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PubMed1998

High incidence of anal high-grade squamous intra-epithelial lesions among HIV-positive and HIV-negative homosexual and bisexual men.

OBJECTIVE: The incidence of anal cancer among homosexual men exceeds that of cervical cancer in women, and HIV-positive homosexual men may be at even higher risk than HIV-negative men. Cervical cancer is preceded by high-grade squamous intra-epithelial lesions (HSIL) and anal HSIL may similarly be the precursor to anal cancer. In this study, we describe the incidence of and risk factors for HSIL in HIV-positive and HIV-negative homosexual and bisexual men. DESIGN: Prospective cohort study of HIV-positive and HIV-negative homosexual men. SETTING: The University of California, San Francisco. PATIENTS: 346 HIV-positive and 262 HIV-negative men enrolled at baseline, 277 HIV-positive and 221 HIV-negative homosexual men followed after baseline. STUDY DESIGN: A questionnaire was administered detailing lifestyle habits, medical history and sexual practices. Anal swabs for cytology and human papillomavirus studies were obtained, followed by biopsies of visible lesions. Human papillomavirus testing was performed using polymerase chain reaction (PCR) and 'hybrid capture'. Blood was obtained for HIV testing and measurement of CD4 levels. MAIN OUTCOME MEASURES: Incident HSIL. RESULTS: HIV-positive men were more likely to develop HSIL than HIV-negative men relative risk (RR), 3.7; 95% confidence interval (CI), 2.6-5.7. Life-table estimates of the 4-year incidence of HSIL was 49% (95% CI, 41-56) among HIV-positive men and 17% (95% CI, 12-23) among HIV-negative men. Among HIV-positive men, those with lower baseline CD4 counts (P = 0.007) and persistent infection with one or more human papillomavirus types, determined using PCR (P = 0.0001), were more likely to develop HSIL. CONCLUSIONS: HIV infection, lower CD4 levels and human papillomavirus infection were associated with high rates of incident HSIL among homosexual men. However, high rates were found at all CD4 levels among HIV-positive men and among HIV-negative men.

Anal Canal↗
PubMed1977

Epidemiological studies of female prisoners. IV. Homosexual behavior.

The existence of homosexual behavior in female offenders is investigated not only as an adaptive process but as an established behavior existing prior to detention. Ninety-five prisoners from the Framingham Institution for Women were included: 26 were self-reported homosexuals, 42 were considered homosexuals by prision staff, and 27 were nonhomosexuals. Suicidal thoughts, suicidal attempts, psychiatric problems during menstruation, and a history of violent crimes against persons were characteristic of the homosexual group, whereas a history of crimes against self and property as well as history of alcoholism were common in the nonhomosexual group. Violet behavior together with suicidal attempts in homosexual female prisoners support the hypothesis that aggressive impulses may be expressed either externally or toward the self, the problem being one of impairment in control mechanisms. The findings also suppor the idea that violent behavior, as shown by this group of incarcerated homosexual females, is multidetermined. The factors that influence its appearance and expression could include a history of family violence, impulse control as children, neurological abnormality, sex role identification problems, biochemical abnormalities (manifested as menstrual irregularities), and impulse control problems as adults. A better understanding of human violence must be based on the recognition of the multidimensional nature of the problem using the tools and insights from many disciplines.

Adaptation, Psychological↗
PubMedDate not supplied

Predictors of partner numbers in homosexual men: psychosocial factors in four societies.

Six hundred four homosexual men in four countries (Sweden, Finland, Australia, and the Republic of Ireland) were investigated with regard to their number of sexual partners over the past year and a number of psychological variables including masculinity and femininity, number of infections with sexually transmitted agents, relationships with parents, attitudes toward homosexuality, degree of homosexuality, sex-role conservatism, and a number of demographic variables. By use of multiple linear regression on partner numbers for each sample, it was found that between 15% and 28% of the variance of number of partners was accounted for by psychosocial factors, and that the great majority of these were significant in more than one country. Predictors included masculine and feminine personality traits, relationships with mother, degree of homosexuality, perceived societal attitudes toward homosexuality, age, and education. The data strongly suggest that psychosocial factors are significant predictors of numbers of partners of homosexual men, and that psychological approaches to treatment and prevention of sexually transmitted diseases may be warranted.

