Demographic and clinical characteristics associated with tobacco smoking and alcohol use disorder among heterosexual people living with HIV in West Papua, Indonesia


Alcohol use


Introduction: Tobacco smoking and Alcohol use disorder (AUD) are common among People living with human immunodeficiency virus (PLHIV), which is associated with increased mortality and morbidity. This study aimed to determine the prevalence of tobacco smoking and AUD, as well as assess the factors associated with tobacco smoking and AUD among heterosexual PLHIV in West Papua.

Methods: A cross-sectional study was conducted involving PLHIV on antiretroviral therapy (ART) at the voluntary counselling and testing (VCT) clinic in Manokwari, Sorong City, and Fak-Fak district. Data were collected from 237 PLHIV using a consecutive sampling technique and interview. Binary logistic regression analysis was performed to determine the prevalence and estimate the factors associated with current tobacco smoking and AUD.

Results: The prevalence of tobacco smoking and AUD among PLHIV was 30.8% and 34.6%, respectively. There were statistically significant associated between tobacco smoking and gender (OR=2.881, CI=2.201-3.772), occupation (OR=1.375, CI=1.116-1.622), CD4+ count (OR=1.865, CI=1.865, CI=1.068-3.259) and opportunistic infections (OR=1.348, CI=1.054-1.7240. In addition, there were statistically significant associated between AUD and gender (OR=2.951, CI=2.16-3.930), occupation (OR=1.392, CI=1.178-1.645), CD4+ count (OR=1.769, CI=1.031-3.073), and opportunistic infections (OR=1.445, CI=1.134-1.842).

Conclusions: Gender, occupation, CD4+ count levels, and opportunistic infection factors were associated with tobacco smoking and AUD among heterosexual PLHIV in West Papua. These findings highlight the critical need for an efficient cigarette and alcohol use control program for PLHIV in developing countries such as Indonesia, especially in West Papua.


[1] Kemenkes R. Direktorat Penyakit Tidak Menular, “Infodatin Perilaku Merokok Masyarakat Indonesia berdasarkan Riskesdas 2007 dan 2013,” Jakarta, 2014.
[2] Badan Penelitian dan pengembangan kesehatan, “Riset kesehatan Dasar 2013,” Jakarta, 2013.
[3], “How Does Smoking Affect People with HIV?,” 2022. (accessed May 27, 2022).
[4] P. Aldaz, C. Moreno-iribas, N. Egüés, F. Irisarri, Y. Floristan, and J. Sola-boneta, “Mortality by causes in HIV-infected adults : comparison with the general population,” BMC Public Health, vol. 11, no. 300, pp. 1–8, 2011.
[5] V. D. RD Simmons, BC Ciancio, MM Kall, BD Rice, “Ten-year mortality trends among persons diagnosed with HIV infection in England and Wales in the era of antiretroviral therapy : AIDS remains a silent killer,” HIV Med., vol. 14, pp. 596–604, 2013, doi: 10.1111/hiv.12045.
[6] S. Lucas, “Causes of death in the HAART era.,” Curr. Opin. Infect. Dis., vol. 25, no. 1, pp. 36–41, Feb. 2012, doi: 10.1097/QCO.0b013e32834ef5c4.
[7] P. Michael N. Bates, PhD; Asheena Khalakdina, PhD; Madhukar Pai, MD, PhD; Lisa Chang, MPH; Fernanda Lessa, MD, MPH; Kirk R. Smith and Background:, “Risk of Tuberculosis From Exposure to Tobacco Smoke,” Rev. Artic., vol. 167, pp. 335–342, 2020.
[8] M. Helleberg et al., “Smoking and life expectancy among HIV-infected individuals on antiretroviral therapy in Europe and North America,” AIDS, vol. 29, no. 2, pp. 221–29, 2015, doi: 10.1097/QAD.0000000000000540.
[9] A. H. Mokdad, J. S. Marks, D. F. Stroup, and J. L. Gerberding, “Actual causes of death in the United States, 2000.,” JAMA, vol. 291, no. 10, pp. 1238–1245, Mar. 2004, doi: 10.1001/jama.291.10.1238.
[10] I. T. Dmd, D. J. V. Drph, F. E. Fletcher, H. D. Mhs, R. Arduino, and E. R. Gritz, “Poly-Tobacco Use Among HIV-Positive Smokers : Implications for Smoking Cessation Efforts,” Nicotine Tob. Res., vol. 15, no. 12, pp. 2100–2106, 2013, doi: 10.1093/ntr/ntt107.
[11] H. I. Hall et al., “Estimation of HIV Incidence in the United States,” JAMA, vol. 300, no. 5, pp. 520–529, 2010, doi: 10.1001/jama.300.5.520.Estimation.
[12] Ola A Selnes, “Impact of HIV infection and alcohol on cognition : a review,” Neurobehav. HIV Med., pp. 85–94, 2010, doi: 10.2147/NBHIV.S7364.
[13] K. J. Bryant, D. Ph, S. Nelson, R. S. Braithwaite, and D. Roach, “Integrating HIV/AIDS and Alcohol Research Ken,” Alcohol Res Heal., vol. 33, no. 3, pp. 167–178, 2010.

