Search PubMed⌕ Search

Biomedical subjects

T J Coates

Publications and source records attributed to T J Coates.

At least 73 records · Page 4Linked to original sources
PubMed1994

Are bisexually identified men in San Francisco a common vector for spreading HIV infection to women?

OBJECTIVES: This article examines sexual risk taking among self-identified bisexual men in San Francisco and whether risk reduction has occurred, with respect to both homosexual and heterosexual behaviors, among human immunodeficiency virus (HIV) antibody-positive and HIV antibody-negative men. It also examines psychosocial correlates of unprotected anal and vaginal intercourse. METHODS: The participants were members of a population-based longitudinal cohort of 1034 single men aged 25 through 54 years recruited from the 19 census tracts in San Francisco that had the greatest prevalence of the acquired immunodeficiency syndrome in 1984. Of the total sample, 140 subjects initially identified themselves as bisexual; 85% of these men remained in the study. RESULTS: The participants reported dramatic reductions in sexual risk taking. Prevalences of unprotected anal sex with men were similar among HIV-positive bisexual men (89% in 1984-1985 and 18% in 1988-1989) and those who were HIV negative (65% and 20%). The prevalence of unprotected vaginal sex was much lower for HIV-positive men (16% in 1984-1985 and 2% in 1988-1989) than for HIV-negative men (35% and 20%). Unprotected intercourse was associated primarily with situational and interpersonal factors. CONCLUSIONS: Striking reductions in risk behaviors were reported. This subgroup of single, bisexually identified men appears unlikely to be a common vector for spreading HIV infection to women.

Adult↗
PubMed1994

Correlates of condom use among black, Hispanic, and white heterosexuals in San Francisco: the AMEN longitudinal survey. AIDS in Multi-Ethnic Neighborhoods survey.

We examined correlates of condom use among heterosexual whites, blacks, and Hispanics (ages 20-45 years) with an human immunodeficiency virus (HIV) risk factor in a community-based longitudinal sample (San Francisco; n = 716). Lag models were used to examine hypothesized antecedents of condom use at wave 2. High levels of condom use were associated with labeling one's sexual behavior as risky for HIV infection, high levels of condom enjoyment and commitment to use condoms, good sexual communication practices, gender (trend), and marital status. The results support the need for wide-ranging intervention programs that stimulate people to make personal risk assessments, teach basic sexual skills, and direct those in need of intensive help to appropriate agencies.

Adult↗
PubMed1994

Psychotherapies for the person with HIV disease.

Work with patients with HIV infections demands the highest degree of professional skill, empathy, and self-understanding on the part of the therapist. He or she must be an excellent diagnostician, must be knowledgeable about the use of medications in a wide array of clinical conditions, and must be willing to confront both psychodynamic issues of the past and realistic medical and social concerns of the present and future. The therapy must be driven not by the disease but informed by the evolving needs, of the individual patient for self-understanding and a sense of enhancing competence. Although decline and death must be confronted during therapy, its center is on living and creating an engaged quality of life "in spite of". To help a person find the sweet-tasting strawberry of life in the face of what would otherwise be an intolerable situation can be one of the most meaningful acts we engage in as therapists.

AIDS Dementia Complex↗
PubMed1993

Depressive symptoms and CD4 lymphocyte decline among HIV-infected men.

