For AIDS Service Organizations and HIV Clinics

The Issue and Why It’s Important

In Ontario, people living with HIV are much more likely to smoke.

Smoking is a serious health threat for people living with HIV. Even with well-monitored HIV care, smokers with HIV lose more life years to smoking than to HIV itself. They are more likely to develop non-AIDS related diseases such as pneumonia, lung cancer, and pneumothorax than people with HIV who don’t smoke. People with HIV who smoke cigarettes are also less likely to adhere to their antiretroviral treatment.

Smokers in the OHTN Cohort Study are more likely to have health issues
Health Issue	Smokers (1,527)	Non-smokers (2,263)
Low CD4 (< 200 cells)	12%	8%
Detectable viral Load	34%	24%
Diagnosed with Hep C (ever)	27%	9%
The Ontario HIV Treatment Network Cohort Study (OCS) is an ongoing research study that collects clinical, social and behavioural information about people living with HIV in Ontario.

Asking about tobacco use and offering support to quit is an evidence-based best practice. All clients will benefit from integrating smoking cessation into your assessments and interactions. Most smokers want to quit but don’t know how to get started.

The need to train staff about smoking cessation

American studies show that 40 – 70% of people living with HIV want to stop smoking. In one Oregon study, 46% of people living with HIV stated that they were seriously considering quitting within the next 30 days.

However, most HIV care providers are not trained to provide smoking cessation counselling. When researchers polled the U.S. HIV Medical Association (a group that includes doctors, nurses, and pharmacists), they found only 23% had received smoking cessation training, even though 97% of HIV care providers thought smoking cessation was important to their patients’ health.

In our resources section, you’ll find smoking cessation training for health care professionals. This training works. A recent Swiss study found that after HIV care providers attended a half day of training on smoking cessation, their patients were more likely to stop smoking and less likely to relapse. HIV clinics and agencies are well-placed to deliver smoking cessation counselling—because routine follow-up visits provide opportunities to reinforce smoking cessation advice.

HIV Clinics — Responses to smoking

Jar with tongue depressors, cotton balls and alcohol.

HIV clinics in Ontario have different approaches when it comes to smoking cessation and to tobacco use in general. Some clinics are integrated within a primary care setting and can offer more comprehensive care while others might have a doctor or pharmacist available for only a few hours a week.

There’s one important intervention that any clinic can offer with no extra resources: just ask the client if they smoke. Asking this question at each visit gives the patient a moment to reflect and think about whether they would like to stop. If your clinic or agency can’t provide smoking cessation support, see our resources page for services where you can refer your patients.

What are some Ontario HIV clinics doing now?

Toronto East General Hospital screens patients for smoking at every visit. If a patient wants to quit or is thinking of quitting, the clinic offers information and refers the patient to the smoking cessation clinic in the hospital’s Outpatient Department. The department reviews the patient's history of quit attempts, helps them choose the right smoking cessation aids and follows the patient through their quitting process.
Lakeridge Health in Oshawa screens all patients and brings up smoking at each appointment. When patients express an interest in quitting, they then work with the pharmacist and a physician to get a nicotine replacement product prescription and/or develop a smoking cessation plan. The pharmacist provides advice and is available by phone to answer questions and concerns. The nurse, physician and pharmacist also follow up with the patient at the next visit.
Another clinic with more limited resources makes referrals to the STOP program – which provides access to free nicotine replacement therapy and counselling.

AIDS Service Organizations — Responses to smoking

Image of 2 men chatting with an ASO worker

ASOs can help their clients stop smoking by:

putting smoking cessation materials and Smokers’ Helpline information throughout their offices
training staff how to talk to people about quitting
learning about local and regional resources and helping anyone offering a smoking intervention develop the knowledge and skills to serve people living with HIV
creating a supportive environment for staff and people living with HIV – consider implementing policies like Positive Living Niagara.

