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PubMed1996

Differences in progression to AIDS between injection drug users and homosexual men with documented dates of seroconversion.

We compared rates of progression to AIDS for 99 injection drug users and 120 homosexual men with documented dates of HIV-1 seroconversion. The crude risk of developing AIDS was higher among homosexual men than injection drug users [relative hazard (RH) = 2.4; 95% confidence interval (CI) = 1.3-4.4]. The relative hazard was slightly smaller among participants with a seroconversion interval of < or = 1 year (RH = 2.2; 95% CI = 1.0-5.2). The effect was partially explained by the inclusion of Kaposi's sarcoma in the AIDS case definition. Excluding those with Kaposi's sarcoma, the relative hazard was 2.0 (95% CI = 1.1-3.8). Using the 1993 AIDS case definition decreased the effect (RH = 1.9; 95% CI = 1.1-3.4). Finally, the high pre-AIDS mortality among injection drug users could partially explain the difference in progression rate between injection drug users and homosexual men. Combining the effect of the above-mentioned factors resulted in a relative hazard of 1.3 (95% CI = 0.7-2.6). Thus, the slower progression to AIDS among injection drug users compared with homosexual men was largely explained by differences in the spectrum of AIDS-defining illnesses, pre-AIDS mortality, and length of seroconversion interval.

Acquired Immunodeficiency Syndrome↗
PubMed2002

HIV incidence on the increase among homosexual men attending an Amsterdam sexually transmitted disease clinic: using a novel approach for detecting recent infections.

OBJECTIVE: Dramatic increases have occurred in sexually transmitted diseases (STD) and in sexual risk behaviour among homosexual men in Amsterdam and internationally. We investigated whether these trends indicate a resurgence of the HIV epidemic. METHODS: HIV incidence was determined among homosexual attendees of an STD clinic in Amsterdam, who had participated in semi-annual anonymous unlinked cross-sectional HIV prevalence studies from 1991 to 2001. Stored HIV-seropositive samples were tested with a less-sensitive HIV assay and, if non-reactive, were further tested for the presence of antiretroviral drugs, indicative of the use of highly active antiretroviral therapy. Seropositive men who tested non-reactive on the less-sensitive assay and had not used antiretroviral drugs were classified as recently infected (< 170 days). Annual HIV incidence and its changes were examined. RESULTS: Among 3090 homosexual participants (median age 34 years), 454 were HIV infected, of whom 37 were recently infectioned. From 1991 to 2001 the overall incidence was 3.0 infections/100 person-years. Incidence increased over time (P = 0.02) and, strikingly, the increase was evident in older (> or = 34 years) men (P < 0.01), but not in the young. Of men recently infected, 84% (n = 31) were unaware of their infection and 70.3% (n = 26) had a concurrent STD. These 26 men reportedly had sex with a total of 315 men in the preceding 6 months. CONCLUSION: HIV incidence is increasing among homosexual attendees of an STD clinic. It is imperative to trace recently infected individuals, because they are highly infectious, and can thus play a key role in the spread of HIV.

Adult↗
PubMed2003

The contribution of steady and casual partnerships to the incidence of HIV infection among homosexual men in Amsterdam.

OBJECTIVE: To assess the relative contribution of steady and casual partnerships to the incidence of HIV infection among homosexual men in Amsterdam, and to determine the effect of increasing sexually risky behaviours among both types of partners in the era of highly active antiretroviral therapy (HAART). METHODS: A mathematical model was developed for the spread of HIV infection among young homosexual men in Amsterdam after the introduction of HAART. The model describes the formation of both steady and casual partnerships. Behavioural parameters were estimated separately for steady and casual partners from the Amsterdam Cohort Study among young homosexual men. HIV incidence and the fraction of new infections attributed to casual contacts were calculated from the model, allowing for uncertainty in the increases in risky behaviour, the effect of HAART, and levels of HIV testing and HAART administration. RESULTS: Currently, 86% (range 74-90%) of new HIV infections occur within steady partnerships. A reduction of 75-99% in infectivity caused by HAART will be counterbalanced by increases of 50% (range 30-80%) in risky behaviour with steady partners, but not by increases of up to 100% with casual partners. If HIV testing is increased from 42 to 80% and HAART administration from 70 to 85%, then even an increase of 100% in risk-taking with steady partners will not outweigh the effect of HAART. CONCLUSION: Most new HIV infections among homosexual men in Amsterdam occur within steady relationships. Prevention measures should address risky behaviour, specifically with steady partners, and the promotion of HIV testing.