OBJECTIVE: To investigate whether high levels of depressive symptomatology at baseline predict more rapid decline of CD4 lymphocyte counts and progression of clinical disease in persons infected with the human immunodeficiency virus (HIV). DESIGN: Prospective cohort study with semiannual data collection waves and up to 66 months of follow-up. SETTING: Population-based probability sample of single men in areas of San Francisco with high case rates of the acquired immunodeficiency syndrome (AIDS). SUBJECTS: All 330 homosexual or bisexual men who by January 1985 had serological evidence of HIV infection but had not had an AIDS diagnosis. Analysis of CD4 lymphocyte change was performed for 277 subjects (83.9%) who had three or more CD4 lymphocyte counts recorded during the study period January 1985 through July 1990. OUTCOME MEASURES: Depressive symptoms were assessed using the Center for Epidemiologic Studies-Depression scale (CES-D). All subjects were classified according to two indicators of depression: (1) as overall depressed using a cut point of 16 or higher on the complete CES-D, and (2) as affectively depressed using a cut point of more than 1 SD above the mean on a subscale of the CES-D measuring affective depression. Laboratory and symptom measures, antiretroviral use, demographics, and behavioral measures were also used. The primary outcome measure was the rate of change of the CD4 lymphocyte count. Secondary outcomes were AIDS-free survival and mortality. RESULTS: At baseline 65 subjects (19.7%) were classified as depressed on the overall scale and 53 (16.1%) were classified as depressed on the affective scale. The unadjusted mean rate of CD4 change was 38% greater for overall depressed subjects than for the overall nondepressed (-0.0812 vs -0.0588 x 10(9)/L [-81.2 vs -58.8/microL per year; P = .07) and 34% greater for affectively depressed subjects than for the affectively nondepressed (-0.0804 vs -0.0598 x 10(9)/L per year; P = .06). In hierarchical multivariate analysis controlling for antiretroviral use, symptoms, and other predictors, baseline overall depression was associated with an excess decline in CD4 count of -0.0285 x 10(9)/L per year (95% confidence interval, -0.0496 to -0.0073), and baseline affective depression was associated with an excess decline in CD4 count of -0.0236 x 10(9)/L per year (95% confidence interval, -0.0464 to -0.0008). Neither overall depression nor affective depression was significantly associated with earlier AIDS diagnosis or earlier mortality. CONCLUSIONS: Overall depression and affective depression predicted a more rapid decline in CD4 lymphocyte counts; this association was not attributable to baseline physiological differences. While the mechanism of the association remains unknown and cannot be addressed directly by this study, the data suggest that it can be explained neither as simply a reflection of perceived somatic symptoms nor as the result of differences in recreational drug and alcohol use. Further study is necessary to determine whether treating depression can alter the course of HIV infection.

Adult↗
PubMed1993

HIV antibody testing among those at risk for infection. The National AIDS Behavioral Surveys.

OBJECTIVE: To determine the prevalence of testing for human immunodeficiency virus (HIV) antibody among adults with various risk factors for infection, particularly those residing in large metropolitan areas where the bulk of cases of acquired immunodeficiency syndrome (AIDS) have occurred. DESIGN: A nationwide, population-based telephone survey eliciting testing, sexual, and injection drug use histories. PARTICIPANTS: A total of 2673 randomly chosen US residents and 8263 randomly chosen residents of 23 metropolitan areas containing 64% of reported cases of AIDS. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Testing for HIV antibody. MAIN RESULTS: Overall, rates of individuals ever tested were only slightly higher in the urban areas (23%) than in the nation as a whole (21%). Testing frequencies were low among all risk groups (less than 40%), except men engaging in same-sex sexual activity (60%) and male and female injection drug users (46% and 73%, respectively). The low rate of testing (35%) among the largest risk group, heterosexual men and women engaging in unprotected sexual intercourse with multiple partners, was particularly worrisome. CONCLUSIONS: To encourage antibody testing among the many at risk for infection who have not yet been tested, promotional campaigns should explain the universal susceptibility to infection among those at risk, and the availability of prophylactic medical therapies and social support services to persons who are HIV-seropositive. As there were comparable levels of risk-taking behavior among subjects in both samples, these campaigns must be designed to reach all segments of the population.

AIDS Serodiagnosis↗
PubMed1993

HIV-infected health care professionals. Public opinion about testing, disclosing, and switching.

BACKGROUND: We wanted to know what the public believes about the risks of human immunodeficiency virus (HIV) transmission in health care settings, and what opinions the public holds regarding HIV-infected health care professionals. We also wanted to uncover the correlates and predictors of those opinions. METHODS: A telephone survey of a nationwide random probability sample of adults was conducted in summer 1991. Thirteen hundred fifty adults completed the survey. The response rate was approximately 63%. We assessed (1) public opinion about whether HIV-infected physicians, surgeons, and dentists should quit working, and (2) the public's self-reported intention to remain in the care of an HIV-infected professional or to switch to another provider. RESULTS: Public concern about HIV transmission in health care settings has increased from 19% in 1988 to 38% in 1991. More of the public now believes that transmission from HIV-infected physicians is likely (up from 33% in 1988 to 46% in 1991). Yet, fewer respondents believe that HIV-infected physicians should not be allowed to work (45% vs 39%). Only 5% would deprive HIV-infected physicians of their livelihood as physicians. Fewer would switch from HIV-infected physicians now than in 1988 (56% vs 37%). Knowing someone with HIV infection was related to less concern and to less belief in likelihood of transmission as well as to increased support of HIV-infected health professionals' right to work. CONCLUSIONS: Although the public is more concerned about HIV transmission in health care settings since 1988, fewer would not allow HIV-infected health care professionals to work now than in 1988. Personalizing the epidemic, by using personal physicians and people with acquired immunodeficiency syndrome as educators, might help continue the trend toward improved attitudes toward HIV-infected health care professionals.

