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PubMed2004

Perceived viral load, but not actual HIV-1-RNA load, is associated with sexual risk behaviour among HIV-infected homosexual men.

BACKGROUND: Increases in sexual risk behaviour and sexually transmitted infections among HIV-infected homosexual men after the introduction of highly active antiretroviral therapy (HAART) confirm the need for innovative prevention activities. The present study focused on time trends in sexual risk behaviour and predictors for unprotected anal intercourse in the HAART era among HIV-infected homosexual men. METHODS: In 2000-2003, 57 HIV-infected homosexual men (mean age 45 years) were interviewed in three serial data waves. Logistic regression, correcting for repeated measurements, was used to assess time trends in risky sex, and the association between HAART-related beliefs, and both the perceived and actual viral load level and CD4 cell counts and subsequent risky sex. RESULTS: Risky sex with casual partners increased from 10.5% in 2000 to 27.8% in 2003 (P < 0.01), and with steady partners of negative or unknown HIV status from 5.3% to 10.7% (P = 0.6). Homosexual men with a favourable perception of their viral load were more likely to engage in subsequent risky sex with steady partners of negative or unknown HIV status than men with a less favourable perception of their viral load; this association was independent of the actual HIV-1-RNA load and CD4 cell counts. CONCLUSION: Risky sex increased in this group of HIV-infected homosexual men. The perceived viral load, but not the actual load, is associated with subsequent risky sex with steady partners of negative or unknown HIV status. Care givers should discuss with patients not only their actual viral load and CD4 cell count but also their perceived viral load.

Adult↗

PubMed1984

Early effeminate behavior in boys. Outcome and significance for homosexuality.

This is a long term follow-up of 55 boys with early effeminate behavior. It was possible to determine the outcome in sexual orientation in 38 of the boys, which included homosexuality or variants of it in 35 (63.6 per cent) of the total of 55 and heterosexuality in three (5.5 per cent). In 10 boys the outcome was uncertain, and seven were lost to follow-up. An analysis of the uncertain cases suggests that the overall outcome in terms of homosexuality may prove to have been higher than 63.6 per cent. These results agree with those of previous prospective and retrospective studies, which are reviewed. From both types of such studies, the prospective ones starting out with instances of early effeminate behavior and the retrospective with cases of established homosexuality, the conclusion is ventured that all male homosexuality begins with early effeminate behavior. This has implications for future research on homosexuality.

Adolescent↗

PubMed1991

Body image dissatisfaction in homosexual and heterosexual males.

A nonclinical sample of 43 homosexual and 32 heterosexual men completed two self-report inventories regarding weight, body satisfaction, eating attitudes, and behaviors. Subjects were also asked to select their current and ideal figures, the weight they felt would be most attractive to a potential partner, and the weight to which they would be most attracted in a potential partner from figures representing very thin to very heavy physiques. Heterosexual men were significantly heavier than homosexual men and desired a significantly heavier ideal weight. Although the current and ideal physiques selected by the homosexual and heterosexual men were almost identical, homosexual men were more likely to desire an underweight ideal. A heightened pursuit of thinness may place homosexual men at an increased risk for developing eating disorders.

Adolescent↗

PubMedDate not supplied

Men and their bodies: a comparison of homosexual and heterosexual men.

The study examined influences on body satisfaction, disordered eating, and exercise behavior of a male subculture that places a heightened emphasis on appearance: the homosexual male subculture. Subjects were 71 homosexual and 71 heterosexual men. Relative to heterosexual men, homosexual men showed more body dissatisfaction and considered appearance more central to their sense of self. Also, their exercise was more motivated by a desire to improve attractiveness. Among the homosexual but not the heterosexual group, men who desired to be thinner showed more attitudes and behaviors associated with disordered eating than men who were thinner than their desired size. In contrast, heterosexual but not homosexual men who wished to be heavier had lower self-esteem scores than men who were heavier than or equal to their desired size. The findings support a view that a male subculture that emphasizes appearance may heighten the vulnerability of its members to body dissatisfaction and disordered eating.

