Smoking behaviors among people living with HIV in Vietnam are shaped by overlapping influences including societal norms, mental health, HIV-related stigma, and other structural stressors, which can inform the development of tailored text-based cessation interventions.
Key Findings
Results
HIV stigma was a major contributor to smoking behavior, with many participants describing increased smoking after their HIV diagnosis.
HIV stigma was identified as one of six major themes emerging from qualitative interviews
Participants specifically described increased smoking as a behavioral response following HIV diagnosis
Stigma was framed as a structural stressor that overlapped with mental health and social factors to shape smoking behavior
This finding was identified through 30- to 45-minute qualitative interviews with 20 people living with HIV in Vietnam
Results
Social smoking and early initiation were identified as important influences on smoking behaviors among people living with HIV.
Social situations were described as shaping smoking as part of everyday life
Early initiation was identified as a distinct influence on smoking behavior
Social smoking was one of six major themes identified through rapid qualitative analysis
Interviews explored social context as a pre-specified domain based on prior literature
Results
Financial concerns and protecting family members from secondhand smoke were identified as motivators for smoking cessation.
Financial concerns emerged as a practical factor promoting quit attempts
Desire to protect family members and others from secondhand smoke was a distinct cessation motivator
These protective and economic factors were identified across the 20 participant interviews
These motivators were contrasted with barriers such as stress and social smoking norms
Results
Some participants used smoking as a coping mechanism for stress and mental health challenges, while others wished to quit for better health.
Stress and mental health were pre-specified interview domains based on prior literature
A subset of participants described smoking as a way to cope with stressors including HIV-related experiences
Other participants expressed desire to quit motivated by health improvement goals
Alcohol use was also identified alongside stress as an overlapping influence on smoking behavior
Results
Participants suggested that cessation support should be better tailored to the specific needs of people living with HIV.
Existing quitline services in Vietnam were described as underused by this population
Participants identified gaps in current cessation support relevance to their lived experiences
Text messaging was identified as a potentially suitable delivery mechanism given its wide use in Vietnam
Interview findings were used to develop prompts to guide peer message writing for a text messaging intervention
Methods
The study used a rapid qualitative analysis approach with 20 people living with HIV recruited from clinics in two Vietnamese provinces.
Participants were recruited from clinics in Hai Phong and Quang Ninh provinces, Vietnam in October 2022
Interviews lasted 30 to 45 minutes and explored substance use, mental health, HIV stigma, social context, and health
Rapid qualitative analysis involved identifying key domains from prior literature, developing a semistructured interview guide, and organizing data within domains for iterative theme development
Six themes were ultimately identified from the data
Vietnam is characterized as an upper-middle-income country where the majority of people living with HIV smoke
What This Means
This research suggests that smoking among people living with HIV (PLWH) in Vietnam is not simply a habit but is deeply intertwined with social norms, stress, stigma, and life circumstances. Researchers interviewed 20 PLWH from clinics in northern Vietnam and found that many began smoking in social settings and early in life, and that receiving an HIV diagnosis often led to increased smoking as a way to cope with the stigma and emotional burden of the disease. Alcohol use and stress further reinforced smoking, while financial worries and concern for family members' health motivated some to consider quitting.
The study also found that existing smoking cessation services, such as telephone quitlines, are underused by this population, and participants felt that available support did not adequately address their unique needs. Because text messaging is widely used in Vietnam, the researchers believe a text-based intervention — including peer-written messages — could better reach and engage PLWH who smoke. The qualitative interviews were specifically designed to inform what those messages should say.
This research suggests that effective smoking cessation programs for PLWH need to account for the complex web of social, psychological, and HIV-specific factors that shape their smoking behavior. Generic cessation approaches may be insufficient, and interventions that directly address HIV stigma, mental health, and social pressures around smoking may be more likely to support quit attempts in this population.
Ballambat N, Rice D, Najjar R, Wijesundara J, Larkin C, Liu A, et al.. (2026). Understanding the Influence of Substance Use, Mental Health, and Stigma on Smoking Behavior Among People Living With HIV: Rapid Qualitative Analysis.. JMIR formative research. https://doi.org/10.2196/97427