Adolescent↗
PubMed1993

Disclosing HIV seropositivity to significant others.

OBJECTIVES: To examine gay men's patterns of self-disclosure of HIV seropositivity to friends, lovers, relatives and colleagues; to assess the effects of disclosure; and to identify reasons for not disclosing to particular individuals. DESIGN: Longitudinal questionnaire survey of gay men. METHODS: A total of 163 HIV-positive men participating in the AIDS Behavioral Research Project, a longitudinal study of San Francisco gay men, completed questionnaires about their self-disclosure patterns, health status, and psychological well-being. RESULTS: HIV-positive men were most likely to disclose their status to lovers and closest gay friends. Asymptomatic men were less likely to disclose to relatives and colleagues than symptomatic men. Friends and lovers were rated as responding more helpfully than relatives and colleagues. Men who perceived their significant others as responding more helpfully were less depressed and anxious currently and 1 year later. A variety of reasons were given for not disclosing, including not wanting to worry others, fear of discrimination, fear of disrupting relationships, and emotional self-protection. CONCLUSION: While disclosure can have advantages for both HIV-positive individuals and their significant others, HIV-positive individuals must be assured that the benefits of doing so will outweigh the potential costs.

Adult↗
PubMed1993

Pregnancy and contraception use among urban Rwandan women after HIV testing and counseling.

OBJECTIVES: This study examined hormonal contraceptive use and pregnancy in urban Rwandan women, following human immunodeficiency virus (HIV) antibody testing and counseling. METHODS: A sample of 1458 childbearing urban Rwandan women aged 18 to 35 years was tested and followed for 2 years. RESULTS: At enrollment, 17% of 998 HIV-negative women and 11% of 460 HIV-positive women were pregnant, and 17% vs 23%, respectively, were using hormonal contraceptives. One year later, half of the HIV-positive and one third of the HIV-negative hormonal-contraceptive users had discontinued use. The 2-year incidence of pregnancy was 43% in HIV-positive and 58% in HIV-negative women. HIV-positive women with fewer than four children were more likely to become pregnant than those with four or more; this association persisted in multivariate analyses but was not noted among HIV-negative women. At the end of the study, over 40% of non-users said that they would use hormonal contraception if it was provided at the study clinic, but 40% of HIV-positive women desired more children. CONCLUSIONS: Research is needed to identify the practical and psychosocial obstacles to effective long-term contraception among HIV-positive women. HIV counseling programs must specifically address the issue of childbearing.

AIDS Serodiagnosis↗
PubMed1993

Determinants of social support among gay men: the context of AIDS.

In this study, the determinants of social support are examined among a probability sample of gay men residing in San Francisco. Using two waves of data (collected in 1985 and 1987), cross-sectional and longitudinal analyses focused on the effects of five sets of factors (demographic, community integration/network, AIDS-related loss, individual, and health) on satisfaction with three types of support (emotional, informational, and practical). Personal acceptance of one's gay identity and talking to family members about AIDS showed the strongest positive associations with concurrent measures of support and changes in support satisfaction over the two-year period. Conversely, depression and number of HIV symptoms were negatively associated with cross-sectional support and support changes. Family knowledge of respondents' homosexuality interacted with HIV symptoms, such that knowledge was negatively associated with support among those experiencing greater numbers of HIV symptoms. Findings suggest that those most in need of support may be the least satisfied with the support they receive. Family appear to have the potential to be particularly helpful or especially harmful to gay men trying to cope with the AIDS crisis.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Prevalence of AIDS-related risk factors and condom use in the United States.

