Background:
While high cigarette smoking rates in people living with HIV are an established phenomenon in high-income countries, little or no information exist in low- and middle-income countries. We used nationally representative data from 2006 and 2017 across twenty countries in sub-Saharan Africa, in order to provide a reliable source of information about the differential in rates of cigarette smoking among men living with and without HIV.

Methods:
We calculated odds ratios (OR) using logistic regression to examine if cigarette smoking was associated with HIV status. The following potential confounders of the association between HIV status and cigarette smoking were considered: age, education attainment, wealth index, employment status and place of residence. We used meta-analysis calculate pooled OR across countries.

Results:
The median prevalence of cigarette smoking among HIV negative and HIV positive individuals was 18% and 24% respectively among these men. In unadjusted analysis, the prevalence of cigarette smoking was more than twice as high in adolescents and young adult males living with HIV than among those not infected (OR=2.07, 95% confidence interval [CI] 1.70 to 2.51). After adjustment for age, education attainment, wealth index, employment status and place of residence the association was greatly attenuated (OR=1.24, 95% CI 1.03 to 1.50). However, among older HIV-positive adult male respondents (≥ 40 years), the proportion of cigarette smoking was lower than among the uninfected, in both unadjusted (OR=0.85, 95% CI 0.74 to 0.97) and adjusted analyses (OR =0.87, 95% CI 0.76 to 1.00).



[Figure 1]



Conclusions:
We found that the prevalence of cigarette smoking was more than twice as high in adolescents and young adult males with HIV than among those not infected with HIV in sub-Saharan Africa countries. Widespread and effective smoking cessation strategies in people living with HIV are needed to prevent the emerging burden of CVD and other non-communicable diseases.