Sexual behavior, smoking, and HIV-1 infection in Haitian Women
N. A. Halsey, J. S. Coberly, E. Holt, J. Coreil, P. Kissinger, L. H. Moulton, J. R. Brutus and R. Boulos
Department of International Health, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md.
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
Cite 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 less than .001), being less likely to be married
(P less than .01), and being more likely to have visited folk healers (P
less than .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 [Cl], 1.6 to 7.5). Other factors
associated with HIV-1 infection included having more than two life-time sex
partners (OR, 3.4; 95% Cl, 1.7 to 6.8) and lower socioeconomic status as
reflected by a dirt floor in the home (OR, 8.6; 95% Cl, 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.
