Commentary

How can we use HIV prevention techniques to lower smoking rates?

How can we use HIV prevention techniques to lower smoking rates?
Photo: AP Photo/Gerald Herbert

Many members of the LGBTQ community are already reacting to the looming Trump presidency (understandably) with a sense of fear, panic, and catastrophe.  How this public figure is intending to challenge our legal protections, medical rights, and basic physical safety, are still unknowns. 

But there is one thing we know for certain:  If people continue to smoke cigarettes at the current rate, then at least 30,000 members of our community will die from tobacco related illnesses every year.  And this is something that we are completely doing to ourselves. 

I only recently learned about the impact of smoking on the LGBTQ community after teaching on a harm-reduction panel in Washington DC. There, on a hot August afternoon, I had an opportunity to talk to a group of lobbyists about PrEP and TasP, and how these combined prevention tools could effectively end the traumatizing HIV plague that we have been coping with for 35 years. 

I explained how we now have an unprecedented opportunity to use these biomedical interventions to reduce and eliminate HIV; all we need to do is provide the education and resources to make this happen over the next decade.  The crowd was inspired and captivated when they saw the potential that already exists to expand the quality and quantity of life for hundreds of thousands of LGBTQ members. 

One of the members of the group contacted me afterwards.  He appreciated the message of hope and joy that PrEP and TasP offers.  But then he asked me what I thought about smoking in our community.  I didn’t have much of an opinion to share.  Although I was aware that gay people smoked more than our heterosexual counterparts, I hadn’t given much thought about its impact.  My focus for most of the past four years has been on PrEP, sexual health, access to healthcare, and seeing how improvement in these factors had resulted in record low new HIV infections and HIV-related deaths.  Cigarettes really weren’t part of my terrain. 

“What if I told you that our community had twice as many deaths from cigarettes than HIV,” he asked. 

I didn’t think that was possible.  Sure I know gay people smoke a lot, I see it at every meeting, conference, event, bar, club, social gathering around the world.  But the reality of more individuals dying from tobacco than HIV?  As a therapist and a sexual health educator, wouldn’t I have been told that at some point?

So I did some research.  Much to my surprise, this information is all public and transparent on several CDC websites.  “More than 30,000 LGBT persons die each year of tobacco-related diseases.”  And, “In 2014, there were 12,333 deaths (due to any cause) of people with diagnosed HIV infection ever classified as AIDS, and 6,721 deaths were attributed directly to HIV.” 

This information is known, determined, reported, transparent.  Yet where is the concern and outrage in our community about these numbers?  Where are the articles, the conferences, the protests against 30,000 senseless deaths every year?  Why, as a community, are we not approaching these losses with the same shock, anger, and, activism as we did with HIV, DADT, and marriage equality?

After 25 years of working in this community, I have learned that there are some people who take action, and some people who complain about those who take action.  I have opted to stay true to the former, working to educate, communicate, and teach about prevention, empowerment, and change.  With those tools in mind, I set out to do something to raise awareness and dialogue around the tobacco epidemic that is stealing the lives of so many beloved men and women. 

The first step was to create an open discussion group on Facebook, titled “Smoking, Vaping, and Heating: Rethinking Nicotine in the LGBT Community.”  This is currently the only social media platform focusing on the consequences of cigarette smoking while honoring the social, emotional, and psychological relationship to nicotine that is unique in our community.  We are considering the mental health issues that often lead to beginning a smoking ritual, and how being gay, living with trauma, violence, and alienation, can often create and sustain a consistent relationship with tobacco and cigarettes. 

This group is also the first of its kind to reach beyond the traditional and stigmatizing rhetoric around quitting.  Traditionally the American medical model advises people to quit smoking and move toward complete abstinence. Unfortunately, that only seems to work for about 6% of smokers. Fortunately there are now a multitude of ways to engage in harm reduction strategies, utilize empirical evidence, and create conversations that can help people make more informed and empowered decisions about how or if to decrease nicotine. 

The second step will be integrating harm reduction frameworks into our health discussions, forums, trainings.  We have accepted harm reduction as a viable approach to prevent HIV while engaging in meaningful sexual encounters.  Why not apply the same tools to nicotine? 

PrEP reduces the risk of acquiring HIV by 99% if used daily.  Vaping reduces the health consequences of nicotine inhalation by 95% when used instead of smoking.  It is time for us to seriously and rationally discuss the empirical data that can make LGBTQ lives healthier, happier, and stronger. 

I still have no idea what’s going to happen to our rights and protections over the next four years.  But I do know that every one of us can step up to protect our own bodies today.  30,000 deaths every year are 30,000 too many. 

Trump and his administration may want to take away our health and happiness, but we don’t have to make it easy for them.  Please join me over at “Smoking, Vaping, Heating” to continue to discuss, engage, and brainstorm ways to take care of ourselves and our loved ones during these trying times. 

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