Adult↗

PubMedDate not supplied

Trends in sexually transmitted diseases in homosexually active men in King County, Washington, 1980-1990.

Trends in sexually transmitted diseases (STDs) in homosexually active men were analyzed in King County, Washington, from 1980 to 1990. New-problem visits to the public STD clinic declined from 4142 in 1980 to 509 in 1988 (-88%), then rose to 937 (+84%) in 1989, and 527 in the first half of 1990. Cases of gonorrhea in homosexually active men treated at the STD clinic plus private sector cases of rectal gonorrhea in men fell from 955 in 1982 to 33 in 1988 (-97%), then rose to 102 in 1989 (+209%). Similar trends were observed for several other STDs. Of 109 Neisseria gonorrhoeae isolates from homosexual or bisexual men in 1988 to 1989, 46 (42%) belonged to 3 auxotype/serovar classes; one of these was a penicillinase-producing strain (PPNG), the first appearance of PPNG in substantial numbers in homosexually active men in King County. The remaining 58% of isolates were distributed among 20 strains. These data imply substantial reductions in the frequency of high-risk sexual behavior in homosexually active men in King County over most of the 1980s, followed by an increased frequency of unsafe behavior after 1988. Maintenance of sexual safety may require increased educational effort and societal support as time passes.

Adult↗

PubMed1989

Evidence for recent changes in sexual behaviour in homosexual men in England and Wales.

Over 80% of cases of Acquired Immune Deficiency Syndrome (AIDS) in England and Wales have occurred in homosexual men. Changes in sexual behaviour in this group may have a substantial influence on the incidence of Human Immunodeficiency Virus (HIV) infection and will therefore be crucial in determining future cases of AIDS. This paper critically weighs the indirect and direct evidence for changes in behaviour in homosexual men since the advent of the AIDS epidemic. The paper reports on falling incidence of gonorrhoea, hepatitis B and syphilis in homosexual men, the changes being most marked from 1985 onwards. Data on temporal trends in HIV prevalence and incidence in homosexual men are reviewed. These suggest that the maximum incidence of HIV infection occurred in 1982-84 and may have fallen since then. Evidence for a concomitant change in sexual behaviour is reported from several sources. This points towards a recent change in sexual behaviour characterized by reduction in the numbers of partners and adoption of safer sexual practices. In some places change may have occurred as early as 1983. A change became apparent generally in 1985 and this appears to have been sustained in 1986-87. Nevertheless, a substantial proportion of homosexual men studied continue to practice high risk sexual practices, such as anal intercourse, including relationships with casual partners.

Acquired Immunodeficiency Syndrome↗

PubMed1991

Sequential serological studies of homosexual men with and without HIV infection. Epstein-Barr virus activation preceding and following HIV seroconversion.

Viral cofactors may be important in the pathogenesis of HIV infection and the development of AIDS, but their role is still imperfectly understood. Sequential serological studies were performed in a cohort of 100 homosexual men and 70 matched healthy controls over a mean period of 4 years. Of the patients, 18 were found to be HIV+ on admission to the study and 15 seroconverted to HIV+ during the follow up (seroconversion group). Serum antibodies of both IgG and IgA isotypes against Epstein-Barr virus (EBV) and cytomegalovirus (CMV) were determined. IgG antibodies indicate past infection, while a marked increase in IgG titre or a positive IgA titre were taken to indicate active infection or reactivated latent infection. EBV and CMV infections were about two to four times more prevalent in the homosexual men both HIV- and HIV+, compared with controls. Active infections were increased in the homosexual men and particularly in the HIV+ patients. The seroconversion group revealed activation of both EBV and CMV following HIV infection. When the antibody profile of seroconverting patients at the time preceding seroconversion was compared with a matched group of 39 homosexual men who remained HIV-, no change was found in CMV antibodies, but four out of 15 (26.6%) of the patients had high titres of anti-EBV IgA preceding seroconversion, as compared with only one out of 39 (2.6%) of HIV- homosexual men (P less than 0.05). This suggests a role for EBV reactivation in the pathogenesis of HIV infection in some patients.

