Smoking, internalized heterosexism, and HIV disease management among male couples

Abstract

High rates of cigarette smoking have been observed among HIV-positive individuals. Smoking has been linked to HIV-related medical complications and non-AIDS defining cancers and negatively impacts on immune function and virologic control. Although internalized heterosexism has been related to smoking behaviors, little is known about associations between partners' reports of smoking, internalized heterosexism, and HIV medication management in male couples with HIV. A sample of 266 male couples completed baseline assessments for a cohort study examining relationship factors and HIV treatment. A computer-based survey assessed self-reported smoking behaviors, alcohol use, internalized heterosexism, and antiretroviral therapy (ART) adherence. HIV-positive men also provided blood samples to assess viral load. Approximately 30% of the sample reported that they are currently smoking cigarettes. After adjusting for demographic characteristics, men in a primary relationship with a partner who reported currently smoking had more than five-fold greater odds of reporting smoking. Higher levels of internalized heterosexism and financial hardship were each independently associated with greater odds of reporting smoking. Among HIV-positive men on ART (n = 371), having a partner who reported smoking was associated with almost three-fold greater odds of having a detectable viral load. Our findings add new support to the evidence of romantic partners influencing each other's health behaviors, and demonstrate an association between smoking and disease management within male couples. Future research should explore the interpersonal and social contexts of smoking in order to develop interventions that meet the unique needs of male couples.

Keywords:

• HIV
• couples
• smoking
• MSM
• viral suppression
• stigma

Acknowledgments

We gratefully thank the men who participated in the study; the tireless efforts of interviewers Gilda Mendez, Vanessa Monzon, Gabriel Ortiz, and Troy Wood; and our colleagues Megan Comfort and Lynae Darbes.

Additional information

Funding

This project was funded by the National Institutes of Health [grant number R01NR010187], [grant number K24MH087220], [grant number K24DA037034] and [training grant number T32MH 078788].