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Sexual Behavior, Smoking, and HIV-1 Infection in Haitian Women
Neal A. Halsey, MD;
Jacqueline S. Coberly, PhD;
Elizabeth Holt, DrPH;
Jeannine Coreil, PhD;
Patricia Kissinger, BSN, MPH;
Lawrence H. Moulton, PhD;
Jean-Robert Brutus, MD, MPH;
Reginald Boulos, MD, MPH
JAMA. 1992;267(15):2062-2066.
Abstract
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Objective.
—To determine whether a previously observed association between human immunodeficiency virus type 1 (HIV-1) infection and smoking in Haitian women could be explained by confounding high-risk behaviors.
Design and Setting.
—A nested case-control study at a primary care health clinic in Cité Soleil, Haiti.
Participants.
—Women who reported having smoked (n=89) and randomly selected nonsmokers (n = 329) who had participated in a survey 1 to 12 months earlier evaluating risk factors for HIV-1 infection.
Main Outcome Measures.
—Lifetime sexual practices, smoking, health beliefs and practices, and other factors potentially confounding the relationship between smoking and HIV-1 infection.
Results.
—Compared with nonsmokers, smokers reported higher rates of high-risk behaviors, including more lifetime sex partners (P<.001), being less likely to be married (P<.01), and being more likely to have visited folk healers (P<.01). No intravenous drug use was reported, and no significant differences were noted between smokers and nonsmokers in numbers of past surgical or dental procedures or injections. Adjustment for all factors associated with HIV-1 infection and smoking in regression analyses revealed an independent association between smoking and HIV-1 infection (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.6 to 7.5). Other factors associated with HIV-1 infection included having more than two lifetime sex partners (OR, 3.4; 95% CI, 1.7 to 6.8) and lower socioeconomic status as reflected by a dirt floor in the home (OR, 8.6; 95% CI, 3.3 to 22.0).
Conclusions.
—Smoking is a marker for high-risk sexual behavior and is associated with an increased risk of HIV-1 infection in this population. The persistent association between smoking and HIV-1 infection after adjustment for all known risk factors suggests the possibility of a biologic effect of smoking that warrants further evaluation in other populations.
(JAMA. 1992;267:2062-2066)
Author Affiliations
From the Department of International Health, The Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md (Drs Halsey, Coberly, Holt, and Moulton); the Department of Community and Family Health, University of South Florida College of Public Health, Tampa (Dr Coreil); and the Centers for Development and Health, Port-au-Prince, Haiti (Ms Kissinger and Messrs Brutus and Boulos).
Footnotes
Reprint requests to Department of International Health, The Johns Hopkins University, 615 N Wolfe St, Baltimore, MD 21205 (Dr Halsey).
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