Adult↗
PubMedDate not supplied

Relationship between antibody to LAV/HTLV-III and the natural course of subclinical cellular immune dysfunction in homosexual men.

To assess the epidemiology and natural history of persistent generalized lymphadenopathy (PGL) and subclinical immunodeficiency in relation to serologic evidence of lymphadenopathy-associated virus/human T-lymphotropic virus type III (LAV/HTLV-III) infection, 109 homosexual men with PGL, 47 homosexual men without lymphadenopathy who attended a sexually transmitted disease (STD) clinic, 25 homosexual male university students, and 26 heterosexual men who attended the STD clinic were studied. In 1982-1983 antibody to LAV/HTLV-III was present in 97%, 35%, 21%, and 4% of the four groups, respectively (P less than .001). Subclinical immunodeficiency was more closely associated with LAV/HTLV-III seropositivity than with lymphadenopathy. Cohorts of 78 homosexual subjects with PGL, 35 homosexual subjects from STD clinic, and 15 homosexual university students were followed for median periods of 13.5, 20, and 14.5 months, respectively. The seroconversion rate was 23% per year among seronegative subjects, and 4% of seropositive subjects developed overt acquired immunodeficiency syndrome (AIDS). Among seronegative subjects, there was significant improvement in T4:T8 ratios (P = .001), whereas most seropositive subjects continued to have subnormal total counts of T4 lymphocytes and low T4:T8 ratios. Some cases of subclinical cellular immunodeficiency apparently are unrelated to LAV/HTLV-III infection, and the presence of antibody to this virus is associated with an unfavorable immunologic prognosis.

AIDS-Related Complex↗
PubMed1985

Bringing the homosexual patient out: teaching the doctor's role.

Little attention is given in the medical school curriculum to providing care for the 5-10% of the population that is homosexual. An elective course was developed to promote more positive attitudes among doctors-in-training towards homosexual patients. The format was primarily small group discussion between students and articulate homosexual people around societal biases towards homosexuals and issues of health care delivery. Students from this seminar and a control group from another elective completed an attitude questionnaire before and after the course. The study group became more accepting towards homosexual lifestyles significantly in 12 of 15 measures while no difference was found in the control group. Students' reaction to this learning experience was highly positive: they appreciated the opportunity to learn about same-sex life-styles in a personal and nonthreatening way, thus enabling them to accept and better care for homosexual people.

Arizona↗
PubMed1989

Low AIDS attack rate among Dutch haemophiliacs compared to homosexual men: a correlate of HIV antigenaemia frequencies.

A cohort of 180 haemophiliacs followed between 1983 and 1986 and a cohort of 961 homosexual men followed between 1984 and 1986 were compared for the prevalence and incidence of HIV-1 antibody (HIV-1-Ab) seropositivity, the incidence of AIDS-related complex (ARC) and AIDS and the prevalence and incidence of serological and immunological markers for HIV-related disease progression. Among the haemophiliacs 23 (12.8%) patients were HIV-1-Ab seropositive at entry and 20 (12.7%) of the remaining 157 seroconverted for HIV-1-Ab during follow-up. Of the homosexual men 238 (24.8%) were HIV-1-Ab seropositive at entry and 68 (9.4%) of the 723 at entry seronegatives seroconverted during follow-up. Clinical follow-up of the HIV-1-Ab seropositive and seroconverted men was 59 months in the haemophiliac cohort and 60 months in the homosexual cohort. Among the HIV-1-Ab seropositive and seroconverted haemophiliacs and homosexual men the cumulative ARC/AIDS incidence was 2 and 18%, respectively. Occurrence of HIV-1-antigenaemia was more frequent among seropositive and seroconverted homosexual men (28%) than among haemophiliacs (7%) (p = 0.001). The groups did not differ significantly for the absence or loss of anti-HIV core antibodies or the occurrence of low CD4+ cell numbers. These data indicate a slower progression of HIV-related disease in seropositive haemophiliacs compared to seropositive homosexual men.

AIDS-Related Complex↗
PubMed2001

Support for instruction about homosexuality in South Carolina public schools.

