:

• COPD (chronic obstructive pulmonary disease, a serious lung disease that causes severe breathing problems and includes emphysema and chronic bronchitis)
• Heart disease and stroke
• Lung cancer, head and neck cancer, cervical cancer, and anal cancer

People with HIV who smoke are also less likely to keep to their HIV treatment plan.

For more information on how smoking affects people living with HIV, see see CDC’s Tips from Former Smokers: Smoking and HIV.

Also see the HRSA Guide for HIV/AIDS Clinical Care: Smoking Cessation (PDF 5.8 MB) and the U.S. Department of Veterans Affairs’ (VA) HIV Patient and Provider Smoking Cessation Resources.

The Benefits of Quitting Smoking

Quitting smoking has major and immediate health benefits for all tobacco users, including those living with HIV/AIDS. Quitting reduces your chances of developing disease, helps you feel better, and improves your quality of life.

Also, stay away from secondhand smoke, which is smoke in the air from other people smoking. Secondhand smoke has immediate harmful effects on your blood and blood vessels, which can raise your risk for a heart attack. People who already have heart disease are at especially high risk for a heart attack. Secondhand smoke can also cause a stroke or lead to lung cancer.

Talk with your health care provider about programs and products that can help you quit.

For more information on the many health benefits of quitting smoking, visit betobaccofree.hhs.gov.

The Role of Healthcare Providers

Surveys have found that two-thirds of smokers living with HIV/AIDS want to quit smoking. Healthcare providers can play an important role in encouraging and supporting them.

Healthcare providers who talk to their patients about quitting smoking—even for just 3 minutes or less—can have a positive impact on those smokers’ decision to quit.

In fact, in a large-scale study of thousands of people with HIV, researchers concluded that smoking represented such a significant risk factor for developing serious clinical diseases and death that healthcare providers should routinely make “stop smoking” programs part of the HIV care they provide.

For tips and tools to assist people with HIV who are seeking to quit smoking, healthcare providers may wish to refer to the HRSA Guide for HIV/AIDS Clinical Care: Smoking Cessation (PDF 5.8 MB) or the VA’s HIV Provider Smoking Cessation Handbook.

Help to Quit Smoking

The Affordable Care Act offers several resources to help people quit smoking. Under the Affordable Care Act, private health insurance policies created after March 23, 2010 are required to cover recommended preventive health services at no extra cost to the consumer. This includes tobacco use screenings for all adults and cessation interventions for tobacco users.

The Act also provides for Medicaid coverage of tobacco cessation services for pregnant women, at no extra cost, along with expanded Medicare coverage of tobacco cessation counseling, making it available to approximately 5 million Medicare tobacco users—not just those with tobacco-related diseases.

In addition, the Affordable Care Act expands employment-based wellness programs, such as those that focus on helping employees stop smoking.

The CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Services (NCHHSTP) offers a helpful table of recommended preventive services for people at risk for HIV and shows which health insurance plans cover these services without cost sharing under the ACA.

The Federal Government also has several other resources to assist individuals in quitting smoking:

• Smartphone Apps—The National Institutes of Health (NIH) has launched QuitPal, a free smartphone app to help smokers change their behavior. Also, the VA has developed the StayQuit Coach app to help individuals stay quit after they have stopped smoking.
• Tips from Former Smokers—The CDC offers "Tips from Former Smokers,” featuring people discussing the health effects they are living with as a result of their tobacco use, as well as resources and tools to help individuals quit smoking.
• Information and Resources—The website, BeTobaccoFree.hhs.gov, provides information on avoiding or ending tobacco use.
• Chat/Phone Support—The National Cancer Institute’s (NCI) Smokefree.gov provides free resources to help people quit smoking, including real-time live instant messaging help from a counselor. You can also call 1-800-QUIT-NOW for free quit coaching and referrals to local resources.
• Help for the Military—The U.S. Department of Defense (DOD) website, Quit Tobacco. Make Everyone Proud, offers resources for members of the U.S. military and their families.