Adult↗
PubMedDate not supplied

Squamous cell carcinoma of the anus and rectum in homosexual men: CT findings.

OBJECTIVE: Homosexual men are at risk for a variety of infectious and neoplastic diseases of the anus and rectum, many of which have been reported in the radiologic literature. The purpose of this study was to describe the CT findings in homosexual men with squamous cell carcinoma of the anus and rectum, a topic that has received little attention. MATERIALS AND METHODS: Computed tomography examinations of the abdomen and pelvis of nine homosexual men with squamous cell carcinoma of the anus and rectum were reviewed retrospectively. Six HIV-positive men were 28-44 years old (average, 37 years). Three HIV-negative men were 47-61 years old (average, 54 years). RESULTS: In six of the nine patients, CT showed a mass involving the anal canal. In five of these six patients, the tumor extended caudad to involve perianal fat and skin (one patient), cephalad to involve the rectum and perirectal fat (two patients), or both (two patients). In three of the nine patients, the anal canal did not appear to be involved by the tumor; CT showed circumferential rectal wall thickening (one patient), an excavated eccentric rectal tumor (one patient), or a cystic extramucosal rectal mass (one patient). Computed tomography evidence of noncontiguous metastasis was limited to inguinal and iliac lymph node enlargement in two of the nine patients. CONCLUSION: Because CT findings are varied and nonspecific, squamous cell carcinoma should be included in the differential diagnosis of anorectal lesions in homosexual men.

Adult↗
PubMedDate not supplied

Isolation of Neisseria meningitidis from anogenital specimens from homosexual men.

By use of the fluorescent antibody technique, the authors examined 663 consecutive anogenital isolates from men that satisfied the presumptive criteria for Neisseria gonorrhoeae of the Center for Disease Control (Atlanta, Ga.). Most urethral isolates (364 of 368; 98.9%) from men presumed to be heterosexual were confirmed as N. gonorrhoeae. In contrast, urethral (98 of 114; 86%) and anal (136 of 175; 78%) isolates from homosexual men contained N. gonorrhoeae significantly less often (P less than 0.001). Most the isolates with negative results in the fluorescent antibody test for N. gonorrhoeae were shown to be Neisseria meningitidis by use of sugar fermentation reactions. Homosexual men sampled at two bathhouses for gay men were more likely to have oropharyngeal Neisseria isolated from anogenital cultures than were homosexual men screened in a clinic for gay men. Reliance on presumptive criteria for the identification of N. gonorrhoeae in anogenital cultures taken from homosexual men is inappropriate.

Anal Canal↗
PubMedDate not supplied

Psychosocial factors in admitting to homosexuality in sexually transmitted disease clinics.

This study investigated the factors that predict nonadmission of homosexual orientation in public and private clinics for sexually transmitted diseases in Sweden, Finland, Ireland, and Australia. Results from 604 respondents indicate that nonadmitters in all four countries are likely to conceal their orientation from most people, to expect the most negative reaction to their homosexuality, to believe in more conservative sex roles for males and females, to report themselves as more bisexual, to have had no previous sexually transmitted infections, and to have had worse relationships with their mother during adolescence than admitters. Men who attend private clinics are usually older, more conservative, of higher social class, and have had more negative reactions to their homosexuality from others. These data suggest that nonadmitters are most likely to be reassured by empathy and, particularly, explicit discussion of and expressed acceptance of homosexuality and bisexuality, reiteration of confidentiality. and avoidance of questions that assume the sex of partner. Thus, manipulation of the clinic environment may help to decrease the number of individuals who do not admit to sexual contacts with members of the same sex.

Adult↗
PubMedDate not supplied

Levels of cytomegalovirus seropositivity in homosexual and heterosexual men.

The prevalence of antibodies to cytomegalovirus (CMV) among 57 homosexual men (77.2%) was significantly higher than that among 155 heterosexual men (32.3%) attending a sexually transmitted disease clinic. The difference in prevalences was most pronounced in those under 30 years of age. No difference in CMV seroprevalence was observed between the heterosexual patients and a control group of blood donors. The geometric mean titer of seropositive homosexuals (1:79) was significantly higher than that of heterosexuals (1:28) in both younger and older age groups. These data suggest that homosexual men are exposed to CMV at a much earlier age than heterosexuals and that homosexuals experience frequent reactivation or reinfection with CMV.

Adolescent↗
PubMed2004

Modeling trends in HIV incidence among homosexual men in Australia 1995-2006.

