title: Smoking, internalized heterosexism, and HIV disease management among male couples.
abstract: High rates of cigarette smoking have been observed among HIV-positive individuals. Smoking has been linked to HIV-related medical complications and non-AIDS defining cancers and negatively impacts on immune function and virologic control. Although internalized heterosexism has been related to smoking behaviors, little is known about associations between partners' reports of smoking, internalized heterosexism, and HIV medication management in male couples with HIV. A sample of 266 male couples completed baseline assessments for a cohort study examining relationship factors and HIV treatment. A computer-based survey assessed self-reported smoking behaviors, alcohol use, internalized heterosexism, and antiretroviral therapy (ART) adherence. HIV-positive men also provided blood samples to assess viral load. Approximately 30% of the sample reported that they are currently smoking cigarettes. After adjusting for demographic characteristics, men in a primary relationship with a partner who reported currently smoking had more than five-fold greater odds of reporting smoking. Higher levels of internalized heterosexism and financial hardship were each independently associated with greater odds of reporting smoking. Among HIV-positive men on ART (n = 371), having a partner who reported smoking was associated with almost three-fold greater odds of having a detectable viral load. Our findings add new support to the evidence of romantic partners influencing each other's health behaviors, and demonstrate an association between smoking and disease management within male couples. Future research should explore the interpersonal and social contexts of smoking in order to develop interventions that meet the unique needs of male couples.
authors.affiliation: a Department of Psychiatry and Human Behavior , Alpert Medical School of Brown University , Providence , RI , USA.
authors.forename: K E
authors.initials: KE
authors.lastname: Gamarel
authors.forename: T B
authors.initials: TB
authors.lastname: Neilands
authors.forename: S E
authors.initials: SE
authors.lastname: Dilworth
authors.forename: J M
authors.initials: JM
authors.lastname: Taylor
authors.forename: M O
authors.initials: MO
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000523:psychology*; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005191:Family Characteristics; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000523:psychology; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D012495:San Francisco; D012649:Self Concept; D020377:Self Efficacy; D012747:Sexual Partners; D012907:Smoking / Q000009:adverse effects* / Q000523:psychology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; MSM; couples; smoking; stigma; viral suppression