Heterosexual transmission of HIV in the USA: male-to-female ratios among immigrants from Pattern II countries compared with American-born heterosexual cases.
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Sexual behaviour of heterosexual individuals with HIV infection naive for antiretroviral therapy in Italy.
BACKGROUND: Specific information about determinants of sexual behaviour of HIV infected heterosexuals, like injecting drug use (IDU), are essential to design interventions aimed at promoting safer sex practices. METHODS: We analysed data on sexual behaviour collected, between March 1997 and March 1999, through a self administered questionnaire among 1050 IDUs and 642 non-IDU heterosexuals enrolled in a prospective multicentre cohort study on the natural history of HIV infection. RESULTS: Among non-IDU heterosexuals, more women (48.5%) than men (25.1%) (p<0.001) reported that they were infected by HIV positive regular partners whose HIV status they were not aware of. Among the 1119 heterosexual males, one fifth reported having had more than 25 sexual partners during their lifetime. Condom use in the last sexual intercourse was more common among heterosexual IDUs (64.9%) than among non-IDU heterosexual males (58.3%) (p=0.05). Heterosexual IDU males were more likely (66.7%) than non-IDU heterosexuals (50.6%) to have an HIV negative partner (p<0.001). Of the 573 heterosexual females studied, 10.2% reported having had more than 25 lifetime sex partners. This proportion was higher among heterosexual IDUs (18.8%) than among non-IDU heterosexuals (4.3%) (p<0.001). Nearly 50% of the women in both groups reported having used a condom in the last intercourse. Almost 57% of heterosexual IDUs had a current HIV negative partner, compared with 34.9% non-IDU heterosexuals (p<0.001). In both sexes, the findings from univariate analysis were confirmed by multiple logistic regression analysis. CONCLUSIONS: This study identified some important differences, in both males and females, in sexual lifestyles according to injecting drug use (for example, in terms of HIV negative partners). This observation indicates the need to tailor HIV prevention messages according to history of injecting drug use.
Adult↗
Humoral immune responses in healthy heterosexual, homosexual and vasectomized men and in homosexual men with the acquired immune deficiency syndrome.
In homosexual men, the acquired immune deficiency syndrome (AIDS) is associated with sexual promiscuity and the appearance of circulating immune complexes (CICs) and antibodies to spermatozoa which crossreact with lymphoid cells. A comparative study was initiated to determine whether similar humoral responses existed in 38 heterosexual men lacking sperm antibodies, 13 heterosexuals with sperm antibodies, 42 heterosexual vasectomized men, 22 healthy homosexual men, 26 homosexuals with lymphadenopathy and 16 with AIDS or Kaposi's sarcoma (KS). Sperm antibodies were detected in 12% of the vasectomized heterosexual men, 23% of the healthy homosexuals, 35% of the lymphadenopathy patients and 44% of the men with KS-AIDS. IgG reactive with peripheral blood T lymphocytes was present in only 3% of heterosexuals lacking sperm antibody and 5% of vasectomized men. In contrast, 23% of heterosexuals with sperm antibody, 36% of healthy homosexuals, 31% of men with lymphadenopathy and 62% of KS-AIDS patients were positive in this assay. Antibodies to the neutral glycolipid asialo GM1 were found in none of the vasectomized men, 3% of the heterosexuals without and 8% with sperm antibodies, 17% of healthy homosexuals and 38% and 31% in patients with lymphadenopathy or KS-AIDS, respectively. Lastly, the incidence of CICs, determined by the Raji cell assay, was 0% in vasectomized men, 3% in heterosexuals lacking sperm antibody, 31% in heterosexuals with sperm antibody, 69% in healthy homosexuals, 81% in lymphadenopathy patients and 87% in KS-AIDS. In the homosexuals with lymphadenopathy and KS-AIDS, levels of CICs, T cell-reactive IgG and asialo GM1 antibody were positively correlated (p less than 0.01). Sperm antibody levels were negatively correlated (p less than 0.01) with CICs levels and T cell reactive IgG in heterosexuals and lymphadenopathy and KS-AIDS patients. The results demonstrate that vasectomized men do not manifest at all, and that non-vasectomized heterosexuals with sperm antibodies manifest to a much lesser extent the range of humoral immune responses exhibited by the three homosexual groups. Thus, the route of sperm immunization and/or exposure to autologous vs. heterologous spermatozoa may be of critical importance for eliciting specific immune responses.
