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Diminished responsiveness of homosexual men to antiviral therapy for HBsAg-positive chronic liver disease.

To identify factors predicting response to antiviral therapy, we reviewed the clinical features of 38 male hepatitis B surface antigen (HBsAg) carriers who received adenine arabinoside or lymphoblastoid interferon. All patients were followed for one year or longer. Response was defined as loss of hepatitis B e antigen, hepatitis B virus DNA and DNA polymerase from the serum. Only 2 of 19 (11%) homosexual men responded, compared with 10 of 19 (53%) heterosexual men (P less than 0.02). Both responders in the homosexual group had received lymphoblastoid interferon. None of the 13 homosexual men, but 8 of 16 heterosexual men, responded to adenine arabinoside or its monophosphate (P less than 0.01). Responders to antiviral therapy had higher (P less than 0.05) serum levels of aspartate aminotransferase (median 115, range 51-344) than did non-responders (median 83, range 32-181). The decreased responsiveness of homosexual men to antiviral therapy may be a result of more severe immunologic abnormalities in homosexual than in heterosexual men with HBsAg-positive chronic liver disease.

Adult↗

A comparison of heterosexual and homosexual long-term sexual relationships.

This is a study of a nonrandom sample of 94 women who are in long-term sexual relationships. The women were divided into groups of heterosexual and homosexual women who reported childhood sexual abuse, and heterosexual and homosexual women who reported no history of childhood sexual abuse. The groups were rated according to their levels of sexual satisfaction and relationship satisfaction. Results indicate that women who have not been abused are more satisfied with their relationships than women who have been abused. Heterosexual and homosexual women who have a history of childhood sexual abuse are less satisfied with their sexual relationships than women without histories of abuse. However, homosexual women who have been abused rated their relationship satisfaction higher than heterosexual women who have been abused. By showing that one cannot draw conclusions about homosexual women based on research on heterosexual women, this study encourages further research to enable nurses to refine their care planning.

Adult↗

Oral lesions as markers of severe immunosuppression in HIV-infected homosexual men and injection drug users.

OBJECTIVES: We examined the diagnostic utility of the presence of oral lesions, individually and in combination, in identifying severe immunosuppression, defined as CD4 cell count under 200. STUDY DESIGN: Data were collected on 82 HIV-seropositive homosexual men and 82 HIV-seropositive injection drug users who volunteered to participate in a longitudinal study of HIV infection. CD4 cell counts were measured within 24 hours of oral examination. METHODS: Sensitivity, specificity, positive predictive value, negative predictive value, and the odds ratio were computed to assess the association between oral lesions and CD4 less than 200. In addition to the individual lesions, we studied the diagnostic properties of sets of three to six lesions. For each set of lesions, a patient was classified as positive for the set if he or she had one or more lesions in that set. RESULTS: In homosexual men and injection drug users, individual lesions had low sensitivity, high specificity, and moderate positive and negative predictive values. Odds ratios reflected weak correlation to immunosuppression. When lesion sets were considered in homosexual men, sensitivity rose dramatically with only modest decreases in specificity. The positive and negative predictive values remained almost the same. Similar results for lesion sets were obtained in injection drug users, with greater reduction in specificity but stable positive and negative predictive values. Odds ratios indicated that for homosexual men, the more lesions included in the set, the stronger the correlation with immunosuppression. For injection drug users, strong correlations were observed for all lesion sets. CONCLUSIONS: Analysis of sensitivities and odds ratios in homosexual men suggest that it may be valid to note the occurrence of a greater number of oral lesions than is currently done in staging patients with HIV infection. Among injection drug users, monitoring a larger number of lesions neither improves nor reduces the correlation to severe immunosuppression.

Biomarkers↗

Time trends in HIV incidence among homosexually active men seen at sexual health clinics in Australia, 1993-1999.

