COVID-19 Stress is Associated with Increased Smoking among People with HIV in Western Washington: A Cross-Sectional Survey.

Background: People living with HIV (PWH) frequently have co-morbid substance use disorders that may have been impacted by the COVID-19 pandemic. This study examined associations between COVID-related stress and increased substance use among PWH in Washington State.

Methods: Between August 2020 and March 2021, we conducted an online survey of 397 PWH in Western Washington. Logistic regression was used to analyze associations between a COVID-19 stress score and four self-reported outcomes: increased alcohol use, increased cigarette smoking, increased marijuana use, and increased use of illicit substances.

Results: Thirty-five (38.0%) of 92 participants who smoked, 61 (23.4%) of 261 participants who used alcohol, 15 (14.6%) of 103 participants who used marijuana and 35 (33.0%) of 102 participants who used illicit substances reported increased use of these substances. Higher COVID-19 stress scores were associated with higher odds of increased cigarette smoking (adjusted odds ratio [aOR]=1.15, 95% confidence interval [CI]: 1.04-1.27), even after adjustment for anxiety and depressive symptoms (aOR 1.14, 95%CI: 1.03-1.27). COVID-19 stress was not associated with increased use of alcohol, marijuana, or illicit substances.

Conclusions: COVID-19-related stress was associated with self-reported increased cigarette smoking among PWH in Western Washington during the pandemic.