Acquired Immunodeficiency Syndrome↗
Digit ratio (2D:4D) in homosexual and heterosexual men from Austria.
Neurohormonal theories of sexual orientation emphasize the organizational effects of testosterone on the developing brain. A recent suggestion, that the ratio of the length of the 2nd and 4th digits (2D:4D) is negatively correlated with prenatal testosterone, has led to a number of studies of 2D:4D in homosexual and heterosexual men and women. The results have been mixed. In comparison to heterosexual men, mean 2D:4D in gay men has been reported to be hypermasculinized (lower 2D:4D), hypomasculinized (higher 2D:4D), or to show no significant difference. Here, we report mean 2D:4D in Austrian homosexual and heterosexual men. We found no significant difference between means for homosexual and heterosexual 2D:4D, with values for both falling between 0.96 to 0.97. There are now 6 reports of 2D:4D in heterosexual and homosexual men. Considering Caucasian men, the studies from the United States show low heterosexual mean 2D:4D, and homosexual mean 2D:4D is higher or similar to that of heterosexuals. The European studies show high heterosexual mean 2D:4D, and comparisons with homosexuals reveal the latter to have lower or similar mean 2D:4D to that of heterosexuals. We discuss these results in relation to the suggestion that mean 2D:4D in heterosexual men differs across populations but mean 2D:4D in homosexuals shows less geographical variation (the "uniform mean hypothesis"). It is concluded that more data are required to clarify whether or not there is a 2D:4D effect for sexual orientation in men.
Adult↗
Is there really a heterosexual AIDS epidemic in the United States? Findings from a multisite validation study, 1992-1995. Mode of Transmission Validation Study Group.
The objective of this study was to verify the mode of exposure to the human immunodeficiency virus (HIV) among cases who obtained acquired immunodeficiency syndrome (AIDS) through heterosexual contact and to determine the proportion of cases initially reported with no risk but whose exposure may have been heterosexual. Adults aged > or = 13 years with AIDS, diagnosed from 1992 through 1995 with heterosexual risk or no risk at six US study sites (Alabama, California, Florida, New Jersey, New York City, and Texas), were eligible. Heterosexual risk was validated in 82% (1,610/1,952) of the heterosexual cases. Men were more likely than women to have a risk other than heterosexual (24% vs. 13%, chi2 p < 0.01). An HIV risk was identified for 351 (55%) of those cases with no risk, and men were more likely than women to remain without risk (48% vs. 38%, chi2 P = 0.02). Of the 415 men with no risk, 215 (52%) were reclassified: 94 (44%) were men who had sex with men, 61 (28%) were injection drug users, 48 (22%) had a heterosexual risk, and 12 (6%) had other exposures. Of the 219 women with no risk, 136 (62%) were reclassified: 82 (60%) had a heterosexual risk, 47 (35%) were injection drug users, and 6 (4%) had infection associated with transfusion. In conclusion, most cases reported with heterosexually acquired AIDS had valid heterosexual risk exposures.
Acquired Immunodeficiency Syndrome↗
No evidence of an epidemic of locally acquired heterosexual HIV infection in Norway.
BACKGROUND: An early sign of a major heterosexual human immunodeficiency virus (HIV) epidemic will be heterosexual infection acquired from persons who were themselves infected through heterosexual intercourse. GOAL: To test the hypothesis that there is a growing heterosexual epidemic of HIV in Norway. STUDY DESIGN: Data from the mandatory, comprehensive, anonymous HIV case reporting system were analyzed concerning Norwegian residents who had acquired HIV heterosexually and for whom such infections were diagnosed before the year 2001. RESULTS: One hundred fifty-five (71%) of 221 men were infected abroad, whereas 107 (76%) of 140 women were infected in Norway (mainly by drug injectors and immigrants); 23 men and 55 women had been infected in Norway by partners who themselves acquired HIV through heterosexual intercourse (secondary heterosexual transmission). There was a slightly increasing incidence of all heterosexual cases and secondary cases. CONCLUSIONS: Secondary heterosexual HIV transmission remains rare in Norway, and a sustainable epidemic of locally acquired infection seems unlikely in the foreseeable future. The magnitude of the heterosexual epidemic will be strongly influenced by infections acquired abroad.
