Smoking and HIV: what are the risks and what harm reduction strategies do we have at our disposal?

AIDS Res Ther. 2018 Dec 12;15(1):26. doi: 10.1186/s12981-018-0213-z.

Abstract

The World Health Organization estimates that smoking poses one of the greatest global health risks in the general population. Rates of current smoking among people living with HIV (PLHIV) are 2-3 times that of the general population, which contributes to the higher incidence of non-AIDS-related morbidity and mortality in PLHIV.

Given the benefit of smoking cessation, strategies to assist individuals who smoke to quit should be a primary focus in modern HIV care.

Tobacco harm reduction focuses on reducing health risk without necessarily requiring abstinence. However, there remains uncertainty about the safety, policy and familiarity of specific approaches, particularly the use of vaporised nicotine products. Evidence suggests that vaporised nicotine products may help smokers stop smoking and are not associated with any serious side-effects. However, there is the need for further safety and efficacy data surrounding interventions to assist quitting in the general population, as well as in PLHIV specifically.

In addition, official support for vaping as a harm reduction strategy varies by jurisdiction and this determines whether medical practitioners can prescribe vaporised products and whether patients can access vaporised nicotine products. When caring for PLHIV who smoke, healthcare workers should follow general guidelines to assist with smoking cessation.

These include: asking the patient about their smoking status; assessing the patient’s readiness to quit and their nicotine dependence; advising the patient to stop smoking; assisting the patient in their attempt to stop smoking through referral, counselling, pharmacotherapy, self-help resources and/or health education; and arranging follow-up with the patient to evaluate their progress.

Australia’s health 2018 (Report)

Australian Institute of Health and Welfare,  Release Date: 

 

Australia’s Health 2018 is the AIHW’s 16th biennial report on the health of Australians. It examines a wide range of contemporary topics in a series of analytical feature articles and short statistical snapshots.

The report also summarises the performance of the health system against an agreed set of indicators.

Australia’s health 2018: in brief is a companion report to Australia’s health 2018.

Table of contents:

Whole report:

PDF Report (17.3Mb)

Australia’s health 2018 in brief:

Companion ‘in brief’ booklet presents highlights in a compact easy-to-use format.

 

Media release from SHINE SA: Teen Pregnancy

SHINE SA, Issued: 25 May 2018

Following the release of the Australian Institute of Health and Wellbeing’s Report, that includes the latest figures on teen birth-rates, SHINE SA believes that a decrease in the teen birth-rate as indicated in the report, is a positive outcome from the study.

“A decrease may reflect better sexual health information for young people including education in schools, and better access to sexual health services”, said Dr Amy Moten, Coordinator, Medical Education at SHINE SA.

“Increased access to Long Acting reversible Contraception for young people, as promoted by Family Planning Alliance Australia, is also a significant factor in reducing teen pregnancy rates”, Dr Moten said.

Low socio-economic status can be a marker of poor health outcomes overall. This increases with remoteness from metropolitan areas and Indigenous status. This has been shown in previous studies and also is supported by national data regarding cervical screening that shows that low socio-economic and Indigenous status reduces the rate of screening compared to people from a higher socioeconomic areas.

Social determinants of health are linked to social and economic factors that influence health. Young people from a lower socioeconomic area are likely to have poorer health literacy, lower levels of education and poorer access to health services including contraception. These have all been shown to be linked to an increased birth rate over all ages. Barriers to access health and contraceptive services such as cost and availability of these services increase with distance from metropolitan areas.

“Generally, teen mums often face increased stigma about being a parent and should be supported in their decision to continue parenting”, Dr Moten said.

“At SHINE SA, we provide pregnancy testing, counselling and advice. When a young person is pregnant they can discuss their options and be referred to appropriate services. For a young person continuing to parent we would refer them to the Metropolitan Youth Health Service for example, which has a Young Parenting program”, Dr Moten said.

SHINE SA believes that young mums should be supported to continue their education as completing secondary school after pregnancy has been shown to improve long term outcomes in both mother and child.

Dr Amy Moten, Coordinator Medical Education, SHINE SA
Issued: 25 May 2018

 

Intercourse, age of initiation and contraception among adolescents in Ireland

BMC Public Health 2018 18:362 https://doi.org/10.1186/s12889-018-5217-z

Abstract

Background

The need to tackle sexual health problems and promote positive sexual health has been acknowledged in Irish health policy. Young people’s sexual behaviour however remains under-researched with limited national data available.

Methods

This study presents the first nationally representative and internationally comparable data on young people’s sexual health behaviours in Ireland. Self-complete questionnaire data were collected from 4494 schoolchildren aged 15–18 years as part of a broader examination of health behaviour and their context. The prevalence of sexual initiation, very early sexual initiation (< 14 years) and non-condom use at last intercourse are reported and used as outcomes in separate multilevel logistic regression models examining associations between sociodemographic characteristics, lifestyle characteristics and young people’s sexual behaviours.

Results

Overall, 25.7% of boys and 21.2% of girls were sexually initiated. Older age was consistently predictive of initiation for both boys and girls, as were alcohol, tobacco and cannabis involvement, living in poorer neighbourhoods and having good communication with friends. Involvement in music and drama was protective. Very early sexual initiation (< 14 years) was reported by 22.8% of sexually initiated boys and 13.4% of sexually initiated girls, and was consistently associated with rural living, cannabis involvement and bullying others for both. Boys’ very early initiation was predicted by alcohol involvement, receiving unhealthy food from parents and taking medication for psychological symptoms, whereas better communication with friends and more experience of negative health symptoms were protective. Girls’ very early initiation was predicted by being bullied and belonging to a non-Traveller community, whereas taking medication for physical symptoms and attending regular health checks was protective. Condom use was reported by 80% of sexually initiated students at last intercourse. Boys’ condom use was associated with older age, higher family affluence, bullying others, more frequent physical activity and health protective behaviours. For girls, condom use was predicted by belonging to a non-Traveller community, healthy food consumption, higher quality of life and being bullied, whereas taking medication for physical and psychological symptoms was associated with non-condom use.

Conclusions

These nationally representative research findings highlight the importance of focusing on young people as a distinct population subgroup with unique influences on their healthsexual health requiring targeted interventions and policy.

 

Smoking causes one in five cancers in people with HIV in North America

aidsmap/nam, 22 January 2018

A fifth of all cancers in people receiving HIV care in North America between 2000 and 2015 was due to smoking, according to US research published this month in advance online by the journal AIDS.

“In the United States, the prevalence of smoking among HIV-infected people is substantially higher than in the general population, and most HIV-infected individuals either currently smoke or have previously smoked,” comment the authors. “Our findings indicated that a substantial fraction of cancer diagnoses among HIV-infected individuals potentially would not have occurred if they had never smoked.”

Thanks to improvements in HIV treatment and care, most people with HIV now have a normal or near-normal life expectancy. As these people age, non-AIDS-related cancers are an important cause of death.

Smoking Highly Dangerous for HIV-Positive Patients

Specialty Pharmacy Times,  Tuesday, October 17, 2017

Patients with HIV who smoke may have an increased risk of lung cancer mortality compared with the risk of dying from HIV, according to a new study published by JAMA Internal Medicine. 

These findings suggest that healthcare providers should strongly advocate for smoking cessation and cancer screening for patients with HIV.

The abstract concludes with: Those PLWH who adhere to ART but smoke are substantially more likely to die from lung cancer than from AIDS-related causes.