Addressing smoking during medical visits: Patients with human immunodeficiency virus

Background: Tobacco use, especially cigarette smoking, is prevalent in patients with HIV and is associated with increased morbidity and mortality. The HIV patient-provider interaction about cigarette smoking is not well understood. Purpose: Assess HIV provider attitudes and practices regarding smoking-related services and interventions for patients with HIV and explore patient-provider interactions regarding cigarette smoking from the perspective of people with HIV. Methods: A one-time survey about provider attitudes and practices regarding smoking among patients with HIV was completed by 92 HIV providers in 2010-2011. Additionally, a semi-structured interview was conducted in 2010 with 32 patients with HIV who smoke about their attitudes toward smoking and patient-provider interactions. The data were analyzed in 2010-2011. Results: Providers and patients reported frequent assessment of smoking during clinic appointments. The most common smoking-related services that providers reported included delivering brief advice to quit or reduce smoking, suggesting the use of nicotine replacement products, and providing smoking-cessation print materials to patients. Greatest barriers to providing smoking interventions in the context of HIV medical care appear to be lack of time, providers feeling insufficiently confident to address smoking, and the perception by patients that providers who did not push them to quit are more understanding. Approximately half of physicians expressed interest in seeking additional education to address cigarette smoking among their patients. Conclusions: Numerous smoking-related services occur in the context of HIV medical encounters. However, patient-provider relationship factors and time restrictions represent major barriers to effective intervention for this complex health problem.