Adult↗
Factors associated with heterosexual transmission of HIV to individuals without a major risk within England, Wales, and Northern Ireland: a comparison with national probability surveys.
OBJECTIVE: To compare the prevalence of HIV risk behaviours reported by heterosexuals without major risks for HIV acquisition diagnosed with HIV in England, Wales, and Northern Ireland, with those of the heterosexual general population. METHODS: Demographic and sexual behaviour data for heterosexuals (without major risks for HIV) aged 16-44 from the British National Surveys of Sexual Attitudes and Lifestyles in 1990 and 2000 were compared to 139 HIV infected individuals without major risks for HIV aged 16+ at diagnosis, interviewed between December 1987 and March 2003. Comparisons were made overall and separately for the early and late 1990s. RESULTS: HIV infected heterosexual men without major risks were significantly more likely to report first heterosexual intercourse before age 16 (adjusted odds ratio (AOR): 2.75; 95% confidence interval (CI),1.65 to 4.57), while both HIV infected heterosexual men and women reported greater partner numbers (AOR: men 2.44; CI, 1.4 to 4.05; AOR women 2.17; CI, 1.28 to 3.66) and never using condoms (AOR: men 7.97; CI,4.78 to 13.3; AOR women 3.95; CI, 2.30 to 6.80) than the heterosexual general population. There is evidence to suggest that the two groups were more similar in their reporting of partner numbers in the late 1990s relative to the early 1990s. CONCLUSION: Heterosexual HIV infected individuals without major risks for HIV acquisition in England, Wales, and Northern Ireland are significantly more likely to report high risk sexual behaviours relative to the British heterosexual general population. However, these differences may have decreased over time, at least for the number of partners. Effective sexual health promotion, including the continued promotion of condom use, would impact on the rising rates of STI diagnoses and also prevent HIV transmission among the heterosexual general population.
Adolescent↗
Trends in heterosexually acquired AIDS in the United States, 1988 through 1995.
We used national AIDS surveillance data to characterize trends in the numbers and proportions of heterosexually acquired AIDS cases diagnosed from January 1988 through December 1995 among adults and adolescents. We adjusted for expansion of the 1993 AIDS surveillance case definition and for delays in reporting, and we redistributed cases initially reported without risk. The chi-square test for linear trend was used to analyze trends at the p < 0.01 level by half-year of diagnosis and by sex, age, race or ethnicity, geographic region of residence at diagnosis, and partner's HIV exposure risk. From 1988 through 1995, heterosexual contact accounted for 10% of all AIDS cases. Heterosexual contact increased the most rapidly of all HIV exposure modes, with increases found among men and women in all age groups; among blacks, whites, and Hispanics: and among persons living in all geographic regions of the country. Blacks and Hispanics accounted for 75% of all persons reported with AIDS attributed to heterosexual contact. Although heterosexual contact with an injection drug user (IDU) accounted for most cases until 1993, cases increased most rapidly among persons reporting heterosexual contact with an HIV-infected partner whose risk was not specified. Findings suggest continued growth of the heterosexual AIDS epidemic. Because of the disproportionate and increasing number of heterosexually acquired AIDS cases among blacks and Hispanics, black and Hispanic communities at risk for HIV infection should be considered a high priority for prevention and education programs specifically targeting heterosexually active adolescents and adults. Epidemiologic and behavioral research and prevention program evaluation are urgent public health priorities to better control and prevent the further spread of HIV among heterosexually active adults and adolescents.
Acquired Immunodeficiency Syndrome↗
Redefining the growth of the heterosexual HIV/AIDS epidemic in Chicago.
