Understanding the Influence of Substance Use, Mental Health, and Stigma on Smoking Behavior Among People Living With HIV: Rapid Qualitative Analysis.

Background: In Vietnam, an upper-middle-income country, the majority of people living with HIV smoke. Vietnam has established quitline services to support this population, but they remain underused. Text messaging is widely used in Vietnam, and studies in other countries have shown that text messaging interventions can promote smoking cessation. Our goal was to conduct a formative study to inform the development of a text messaging intervention to increase access to quitline services and promote smoking cessation among people living with HIV who smoke in Vietnam. Objective: This study aimed to identify factors influencing smoking behaviors among people living with HIV in Vietnam through qualitative interviews to inform a tailored text messaging intervention. Methods: In October 2022, study staff conducted 30- to 45-minute qualitative interviews with 20 people living with HIV from clinics in Hai Phong and Quang Ninh provinces, Vietnam. Interviews explored factors that influenced smoking, such as substance use, mental health, HIV stigma, social context, and health. A rapid qualitative analysis approach was used to synthesize themes from the data, including identifying key domains based on prior literature, developing a semistructured interview guide, and organizing data within domains to support iterative theme development. These interviews were used to develop prompts to guide people living with HIV who smoke in writing peer messages for a text messaging intervention. Results: Across 6 themes, participants described smoking as part of their everyday lives, shaped by social situations, stress, alcohol use, and their experiences living with HIV. Social smoking and early initiation were important influences on smoking behaviors, whereas financial concerns and protecting family members and others from secondhand smoke promoted cessation. Some participants used smoking to cope, whereas others wished to quit for better health. HIV stigma was a major contributor to smoking, with many participants describing increased smoking after diagnosis. Participants suggested that cessation support should be better tailored to their needs. Conclusions: Smoking behaviors among people living with HIV are shaped by overlapping influences, including societal norms, mental health, HIV-related stigma, and other structural stressors. An understanding of these overlapping factors can inform the development of text-based interventions that offer effective cessation support tailored to this population.