Andrea H. Weinberger, Philip H. Smith, Allison P. Funk, Shayna Rabin, Jonathan Shuter

Persons living with HIV/AIDS (PLWH) smoke at higher rates than other adults and experience HIV-related and non-HIV-related adverse smoking consequences. The current study conducted a systematic review to synthesize current knowledge about gender differences in smoking behaviors among PLWH. Over three thousand abstracts from MEDLINE were reviewed and seventy-nine publications met all of the review inclusion criteria (i.e., reported data on smoking behaviors for PLWH by gender). Sufficient data were available to conduct a meta-analysis for one smoking variable: current smoking prevalence. Across studies (n=51), the meta-analytic prevalence of current smoking among female PLWH was 36.3% (95% CI=28.0%-45.4%) and male PLWH was 50.3% (95% CI=44.4%-56.2%; meta-analytic OR=1.78, 95% CI=1.29-2.45). When analyses were repeated just on United States (U.S.) studies (n=23), the prevalence of current smoking was not significantly different for female PLWH (55.1%, 95% CI=47.6%-62.5%) compared to male PLWH (55.5%, 95% CI=48.2%-62.5%; meta-analytic OR=1.04, 95% CI=0.86-1.26). Few studies reported data by gender for other smoking variables (e.g., quit attempts, non-cigarette tobacco product use) and results for many variables were mixed. Unlike the general U.S. population, there was no difference in smoking prevalence for female versus male PLWH (both >50%) indicating that HIV infection status was associated with a greater relative increase in smoking for women than men. More research is needed in all areas of smoking behavior of PLWH to understand similarities and differences by gender in order to provide the best interventions to reduce the high smoking prevalence for all genders.