UNLABELLED: A dramatic shift in the relative distribution of the five categories of heterosexual transmission for AIDS cases diagnosed in Chicago since 1991 prompted a mode-of-transmission validation study of what had become the most frequently reported heterosexual exposure: heterosexual relations with a person with AIDS (PWA) or documented HIV infection whose risk is not specified. METHODS: For 395 cases with originally reported heterosexual exposure, one or more of three supplemental data sources were employed: medical records were reviewed, medical providers were interviewed, and patients or proxies (i.e., spouse, significant other, or family member) were interviewed when possible. When reported HIV exposure could not be validated or reclassified, the transmission category employed was "no identifiable risk" (NIR). RESULTS: Eighty-five percent (336 of 395 cases) were reclassified into different transmission categories. Most notably, 69% (272 of 395 cases) were reclassified into transmission categories that did not involve heterosexual contact, including NIR. The cumulative percentage of cases attributable to heterosexual contact declined from 8% to 5% as a result of reclassification. Additionally, reclassification resulted in a reduction of nearly 50% in the number of AIDS cases attributable to heterosexual contact diagnosed in 1993 and 1994. CONCLUSIONS: In Chicago, an emerging problem in AIDS surveillance appears to be the use of an ambiguous heterosexual exposure category as a default when other information is not readily available. This study has found the growth in AIDS cases among persons exposed to HIV through heterosexual contact to be much slower than previously perceived. This finding may have important implications for the national debate over the extent to which heterosexual people are being infected and how funding and prevention strategies should be prioritized.
Acquired Immunodeficiency Syndrome↗
Prevalence of polycystic ovaries and polycystic ovary syndrome in lesbian women compared with heterosexual women.
OBJECTIVE: To determine the prevalence of polycystic ovaries (PCO) and polycystic ovarian syndrome (PCOS) in lesbian women compared with heterosexual women undergoing fertility treatment. DESIGN: A prospective observational study. SETTING: The London Women's clinic and The Hallam Medical Center. Tertiary referral fertility setup. PATIENT(S): Six hundred eighteen women undergoing ovarian stimulation with or without IUI treatment between November 2001 and January 2003. Of these, 254 were self-identified as lesbians and 364 were heterosexual women. INTERVENTION(S): Baseline pelvic ultrasound examination and blood tests conducted to measure biochemical parameters such as FSH, LH, E(2), PRL, T, androstenedione (A), sex hormone-binding globulin (SHBG), and DHEAS were performed between day 2 and 3 of each woman's menstrual cycle. Tubal patency tests were performed by hysterosalpingography or laparoscopy. MAIN OUTCOME MEASURE(S): Biochemical parameters. RESULT(S): Eighty percent of lesbian women, compared with 32% of the heterosexual women, had PCO on pelvic ultrasound examination. Thirty-eight percent of lesbian women, compared with 14% of heterosexual women, had PCOS. There were no significant differences in the androgen concentrations between lesbian and heterosexual women with normal ovaries. However, lesbian women with PCO and PCOS had significantly higher androgen concentrations compared with heterosexual women with PCO and PCOS. Tubal disease was as common in lesbian women as in heterosexual women. CONCLUSION(S): There is a significantly higher prevalence of PCO and PCOS in lesbian compared with heterosexual women. Lesbian women with either PCO or PCOS had more pronounced hyperandrogenism than did heterosexual women with either PCO or PCOS.
Adult↗
The mental health status of young adult and mid-life non-heterosexual Australian women.
OBJECTIVES: To compare the mental health status of early adult and mid-life Australian women according to sexual orientation. METHODS AND SAMPLE: Cross-sectional analyses of the Australian Longitudinal Study on Women's Health (ALSWH) surveys for the younger (22-27 years) and mid-age (50-55 years) cohorts. Women were classified into one of four groups: exclusively heterosexual, mainly heterosexual, bisexual and lesbian. Regression analyses were used to examine the effects of sexual orientation on mental health after adjusting for age, region of residence and education and to assess the potential mediating roles of stress, abuse and social support. RESULTS: Younger, mainly heterosexual, bisexual and lesbian women had poorer mental health outcomes than exclusively heterosexual women on all outcome measures except anxiety in lesbian women, even after adjustment for age, region and education. Mid-age mainly heterosexual women had poorer mental health on all outcomes except for medically diagnosed anxiety and bisexual women had significantly higher odds of self-harm than exclusively heterosexual women. All non-heterosexual women in both cohorts reported higher levels of stress and lifetime abuse. Controlling for stress, abuse and social support attenuated the mental health findings. CONCLUSIONS: The poorer mental health in young non-heterosexual women and mid-life mainly heterosexual women highlights the need for health care providers to be particularly sensitive to mental health issues in these women. Stress, social support and lifetime abuse may play a role in explaining the poorer mental health and discrimination may also be important.
Adult↗
What proportion of heterosexuals is ex-homosexual?
