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The epidemics of tobacco use, TB, and HIV disproportionately affect poor populations throughout the globe - the joint impact of these conditions is greater when occurring together than as single diseases. This is known as the ‘syndemic’ disease burden of multiple conditions. TB is one of the main opportunistic infections associated with HIV/AIDS, and tobacco use has important implications for health outcomes for both TB and HIV/AIDS patients.

Focus WCTOH symposium presenters bwIn many low- and middle-income countries where TB and HIV/AIDS pose major threats, tobacco use is also increasing, thus driving these epidemics onto a collision course. To date, these epidemics have been addressed through separate and distinct intervention programmes. But interventions against TB and HIV must include smoking cessation, not only for the health of the patients who smoke, but also for the sake of smokers and non-smokers in households where there is tobacco use.


In 2014, members of the Tobacco Control Section set up a TB, HIV and tobacco working group to tackle these complex issues:

Led by Dr Thomas E. Novotny (San Diego State University, USA), and Dr. Kamran Siddiqi, (York University, UK), it aims to elevate the joint research agenda on tobacco use, HIV, and tuberculosis.
For more information, or to join this group, email This email address is being protected from spambots. You need JavaScript enabled to view it. or This email address is being protected from spambots. You need JavaScript enabled to view it..

The group’s latest work includes:

  1. Tuberculosis, HIV, and Tobacco Use: This is a global syndemic that challenges integration of interventions.
    An analysis piece on the need for a systems-based approach in order for tobacco control to be integrated within TB and HIV programmes globally. Pitched for publication.
    Key messages: 1) Integrated TB/HIV tobacco control research and intervention programmes are needed in high disease burden countries in order to reduce the syndemic impact of these three conditions; and 2) Studies are needed to explore barriers and facilitators for integration policies and evaluation of syndemic interventions.
  2. HIV/AIDS, TB, and Tobacco Use in Brazil – A syndemic that calls for integrated interventions.
    A perspective article published in Cadernos de Saude Publica (Public Health Reports) in Brazil as part of a special issue dedicated to tobacco control.
    Key messages: 1) Implementation research is needed to address the syndemic of HIV, TB, and tobacco use in Brazil, taking into account the common social determinants of these three conditions; 2) Behavioural interventions alone are insufficient to reduce smoking prevalence among poor, marginalised, and highly vulnerable populations affected by TB and HIV/AIDS; 3) Comprehensive, policy-based approaches must be implemented in order to reinforce clinical behavioural interventions; and 4) Brazil’s primary care and tobacco control efforts should provide an appropriate setting to test interventions among those affected by the HIV, TB, and tobacco syndemic.
  3. Tobacco cessation in TB and HIV patients -- ‘a low hanging fruit’
    Sponsored core symposium at the 16th World Conference on Tobacco or Health (17- 21 March, 2015) in Abu Dhabi.
  4. Second-hand smoke and the risk of tuberculosis: a systematic review and a meta-analysis
    Article published in Epidemiology and Infection found that second-hand smoke exposure may increase the risk of acquiring TB infection and development of TB disease, however; further longitudinal studies are warranted to strengthen this evidence. The findings are of particular relevance to those in low- and middle-income countries, where TB is endemic, and tobacco smoking is also increasingly becoming common, visible and socially acceptable.

Photo: WCTOH symposium presenters for ‘Tobacco cessation in TB and HIV patients – a low hanging fruit’: from left to right- Ryan Lindsay, Kamran Siddiqi, Erica Pool, Lekan Ayo Yusuf, Ellen Gritz, Thomas Novotny, Omara Dogar. 
Credit: Thomas Novotny


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The Tobacco Control Department is based at The Union Europe Office, Edinburgh, registered charity no. SC039880
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