A national probability survey of human immunodeficiency virus (HIV)-related risk factors among the general heterosexual population, the National AIDS (acquired immunodeficiency syndrome) Behavioral Surveys, has obtained data from 10,630 respondents. Data are presented on the prevalence of HIV-related risks in the general heterosexual population, on the distribution of the three largest risk groups across social strata, and on the prevalence and distribution of condom use among heterosexuals reporting a risk factor. Between 15 and 31 percent of heterosexuals nationally and 20 and 41 percent in cities with a high prevalence of AIDS reported an HIV risk factor. Condom use was relatively low. Only 17 percent of those with multiple sexual partners, 12.6 percent of those with risky sexual partners, and 10.8 percent of untested transfusion recipients used condoms all the time. Overall, the results suggest that current HIV prevention programs have, to a very limited extent, reached those heterosexuals with multiple sexual partners but have failed to reach many other groups of the heterosexual population at risk for HIV. New public health strategies may be needed for these specific risk groups.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Social support, AIDS-related symptoms, and depression among gay men.

This study examined the impact of social support and HIV-related conditions on depression among 508 gay men participating in the San Francisco Men's Health Study, a population-based prospective study of single men aged 25-54 years. The number of HIV-related symptoms experienced significantly predicted depression cross-sectionally and 1 year later. Satisfaction with each of three types of social support (emotional, practical, informational) was inversely correlated with depression. Men who were more satisfied with the social support they received were less likely to show increased depression 1 year later. Degree of satisfaction with informational support appeared especially critical in buffering the stress associated with experiencing HIV symptoms. These findings offer valuable insight in understanding the psychological needs of gay men confronting the AIDS crisis and have important practical implications for designing mental health services to meet those needs.

Acquired Immunodeficiency Syndrome↗
PubMed1992

High-risk sexual behavior and condom use among gay and bisexual African-American men.

OBJECTIVES: Little is known about the human immunodeficiency virus (HIV) high-risk sexual practices of gay and bisexual African-American men. These data are needed so that better interventions can be developed and implemented in this population. METHODS: The frequency and correlates of unprotected anal intercourse were examined among 250 gay and bisexual African-American men in the San Francisco Bay Area. The cohort was recruited in 1990 from bars, bathhouses, and erotic bookstores, and through African-American gay organizations, street outreach, advertisements in gay mainstream and African-American newspapers, health clinics, and personal referral from other participants. RESULTS: More than 50% of the men in our sample reported having unprotected anal intercourse in the past 6 months, a considerably higher percentage than that among gay White men in San Francisco through 1988 and 1989. Men who practiced unprotected anal intercourse were more likely to be poor, to have been paid for sex, or to have used injection drugs; to have a higher perceived risk of HIV infection; and to report less social support for concerns about risky sexual behavior. Condom norms, condom efficacy, and negative expectations about using condoms predicted these men's failure to use them. CONCLUSION: In the second decade of the acquired immunodeficiency syndrome epidemic, risk reduction programs are still needed for gay and bisexual African-American men.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Condom use in multi-ethnic neighborhoods of San Francisco: the population-based AMEN (AIDS in Multi-Ethnic Neighborhoods) Study.

We examined the prevalence and correlates of condom use in a community-based sample of unmarried heterosexual and gay/bisexual Whites, Blacks, and Hispanics (aged 20 to 44 years) in San Francisco (n = 1229). Only 9% of heterosexual males reported always using condoms, and fewer of those with multiple sexual partners (6%) reported always using condoms compared with those in monogamous relationships (12%). Much higher proportions of gay/bisexual men reported always using condoms (48%). Racial differences in condom use were observed only among women. Sexual communication and the sexual enjoyment value of condoms were consistent correlates of condom use across gender and sexual orientation, while other condom-related beliefs were significant predictors of condom use only for men. In general, condom promotion programs should build sexual communication skills, teach people how to enhance enjoyment with condoms, and reduce psychological barriers to condom acquisition and use.

Adult↗
PubMed1992

Handedness, dyslexia and twinning in homosexual men.

A study of handedness, dyslexia, stuttering and twinning, was included in a study of sexual habits of homosexual men. A questionnaire was mailed to homosexuals, and 394 forms suitable for data analysis were received. The results showed an increased rate of lefthand writing (17.5% compared to 8-8.4%), and a clear left shift. There were increased occurrence of both stuttering (7.1% compared to 1.6%) and reading difficulties (7.9% compared to 1-3%). The incidence of twins was lower than the population (1.3%). The results confirm earlier attempts to show a left shift in homosexuals, and support Geschwind's hypotheses about etiological factors for both lefthandedness and homosexuality.