Antibodies, Viral↗

PubMed1985

Antibodies to human T-cell lymphotropic virus type III in promiscuous healthy homosexual men. Relation to immunological and clinical findings.

Antibodies to human T-cell lymphotropic virus type III (HTLV-III Ab) were present in twenty-one out of sixty-four asymptomatic promiscuous homosexual men from Copenhagen. The presence of HTLV-III Ab was associated with lymphadenopathy (P less than 0.0005), cytomegalovirus isolation (P less than 0.01), low skin test reactivity (P less than 0.01) and episodes of fever within the 2 month period prior to investigation (P less than 0.05). No significant differences occurred in the total number of T-cells, T-suppressor cytotoxic cells, T-helper cells or helper to suppressor ratio (H/S ratio) between HTLV-III Ab positive and negative homosexuals. An H/S ratio less than or equal to 1.0 was significantly more frequent in homosexual men who both had HTLV-III Ab and excreted cytomegalovirus (P less than 0.01). The H/S ratio of HTLV-III negative homosexuals were significantly lower than that of the controls suggesting that a non-HTLV-III related immunosuppression occurs among homosexuals. Within 2 years after the investigation AIDS or the AIDS related complex developed in three of the men, who at the first investigation all had HTLV-III Ab, alterations in T-lymphocyte subsets and cutaneous anergy. It is suggested that a combination of T-cell subset determination and determination of HTLV-III Ab may provide more valuable prognostic information than isolated determination of HTLV-III Ab.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Increased prevalence of oral Candida albicans serotype B in homosexual men: a comparative and longitudinal study in HIV-infected and HIV-negative patients.

Several investigators have shown a comparatively high prevalence of Candida albicans serotype B among HIV-infected individuals. We serotyped oral C. albicans strains from 50 HIV-infected homosexual men, 39 HIV-seronegative homosexual men and 40 clinical oral isolates of a control group. The prevalence of serotype B was significantly higher in homosexual men, regardless of HIV serostatus, than in the control subjects. We suggest that the reported high prevalence of serotype B among AIDS patients in Europe and the USA simply reflects the high proportion of homosexual men among HIV-infected patients. In 22 subjects, oral C. albicans isolates were obtained at two or more time points, up to 8 years apart. No change in serotype was observed over time. The serotype prevalences in HIV-infected patients with oral thrush or AIDS-defining illness were similar to the group of homosexual men as a whole, indicating that there is no serotype-related variation in pathogenicity.

AIDS-Related Opportunistic Infections↗

PubMed1986

Hepatitis B virus and delta infection in male homosexuals.

Six hundred and sixty-six homosexuals were analysed in respect of hepatitis B virus and delta infections. Evidence of ongoing or recent hepatitis B virus infection was found in 450/666 (67.6%) homosexuals; 44 were HBsAg positive. Anti-delta was found in two HBsAg-positive homosexuals. Both individuals had a non-replicative form of HBV infection and biochemical evidence of liver disease. The study confirms that HBV infection is frequent in homosexuals and indicates that delta-infection is rare in male homosexuals.

Berlin↗

PubMed1991

School counselors' perceptions of adolescent homosexuals.

Data from a national survey of secondary school counselors (N = 289) were collected regarding their perceptions of adolescent homosexuality. Most counselors underestimated the prevalence of homosexual adolescents. Almost one in five counselors reported that counseling a homosexual student concerning gay issues would not be professionally gratifying, and 20% thought they were not very competent in counseling gay adolescents. One-fourth of the school counselors reported that teachers seem to exhibit significant prejudice toward homosexual students, and 41% believed schools are not doing enough to help gay students adjust to their school environment. Perceptions of adolescent homosexuality did not vary by gender, age, or education level of the counselors.