Research has demonstrated that recognition of sexual orientation begins in adolescence. However, students who identify as gay or lesbian report that the subject of homosexuality is virtually absent from classroom instruction. In South Carolina public schools, the subject of homosexuality may not be discussed except during instruction about sexually transmitted diseases. In 1997, survey data were obtained from 534 South Carolina registered voters to determine level of support for school-based sexuality education, including support for instruction about homosexuality. Overall, support for sexuality education was strong, however, homosexuality was the least-supported subject in the survey. In addition, registered voters were less sure as to what grade level instruction about homosexuality should begin. Characteristics of voters who supported and opposed instruction about homosexuality in the public schools were examined and compared. These data may be useful in building support for sexuality education programs that address this controversial topic.

Adolescent↗
PubMed1976

Some characteristics of homosexual men.

Although recognition of homosexuals is often important, many doctors lack the necessary skill or experience, so to assist them a group of 5,302 men was surveyed using a computer-based data system and 9-1 per cent. were recorded as homosexual. Analysis showed a relatively high proportion of homosexuals among men with syphilis and gonorrhoea, and a low proportion among men with nonspecific genital infection (non-specific urethritis and proctitis) and other infections. All men with secondary syphilis were homosexual. A relatively high proportion of men born in Eire, Spain, and North America were homosexual and a relatively high proportion of men living in the West End of London were homosexual. While these findings will be of most value to those working in STD clinics in London they may also be helpful to those working elsewhere and in other disciplines.

Adolescent↗
PubMed1983

Immunocompromise syndrome in homosexual men. Prevalence of possible risk factors and screening for the prodrome using an accurate white cell count.

The immunocompromise syndrome in homosexual men in the USA is thought to be associated with cytomegalovirus (CMV) infection and nitrite intake. Such men often have a lymphopenia. In a clinic in London 76% of 46 unselected homosexual men and 50% of 76 heterosexual controls had serum CMV IgG antibody at a titre of 1/16 or more (p less than 0.01). No case of excretion of CMV in the urine was found. Thirty per cent of the homosexual men admitted to using nitrites. These figures suggest that this population of homosexual men uses nitrites less often than their counterparts in the USA and is less likely to have evidence of active or past CMV infection. In addition, these male homosexual patients seem to be less promiscuous than those reported from the USA. Mean accurate total and differential white blood cell counts, using the Haemalog D automatic white cell counter, were no different in homosexual men (and various at risk subgroups of them) than heterosexuals, suggesting that the prodrome to the immunocompromise syndrome was not present in the London clinic population.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Sexually transmitted diseases, T cell subsets, and sexual practices in homosexual men attending an STD clinic.

Sixty three homosexually active men and 42 heterosexual men answered questionnaires regarding aspects of their social life and sexual practices. Assessment of past sexually transmitted disease showed the homosexual group to have had a significantly greater incidence of syphilis, gonorrhoea, perianal warts, and cytomegalovirus infections. T cell subset counts were carried out, and results for 60 of the homosexual men and 39 of the heterosexual men showed that the homosexuals had a significantly greater mean T cell suppressor cell count (p = 0.0019). The mean T helper cell count was not significantly different between the two groups, but it was significantly more (p = 0.033) in the more promiscuous homosexuals (who had more than 20 sexual partners a year) than in the heterosexuals. No relation was found between T cell subset counts and evidence of past cytomegalovirus infection. The practice of passive anal intercourse, oroanal sex, and swallowing semen during oral sex did not appear to influence T cell subset counts in the homosexuals.

Adult↗
PubMed1999

Homosexual men's HIV related sexual risk behaviour in Scotland.