Creating a supportive environment

Clinics and ASOs can help smokers living with HIV by complying with the Smoke-Free Ontario Act and ensuring that no one smokes at or around the workplace. Positive Living Niagara recently decided that, as an agency committed to harm reduction, it would create a safe and supportive environment for staff or clients who might be trying to quit or thinking about quitting.

The agency created a policy declaring Positive Living Niagara to be a smoke-free and tobacco-free environment. Currently, no smoking or tobacco use is allowed in any space rented or owned by the agency. Smoking is also not permitted in clients’ homes or cars when staff members are present. Staff are permitted to smoke on breaks, and the agency offers assistance to any staff member, volunteer or client who expresses interest in quitting or reducing smoking.

For more information, or for ideas about setting up your own smoke-free policies, please contact us.

“Staff have quit. Clients have quit.”

Watch Glen Walker, Executive Director of Positive Living Niagara, describe what happened at his organization when it went smoke-free. Find out what to expect if your organization goes smoke-free, and listen to Glen describe the energy and momentum that smoke-free policies have created at Positive Living Niagara.

Referral programs for patients and/or clients

The STOP on the Road Program

The Centre for Addiction and Mental Health’s Smoking Treatment for Ontario Patients (STOP) Program is for the general public and offers:

five weeks of free smoking cessation medication
smoking cessation treatment
counselling support.

The one-time, three hour workshop is led by trained public health nurses and offered at community centres and clinics across Ontario. Workshop dates and eligibility information are available here.

If you are an HIV service provider and would like to reach a local STOP smoking cessation contact, please download the contact list.

Smokers’ Helpline

The Canadian Cancer Society’s Smokers’ Helpline (1-877-513-5333) offers a variety of free, personalized tools across Ontario including:

online quit programs
free help by phone
text messaging services
self-help workbooks.

Training ASO and clinic staff about smoking cessation

The TEACH Project

The Centre for Addiction and Mental Health’s TEACH Project (Training Enhancement in Applied Cessation Counselling and Health) offers an accredited certificate program in intensive tobacco interventions for health care providers. Providers can receive the training through one or three day courses, or through online modules.

The TEACH Project also offers a monthly “Lunch and Learn” webinar series that allows health care practitioners to learn about “standalone” issues or strategies.

Tobacco-Free RNAO

The Registered Nurses’ Association of Ontario offers free Smoking Cessation E-Learning Courses to nurses and other health care professionals who want to help clients quit smoking. The courses teach health care professionals how to talk to their patients about smoking cessation. A special module is also available for health care providers who work with First Nations, Inuit and Métis clients. It offers culturally appropriate smoking cessations interventions.

You Can Make it Happen

You Can Make it Happen is a collaboration between Smokers’ Helpline and Public Health Units from across Ontario. The site is a comprehensive source of information and tools about smoking cessation for health care providers, including detailed information for different practice settings (such as hospitals, pharmacies and primary care clinics).

Creating a supportive environment within your ASO or clinic

Ontario Toolkit

The Ontario No Butts About It Collaborative has created a How to Make Your Workplace Tobacco-Free Toolkit. The Toolkit includes two sample workplace policies (one for a total ban, one allowing for designated smoking areas) as well as information about the Smoke-Free Ontario Act.

U.S. Toolkit

The Smoking Cessation Leadership Center in the United States offers a special Tobacco-Free Toolkit for Community Health Facilities . While not aimed at an Ontario audience, the Toolkit offers a helpful list of Ten Steps to Success, a model timeline, sample letters, and a chart sticker template.

One Agency’s Story

This TEACH Community of Practice Implementation Series webinar, featuring representatives from Ontario’s MacKay Manor, describes the role that an in-house champion can play in promoting smoking cessation and describes one agency’s journey towards becoming smoke free.

Additional Resources

Smoking Rapid Response

This Rapid Response, prepared by the Ontario HIV Treatment Network, provides an overview of smoking cessation interventions for people living with HIV/AIDS.
Read "Smoking Cessation Interventions in People with HIV/AIDS" on the OHTN website