Adolescent↗

PubMed1977

Homosexuality in adolescence.

This paper asserts that homosexuality in adolescence should not be regarded in the same way it would be in adults. Different types of homosexuality emerge during adolescence according to the different psychodynamic conditions which occur at different stages of adolescence, particularly the changing relationship to the individual's parents, and these may subside or make an important contribution to the establishment and nature of an individuals' homosexuality in adulthood. The characteristic 'identificatory facility' of adolescence is discussed and it is suggested that this is retained in the make-up of the adult homosexual. Some comments on the clinical assessment of homosexuality in adolescence are briefly made.

Adolescent↗

PubMed1986

Long term follow up of chronic hepatitis B virus infection in intravenous drug abusers and homosexual men.

Long term follow up of 16 homosexual men and 78 intravenous drug abusers who were chronic carriers of hepatitis B surface antigen (HBsAg) showed fundamental differences between the two groups. Viral replication, expressed by the presence of hepatitis B e antigen, lasted for four years or more in 10 out of 14 (71%) of the homosexual men whereas it was not present in 43 out of 73 (59%) of the drug addicts within one year. This shows a difference in the immunological response between homosexual HBsAg carriers and addicts that is not related to infection with human T cell lymphotropic virus type III. Severe histological damage such as chronic aggressive hepatitis, cirrhosis, or primary liver cancer was found in more than half of the homosexual men who underwent biopsy examinations. In drug addicts chronic persistent hepatitis was a regular finding in the absence of markers of delta infection, but in those addicts infected with the delta agent the degree of liver damage was comparable with that found in homosexual men.

Adolescent↗

PubMed1984

Sociological and psychological predictors of STD infection in homosexual men: a study of four countries.

I investigated over 600 homosexual men in four countries (Sweden, Finland, Ireland, and Australia) regarding the number of times they had contracted a sexually transmitted disease (STD) and several psychological variables including masculinity and feminity, sex role conservatism, relationships with parents, number of sexual partners, attitudes towards homosexuality, and involvement in the homosexual subculture. Using multiple linear regression in each country, it was found that 19-42% of the variance of number of times infected could be accounted for by psychosocial factors, seven of which were common to all countries. The number of sexual partners was not a significant variable in any country. These data strongly suggest that numbers of infections in homosexual men are best predicted by psychological factors, and this has considerable implications for preventative and treatment programmes for homosexuals.

Adult↗

PubMed1991

Sexually transmitted diseases in homosexual males in Seville, Spain.

BACKGROUND AND METHODS: The absence of any official statistics on the prevalence of STD in homosexual men in Spain induced us to carry out a prospective study of new homosexual patients who consulted the STD Clinic of the School of Medicine in Seville, between January 1988 and December 1989. The aim of the study was to determine the prevalence of symptomatic and asymptomatic infections in this group of patients. RESULTS: 1805 patients were seen during the study period; 318 patients were homosexual of whom 309 agreed to participate in the study. Of the 309 homosexual men, 108 (35%) had symptoms and the remaining 201 (65%) were asymptomatic. In the symptomatic group the diagnoses were: syphilis 28 (25.9%); urethritis 40 (37%) (of these 40, 11 had Neisseria gonorrhoeae, five had Chlamydia trachomatis, five had Ureaplasma urealyticum, one had Herpes simplex virus and in 18 no pathogen was detected); genital herpes seven (6.4%). Eleven (10%) had concomitant infections. The following infections were found in the asymptomatic group: syphilis 23 (11.4%), N gonorrhoeae six (3%), C trachomatis two (1%), Herpes simplex virus one (0.5%). Antibodies against HIV were detected in 30 (9.6%) of the total group. CONCLUSIONS: Sexually transmitted diseases are common amongst homosexual men in Seville and many of these are asymptomatic.