BACKGROUND: Increases in sexual risk behaviour have recently been reported among homosexually active men in Australia and in other industrialised countries, potentially facilitating an increase in HIV incidence. OBJECTIVE: To monitor HIV incidence among homosexually active men seen through a network of sexual health clinics in Australia. STUDY DESIGN: Selected metropolitan public sexual health clinics provided counts of the number of people seen at the clinics during a calendar year, the number voluntarily tested for HIV antibody and the number newly diagnosed with HIV infection, broken down by sex, age group, HIV exposure category and HIV antibody testing history. HIV incidence was estimated among homosexually active men with a history of a negative test in the 12 months prior to last being seen in a calendar year. RESULTS: Of 23924 men seen at the clinics in 1993-1999 with a reported history of male homosexual contact, 7440 (31.1%) had a negative test in the 12 months prior to last being seen in a calendar year. The percentage of men with a recent negative test declined significantly over time, from more than 33% in 1994-1996 to 29% in 1999 (P=0.003), and with increasing age, from 34.3% among men aged 25-29 years to 27.4% among men aged 40 years or older (P<0.0005). A total of 5346 (71.9%) men were retested for HIV antibody within 12 months of the last negative test. The percentage of men retested declined significantly over time, from 77.8% in 1994 to 67.2% in 1999 (P=0.021) but did not change by age group (P=0.132). Overall, 56 men were newly diagnosed with HIV infection. Estimated HIV incidence was 2.1% in 1993-1999; incidence did not change significantly by year (P=0.498) or age group (P=0.757). CONCLUSION: HIV incidence has remained stable among homosexually active men seen through a network of sexual health clinics in Australia.

Adolescent↗

Lack of evidence for increased risk of hepatitis A infection in homosexual men.

In 1997, prevalence of and risk factors for hepatitis A virus (HAV) infection were evaluated in 146 homosexual and 286 heterosexual men attending a Sexually Transmitted Disease (STD) Clinic in Rome, Italy. Total HAV antibody (anti-HAV) was detected in 60.3% of homosexuals and 62.2% of heterosexuals. After adjustment for the confounding effects of age, years of schooling, number of sexual partners, use of condoms, and history of STD, homosexuals were not found to be at increased risk of previous HAV exposure than heterosexuals (OR 1.1; 95% CI 0.7-1.9). Independent predictors of the likelihood of anti-HAV seropositivity among homosexuals and heterosexuals were: age older than 35 years and positive syphilis serology which is likely a proxy of lifestyles that increase the risk of faecal-oral infections. These findings do not support a higher risk in homosexual men but could suggest a role for the vaccination of susceptible patients attending STD clinics.

Adult↗

Sexual partner age preferences of homosexual and heterosexual men and women.

The sexual age preferences of 192 adults (equal groups of heterosexual men, heterosexual women, homosexual men, and homosexual women) were examined. Participants rated the sexual attractiveness of pictures of 15 male and 15 female faces arranged into five apparent average age categories ranging from 18 to 60 years. It was predicted that homosexual and heterosexual men would prefer younger partners of their preferred sex than would homosexual and heterosexual women and that age preference would not vary with participant age. Both predictions were supported, although homosexual women preferred older partners than expected. Results suggest that age and sex preferences develop independently.

Adolescent↗

Familial aspects of male homosexuality.

Research has generally supported the existence of familial-genetic factors for male sexual orientation, but has not shed much light on the specific nature of those influences. Gay men with gay brothers provide the opportunity to examine several hypotheses. Sixty-six men, representing 37 gay male sibling pairs, completed questionnaires assessing behavior on various measures including childhood and adult gender nonconformity, timing of awareness of homosexual feelings, self-acceptance, and the quality of family relationships. Consistent with prior findings using twins, gay brothers were similar in their degree of childhood gender non-conformity, suggesting that this variable may distinguish etiologically (e.g., genetically) heterogeneous subtypes. The large majority of gay men with brothers knew about their own homosexual feelings before they learned about their brothers' homosexual feelings, suggesting that discovery of brothers' homosexuality is not an important cause of male homosexuality.

Adult↗

Additive effects of older brothers and homosexual brothers in the prediction of marriage and cohabitation.

Research has shown that male homosexuality tends to cluster in families and that homosexual males have, on average, a greater number of older brothers than do heterosexual males. This study investigated whether the former, between-families effect and the latter, within-families effect are additive. The subjects were 717 full siblings over age 40 reported by 343 heterosexual and homosexual male probands examined in Southern Ontario in 1994-1995. The sibling's history of legal marriage or cohabitation in a heterosexual relationship was taken as a proxy variable for sexual orientation. There were no significant findings for the female siblings. As expected, the never-married male siblings were more likely to come from the sibships of the homosexual probands, and they had a greater average number of older brothers. A bootstrapped logistic regression analysis showed that an additive model best explained the male siblings' data. The results suggest that the familial aggregation of male homosexuality cannot be explained by the birth order effect and that older brothers and family membership reflect separate influences on sexual orientation or sexual orientation-correlated behavior.

Adult↗

Effects of sex role attitudes and similarity on men's rejection of male homosexuals.