BACKGROUND: Previous mathematical models have indicated that any decrease in HIV incidence in homosexual men due to decreased infectiousness from antiretroviral treatment (ARV) may be offset by modest increases in unsafe sex. The aims of this study were to assess the effects of ARV use and increasing unprotected anal intercourse with casual partners (UAIC) in homosexual men on HIV incidence during 1995-2001 and to project HIV incidence depending on trends in ARV use and UAIC. METHODS: A mathematical model of HIV transmission among homosexual men in Australia was developed. HIV incidence during 1995-2001 was estimated assuming that 70% of men in whom HIV was diagnosed received ARVs and assuming a 10% annual increase in UAIC. For 2001-2006, scenarios included ARV levels remaining at 70% or declining to 50% by 2006, combined with UAIC levels remaining at the 2001 level or continuing to increase annually by 10%. FINDINGS: The number of incident HIV cases per year was predicted to have declined during 1996-1998 due to the introduction of effective ARVs, with a slow increase during 1998-2001 due to increased levels of UAIC when use of therapies was fairly stable. From 2001, a continued increase in UAIC was predicted to lead to a rise in HIV incidence. A rise in UAIC combined with a moderate decline in ARV use could lead to a 50% increase in HIV incidence by 2006. INTERPRETATION: These models suggest that widespread ARV use has had some effect in reducing HIV incidence among homosexual men in Australia. However, if current trends in UAIC and ARV use continue, a resurgent HIV epidemic is predicted.

Anti-Retroviral Agents↗
PubMed2006

Association between 'safer sex fatigue' and rectal gonorrhea is mediated by unsafe sex with casual partners among HIV-positive homosexual men.

OBJECTIVE: The objective of this study was to investigate whether and what sexual risk behavior is a mediator of associations between rectal gonorrhea (RG) and highly active antiretroviral therapy-related beliefs, safer sex fatigue, or sexual sensation-seeking among homosexual men. STUDY DESIGN: This study consisted of a cross-sectional survey between March 2002 and December 2003 among homosexual visitors of the Amsterdam sexually transmitted disease clinic. METHODS: In total, 1568 men answered a written questionnaire. Associations were determined using logistic regression corrected for repeated measurements. RESULTS: The RG infection rate was high among homosexual men who were HIV-positive (16%) compared with those with negative or unknown HIV status. Mediation could be confirmed among HIV-positive men only. Those who experienced higher levels of safer sex fatigue were more likely to be positive for RG. This association was mediated by unprotected anal intercourse (UAI) with casual partners. CONCLUSION: Addressing safer sex fatigue might help prevent UAI with casual partners and possibly also RG among HIV-positive homosexual men.

Adult↗
PubMed2006

Genetic models of homosexuality: generating testable predictions.

Homosexuality is a common occurrence in humans and other species, yet its genetic and evolutionary basis is poorly understood. Here, we formulate and study a series of simple mathematical models for the purpose of predicting empirical patterns that can be used to determine the form of selection that leads to polymorphism of genes influencing homosexuality. Specifically, we develop theory to make contrasting predictions about the genetic characteristics of genes influencing homosexuality including: (i) chromosomal location, (ii) dominance among segregating alleles and (iii) effect sizes that distinguish between the two major models for their polymorphism: the overdominance and sexual antagonism models. We conclude that the measurement of the genetic characteristics of quantitative trait loci (QTLs) found in genomic screens for genes influencing homosexuality can be highly informative in resolving the form of natural selection maintaining their polymorphism.

Alleles↗
PubMed1984

Comparison of delayed type hypersensitivity and T subsets in random and homosexual populations in western Australia.

Random and homosexual populations were tested for delayed type hypersensitivity (DTH) (Multitest) reactivity and T cell subsets. In the random population DTH reactivity was stronger in males irrespective of age. Reactivity in the homosexuals was generally even stronger especially with respect to tuberculin. As a group, male homosexuals had low OKT 4/8 ratios when compared with sex and age matched controls. Analysis of DTH and T cell subset results in the random group showed an association between anergy and low OKT 4/8 ratios. It is concluded that homosexuals demonstrate some alteration of cell mediated immunity and therefore may be at risk of various infections.

Adult↗
PubMed1998

Hepatitis B and C virus sexual transmission among homosexual men.