Adult↗
PubMed1992

Coping with death anxiety: help-seeking and social support among gay men with various HIV diagnoses.

UNLABELLED: OBJECTIVE, DESIGN AND PARTICIPANTS: We examined sources of help-seeking related to worries or concerns about death and dying and the effects of social support on death anxiety in a longitudinal sample of gay men (n = 52). RESULTS: Friends and primary sexual partners were the most frequent sources sought in dealing with death concerns for all groups of respondents (HIV-negative, HIV-positive asymptomatic, and HIV-positive symptomatic). Men experiencing HIV symptoms were more likely than HIV-negative and asymptomatic men to use formal sources of support (medical, psychological). Although HIV-positive symptomatic men did not differ from HIV-negative men in terms of help-seeking from family sources, they were significantly more likely to seek the help of family members than HIV-positive asymptomatic men. All three HIV groups showed significantly different mean levels of death anxiety, with HIV-negative men reporting the lowest level and HIV-positive symptomatic men the highest. Among HIV-negative men, only mental health sources of support (psychologists and clergy) were significantly related to death anxiety, measured 1 year later (beta = -0.35). These sources of support were also associated with death anxiety among HIV-positive asymptomatic men, but in the opposite direction (beta = 0.26). Contrary to expectations, men experiencing HIV symptoms benefited most from family support (beta = -0.31), although peer (beta = -0.19) and medical (beta = -0.28) support sources were also prominent. CONCLUSIONS: Thus, while earlier research found peers to be the most common and effective source of support among gay men, this study suggests that obtaining support from family may become particularly important as one approaches death. The effectiveness of social support in reducing death anxiety appears to vary over the course of the disease from asymptomatic to symptomatic. HIV-symptomatic men obtain support from a wide range of helpers, including medical and peer supports and family.

Adult↗
PubMed1992

The impact of HIV antibody status on gay men's partner preferences: a community perspective.

As more gay men are tested for antibodies to human immunodeficiency virus (HIV), serostatus may influence the formation of primary partner bonds in this community. We compared seropositive (n = 157), seronegative men (n = 205), and those who had not been tested (n = 158) from our ongoing AIDS Behavioral Research Project (total response in 1988 = 540). Subjects responded to mailed surveys regarding sexual behavior, relationship status, HIV antibody testing and serostatus preference when forming relationships for romance and friendship. Sixty-eight percent of seropositive gay male respondents reported no serostatus preference in partners for romance, while 83% of seronegative respondents and 74% of untested respondents preferred seronegative partners for romance. In addition, 15% of seronegative respondents and 12% of untested respondents preferred seronegative individuals for friendship. Seropositive individuals were much less likely to be desired for romance or friendship by seronegatives and those who have not been tested--at a time when emotional support and companionship are obviously needed.

Adult↗
PubMed1992

Correlates of HIV risk behaviors in black and white San Francisco heterosexuals: the population-based AIDS in multiethnic neighborhoods (AMEN) study.

This study, the first random household probability sample of unmarried adults in an HIV epicenter, examined the prevalence and correlates of HIV risk behaviors among sexually active unmarried heterosexual white and black adults (n = 848) in San Francisco, California. Racial or gender differences were found in the HIV risk factors among the men and women in our sample. More whites (17% men, 15% women) than blacks (12% men, 5% women) reported they had ever used injection drugs. White women were more likely to report that they had a sexual partner who used injection drugs (17%) than white men (11%), black women (5%), or black men (4%). Also, men were more likely than women to have had two or more sexual partners in the past year without using condoms: 43% of white men compared to 34% of white women and 40% of black men compared to 24% of black women. Among all ethnic and gender groups, more than half of those at sexual risk for HIV infection reported never using condoms. Of those at risk, more black women (75%) than white women (53%) reported they never used condoms with their sexual partners within the past year. However, only slightly more black men (62%) than white men (60%) at sexual risk for HIV reported they never used condoms with their sexual partners during the past year. High levels of HIV risk behaviors were associated with low income, not having a primary sexual partner, less enjoyment of condoms, and greater barriers to using condoms. The results support the need for major intervention programs and social marketing campaigns to promote the use of condoms by enhancing enjoyment of and reducing barriers to condom use, especially among sexual partners of black women.

Adult↗