Background:
In high-income countries, being HIV positive is associated with higher rates of smoking. This is important to public health because evidence suggests that HIV/AIDS patients who smoke have poorer treatment and survival outcomes. Moreover, both smoking and HIV are risk factors for comorbidities such as tuberculosis, which is highly prevalent in some low-and middle-income countries. The HIV-smoking relationship is understudied in sub-Saharan Africa, where tobacco use patterns and HIV prevalence differ greatly from other world regions. This study is an effort to fill this gap in the literature.

Methods:
This study examined cross-sectional data from the Demographic Health Surveys (DHS) and AIDS Indicator Surveys. Data from 25 sub-Saharan African countries were pooled (n=286,850), and the association between cigarette smoking and HIV status was analysed through hierarchical logistic regression models. As a secondary aim, this study also examined the relationship between smokeless tobacco use (chew and/or snuff) and HIV status.

Results:
Overall, men who had HIV/AIDS had a significantly (p < 0.0001) higher smoking prevalence (25.90%) than men who did not (16.09%), as did women who had HIV/AIDS compared with women who did not (1.15% vs. 0.73%; p < 0.001). Multivariate logistic regression analysis revealed that people living with HIV/AIDS were 12% more likely to smoke than people living without (OR = 1.12, 95% CI=1.04, 1.21; p < 0.001) when adjusting for socioeconomic, demographic, and sexual risk factors. Similarly, multivariate logistic regression revealed that HIV-positive individuals were 34% more likely to use smokeless tobacco than HIV-negative individuals (adjusted OR = 1.34, 95% CI = 1.17, 1.53).

Conclusions:
This study complements evidence from other world regions showing that HIV infection is associated with a higher likelihood of cigarette smoking as well as smokeless tobacco use in subSaharan Africa, even when controlling for demographic, socioeconomic, and sexual risk factors.