OBJECTIVE: To date, the epidemic of HIV infection in Scotland has been primarily associated with injecting drug use. However, the epidemiology of HIV in Scotland changed in the late 1980s, with homosexual men becoming the largest group at risk of HIV infection and AIDS. Our aim was to describe homosexual men's sexual risk behaviours for HIV infection in a sample of men in Scotland's two largest cities. DESIGN/SETTING: Trained sessional research staff administered a short self completed questionnaire, to homosexual men present in all of Glasgow's and Edinburgh's "gay bars," during a 1 month period. SUBJECTS: A total of 2276 homosexual men participated, with a response rate of 78.5%. Of these, 1245 were contacted in Glasgow and 1031 in Edinburgh. MAIN OUTCOME MEASURES: Sociodemographic data, recent (past year) sexual behaviour, information on last occasion of anal intercourse with and without condoms, and sexual health service use. RESULTS: Anal intercourse is a common behaviour; 75% of men have had anal intercourse in the past year. A third of our sample report anal intercourse with one partner in the past year, but 42% have had anal intercourse with multiple partners. Over two thirds of the total population have not had any unprotected anal intercourse (UAI) in the past year and a quarter of the sample have had UAI with one partner only. 8% report UAI with two or more partners. More men in Edinburgh (17% v 10%) reported unprotected sex with casual partners only, but more men in Glasgow (29% v 20%) reported UAI with both casual and regular partners (chi 2 = 12.183 p < 0.02). Multiple logistical regression found that odds of UAI are 30% lower for men with degree level education and 40% lower for men who claim to know their own HIV status, whereas they are 40% higher for those who have been tested for HIV and 48% higher for infrequent visitors to the "gay scene". Men who have had an STI in the past year are 2.4 times more likely to report UAI than those who have not. Men with a regular partner were significantly more likely to report UAI, as were those who had known their partner for longer, and who claimed to know their partner's antibody status. CONCLUSION: On the basis of current sexual risk taking, the epidemic of HIV among homosexual men in Scotland will continue in future years. The data reported here will prove useful both for surveillance of sexual risk taking, and the effectiveness of Scotland-wide and UK-wide HIV prevention efforts among homosexual men.

Adolescent↗
PubMed2002

Seroprevalence of hepatitis A immunity in male genitourinary medicine clinic attenders: a case control study of heterosexual and homosexual men.

OBJECTIVES: To compare the seroprevalence of hepatitis A in homosexual and heterosexual men to determine their susceptibility to infection and provide guidance for a policy on vaccination. METHODS: A case-control study design was utilised to compare the risk factors associated with hepatitis A in homosexual and heterosexual men attending a city centre genitourinary medicine clinic. Demographic and sexual behavioural characteristics were included in univariate and multivariate models. RESULTS: The overall seropositivity rate was 29% with no significant difference between homosexual and heterosexual men. Ethnicity and age were strongly associated with hepatitis A seropositivity in both homosexuals and heterosexuals. A history of sex in a sauna in homosexual men, and being born outside the United Kingdom for heterosexual men, was associated with hepatitis A seropositivity. CONCLUSIONS: Targeted hepatitis A screening and vaccination of homosexual men attending UK genitourinary medicine clinics is not supported by the results of this study.

Adolescent↗
PubMed2003

Is use of antiretroviral therapy among homosexual men associated with increased risk of transmission of HIV infection?

BACKGROUND/OBJECTIVE: There is concern that use of highly active antiretroviral therapy (HAART) may be linked to increased sexual risk behaviour among homosexual men. We investigated sexual risk behaviour in HIV positive homosexual men and the relation between use of HAART and risk of HIV transmission. METHODS: A cross sectional study of 420 HIV positive homosexual men attending a London outpatient clinic. Individual data were collected from computer assisted self interview, STI screening, and clinical and laboratory databases. RESULTS: Among all men, sexual behaviour associated with a high risk of HIV transmission was commonly reported. The most frequently reported type of partnership was casual partners only, and 22% reported unprotected anal intercourse with one or more new partners in the past month. Analysis of crude data showed that men on HAART had fewer sexual partners (median 9 versus 20, p=0.28), less unprotected anal intercourse (for example, 36% versus 27% had insertive unprotected anal intercourse with a new partner in the past year, p=0.03) and fewer acute sexually transmitted infections (33% versus 19%, p=0.004 in the past 12 months) than men not on HAART. Self assessed health status was similar between the two groups: 72% on HAART and 75% not on HAART rated their health as very or fairly good, (p=0.55). In multivariate analysis, differences in sexual risk behaviour between men on HAART and men not on HAART were attenuated by adjustment for age, time since HIV infection. CD4 count and self assessed health status. CONCLUSION: HIV positive homosexual men attending a London outpatient clinic commonly reported sexual behaviour with a high risk of HIV transmission. However, behavioural and clinical risk factors for HIV transmission were consistently lower in men on HAART than men not on HAART. Although use of HAART by homosexual men with generally good health is not associated with higher risk behaviours, effective risk reduction interventions targeting known HIV positive homosexual men are still urgently needed.

Adult↗
PubMed1976

Male transsexuals in the homosexual subculture.

