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PubMed2003

Sexually Transmitted Diseases in Men Who Have Sex with Men: A Clinical Review.

Increases in sexually transmitted diseases (STDs) among men who have sex with men (MSM) have coincided with recent increases in sexual risk behaviors across the United States and Europe. The identification of same-sex sexual risk behavior in men and the subsequent risk for certain bacterial and viral infections requires competency in taking a sexual history. Recent advances in the diagnosis and treatment of STDs have made STD management easier for physicians and patients and expanded the ability of a variety of health care professionals to participate in the management of STDs. This review focuses on recent developments in the epidemiology, pathogenesis, diagnosis, and management of common STDs in MSM.

Journal Article↗
PubMed1988

Assessment of sexual function in depressed, impotent, and healthy men: factor analysis of a Brief Sexual Function Questionnaire for men.

We report a study of sexual function in outpatient men with major depressive disorder (n = 42), compared with healthy control men (n = 37) and a clinic sample complaining of erectile dysfunction (n = 13). A principal-components factor analysis of the Brief Sexual Function Questionnaire confirmed differences in the clinical dimensions of sexual activity/performance, interest, satisfaction, and physiological competence. The four factors accounted for 72% of the variance in the analysis. Acceptable test-retest reliability, construct validity, and concurrent validity (with the Derogatis Sexual Function Inventory and a self-report behavioral log) were demonstrated. Parallel observations with findings from previous nocturnal penile tumescence studies in these same men are discussed.

Adult↗
PubMedDate not supplied

Triglycerides and blood glucose are the major coronary risk factors in elderly Swedish men. The study of men born in 1913.

In 1980 we examined 707 67-year-old men, 656 of whom had no previous myocardial infarction. During 8 years of follow-up, 70 (10.7%) of the 656 men developed a first myocardial infarction or died from coronary heart disease (CHD). The incidence of CHD increased 1.6-fold from the lowest to the highest quintile of cholesterol levels, 2.7-fold from the lowest to the highest quintile of triglyceride levels, and 2.2-fold among those with diabetes. Blood pressure, smoking habits, and two measurements of obesity (body mass index and waist circumference) were not significantly related to the incidence of CHD. In multivariate analysis, serum triglyceride levels and blood glucose concentration remained as significant risk factors for CHD. This may reflect that disturbances in glucose and triglyceride metabolism (as part of a metabolic syndrome?) are more important CHD risk factors in older than in younger men.

Aged↗
PubMed2004

Comparison of levels of large and small high-density lipoprotein cholesterol in Asian Indian men compared with Caucasian men in the Framingham Offspring Study.

Asian Indians have a higher incidence of coronary artery disease (CAD) than do other ethnic groups, despite similar standard risk factors and lipid profiles. The large subclass of high-density lipoprotein (HDL) cholesterol is predominantly associated with protection against coronary artery disease. We compared various lipoprotein concentrations and sizes in 211 healthy Asian Indian men with those in 1,684 Caucasian men from the Framingham Offspring Study as measured by nuclear magnetic resonance spectroscopy. Concentrations of HDL cholesterol were similar in the 2 groups, but concentrations of large HDL cholesterol were lower and concentrations of small HDL cholesterol were significantly higher in Asian Indian than in Caucasian men. HDL particle size was smaller in Asian Indians. Levels of low-density lipoprotein cholesterol, low-density lipoprotein particle size, and prevalence of pattern B were similar in the 2 groups.

Cholesterol, HDL↗
PubMed2004

A comparison of injection and non-injection methamphetamine-using HIV positive men who have sex with men.

There is a paucity of research on the psychosocial and behavioral characteristics of individuals who inject methamphetamine (meth). The present study compared injection and non-injection users of meth in terms of background characteristics, drug use patterns, health and social problems, sexual risk behavior, and psychosocial factors. The sample consisted of 194 HIV+Men who have Sex with Men (MSM) who were enrolled in a sexual risk reduction intervention for meth users. Men who injected meth were significantly more likely to be Caucasian, bisexual, homeless, divorced/separated, with lower educational attainment as compared to non-injectors. Injectors also reported more years of meth use, greater frequency and amount of meth use, more social and health problems, including higher prevalence of STDs and Hepatitis C, and more sexual risk behaviors. In terms of psychosocial factors, injection users of meth scored significantly higher on measures of impulsivity and experiences of rejection, and lower on a measure of emotional support. A multivariate logistic regression revealed that educational attainment and experiences of rejection were the factors that best discriminated between injection and non-injection users of meth. The unique characteristics of injection meth users are discussed in relation to the development of effective HIV prevention programs for the target population.

