Accepted for/Published in: JMIR Formative Research
Date Submitted: Apr 7, 2026
Date Accepted: Sep 23, 2026
Understanding smoking influences among people living with HIV in Vietnam: Rapid qualitative analysis on substance use, mental health, and stigma
ABSTRACT
Background:
In Vietnam, a low- and middle-income country, the majority of people living with HIV (PLWH) smoke. Vietnam has established Quitline services to support this population, but they remain underutilized. 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 PLWH who smoke in Vietnam.
Objective:
To identify factors influencing smoking behaviors among PLWH in Vietnam to inform a tailored text messaging intervention, using qualitative interviews.
Methods:
In October 2022, staff conducted 30–45-minute qualitative interviews with 20 PLWH from clinics in Hai Phong and Quang Ninh, 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 semi-structured interview guide, and organizing data within domains to support iterative theme development. These interviews were used to develop prompts to guide PLWH who smoke and write peer messages for a text messaging intervention.
Results:
Across six 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, while financial concerns and protecting family members and others from secondhand smoking promoted cessation. Some participants used smoking to cope, while 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 PLWH are shaped by overlapping influences, including societal norms, mental health, HIV-related stigma, and other structural stressors. Interventions must account for these overlapping factors to effectively support cessation and can inform the development of text-based cessation support tailored to this population Clinical Trial: Nct05863923
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