The author describes 20 male transsexuals who differ from most discussed in professional studies and from those in media portrayals in that they live in the male homosexual subculture. Furthermore, interviews with these individuals indicated that transsexuals are no more sexually or socially homogeneous than heterosexuals or homosexuals. In general, these men entered the homosexual subculture in their teens; they knew they were not heterosexual and therefore assumed they must be homosexual. As their gender identity crystallized, homosexual activity became repugnant and they rejected and were rejected by male homosexuals. Being unable to attract heterosexual men, they sought bisexual partners in a futile effort to confirm their identity as females. The author suggests that in addition to efforts to help transsexuals shift their gender identity, psychiatrists should emphasize prevention of this psychopathologic symptom.

Dominance-Subordination↗
PubMed1980

Transference and countertransference in homosexuality--changing psychoanalytic views.

This retrospective review of the psychoanalytic treatment literature about homosexuals traces the development over the years of views of transference and countertransference. Shifts are identified in the dynamic understanding of transference phenomena, from an early emphasis on Oedipal issues to the contemporary focus on early maternal relations and how disturbances in these are recapitulated in the homosexual transference; this evolution parallels broader trends in clinical psychoanalysis. Against the background of rapidly changing social and professional attitudes toward homosexuality, and in light of burgeoning interest in countertransference among psychoanalysts, the absence of any discussion of countertransference in the treatment of homosexuals is considered significant. Further, the overwhelming attention given to male, compared to female, homosexuals is noted. Finally, some questions are raised about the implications of the contemporary status of psychoanalytic thinking about the treatment of homosexuality.

Countertransference↗
PubMed1994

A comparison of the progression rate to acquired immunodeficiency syndrome between intravenous drug users and homosexual men.

In order to study differences in progression to Acquired Immunodeficiency Syndrome (AIDS) between risk groups, 205 homosexual men and 185 intravenous drug users (IVDUs) were followed from diagnosed seropositivity for Human Immunodeficiency Virus Type-1 (HIV) for a mean period of 46 months (range 1-88 months). Seven (4%) IVDUs and 55 homosexual men (27%) were diagnosed with AIDS during the follow-up period. The probability of being AIDS-free four years after diagnosed HIV positivity was 0.96 for IVDUs (SE 0.02) and 0.73 (SE 0.04) for homosexual men (p < 0.001, log rank test). When controlling for age and gender, the relative risk of AIDS progression for homosexual men was 9.1 (3.5-24.1, 95% confidence interval) as compared with IVDUs. Even when 24 months of follow-up time without progression were added for all homosexual men, assuming that the epidemic started two years earlier in this group, the relative risk of progression was 5.4 (2.1-14.4, 95% confidence interval) for homosexual men.

Acquired Immunodeficiency Syndrome↗
PubMed1999

British psychiatry and homosexuality.

BACKGROUND: Opposition to homosexuality in Europe reached a crescendo in the 19th century. What had earlier been regarded as a vice evolved as a perversion or psychological illness. Official reviews of homosexuality as both an illness and (for men) a crime led to discrimination, inhumane treatments and shame, guilt and fear for gay men and lesbians. Only recently has homosexuality been removed from all international diagnostic glossaries. AIMS: To review how British psychiatry has regarded homosexuality over the past century. METHOD: Review of key publications on homosexuality in British psychiatry. RESULTS: The literature on homosexuality reflects evolving theories on sexuality over the past century. The assumptions in psychoanalysis and the behavioural sciences that sexuality could be altered led to unscientific theory and practice. CONCLUSIONS: Mental health professionals in Britain should be aware of the mistakes of the past. Only in that way can we prevent future excesses and heal the gulf between gay and lesbian patients and their psychiatrists.

Attitude of Health Personnel↗
PubMed1976

Reported consequences of decriminalization of consensual adult homosexuality in seven American states.

This article reports results of a survey of police officials, prosecuting attorneys, and members of homosexual groups in the seven states that had decriminalized private homosexual behavior between consenting adults. Despite the dire predictions of many, the responses indicate that, among other things, decriminalization has had no effect on the involvement of homosexuals with minors, the use of force by homosexuals, or the amount of private homosexual behavior. Additionally, decriminalization reportedly eased somewhat the problems of the homosexual community and allowed the police to devote more time to the investigation of what generally are regarded as more serious criminal offenses.

Adult↗