How many heterosexuals are 'ex-homosexuals'? In 1984, a random sample of Dallas adults indicated that 8 (2.7%) of 294 currently heterosexual men and 4 (1.0%) of 393 currently heterosexual women said that they were ex-homosexual. Of an urban sample from 5 additional cities, 0.5% of current heterosexuals reported that they had been homosexually 'married'. It thus appears that perhaps 1-2% of heterosexuals are ex-homosexuals. Proportionately more adults than teenagers and more men than women moved from homosexuality to heterosexuality. Of the 18 who changed, 12 became heterosexual and 6 bisexual, suggesting that perhaps two-thirds of those who abandon "being" homosexual 'become' heterosexual and a third 'become' bisexual. Because labeling oneself 'homosexual' is so mutable and value-laden, the term 'omnisexual' is suggested.
Adult↗
Contact tracing for gonorrhoea in homosexual and heterosexual men.
We aimed to determine whether the success of partner notification for gonorrhoea in men was affected by sexual orientation. Analysis of standard clinic and health adviser records of all male patients found to be infected with gonorrhoea between October 1992 and September 1993 were carried out. Of the 278 cases of gonorrhoea in men, 9% (25) were acquired through homosexual intercourse and 91% (253) by heterosexual contact. Fifteen per cent (24) of Caucasians were homosexual but only 0.9% (1) of Afro-Caribbeans were. The mean number of contacts was 1.36 for homosexuals and 1.38 for heterosexuals. Contact information was given by 55% of heterosexuals and 48% of homosexuals. The proportion of acknowledged contacts attending was 38% for homosexuals and 56% for heterosexuals (P = 0.054). Fifty-two per cent of homosexuals and 59% of heterosexuals had at least one contact attend. Data analysis on Caucasians only showed Caucasian gay men had a higher mean number of contacts (1.38) than Caucasian heterosexuals (1.28). Caucasian homosexuals had a lower proportion of contacts attending (40% vs. 77%) (P = 0.05), 54% of homosexual men and 60% of heterosexual men had at least one contact attending (P = 0.74). There is a trend for partner notification to be less successful in homosexual men when all ethnic groups are considered together. In Caucasian men with gonorrhoea, homosexuals have a greater number of partners than heterosexuals and have a lower proportion of total contacts attending but there is no difference in the proportion having at least one contact attending. Data on sexual orientation and ethnicity should be reported in studies assessing efficacy of contact tracing.
Contact Tracing↗
Assessing and modeling heterosexual spread of the human immunodeficiency virus in the United States.
Epidemiologic investigation of the AIDS epidemic among heterosexuals has consisted chiefly of studies of partners of individuals infected with the human immunodeficiency virus (HIV) and population surveillance. Heterosexual partners of infected individuals appear to be at high risk of infection, but only a small proportion of cases of AIDS have been attributed to heterosexual contact in the United States and Europe. An epidemic model for heterosexual spread of HIV infection is developed and fit to surveillance data. Fitted values are restricted to a range consistent with findings from partner studies. Because, at present, most HIV-infected heterosexuals and bisexuals have been infected through other means (intravenous drug use or homosexual contact), the model considers two interacting populations: a small population of individuals rapidly infected by high-risk activity and a large population of individuals at risk only from heterosexual contact. No precise predictions concerning the AIDS epidemic among heterosexuals are possible now, but current epidemiologic findings neither predict nor preclude a major heterosexual epidemic. Projections depend strongly on the delay between infection and infectivity. The model can also be used to demonstrate how interpretation of results of case-control studies of HIV infection depends on underlying assumptions about the dynamics of the epidemic.
Acquired Immunodeficiency Syndrome↗
Erectile and ejaculatory problems in gay and heterosexual men.
The prevalence of erectile difficulties (ED) and problems with rapid ejaculation (RE) were studied in a convenience sample of gay men (n = 1379) and an age-matched sample of heterosexual men (n = 1558). ED was reported more frequently by gay men and RE more frequently by heterosexual men. The heterosexual men were more likely to be in exclusive relationships and those in a current relationship (exclusive or non-exclusive) were more likely to report ED than those not in a relationship. Heterosexual men in an exclusive relationship were more likely to report RE than the rest. These associations were not found in the gay sample. The following personality traits were assessed as possible predictors of ED and RE: sexual inhibition proneness (SIS1 and SIS2), sexual excitation proneness, impact of mood on sexuality, and trait measures of depression and anxiety. Age and SIS1 (inhibition due to threat of performance failure) were strong predictors of ED in both gay and heterosexual men. Gay men scored higher on SIS1 whether or not they reported ED, consistent with greater concerns about performance failure in gay men. Anxiety was predictive of RE, but only in the heterosexual men. If replicated in other samples, these differences may reflect a greater importance of erectile function in the sexual lives of gay men and greater importance of ejaculatory control in heterosexual relationships.
