Tobacco Harm Reduction Should Be Part of HIV Care

Around 41 million people globally are living with HIV, and smoking rates in this population are significantly higher than national averages—up to four times greater. In Australia, 21 percent of people with HIV smoke, compared to 11 percent of the general population, while in countries like Austria, Germany, and Italy, nearly half of those with HIV are smokers. South Africa, with the world’s highest HIV rates, sees smoking rates of 52 percent among men and 13 percent among women with HIV, compared to 32 percent and 7 percent in the general population. In the United States, smoking rates among people with HIV range from 34 to 47 percent, far exceeding the national average of just over 12 percent. The National Cancer Institute notes that lung cancer is the leading cause of cancer death among people with HIV on antiretroviral therapy (ART). Despite advances in medical care, smoking negates the life-extending benefits of ART, with over 4 million of the 24.5 million people on treatment estimated to smoke. A briefing paper by the Global State of Tobacco Harm Reduction emphasizes that smokers living with HIV are more likely to die from smoking-related diseases than from HIV itself. High smoking rates among people with HIV may stem from shared challenges with other marginalized groups, such as poverty, homelessness, and incarceration, where smoking is often used to cope with stress, anxiety, and pain. For those with HIV, smoking further weakens immune systems, increasing risks of infections like *Pneumocystis* pneumonia and cardiovascular diseases. The U.S. Centers for Disease Control and Prevention warns that smoking exacerbates these risks even for those with suppressed virus levels. Dr. Mark Tyndall, a medical doctor and epidemiologist, highlights that while smoking’s impact was previously overshadowed by HIV treatment priorities, it now poses a critical threat. He notes that smoking increases cardiovascular risks and may worsen opportunistic infections, even for those with controlled HIV. Tyndall, known for pioneering opioid harm reduction programs, stresses the urgent need to integrate tobacco harm reduction into HIV care to improve outcomes for affected individuals.