Adult↗
PubMed2006

Crystal methamphetamine: a source of added sexual risk for Hispanic men who have sex with men?

OBJECTIVES: To determine whether use of crystal methamphetamine increases HIV risk behaviors beyond the risk associated with use of other recreational drugs among Hispanic men who have sex with men (HMSM). DESIGN: We compared the sexual behaviors and psychosocial characteristics of non-recreational drug users (non-users), recreational drug users who did not use crystal (non-crystal drug users), and recreational drug users who used crystal (crystal users). METHODS: We recruited 294 HMSM from Internet and 272 from community venues. Eligible men completed an ACASI to assess socio-demographic factors, drug use, sexual behaviors and psychosocial factors and received 50 dollars. RESULTS: In the multivariate model, crystal users were more likely than non-crystal drug users to have lower Hispanicism, higher attachment to the gay community, and history of suicide attempts. Crystal users were not significantly different from non-crystal drug users in number of sex partners; however, differences in unprotected receptive anal sex approached significance. CONCLUSIONS: The additional risk of crystal above that of other recreational drugs needs to be disentangled from those associated with poly-drug use. Our data suggest that it may depend on how one defines risky sexual behavior and is influenced by psychological, physiologic and social factors.

Adult↗
PubMed2006

Laparoscopic radical prostatectomy in men older than 70 years of age with localized prostate cancer: comparison of morbidity, reconvalescence, and short-term clinical outcomes between younger and older men.

OBJECTIVES: To analyze the safety and efficacy of extraperitoneal laparoscopic radical prostatectomy (eL-RPE) in elderly versus younger men with localized prostate cancer. METHODS: Patients undergoing eL-RPE were retrospectively subdivided into group eL-RPE1 (72 men aged 71 yr and older) and group eL-RPE2 (132 men aged 59 yr and younger). Group eL-RPE1 was compared with a group of 70 contemporary, comparable patients aged 71 yr and older undergoing open retropubic radical prostatectomy (group OPEN-RPE). RESULTS: Compared with group eL-RPE2, patients of group eL-RPE1 had a higher pathologic stage (45% vs. 32% stage pT3 or greater, p<0.001) and higher Gleason score (median 7 vs. 6, p<0.001). Prostate-specific antigen recurrence was significantly worse compared with age-matched controls for younger patients with high-stage or high-grade lesions (p<0.001). Importantly operative time, analgesic requirements, hospital stay, convalescence, and complication rates were comparable. Urinary continence rate was significantly better in group eL-RPE2 at 6 mo (67% vs. 91%, respectively, p<0.001). Group eL-RPE1 and group OPEN-RPE patients had statistically similar pathologic stage and Gleason score (each p>0.05), similar operative time (p=0.12), but less blood loss (p<0.001), shorter hospital stay (p<0.001), and more rapid convalescence (p<0.001) occurred in eL-RPE1. CONCLUSIONS: eL-RPE is feasible and efficacious even in elderly patients with unfavorable, large-volume disease. eL-RPE offers the advantages of decreased blood loss, shorter hospital stay, and more rapid recovery over OPEN-RPE. However, the elderly patient must be informed preoperatively about the observed higher incontinence rate.

Age Factors↗
PubMed2005

The impact of the transmission dynamics of the HIV/AIDS epidemic on sexual behaviour: a new hypothesis to explain recent increases in risk taking-behaviour among men who have sex with men.