The present study investigated reactions to homosexuals as a function of perceived attitude similarity and subjects' sex role attitudes. Male subjects, preselected on the basis of their profeminist, moderate, or antifeminist scores on the Attitude Toward Feminism Scale were assigned at random to one of the four experimental conditions. Using a standard attraction paradigm design, subjects rated a bogus "partner," who was represented as either homosexual or heterosexual and as having attitudes either similar or dissimilar to theirs. Consistent with predictions, similar partners were liked more than dissimilar partners, and heterosexual partners were liked more than homosexuals. Homosexuals were seen as more dissimilar to the subjects in all conditions. Further, liberals were more accepting of homosexuals and dissimilar partners than were traditionals. The results are discussed in terms of the relationship between sex role attitudes and tolerance of dissimilarity.

Attitude↗

Sexual transmission of hepatitis A in homosexual men: incidence and mechanism.

We performed monthly examinations and serologic tests for antibody to hepatitis virus A (anti-HA) in a study of 57 heterosexual men and 102 homosexual men followed prospectively for a mean of 8.9 months and 6.1 months, respectively. The initial prevalence of anti-HA was 30 per cent in homosexual men and 12 per cent in heterosexual men P less than 0.01). The annual incidence of hepatitis A in susceptible (seronegative) homosexual men was 22 per cent, whereas no heterosexual men acquired hepatitis A. Diaries concerning sexual behavior kept by homosexual men showed that the acquisition of hepatitis A virus infection contact. Hepatitis A should be considered one of the enteric infections that appear to be sexually transmitted among homosexual men.

Adolescent↗

Is screening for anal cancer warranted in homosexual men?

Some investigators have proposed screening homosexual men for anal cancer and its probable precursor, high grade anal intraepithelial neoplasia (AIN). Using widely accepted criteria for the introduction of screening programmes, this paper reviews the current evidence for screening for this condition in this high risk population and highlights areas where additional research is required. While it is accepted that the incidence of anal cancer is at least 20 times higher in homosexual men than the general population, the natural history of anal cancer and its precise relationship with AIN is not clearly understood. Anal intraepithelial neoplasia is a very highly prevalent disease among homosexual men, but little is known about what predicts progression to invasive disease. The screening tests, exfoliate cytology and high resolution anoscopy, have a sensitivity of between 45 and 70%. Treatment options for AIN are limited by morbidity and high recurrence rates and there are no randomised controlled trials studying the efficacy of therapeutic agents or surgery for high grade AIN, although immunotherapies show very early promise. Theoretically, early detection may lead to better treatment outcomes. Studies of the potential negative consequences of screening programmes on the homosexual population are needed. The currently available data does not support the implementation of a screening programme for AIN and anal cancer in homosexual men in Australia.

Anus Neoplasms↗

Becoming homosexual: a model of gay identity acquisition.

How do male homosexuals who choose homosexuality as a way of life recall having acquired their gay identities? This question provided the impetus for the descriptive study presented here. Rather than concerning itself with the etiology of homosexuality, this report-- a synthesis of and elaboration on recent investigations of homosexual and/or gay identity--concerns itself with documenting the ways in which a man learns that he is homosexual, how he realizes or decides that he is gay, and how he integrates this affectional and sexual preference into his identity or self-conception.

Adult↗

Gender role/identity and sibling sex ratio in homosexual men.

Previous research has suggested that homosexual men's sibling sex ratio-the ratio of brothers to sisters collectively reported by a group of individuals-is elevated but only in samples of extremely feminine (e.g., transsexual) homosexual men. I conducted an additional test of a sibling sex ratio effect in a general sample of homosexual men (N = 237), and examined the correlation between sibling sex ratio and childhood gender identity. I found no significant effects. My discussion focuses on why little evidence of a relationship between sibling sex ratio and cross-gender behavior in childhood occurs within this general sample of homosexual men when samples selected for very feminine homosexual men have detected an elevated sibling sex ratio.

Birth Order↗

Treating homosexuality: a response to Yarhouse.

Professor Mark A. Yarhouse proposes an 'identity synthesis' model of sexual modification therapy for homosexuals. This model is meant primarily to target the process by which one's sexual identity is synthesized, rather than the changing of sexual orientation itself. I highlight some of the advantages of Yarhouse's model along with some of its potential pitfalls. My primary point of departure with Yarhouse concerns how one ought to direct those self-identified homosexual clients who fall within our clinical sphere of influence and who, in the end, contrary to our better judgment, decide that they would like to pursue a course of "homosexualization." Based on the "autonomy" - emphasizing aspects of the identity synthesis model, it appears that Yarhouse is willing to sanction the referral of certain clients to "therapists" who are willing to facilitate these clients' homosexualization. I do not believe that Christians involved in the care of homosexuals can licitly participate in such referrals.

