Associations Between Internalized HIV Stigma and Tobacco Smoking Among Adolescents and Young Adults Living with HIV: The Moderating Role of Future Orientations.

HIV stigma and future orientations impact the health of adolescents and young adults living with HIV (AYALWH); however, little is known about how these factors may impact tobacco use, and thereby long-term health status. This study examined associations between internalized HIV stigma, future orientations, and smoking behavior using a cross sectional survey of AYALWH ages 18 to 29 (N = 109). Greater levels of stigma were associated with increased odds of smoking, and greater future orientations were associated with a reduced odds of smoking. The interaction was significant, illustrating that stigma was significantly associated with an increased odds of smoking among AYALWH who reported low levels of future orientations, but not for those with high levels of future orientations. Findings underscore the importance of understanding how HIV stigma may undermine future aspirations of AYALWH. Interventions that target HIV stigma and future orientations may be critical for tobacco prevention and cessation.