However, it is possible to
come off, and stay off, cigarettes. A French study of 233 smokers with HIV
found that about 7% stopped within the next two years.
This quit rate is
approximately what Carolina Herberts sees at the Royal Free.
“We know that about 3% of
patients a year, who simply decide to stop and have no other help, manage to
quit permanently after any one attempt.
“If they also use medication
such as nicotine replacement therapy or the anti-smoking drugs Zyban (bupropion) or Champix, the one-year success rate is
7%. But if they get medication and support, such as an anti-smoking course, the
success rate is 20%.”
Short-term success is much
greater: a month after stopping smoking 60% of smokers have still stopped. But,
as I found, the addictiveness of nicotine means that there’s a high relapse
Vince knows about relapse.
He’s 64, has had HIV for 23 years, and used to smoke 30 a day. A tough
proposition for a stop-smoking course.
“I started smoking at 17, and
was smoking for 38 years before I stopped in 2000,” he says. “I managed to stay
smoke-free till last year when I was having a bad time.
“I started again in June and
was soon up to 30 a day. I was coughing again within a month. A friend said:
‘You’re already sounding like you did ten years ago’.”
The first time round he had
attended a stop-smoking course at the Royal London
Hospital. He initially
tried nicotine replacement therapy but, finding it didn’t work, started taking Zyban.
It’s still not clear exactly
how Zyban works. It has tended to
become less popular over time – in favour of Champix – because a lot of people complain of side-effects,
including Vince. “I felt really spaced out, like I was unpleasantly drunk and
had a woolly mind. However they halved the dose and I then felt much better.”
This may have been because anti-HIV
drugs, including both protease inhibitors and non-nucleoside (NNRTI) drugs,
increase the amount of Zyban in the
This time round he tried the GMFA stop-smoking course and Champix. This is the first drug specifically designed as an
anti-smoking medication. It works by blocking the nicotine receptors on nerve
cells, so smokers experience fewer cravings when they stop. It doesn’t interact
with HIV drugs.
The most common side effect
is mild nausea in the first couple of weeks. Vince also experienced disturbing
dreams and disrupted sleep, though he says “it was hard to tell if it was part
of the mental process of giving up.” And he says it has not entirely abolished
cravings. But at the time I interviewed him, five weeks after the stop-smoking
course, he only admitted to once having a puff on a tobacco-free marijuana
Only a minority take an anti-smoking
pill; the most popular choice is still to use nicotine replacement therapy
(NRT), which gives you a hit of nicotine without filling you full of the tar
and carbon monoxide you would get from smoking a cigarette.
NRT comes in a variety of
different guises, tailored to smokers’ individual habits. Habitual smokers who
light up first thing in the morning might use patches, which deliver a regular
supply of nicotine. Occasional smokers might benefit more from gum, fast-acting
lozenges, or a nicotine nasal spray to tackle cravings.
Milo is another GMFA
course graduate. He’s 35 and HIV-negative and saw his cigarette consumption
increase to about 15 a day since he started smoking eleven years ago. He had
tried to give up three times before he decided to try a course.
Most smokers need a lot of attempts before they quit successfully. If it doesn't work this time, come back!
Barrie Dwyer, GMFA
“I think the course really
helped; sharing experiences, going through something similar to everyone else.
If you relapse you’re letting others down as well as yourself – though I liked
the honesty of it too, and people feeling able to admit their slip-ups. It’s
the first group therapy thing I’ve ever done.”
Vince chose the GMFA course because “courses are the only thing that
have ever worked for me. It’s the ego thing, being able to come back the
following few weeks and tell people you’re smoke-free.”
He wants to stay a non-smoker
“because it’s the one thing in my life I can
control. I need meds for my HIV, and I take antidepressants too. At least I can
bloody well stop cigarettes. And I want to stay alive for my partner Ray.”
Barrie Dwyer emphasises there
is no disgrace in relapse. “Most smokers need a lot of attempts before they
quit successfully. If it doesn’t work this time, come back!”
I’m already thinking of it…
- For the GMFA
stop-smoking course, go to www.gmfa.org.uk/quitsmoking
or call 020 7738 3712.
- In Manchester
the Lesbian and Gay Foundation also offers help with quitting – see www.lgf.org.uk/queer-as-smoke
- Most NHS trusts offer individual and group
support to stop smoking; ask your GP for further information, phone the
NHS Stop Smoking Helpline on 0800 022 4 332 or visit the NHS website www.smokefree.nhs.uk.