Smoking is the biggest single cause of illness and death in the UK. It contributes to cancers, heart disease and stroke. It’s also a particular problem for people with HIV.

Research shows that HIV positive smokers die younger than HIV positive non-smokers. Smoking increases the risk of:

• Cardiovascular disease. This may already be more likely because of lipodystrophy and raised blood fats (see box on page 18).
• Cancer in the lungs and around the mouth. This affects more HIV positive smokers than HIV negative smokers.
• Emphysema, a disease which causes breathlessness.
• HPV, a virus that increases the risk of cervical cancer for women.
• PCP, a form of pneumonia that affects the lungs.
• Bronchitis and other lung diseases.

Doctors say that just cutting down on the amount you smoke, or smoking low tar cigarettes, won’t make a big difference to  your health. It’s better to give up completely.

The earlier you stop, the better for your health. Still, it’s never too late to quit – even people who stop aged 50 or 60 substantially reduce their risk of getting lung cancer.

But as everyone knows, stopping smoking is hard. Many people find it takes several attempts. You may have to cope with physical cravings, moments  of temptation, making changes to your habits, and being in places where other people are smoking.

Smoking 20 cigarettes a day costs more than £1,800 a year.

If you decide to stop smoking, it may help if you think through why you want to give up. Keep in mind the reasons that matter to you, whether it’s always  smelling of smoke, feeling addicted, the money you spend or the long term health problems.

Perhaps you’re someone who smokes at particular times of the  day, or in particular situations. It may be when you have a drink with friends, have a coffee break or when you’re stressed. If this is the case, try to work out what  are the ‘triggers’ for you to have a cigarette, and see how you can either avoid those situations, or do something instead of smoking.

Some people do manage to stop with willpower alone. But research has shown that more people are able to quit when they get professional help, or use  nicotine replacement therapy (NRT).

This could be from a doctor, nurse or counsellor. It could be one-to-one information and advice, or it might involve taking part in weekly group meetings. In a  group, you can get support from other people who are quitting at the same time, and this may help keep you motivated.

Help like this is provided free by the NHS Stop Smoking Service who can be contacted on 0800 169 0 169 (www.givingupsmoking.co.uk). They also publish a useful booklet, Giving up for life.

Some HIV organisations also run stop smoking groups.

Nicotine patches, gum, nasal sprays, inhalers, lozenges, and tablets that you put under your tongue are all forms of nicotine replacement therapy (NRT).

They give you a small, short-term supply of nicotine, while you get out of the habit of smoking. Most people use it for the first three months after stopping smoking, although you can use it for longer if you need to.

You can use NRT to help you get over the addiction to nicotine gradually. Tobacco smoke contains carbon monoxide and tar – these are the chemicals which  contribute to heart disease and cancer. Nicotine is less damaging, but is addictive.

Using NRT should mean your withdrawal symptoms will be less severe. These can include feeling depressed, irritable, frustrated or anxious; having trouble sleeping; or craving cigarettes.

Some people get side effects from NRT,  including headaches, nausea and dizziness. They may also cause irritation wherever they are applied – for example, patches can irritate the skin, and gums may cause dryness in the mouth and throat. It’s worth getting more detailed information before you start.

But research has shown that you can almost double your chances of quitting if you use nicotine replacements. They are available on prescription from the NHS Stop Smoking Service and GPs. Chemists sell  them without a prescription, but they can be more expensive this way.

If you have a heart or circulatory condition, or are pregnant, it’s worth getting a doctor’s advice before using NRT.

NRT

• Patches are worn on the skin throughout the day, and provide a slow constant dose of nicotine.

• Gum can be used whenever you feel the urge to smoke. It should be chewed slowly and then rested between your gum and the side of your mouth, repeatedly, for about 30 minutes.

• Nasal sprays are most useful for heavy smokers who are highly dependant as the nicotine gets into the bloodstream quicker.

• Lozenges, tablets and inhalers also exist.

• Most of these products are available in different strengths.

• The choice of NRT products will depend on how often and when you smoke.

Zyban (also known as Bupropion) is a drug which helps people quit, by interfering with brain chemicals. However Zyban interacts with some anti-HIV drugs. It’s essential that the person prescribing it knows about any other medication, including anti-HIV drugs that you are taking.