Associations Between Internalized HIV Stigma and Tobacco Smoking Among Adolescents and Young Adults Living with HIV: The Moderating Role of Future Orientations


HIV stigma and future orientations impact the health of adolescents and young adults living with HIV (AYALWH); however, little is known about how these factors may impact tobacco use, and thereby long-term health status. This study examined associations between internalized HIV stigma, future orientations, and smoking behavior using a cross sectional survey of AYALWH ages 18 to 29 (N = 109). Greater levels of stigma were associated with increased odds of smoking, and greater future orientations were associated with a reduced odds of smoking. The interaction was significant, illustrating that stigma was significantly associated with an increased odds of smoking among AYALWH who reported low levels of future orientations, but not for those with high levels of future orientations. Findings underscore the importance of understanding how HIV stigma may undermine future aspirations of AYALWH. Interventions that target HIV stigma and future orientations may be critical for tobacco prevention and cessation.


El estigma asociado con el VIH y orientación futura de adolescentes y adultos jóvenes viviendo con VIH (AYALWH) impacta la salud de estos; sin embargo, se conoce poco sobre cómo estos factores pueden impactar el uso de tabaco y, por lo tanto, el estado de salud a largo plazo. Este estudio examinó las asociaciones entre el estigma internalizado hacia el VIH, las orientaciones futuras, y hábitos de fumar mediante una encuesta transversal con AYALWH entre las edades de 18 a 29 años (N = 109). Niveles elevados de estigma fueron asociado con mayores probabilidades de fumar, y mayores orientaciones futuras se asociaron con menores probabilidades de fumar. La interacción entre variables fue significativa, demostrando que el estigma se asoció significativamente con un aumento de las probabilidades de fumar entre AYALWH que reportaron niveles bajos de orientaciones futuras, pero no para aquellos con niveles altos de orientaciones futuras. Los hallazgos resaltan la importancia de comprender cómo el estigma hacia el VIH puede socavar las aspiraciones futuras de los AYALWH. Intervenciones dirigidas al estigma hacia el VIH y las orientaciones futuras pueden ser críticas para la prevención y abandono del tabaco.

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This work was supported by the University of Michigan Roger Cancer Center Outreach & Health Disparities grant (PI: Gamarel). We are indebted to the W’SUP team at Wayne State University and the young people who participated in this study.

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Correspondence to Kristi E. Gamarel.

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Gamarel, K.E., Finer, Z., Resnicow, K. et al. Associations Between Internalized HIV Stigma and Tobacco Smoking Among Adolescents and Young Adults Living with HIV: The Moderating Role of Future Orientations. AIDS Behav 24, 165–172 (2020).

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  • Youth and young adults
  • Smoking
  • Internalized HIV stigma
  • Future orientations