Deaths from smoking and from HIV/AIDS among gay and bisexual men in California, 2005-2050

Tob Control. 2020 May;29(3):305-311. doi: 10.1136/tobaccocontrol-2018-054850. Epub 2019 May 30.


Introduction: Deaths from HIV/AIDS have long been of concern to the gay community, but less attention has focused on smoking-attributable deaths despite the relatively high smoking rates among gay and bisexual men. This study compared deaths from HIV/AIDS with smoking-attributable deaths among California gay and bisexual men from 2005 to 2050.

Methods: Smoking-attributable fractions (SAFs) were estimated using smoking prevalence for gay and bisexual men from the 2011-2014 California Health Interview Surveys and published relative risks of death. Smoking-attributable deaths were calculated by multiplying the SAFs by deaths among gay and bisexual men. Deaths from HIV/AIDS among men who have sex with men was obtained from the California Department of Public Health. Future deaths from smoking and HIV/AIDS were projected using regression equations based on time trends.

Results: From 2005 to 2014, smoking caused over 6800 deaths among gay and bisexual men, while nearly 9500 died from HIV/AIDS. Mortality from both causes has been falling, but deaths from HIV/AIDS have been falling more rapidly. Projections suggest that in the mid-2040s, more gay/bisexual men will die from smoking than from HIV/AIDS.

Conclusion: Smoking will surpass HIV/AIDS as a cause of death among gay and bisexual men in California within a few decades. The lesbian, gay, bisexual and transgender (LGBT) community was highly effective in drawing attention and resources to the fight against HIV/AIDS, saving untold lives by hastening effective treatments. Lessons learnt in the fight against AIDS should be used to help fight the tobacco epidemic.

Keywords: advocacy; disparities; priority/special populations.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acquired Immunodeficiency Syndrome / etiology
  • Acquired Immunodeficiency Syndrome / mortality*
  • Adult
  • Aged
  • Bisexuality*
  • California / epidemiology
  • Cigarette Smoking / mortality*
  • HIV Infections / etiology
  • HIV Infections / mortality
  • Homosexuality, Male*
  • Humans
  • Male
  • Middle Aged
  • Sexual Behavior*
  • Sexual and Gender Minorities*