Influence of socioeconomic position and gender on current cigarette smoking among people living with HIV in sub-Saharan Africa: disentangling context from composition

BACKGROUND: Smoking is still gaining ground in Sub-Saharan Africa, especially among socially disadvantaged groups. People living with HIV represent a subgroup with a significantly elevated prevalence of cigarette smoking. The objective of the study was to examine the influence of individual-, neighbourhood- and country-level socioeconomic position on current cigarette smoking among people living with HIV in Sub-Saharan Africa. METHODS: We applied multivariable multilevel logistic regression analysis on Demographic and Health Survey data collected between 2003 and 2012 in sub-Saharan Africa. We identified 31,270 individual living with HIV (Level 1) nested within 7,054 neighbourhoods (Level 2) from 19 countries (Level 3). RESULTS: After adjustment for individual-, neighbourhood- and country-level factors, respondents, the following significant independent risk factors for increasing odds of being a current cigarette smokers among people living with HIV: male gender (odds ratio [OR] = 62.49; 95 % credible interval [CrI] 45.93 to 78.28), from the poorer households (OR = 1.62, 95 % CrI 1.38 to 1.90); living in urban areas (OR = 1.24, 95 % CrI 1.09 to 1.41), from neighbourhoods with low poverty rate (OR = 1.25, 95 % CrI 1.09 to 1.43), illiteracy rate (OR = 1.28, 95 % CrI 1.14 to 1.42), low unemployment rate (OR = 1.11, 95 % crI 1.01 to 1.43); and from countries with low socio-economic deprivation (OR = 1.53, 95 CrI 1.08 to 1.96). About 3.4 % and 39.4 % variation in cigarette smoking behaviour among people living with HIV is conditioned by differences between neighbourhoods and countries. CONCLUSIONS: Gender, education and socioeconomic context are independently associated with current cigarette smoking among people living with HIV in sub-Saharan Africa.