[14] R. S. Braithwaite, K. J. Bryant, and D. Ph, “Influence of Alcohol Consumption on Adherence to and Toxicity of Antiretroviral Therapy and Survival,” Alcohol Res Heal., vol. 33, no. 3, pp. 280–7, 2010.
[15] M. G. Neuman, M. Schneider, R. M. Nanau, and C. Parry, “Alcohol Consumption , Progression of Disease and Other Comorbidities , and Responses to Antiretroviral Medication in People Living with HIV,” AIDS Res. Treat., vol. 2012, 2012, doi: 10.1155/2012/751827.
[16] D. N. Bhatta, “HIV-related sexual risk behaviors among male-to-female transgender people in Nepal,” Int. J. Infect. Dis., vol. 22, pp. 11–15, 2014, doi: 10.1016/j.ijid.2014.01.002.
[17] J. Shuter, B. K. Pearlman, C. A. Stanton, A. B. Moadel, R. S. Kim, and A. H. Weinberger, “Gender Differences among Smokers Living with HIV,” HIV Clin. Manag. Gend., vol. 15, no. 5, pp. 412–417, 2016, doi: 10.1177/2325957416649439.
[18] S. Shiffman, C. M. Dresler, P. Hajek, S. J. A. Gilburt, D. A. Targett, and K. R. Strahs, “Efficacy of a Nicotine Lozenge for Smoking Cessation,” Arch Intern Med, vol. 162, pp. 1267–1276, 2002.
[19] I. Torchalla, C. T. C. Okoli, J. L. Bottorff, A. Qu, N. Poole, and L. Greaves, “Smoking cessation programs targeted to women: a systematic review.,” Women Health, vol. 52, no. 1, pp. 32–54, 2012, doi: 10.1080/03630242.2011.637611.
[20] W. Xu, W. Tang, J. Zhang, X. Shi, and Y. Zheng, “Cigarette Smoking and Its Associations with Substance Use and HIV-Related Sexual Risks among Chinese Men Who Have Sex with Men,” Int. J. Environ. Res. Public Health, vol. 17, no. 1653, pp. 1–14, 2020.

[21] T. Collaborators, “Articles Smoking prevalence and attributable disease burden in 195 countries and territories , 1990 – 2015 : a systematic analysis from the Global Burden of Disease Study 2015,” Lancet, vol. 389, pp. 1885–1906, 2017, doi: 10.1016/S0140-6736(17)30819-X.
[22] S. P. Barrett, C. Darredeau, and R. O. Pihl, “Patterns of simultaneous polysubstance use in drug using university students.,” Hum. Psychopharmacol., vol. 21, no. 4, pp. 255–263, Jun. 2006, doi: 10.1002/hup.766.
[23] D. N. Bhatta, A. Subedi, and N. Sharma, “Tobacco smoking and alcohol drinking among HIV infected people using antiretroviral therapy,” Tob. Induc. Dis., vol. 16, pp. 1–10, 2018.
[24] S. E. Woolf-king, R. Fatch, D. M. Cheng, C. Ngabirano, A. Kekibiina, and J. A. Hahn, “Alcohol use and unprotected sex among HIV-infected Ugandan adults : Findings from an event-level study,” Arch Sex Behav., vol. 47, no. 7, pp. 1937–1948, 2019, doi: 10.1007/s10508-017-1131-1.Alcohol.
[25] E. P. Peter Fernando, Saptiko, “Hubungan Tingkat pendidikan, pekerjaan dan Umur Terhadap Perilaku Merokok di Kota Pontianak tahun 2015,” FK Univ. Tanjungpura, 2015.
[26] D. E. Yanti et al., “Hubungan Pekerjaan dengan Perilaku Merokok di Wilayah Kerja Puskesmas Bumi Emas Lampung Timur,” J. Dunia kesmas, vol. 10, no. 1, pp. 51–55, 2021.
[27] T. Santoso and F. A. Yuniarti, “Hubungan Pekerjaan dan Penghasilan dengan Konsumsi Minuman Keras pada Remaja di Ngemplak Seneng Manisrenggo Klaten Jawa Tengah,” J. Heal. Promot. Behav., vol. 4, no. 2, pp. 87–91, 2015.

