High COVID-19 vaccine uptake among HIV-positive smokers in Japan: effects of the health belief model - a single-center survey

Background The effectiveness of vaccination against coronavirus disease 2019 (COVID-19) among people living with HIV (PLWH) has been increasingly documented in recent years. Large-scale cohort studies from Canada have demonstrated that COVID-19 vaccines confer significant protection in this population. However, low vaccination coverage among PLWH remains a concern. In parallel, previous studies have reported that smokers are more likely to exhibit vaccine hesitancy, resulting in reduced uptake of COVID-19 vaccination. This study aimed to investigate differences in the vaccination rates and clinical outcomes of COVID-19 infection between smokers and nonsmokers in a cohort of PLWH at a single center in Japan. Methods Among approximately 250 PLWH aged ≥ 18 years who were receiving outpatient care at a university hospital in Tokyo, Japan, 51 who had been diagnosed with COVID-19 between 2020 and 2023 were invited to participate in a questionnaire-based survey. Among these 51 patients, 38 provided informed consent and responded to the survey. A total of 43 infection episodes, including cases of multiple infections, were analyzed. Results A total of 38 participants (age range, 31–66 years) responded to the questionnaire (response rate: 74.5%). Five individuals experienced COVID-19 infection twice, resulting in a total of 43 infection episodes. As of April 20, 2025, the majority of participants were in their 40s (n = 15), and 97.4% (37/38) were male. Over 60% of the respondents reported a history of both smoking and alcohol consumption. All patients maintained virological suppression before and after COVID-19 infection. In total, 92.1% (35/38) of the patients had received at least one dose of a COVID-19 vaccine. Among smokers, the vaccination rate was 96%, which was higher than that among nonsmokers (86%); however, this difference was not statistically significant (p = 0.3743). Conclusions The present study found that smokers had a higher COVID-19 vaccination rate than nonsmokers. This finding contrasts with previous findings suggesting that smokers tend to have more negative attitudes toward vaccination. Factors such as access to health care, perceived infection risk, and treatment adherence may contribute to this discrepancy.