Increases in sexually transmitted infections and related high-risk behaviours have been reported among men who have sex with men (MSM) in industrialised countries when effective antiretroviral therapy against HIV infection has become widely available, in the mid-nineties. The reasons for these increases are not fully understood and often conflicting. Prevention fatigue, relapses to unsafe sex, as well as optimism toward the risk of developing AIDS among people living with HIV are not unique to the era of antiretroviral therapy (ART). This has led researchers to highlight the need to investigate other potential reasons that could explain the increase in high-risk taking following the ART introduction. We put forward the hypothesis that the change in the transmission dynamics of the HIV/AIDS epidemic before and after the introduction of ART has contributed to this change in high-risk behaviour. It is suggested that a decline in sexual risk activities has occurred at the population-level following the initial spread of the HIV/AIDS epidemic because AIDS mortality and severe morbidity disproportionately depleted the pool of high-risk taking individuals. As a result, non-volitional changes may have occurred at the individual-level over time because the depletion of this pool of high-risk individuals made it more difficult for the remaining high-risk taking individuals to find partners to engage in risky sex with. Following its introduction, ART has facilitated the differential replenishment of the pool of individuals willing to engage in high-risk taking behaviours because ART reduces AIDS mortality, and morbidity. Consequently, high-risk taking individuals who had previously reduced their level of risky sex non-volitionally (i.e., as a result of the reduced availability of high-risk partners) were able to resume their initial high-risk practices as the pool of high-risk taking individuals replenished over time. Thus, a fraction of the recently reported increase in high-risk sexual activities may be secondary to the fact that those MSM who were unable to engage in their desired high-risky sexual activities (because of reduced availability) are now able to revert to them as the availability of men willing to engage in risky sexual behaviours increases partly due to ART. Therefore, we suggest that a fraction of the changes in individual behaviour are non-volitional and can be explained by a change in "sexual partner availability" due to the transmission dynamics of HIV/AIDS before and after ART. The hypothesis is formulated and explained using simple social network diagrams and the Theory of Planned Behaviour. We also discuss the implication of this hypothesis for HIV prevention.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Comorbidity and survival in HIV-infected men in the San Francisco Men's Health Survey.

The course of disease associated with infection with the human immunodeficiency virus varies widely. Some patients deteriorate rapidly, while others live for years, even after an illness that defines the acquired immunodeficiency syndrome (AIDS). In this study, comorbidity, or the presence of concurrent health problems, was investigated prospectively as a possible co-factor for different rates of decline in 395 homosexual/bisexual men in the San Francisco Men's Health Study (SFMHS) who were infected with the human immunodeficiency virus (HIV). Comorbidity data obtained from baseline interviews included both chronic and infectious diseases as well as depression. Smoking, alcohol, and drug use were also examined. The most prevalent comorbid conditions were sexually transmitted diseases (90%) and hepatitis B infection (76%). Most chronic and acute concurrent health conditions were not significant discrete predictors of survival to AIDS or death after controlling for immune status and markers of disease progression. Significantly, other risk factors (e.g., depression and smoking) were found to be associated with more rapid progression. Men with symptoms of depression had a higher risk of progression of AIDS diagnosis; the relative hazard (RH) was 1.4 (95% confidence interval [CI], 1.00-2.08); smoking was associated with higher risk of death (RH, 1.6; 95% CI, 1.20-2.17). Older age was marginally associated with poorer survival to death. No associations were found between survival and alcohol and drug use.

Adult↗
PubMedDate not supplied

Childhood sexual abuse in men who have sex with men: the current state of the science.

The experience of childhood sexual abuse (CSA) among men, particularly men who have sex with men (MSM), is poorly understood. Consequently, the long-term psychological and behavioral consequences of this phenomenon are unclear. This article provides a critique and synthesis of the existing literature on childhood sexual abuse in MSM. After an examination of prevalence estimates reported in the literature, the mental health and substance abuse behaviors in MSM that were the victims of CSA will be examined. In addition, the relationship between CSA and sexual identity development and HIV risk behaviors is critically evaluated. Finally, implications for nursing practice are explored.

Adult↗
PubMed2001

Negotiating risks in context: a perspective on unprotected anal intercourse and barebacking among men who have sex with men--where do we go from here?