Adult↗
Mate retention behavior of men and women in heterosexual and homosexual relationships.
Comparing the behavior of heterosexual and homosexual persons can provide insight into the origins of heterosexual sex differences in psychology. Evidence indicates that, aside from sexual partner preference, the mating psychology of homosexual men is sex-typical whereas that of homosexual women tends to be more sex-atypical. The current study examined one aspect of mating psychology, mate retention behavior, and tested whether homosexual men and women were sex-typical or sex-atypical for those mate retention tactics where heterosexual men and women differed. Men and women in heterosexual and homosexual relationships were asked to provide information regarding their partners' mate retention behavior by using the Mate Retention Inventory Questionnaire. Heterosexual men and women differed significantly for six of the 19 mate retention tactics considered. With respect to the six mate retention tactics where heterosexual sex differences existed, homosexual men behaved in a sex-typical manner for five of the tactics, whereas homosexual women behaved in a sex-atypical manner for all six tactics. We discuss the significance of these findings for explaining the origins of the mate retention behavior of heterosexual men and women. In addition, we consider what the pattern of sex-typical and sex-atypical mating psychology among homosexual men and women, respectively, suggests in regard to sex differences in the development of mating psychology and the development of homosexual persons.
Adolescent↗
Do homosexual persons use health care services more frequently than heterosexual persons: findings from a Dutch population survey.
Use of health care services has been suggested to be lower among homo- or bisexual persons than among heterosexual persons, due to a lack of trust in the health care system. However, population-based studies on differences in health care utilization according to sexual orientation are scarce. The purpose of the current study was to explore differences in health care utilization and confidence in health care between heterosexual, bisexual and homosexual persons. A survey of a random sample of patients of Dutch general practices (n = 9684) gathered data on socio-demographic variables, sexual orientation, health status, confidence in health care and health care utilization. Differences in health care utilization between homo- or bisexual persons and heterosexual persons were analyzed with logistic regression analysis, in which we statistically adjusted for socio-demographics and health status. Reported health was lower among homosexual men and women as compared to heterosexual persons. There were no sexual orientation-related differences in confidence in health care. Controlling for health status, it appeared that gay men more frequently used mental and somatic health care than heterosexual men, and that lesbian or bisexual women more frequently used mental health care than heterosexual women. We found a higher rate of health care use among homosexual and bisexual persons as compared to heterosexual persons, that could only be partly explained by differences in health status. To gain a better understanding of our findings, data on the predisposition to use health services among homosexual and bisexual men and women is needed.
Adult↗
Body-image dissatisfaction in gay versus heterosexual men: is there really a difference?
BACKGROUND: Gay men are thought to experience body-image concerns or disorders more frequently than heterosexual men. It is unclear, however, whether these putative concerns are due to unrealistic body ideals (aspiring to a body shape that is difficult or impossible to attain), body-image distortion (misperceiving the actual shape of one's body), or both. METHOD: We administered a well-established computerized body-image test, the "somatomorphic matrix," to 37 gay men recruited from the community in April 1999 and compared the results with previous data from 49 community-recruited heterosexual comparison men and 24 clinic-recruited heterosexual men with eating disorders. RESULTS: Gay men were indistinguishable from the community-recruited heterosexual comparison men on measures of both body ideals and body-image distortion. By contrast, eating-disordered men were significantly distinguishable from both other groups on body-image distortion. The lack of differences between community gay and heterosexual men on body-image indices seems unlikely to represent a type II error, since the somatomorphic matrix showed ample power to detect abnormalities in the eating-disordered men, despite the smaller sample size of the latter group. CONCLUSION: Contrary to our hypotheses, gay men did not differ significantly from heterosexual men on measures of body image. These unexpected findings cast doubt on the widespread belief that gay men experience greater body-image dissatisfaction than heterosexual men. If our findings are valid, it follows that some previous studies of body image in gay men may possibly have been influenced by selection bias.
Adult↗