HIV and Smoking: Burning Up Lives

Ten years ago, back in 1995, when I had been diagnosed HIV-positive for about six years, I used to take a long Bette Davis drag on my Marlboro Light and joke that I aspired to die of lung cancer, dahling. The morbid joke was that, with limited, problematic medicines for AIDS, I’d be lucky to live long enough to have to deal with the chronic health problems of people without the virus. Coronary problems? Bring ‘em on! Yuk, yuk.

Well, the joke was on me. Nowadays, with HIV transformed into a sometimes manageable illness—at least for those of us in the developed world with access to combination therapies—people with the virus are contending with the health problems that sadly affect many in late middle age: cancer, cardiovascular problems, diabetes, liver disease, and more. Certainly, those are serious concerns, but many will think them less daunting foes than AIDS-related pneumonia and the other conditions that killed so many so quickly in the ‘80s and early ‘90s.

But what’s scary now is the special and heightened risk that people with HIV face that very few people seem aware of—the nefarious relationship between HIV and smoking cigarettes.

The culture of AIDS is a culture of smoking. Amazingly, HIVers smoke cigarettes at triple the rates of the general population. While around 22 percent of Americans smoke, a recent study showed that up to 66 percent of people with HIV are lighting up. That’s not all. People with HIV are at much greater risk of negative health outcomes related to smoking than those without the virus. Rates of heart attack are on the rise among the HIV-positive; chronic bronchitis and emphysema, too. And many different types of cancers are shown to be spiking among the HIV-positive. Why would people whose health is already compromised engage in an activity that dramatically increases their risk of serious negative health outcomes? What can we do to help people with HIV stub out the danger?

Those were some of the questions asked at the world’s first conference on HIV and smoking on November 15 at Rockefeller University on the Upper East Side. The Lesbian, Gay, Bisexual and Transgender Community Center, in collaboration with the New York City and State departments of health, the American Cancer Society, Memorial Sloan Kettering Cancer Center, the New York City Coalition for a SmokeFree City, and a host of community organizations including Callen-Lorde Community Health Center, Gay Men’s Health Crisis, Harlem United, and the Latino Commission on AIDS joined forces for Light Up Your Life: A Leadership Conference on HIV and Smoking.

More than 200 anti-tobacco activists, AIDS educators, and community leaders living with HIV came together to learn about the powerful and deadly symbiosis between smoking and the virus. What was clear was that there is a new paradigm at play with AIDS these day—infected people are living longer and when death does occur, different things are taking us out; smoky things. In 1996, a study shows, about 45 percent of people with HIV died of non-HIV-related causes. That number, by 2002, was up to more than 70 percent. What’s maddening about this is that people with HIV could be drastically improving their health, and increasing their longevity, by giving up the smokes, but they aren’t.

A new study by Dr. Jack Burkhalter and his colleagues at Memorial Sloan Kettering who study HIV-positive and LGBT smokers showed that out of just under 500 HIV-positive Medicaid recipients in New York State, almost 70 percent smoked and about one-fifth were ex-smokers. The smokers in the group were more likely to use illicit drugs and less likely to think that continuing smoking was bad for them.

As an ex-smoker with HIV myself, I can tell you that many of us smoke to deal with the stress of having a serious, potentially life-threatening disease. It may be counter-intuitive, but the tobacco that’s so bad for us helps ease the burden of the still powerful stigma of the disease, the drudgery of the endless doctors appointments and pill-popping, the fear of rejection from potential lovers, and for some, the mind-numbing boredom of a life on disability combined with the fear that any moment, the other shoe may drop.

Add to this the unintentional collusion of well-intentioned health care workers some of whom still have the mindset of “Oh, let ‘em smoke, it’s the one pleasure they have left.”

Well, it’s time for a change. Just as New York City bit the bullet and lowered smoking rates by an unprecedented 11 percent in the general population over the last few years by the combined impact of the Clean Air Law and aggressive public health campaigns that gave out tens of thousands of supplies of the nicotine patches, the HIV/AIDS community must now change its smoking ways. Programs need to educate people with the virus about the negative health impact of smoking and remind those on Medicaid that the program pays for nicotine replacement therapy.

We need to find novel ways of helping HIVers deal with the stress in their lives by methods other than smoking. Just as with the general population, about three-quarters of HIV-positive smokers want to quit. It’s time we helped them.

QueerQuit 2006, a special one-shot workshop on everything you need to know about making that New Year’s resolution a reality by quitting smoking for good, will take place on Thursday, January 5 from 6 p.m. to 9 p.m. and again on Saturday, January 14 from 1 p.m. to 4 p.m. at the LGBT Community Center. QueerQuit 2006 is free but registration is required. Call 212-620-7310, ext 212 or visit for more information.

Christopher Murray, LMSW, is a substance use counselor and runs the LGBT SmokeFree Project at the Center. He is also on the executive committee of the New York City Coalition for a SmokeFree City.