Recently, an alarming trend toward unprotected anal intercourse has emerged in men who have sex with men. A highly dangerous form of unprotected anal intercourse, barebacking--the deliberate and conscious choice to engage in anal sex without condoms knowing that there are risks involved--has received much attention in the gay press. This trend poses new challenges for HIV prevention. As the target population changes, prevention interventions must also evolve to remain effective. A review of the scientific literature on risk behaviors and the popular literature and websites devoted to barebacking suggests that many contextual factors influence the decision to engage in unprotected anal intercourse. This review examines the most salient contextual factors affecting risk behavior in gay/bisexual men. It also identifies four main cohorts and predominant contextual factors that appear to motivate unprotected anal intercourse in each. In answering the question "where do we go from here," we conclude that contextual issues must be addressed in hybrid prevention interventions that include harm reduction, motivational interviewing, and traditional approaches.

Anal Canal↗
PubMed2002

A study of the STD/AIDS related attitudes and behaviors of men who have sex with men in Hong Kong.

A random population based study was carried out to understand HIV-related attitudes and behaviors and self-reported sexually transmitted diseases (STDs) among men who have had sex with men (MSM) in Hong Kong. A special computerized telephone survey method was used and 85 MSM were identified (from a total sample of 2,074 men), 47.1% of whom had at least one male sex partner in the past 6 months. Among these 85 MSM, 29.4% had multiple partners and 37.5% had had anal sex in the last 6 months (67% of them were inconsistent condom users). MSM were more likely to have contracted at least one STD in the last 6 months (10.6%) and were less likely to perceive susceptibility for contracting HIV (62.4%) than those other respondents who visited a female sex worker (FSW) in the past 6 months (4.3% and 43%, respectively). About 45% of the MSM did not perceive condom use to be efficacious for HIV prevention (vs. 30% for male clients of FSW). The study is limited by its small number; however, it suggests that MSM in Hong Kong may be at high risk of contracting HIV. Prevention programs should attempt to change attitudes (e.g., perceived efficacy of condom use, perceived susceptibility, awareness of risk involved, etc.) as well as behaviors. The feasibility for establishing a behavioral surveillance system for this population was demonstrated.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Virtual and physical venues as contexts for HIV risk among rural men who have sex with men.

Rural men who have sex with men (MSM) have few identifiable venues in which to congregate and meet potential sex partners. The Internet provides a venue for rural MSM to meet, and this is potentially troubling because studies of urban MSM suggest that HIV risk is higher for men who date online. The goals of this study were to identify venues where rural MSM meet their sexual partners and to examine their association with high-risk sexual practices. Six hundred sixty-three predominantly single, gay, Caucasian MSM completed an online survey of their sexual activities. Results showed that the Internet and bars were the most popular venues for meeting sex partners. Highest rates of risk behaviors were associated with Internet dating and venues in which immediate sexual encounters typically occur, suggesting that prevention in rural areas should target multiple-risk environments.

Adolescent↗
PubMed2006

Japanese men have larger areas of visceral adipose tissue than Caucasian men in the same levels of waist circumference in a population-based study.

Visceral adipose tissue (VAT) is an independent risk factor for metabolic and cardiovascular disorders. There has been no study that demonstrated different abdominal fat distribution between Asian and Caucasian men. As the Japanese are less obese but more susceptible to metabolic disorders than Caucasians, they may have larger VAT than Caucasians at similar levels of obesity. We compared the abdominal fat distribution of the Japanese (n=239) and Caucasian-American (n=177) men aged 40-49 years in groups stratified by waist circumference in a population-based sample. We obtained computed tomography images and determined areas of VAT and subcutaneous adipose tissue (SAT). We calculated VAT to SAT ratio (VSR). The Japanese men had a larger VAT and VSR in each stratum, despite substantially less obesity overall. In multiethnic studies, difference in abdominal fat distribution should be considered in exploring factors related to obesity.

Adult↗
PubMed1999

The prostate, men and men's health.

Benign prostatic hyperplasia (BPH) is the most prevalent disease in the ageing male and the incidence of symptomatic disease is likely to increase in the millenium with increased life expectancy. BPH can have a severe impact on quality of life, including sexual function, and yet many men do not seek medical attention for this and many other diseases. Surgery is no longer a mandatory treatment for BPH. Medical management can provide excellent symptom relief and improvement in urinary flow rates, as well as quality of life, and men need to be made aware of this in order to make informed treatment decisions. In the broader context, men should be encouraged to become more health conscious and develop a more positive attitude towards their health.