[28] S. J. Hile, M. B. Feldman, E. R. Alexy, and M. K. Irvine, “Recent Tobacco Smoking is Associated with Poor HIV Medical Outcomes Among HIV-Infected Individuals in New York,” AIDS Behav., vol. 20, no. 8, pp. 1722–1729, 2016, doi: 10.1007/s10461-015-1273-x.
[29] M. S. Webb, P. A. Vanable, M. P. Carey, and D. C. Blair, “Cigarette Smoking among HIV+ Men and Women: Examining Health, Substance Use, and Psychosocial Correlates across the Smoking Spectrum,” J Behav Med, vol. 30, no. 5, pp. 371–383, 2008, doi: 10.1007/s10865-007-9112-9.Cigarette.
[30] T. Winhusen et al., “Baseline cigarette smoking status as a predictor of virologic suppression and CD4 cell count during one-year follow up in substance users with uncontrolled HIV infection,” AIDS Behav, vol. 22, no. 6, pp. 2026–2032, 2019, doi: 10.1007/s10461-017-1928-x.Baseline.
[31] P. S. S. Rao, A. Ande, N. Sinha, A. Kumar, and S. Kumar, “Effects of Cigarette Smoke Condensate on Oxidative Stress , Apoptotic Cell Death , and HIV Replication in Human Monocytic Cells,” PLoS One, pp. 1–17, 2016, doi: 10.1371/journal.pone.0155791.
[32] M. Reilly, N. Delanty, J. A. Lawson, and G. A. FitzGerald, “Modulation of oxidant stress in vivo in chronic cigarette smokers.,” Circulation, vol. 94, no. 1, pp. 19–25, Jul. 1996, doi: 10.1161/01.cir.94.1.19.
[33] G. N. Delorenze, C. Weisner, A. Tsai, D. D. Satre, and P. Charles, “Excess Mortality Among HIV-Infected Patients Diagnosed With Substance Use Dependence or Abuse Receiving Care in a Fully Integrated Medical Care Program,” Alcohol Clin Exp Res., vol. 35, no. 2, pp. 203–210, 2012, doi: 10.1111/j.1530-0277.2010.01335.x.Excess.

[34] Gyongyi Szabo and Pranoti Mandrekar, “A recent perspective on alcohol, immunity and host defense Gyongyi,” Alcohol Clin Exp Res., vol. 33, no. 2, pp. 220–232, 2013, doi: 10.1111/j.1530-0277.2008.00842.x.A.
[35] World Health Organization (WHO), “Tobacco companies spend tens of billions of dollars each year on tobacco advertising, promotion and sponsorship,” Geneva Switzerland, 2013.
[36] S. Basu, D. Stuckler, A. Bitton, and S. A. Glantz, “Projected effects of tobacco smoking on worldwide tuberculosis control : mathematical modelling analysis,” BMJ, vol. 343, pp. 1–11, 2011, doi: 10.1136/bmj.d5506.
[37] P. D. O. Davies et al., “Smoking and tuberculosis: the epidemiological association and immunopathogenesis,” Trans. R. Soc. Trop. Med. Hyg., vol. 100, no. 4, pp. 291–298, 2006, doi: 10.1016/j.trstmh.2005.06.034.
[38] R. Alavi-naini, B. Sharifi-mood, and M. Metanat, “Association Between Tuberculosis and Smoking,” Int. J. High Risk Behav. Addict., no. 3, pp. 1–4, 2012, doi: 10.5812/ijhrba.5215.
[39] V. Gajalakshmi, R. Peto, T. S. Kanaka, and P. Jha, “Smoking and mortality from tuberculosis and other diseases in India: retrospective study of 43000 adult male deaths and 35000 controls.,” Lancet (London, England), vol. 362, no. 9383, pp. 507–515, Aug. 2003, doi: 10.1016/S0140-6736(03)14109-8.
[40] R. O. Connell, N. Chishinga, E. Kinyanda, V. Patel, H. Ayles, and A. Helen, “Prevalence and Correlates of Alcohol Dependence Disorder among TB and HIV Infected Patients in Zambia,” PLoS One, vol. 8, no. 9, pp. 1–9, 2013, doi: 10.1371/journal.pone.0074406.