HIV interventions should be expanded to incorporate relationship dynamics and involve smoking cessation methods, according to results from a study led by a University researcher. The study recruited male couples in its investigation of the association between smoking behavior, HIV disease management and internalized heterosexism — a negative self-image some gay men have of themselves.
The research — published in the most recent issue of the journal AIDS Care —was led by Kristi Gamarel, a post doctoral research fellow in the Department of Psychiatry and Human Behavior.
Higher levels of smoking are seen among people living with HIV compared to the general population, Gamarel said. Feeling stigmatized, a feeling common among gay people, is correlated with a greater smoking rate as well as a lower adherence to HIV treatment, she added.
Gamarel said she was particularly interested in investigating this dynamic in couples. The study used survey results from 266 male couples in the San Francisco Bay Area who were involved in a separate longitudinal study based on relationship factors and HIV treatment. The participants reported sociodemographic information as well as smoking, alcohol and stimulant usage. They were also assessed for internalized heterosexism, depressive symptoms, HIV treatment adherence and HIV viral load levels — the amount of the virus present in one’s blood.
Analysis of these surveys indicated that “having a smoking partner was associated with over five-fold greater odds of reporting smoking,” and higher levels of internalized heterosexism are also linked to increased smoking rates, according to the study.
“When people are diagnosed with HIV they stop doing things that damage their health,” said Seth Kalichman, professor of social psychology at the University of Connecticut who researches HIV/AIDS prevention and was not involved with the study. “Internalized heterosexism is a specifically important part of negative self-concept that can undermine efforts to stop health-harming things like smoking,” he added.
Gamarel said she did not expect there to be an association between HIV viral load levels and having a partner who smokes. “The reasoning behind this is cross sectional,” she said, adding that the higher viral load could potentially be attributed to second hand smoke.
Kalichman said he was also surprised by the linkage between partner smoking and HIV viral load, and said the finding could be an anomaly or a finding related only to this particular sample. “Nevertheless, an interesting finding like this could point to future research initiatives,” he said.
“When we think about people living with HIV, a lot of the intervention methods have been focused on the individual,” said Gamarel, adding that the significance of the study results “calls to the need for moving beyond the individual framework of intervention modality.” Interventions should focus on relationships not only between couples, but with friends and family, she said.
The study’s results emphasized the importance of targeting internalized heterosexism as a means to improve intervention services, Kalichman said. “Negative self-image is often related to depression, and this makes people with HIV less likely to take care of themselves,” he said.
Gamarel said she is continuing her research on this subject by conducting a pilot study that investigates the unique treatment needs of couples with at least one smoking and one HIV positive partner. “We are trying to move towards what an improved intervention would actually mean,” she said.