Journal Article↗
PubMed2002

Indwelling catheter treatment and health-related quality of life in men with prostate cancer in comparison with men with benign prostatic hyperplasia.

Experiences from indwelling urinary catheter treatment periods were studied. Little is known of what is felt from a male perspective although catheter treatment is a common pre- and postoperative measure for men with prostate cancer and benign prostatic hyperplasia (BPH). Also studied were health-related quality of life (HRQOL) and sense of coherence (SOC). Men with catheter experience (prostate cancer n = 71, BPH n = 37) were selected from a larger questionnaire study. Assessment was made with study-specific questions together with the QLQ C-30 assessing HRQOL and the SOC questionnaire measuring sense of coherence. Data reduction method was applied to study specific variables to determine problem patterns. Correlation between HRQOL and SOC was determined. Results showed similar problem patterns in men with prostate cancer and BPH: discomfort in wearing catheter (e.g. uneasiness 48.2%), practical and psychosocial difficulties in handling and wearing catheter (e.g. attaching catheter 32.4%) and discomfort at installation (e.g. pain 29.7%). There was lack of knowledge about wearing and practical handling of the catheter. Having a cancer diagnosis did not add to uneasiness or practical problems. Life quality was correlated to SOC (p <or= 0.001).

Aged↗
PubMed2004

Testing men who have sex with men for Neisseria gonorrhoeae and Chlamydia trachomatis prior to the introduction of guidelines at an STD clinic in Melbourne.

BACKGROUND: Guidelines for testing men who have sex with men (MSM) were published in 2002. They did not recommend asymptomatic screening for urethral gonorrhoea or pharyngeal screening for chlamydia. To determine if these guidelines were appropriate, we audited gonorrhoea and chlamydia testing of MSM at our Centre. METHODS: We carried out two audits at our Centre between August 2001 and July 2002. The first was an audit of testing MSM for gonorrhoea and/or chlamydia over 12 days. The second was an audit of all positive tests over this 12-month period for gonorrhoea or chlamydia among MSM. RESULTS: During the 12 selected days 89 of 286 men tested (31%) were MSM. Among the MSM testing positive for gonorrhoea and/or chlamydia infection (15, 17%), symptomatic urethral infection was the most common (n = 8). No rectal and pharyngeal infections had site-specific symptoms. Based on the guidelines, 100 of the 334 tests ordered (30%) were not recommended according to the guidelines, and none of these 100 tests yielded a positive result. Over the 12-month audit period, 135 MSM were diagnosed with gonorrhoea and/or chlamydia. For gonorrhoea, site specific symptoms were present in 42 of 43 cases of urethral infection (98%), six of 23 cases of rectal infection (26%), and no cases of pharyngeal infection had symptoms. For chlamydia, site-specific symptoms were present in 29 of 48 cases of urethral infection (60%), six of 33 cases of rectal infection (18%), and in one of the two cases of pharyngeal chlamydia identified. A substantial proportion of cases occurred in clients with HIV infection (21, 16%). CONCLUSIONS: These findings strongly support screening among MSM and in particular not testing asymptomatic MSM for urethral gonorrhoea or any MSM for pharyngeal chlamydia.

Adult↗
PubMed2002

Childhood sexual experiences and the perception of abuse among Latino men who have sex with men.

There is a lack of consensus on how to define childhood sexual abuse (CSA). In this study we explore the perceptions of CSA among men who had such experiences. One hundred Latino men (predominately gay) who had childhood sexual experiences with an older partner (CSEOP) were asked whether they considered their experiences sexual abuse (41 said no; 59 said yes). Those who felt abused were younger when the events happened and were more likely to have been physically forced, physically hurt, threatened, and emotionally hurt. Negative correlates of CSEOP in adulthood were also explored. Men who considered themselves the victims of CSA differed from those without CSEOP in having more alcohol use, unprotected anal sex, and male sex partners.

Adolescent↗