HIV & smoking in India

Indian Journal of Medical Research, July, 2009 by S. Ramesh Kumar, Soumya Swaminathan, Timothy Flanigan, K.H. Mayer, Raymond Niaura

The US Department of Health and Human Services, Public Health Service, 2000 (49) recommends the "5 A" strategy for use by primary care clinicians/health care personnel as an intervention in the primary care setting. Clinicians should ask the patient if he or she uses tobacco, advise him or her to quit, assess willingness to make a quit attempt, assist him or her in making a quit attempt, and arrange for follow up contacts to prevent relapse. Currently there are no standard guidelines for smoking cessation treatment in India. Recent efforts to ban smoking in public places and increase in tobacco tax are likely to be helpful in reducing the number of smokers or at the very least, the amount smoked by individuals. Experience from Canada suggests that such a ban resulted in high levels of public support and a reduction in smoking prevalence (66). A multi-pronged strategy is required, and in addition to public measures, individual guidance and assistance is required to help smokers quit. Guidelines for health care workers need to be developed and disseminated as efforts to encourage smoking cessation within the health care setting which are currently negligible.

Conclusion

India is home to a large number of HIV-infected individuals--adult males who are uneducated and from the lower socio-economic strata especially vulnerable group. These groups also have the highest rates of smoking. HIV-infected smokers are at a high risk for bacterial pneumonia, tuberculosis and a host of other infectious and non infectious complications that substantially increase morbidity and possibly mortality. While data on smoking rates among HIV-infected persons in India are lacking, preliminary observations suggest that it is likely to cause significant co-morbidity. Physicians and public health specialists need to pay attention to the growing epidemic of smoking and try innovative approaches to prevent young people from starting as well as to help people quitting smoking. In addition to the ban on smoking in public places and increase in tobacco tax, incorporation of advice regarding the harmful effects of smoking and assistance with smoking cessation should be one of the components of primary care, with special focus on patients with HIV infection.

Acknowledgment

Dr S. Ramesh Kumar was the recipient of a Fogarty AIDS International Training and Research Programme (D43-TW000237) funded by the U.S. National Institutes of Health at Miriam Hospital / Brown University, RI, USA in 2006. The authors thank Dr P.R. Narayanan, formerly Director, Tuberculosis Research Centre for his support, and Ms D. Kalaivani for secretarial assistance.

Received June 23, 2008

References

(1.) WHO Framework Convention on Tobacco Control: why is it important? Available at: http://www.who.int/topics/tobacco/ qa/en/, accessed on December 10, 2007.

(2.) International Policy Conference on Children and Tobacco. World Health Organization. Available at: http://www.who.int/ directorgeneral/speeches/1999/english/19990318_international_ policy_conference.html, accessed on December 10, 2007.