Behavior Therapy↗

High prevalence of Epstein-Barr virus type 2 among homosexual men is caused by sexual transmission.

To investigate whether Epstein-Barr virus (EBV) type 2 infection is highly prevalent among homosexual men, the prevalence of EBV type 2 was studied among homosexual and heterosexual white men who were at high and low risk for sexually transmitted diseases; these data were correlated with sexual behavior. The prevalence of EBV type 2 among homosexual men was significantly higher than it was among heterosexual men (39% vs. 6%). Among high-risk heterosexual men, prevalence was significantly higher than it was among low-risk heterosexual men (15% vs. 0). In univariate analyses, EBV type 2 infection in homosexual men was significantly associated with human immunodeficiency virus (HIV) seropositivity, increased numbers of intercourse partners, non-Dutch nationality, and human herpesvirus 8 seropositivity. In multivariate analyses, an independent association with EBV type 2 was observed only for HIV seropositivity and number of sex partners. These data support the conclusion that EBV type 2 infection is more prevalent among white homosexual men and is caused by sexual transmission.

Adult↗

Cancer in a population-based cohort of men and women in registered homosexual partnerships.

Cancer patterns among broad populations of homosexual men and women have not been studied systematically. The authors followed 1,614 women and 3,391 men in Denmark for cancer from their first registration for marriage-like homosexual partnership between 1989 and 1997. Ratios of observed to expected cancers measured relative risk. Women in homosexual partnerships had cancer risks similar to those of Danish women in general (overall relative risk (RR) = 0.9, 95% confidence interval (CI): 0.6, 1.4), but only one woman developed cervical carcinoma in situ versus 5.8 women expected (RR = 0.2, 95% CI: 0.0, 0.97). Overall, men in homosexual partnerships were at elevated cancer risk (RR = 2.1, 95% CI: 1.8, 2.5), due mainly to human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)-associated Kaposi's sarcoma (RR = 136, 95% CI: 96, 186) and non-Hodgkin's lymphoma (RR = 15.1, 95% CI: 10.4, 21.4). Anal squamous carcinoma also occurred in excess (RR = 31.2, 95% CI: 8.4, 79.8). After exclusion of Kaposi's sarcoma, non-Hodgkin's lymphoma, and anal squamous carcinoma, no unusual cancer risk remained (RR = 1.0, 95% CI: 0.8, 1.3). With anal squamous carcinoma and HIV/AIDS-associated cancers as notable exceptions in men, cancer incidence rates among homosexual persons in marriage-like partnerships are similar to those prevailing in society at large.

Acquired Immunodeficiency Syndrome↗

Prevalence of cytomegalovirus infection in homosexual men.

Cytomegalovirus (CMV) was cultured from the urine of 14 of 190 homosexual but none of 101 heterosexual men attending a venereal disease clinic (P less than 0.005). Viruria was confined to men less than 30 years of age and was present in 14% of this group. Antibody to CMV was measured in the sera of 139 homosexual and 70 heterosexual men attending the same clinic and in 103 male volunteer blood donors. Titers were found in 94% of homosexual patients but in only 54% of heterosexual patients (P less than 0.005) and 43% of male volunteer blood donors (P less than 0.005). The data suggest that sexual transmission is an important mode of spread of CMV among adults and the homosexual men are at greater risk for CMV infections than are heterosexual men. Homosexual men might considered candidates for the evaluation of the efficacy of CMV vaccines in preventing horizontal transmission of infection.

Adolescent↗

'A field for private members': The Wolfenden committee and Scottish homosexual law reform, 1950-67.

The proceedings and report of the Wolfenden Committee on Prostitution and Homosexual Offences (1954-7) figure prominently in the historiography of homosexuality in later twentieth-century Britain. However, in the main, research has centred on the social politics of the Committee and its implications for sexual law reform in England, and there is a notable lack of regional studies. Using a range of government archives, this article focuses on the written and oral evidence of Scottish witnesses to the Committee. It documents the pre-existing legal and medical provisions for the treatment of 'homosexual offences' in Scotland, and surveys the Scottish evidence for and against the decriminalization of homosexual practices. Thereafter, it examines the views of the Scottish members of the Committee in the context of the Wolfenden Report. The article then surveys the wide-ranging opposition to homosexual law reform within Scotland in the period 1957-67, culminating in its exclusion from the 1967 Sexual Offences Act. Finally, it evaluates the implications of the Scottish experience and concludes that, in some important respects, it does not conform to the innovative and transitional picture advanced in many previous interpretations of the Wolfenden Committee and its aftermath.

Governing Board↗