Adult↗

PubMed1997

Surveillance of sexual behaviour among homosexual men in a central London health authority.

OBJECTIVE: To establish a surveillance mechanism of high risk sexual behaviour among homosexual and bisexual men living, socialising and using services in a central London health authority. DESIGN: Baseline survey for a system of repeatable behavioural surveillance using a self-completed questionnaire delivered by healthcare providers. SETTING: Genitourinary medicine clinics, gay bars, clubs, community groups and a cruising ground in the defined geographical area of a central London health authority. PARTICIPANTS: Five hundred and fifty three homosexual and bisexual men. MAIN OUTCOME MEASURES: Self-reported behaviours including unprotected anal intercourse (UAI), HIV status of unprotected anal intercourse partners, uptake of HIV testing and use of condoms at first time of anal intercourse. RESULTS: Five hundred and sixty questionnaires were returned (response rate 76%) from 553 men. A third (35%) of men surveyed had had UAI in the previous year. Nearly a fifth (19%) of the sample had had UAI with one or more partners of a discordant or unknown HIV status. A total of 343 (63%) men had had an HIV test. The proportion of men using condoms on the occasion of first anal intercourse has risen from 6% before 1980 to 88% after 1993. CONCLUSIONS: We have demonstrated that a surveillance programme to monitor high risk sexual behaviour among homosexual men can be easily established. The results can be employed to assess progress towards risk reduction targets and also inform future policy development. Our baseline data demonstrate that a large proportion of homosexual men are continuing to engage in high risk sexual behaviour, although there is some evidence of improvement in condom use at first anal intercourse over time. There is a need for continuing health promotion with evaluation among homosexual men.

Adolescent↗

PubMed1976

Syphilis, homosexuality and legislation.

The proportion of cases with fresh syphilis in males contracted by homosexual contacts in Helsinki before and after the change of the criminal law in 1971 was studied. Since 1971, homosexuality is by law no longer a crime in Finland. In 1964, only 2% of males with fresh syphilis admitted a homosexual contact. The same figure was 8% in 1970, and increased to about 50% in 1974 and 1975. It was concluded that a change of legislation concerning homosexuality, probably by several different routes, changed the proportion of cases of detected homosexually transmitted early syphilis. This was thought to be of special importance for case finding and controlling of the spread of syphilis.

Finland↗

PubMed1984

Functional T lymphocyte immune deficiency in a population of homosexual men who do not exhibit symptoms of acquired immune deficiency syndrome.

To determine whether healthy homosexual men are immunologically impaired, peripheral blood leukocytes (PBL) from 20 male homosexuals were compared prospectively with PBL from 14 age-matched male heterosexual donors with respect to: (a) the capacity of their PBL to generate functional T cell immune responses in vitro; and (b) the content of total T cells and T cell subsets in their peripheral blood. The homosexual donors studied indicated moderate sexual life styles in that all but one of the donors had less than five current sexual partners. The percentages of OKT3+, OKT4+, and OKT8+ T cells were similar to those of heterosexual controls. T cell function was assessed by measuring cytotoxic T cell responses to influenza virus and to allogeneic cells. Approximately one-third of the homosexual donors consistently exhibited weak cytotoxic T lymphocyte (CTL) responses to influenza virus, whereas all of the heterosexual donors generated strong CTL responses to influenza. There was no correlation between the strength of CTL responsiveness to influenza virus and the strength of CTL responses to allogeneic cells. These results suggest that the influenza-specific CTL response may be a sensitive indicator of immunologic defects in asymptomatic homosexuals. If acquired immune deficiency syndrome results from an infectious agent, it remains to be seen if such immunosuppression predisposes to the infection, or if it reflects early consequences of infection.

Acquired Immunodeficiency Syndrome↗