How to Stop Smoking If You Have HIV

Cessation Resources from Insurance to Medicaid

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Photograph © Matt Trostle

Smoking is a preventable factor that accounts for the highest number of lost life-years among people with HIV in the developed world. In fact, 42 percent of people living with HIV today are classified as current smokers, literally twice the national average.

These statistics highlight the need for more effective interventions, whereby people newly diagnosed with HIV are actively screened for tobacco use and provided the tools for cessation based on the complex social, economic, psychological, and medical needs of the HIV community.

Integrating Smoking Cessation into HIV Care

Since as far back as the 1980s, research has shown the efficacy of integrating smoking cessation counseling into primary HIV care. Sadly, implementation has been lagged behind, with fewer than 50 percent of HIV care providers offering their patients smoking cessation interventions or referrals, according to data from the U.S. Department of Veteran Affairs.

However, there have been efforts in recent years to improve integration among providers, the key recommendations of which include:

  • Providing patients with information on the risks of HIV and smoking, including such comorbidities as cardiovascular disease, lung cancer, and chronic obstructive pulmonary disease (COPD).
  • Administering two smoking cessation medications in combination with regular counseling and follow-up.
  • Referring patients to specialists (e.g. mental health providers, substance abuse programs, social workers, support groups), as needed.
  • Actively re-prescribing smoking cessation medications after relapse. Studies have shown that smokers will try to quit five to seven times, on average, before succeeding. On-going follow-up and support are seen to be key in identifying (and addressing) smoker relapse.

Meanwhile, other teams are investigating ways to further improve the integrated model. In one study conducted at the University of Texas, researchers showed that nicotine replacement therapy (NRT), when used in conjunction with frequent cellular phone counseling, improved abstinence rates in people with HIV by almost 400 percent over to traditional, unsupported NRT.

Smoking Cessation Options Under the Affordable Care Act

Under the Affordable Care Act (ACA), private insurance created after March 23, 2010 must include a provision for free preventive health services, including tobacco use screening for adults and smoking cessation interventions for tobacco users. Similarly, expansion of Medicaid benefits now affords smoking cessation treatment for all adults (wherein benefits in some states were limited to pregnant women only).

The breakdown of coverage by provider is as follows:

  • Medicaid - Expansion of smoking cessation treatment for all adults in all U.S. states effective January 1, 2013. The ACA further expands Medicaid eligibility to all low-income adults.
  • Medicare - Nicotine nasal spray, nicotine inhaler, bupropion and varenicline, as well as individual counseling, for two quit attempts per year. The closing of the Medicare Part D "donut hole" also makes medications far more affordable for out-of-pocket expenses.
  • State Health Insurance Exchanges - Requires all plans to cover Essential Health Benefits, including smoking cessation (although benefits may vary by plan and/or provider).
  • Employer-Sponsored Insurance - Requires coverage of all preventive services given an "A" or "B" rating by the U.S. Preventive Services Task Force, including smoking cessation (although benefits may vary by plan and/or provider).

To learn more about eligibility or treatment access, contact 1-800-QUIT-NOW (1-800-784-8669) to connect directly with a staffed hotline in your state. The National Cancer Institute also offers an instant messaging LiveHelp hotline (in English only) from 8:00 a.m. to 8:00 p.m. EST.

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Article Sources
  • U.S. Centers for Disease Control and Prevention (CDC). "Cigarette smoking among adults - United States, 2011." Morbidity and Mortality Weekly Report (MMWR). November 9, 2012; 61(44):889-994.
  • Mdodo, R.; Frazier, E.; Mattson, C.; et al. "Cigarette smoking among HIV+ adults in care: Medical Monitoring Project, US, 2009." 20th Conference on Retroviruses and Opportunistic Infections (CROI 2013). Atlanta, Georgia; March 3-6, 2013: Abstract 775.
  • Hughes, J. "New treatments for smoking cessation." CA: A Cancer Journal for Clinicians. May-June 2000; 50(3):143-145.
  • Vidrine, D.; Arduino, R.; Lazev, A.; et al. "A randomized trial of a proactive cellular telephone intervention for smokers living with HIV/AIDS." AIDS. January 9, 2006; 20(2):253-260.
  • American Lung Association. "Helping Smokers Quit - Tobacco Cessation Treatment: What Is Covered?" Washington, D.C.; 2012.