OBJECTIVE: We estimated hepatitis B virus (HBV) and hepatitis C virus (HCV) sexual transmission among homosexual men. METHODS: Two hundred twenty-eight homosexually active men attending two clinical centers and presenting no risk factors except for sexual exposure were interviewed, and a blood sample was drawn. HBV marker test was performed using enzyme-linked immunosorbent assay (ELISA) and radioimmunoassay, and HCV was tested using ELISA-2 and recombinant immunoblot assay-2. RESULTS: HBV and HCV infection prevalence rates were 34.4% and 12.7%, respectively. Using logistic regression analysis including sexual exposure and controlling for confounders, we found that anal receptive intercourse (odds ratio [OR] = 4.01; 95% confidence interval [CI] = 1.34-11.94), duration of homosexuality (OR = 3.43; 95% CI = 1.29-9.12), insertive anilingus (OR = 2.02; 95% CI = 1.06-3.87), and sexually transmitted diseases (OR = 1.87; 95% CI = 1.00-3.47) were independently associated with the risk of HBV sexual transmission. We did not find any association between sexual behavior and HCV transmission. CONCLUSIONS: Sexual behavior is a plausible explanatory factor of HBV sexual transmission among homosexual men. Further evidence is needed to elucidate the occurrence and the efficiency of HCV sexual transmission in the absence of other risk factors.

Adult↗
PubMed1999

Asymptomatic amebic colitis in a homosexual man.

We describe case of a 75-yr-old Japanese homosexual man who was diagnosed as having amebic colitis. The present case is unique in that invasive amebiasis has occurred in a homosexual man, because Entamoeba histolytica in homosexual patients is considered to be a nonpathogenic and commensal organism in western countries, and that the patient has not complained of any gastrointestinal symptoms associated with minute colonic lesion of an isolated cecal ulcer. This report indicates that the absence of gastrointestinal symptoms does not rule out invasive amebiasis. Therefore, once the ameba is identified in stool specimens, even in homosexual men, it is important to differentiate pathogenic from nonpathogenic species irrespective of whether the patient is symptomatic, and to treat the patient infected with pathogenic species. By means of this strategy, we can prevent pathogenic ameba from spreading in the community.

Aged↗
PubMed1985

A psychoendocrine study in male paranoid schizophrenics with delusional ideas of homosexual content.

The serum prolactin (PRL), luteinizing hormone (LH), testosterone (T) and estradiol (E) levels were investigated in a group of male paranoid schizophrenics with delusional ideas of homosexual content, in a group of male paranoid schizophrenics without delusional ideas of homosexual content, and in a group of healthy, male heterosexual subjects. Only male paranoid schizophrenics with delusional ideas of homosexual content had significantly lower serum PRL values and significantly higher serum E levels than those of the age-matched group of normal, male heterosexual controls; also, these patients tended to have higher (though not to a statistically significant degree) serum LH and T levels than those of normal controls. Findings of this study are discussed within the framework of the possible involvement of endocrine factors in the occurrence of delusional ideas of homosexual content in male patients with paranoid schizophrenia.

Adult↗
PubMed1993

Hepatitis C virus infection in anti-HIV positive and negative French homosexual men with chronic hepatitis: comparison of second- and third-generation anti-HCV testing.

To determine the prevalence of hepatitis C virus (HCV) infection in homosexuals with chronic hepatitis, we tested for anti-HCV antibodies 113 (47 anti-HIV positive) French non-drug-addicted homosexual men admitted for chronic viral hepatitis. Anti-HCV were detected with second- and third-generation ELISAs (ELISA2 and ELISA3) and RIBAs (RIBA2 and RIBA3). Chronic hepatitis was related to non-A, non-B infection in four, to hepatitis D virus (HDV) infection in five and to hepatitis B virus (HBV) infection in 104 patients. Anti-HCV positivity was found in 50.4% and 12.4% of the 113 patients, with ELISA2 and ELISA3, respectively. Positivity with RIBA2 and RIBA3 was found in only six of the 57 ELISA2 positive patients (all six were ELISA3 positive). The high prevalence of positivity with ELISA2 not confirmed by RIBA2 or RIBA3 suggests false-positive results. ELISA2 positive results were more frequent with frozen serum samples than with fresh serum samples (62% vs 23.5%, p = 0.0003). However, even with fresh serum, ELISA2-positive RIBA-negative results remained frequent in anti-HIV positive patients. ELISA3 seems to give more specific results. We conclude that the prevalence of HCV infection, as assessed with RIBA, was 5.3% among French homosexual men with chronic hepatitis (3.8% after exclusion of transfused patients). This low prevalence suggests that homosexual transmission of HCV is relatively uncommon.

Adult↗
PubMed2003

Adolescent homosexuality: we need to learn more about causes and consequences.

UNLABELLED: In this issue a descriptive study of various aspects of homosexual orientation among adolescents is presented. In agreement with previous American studies, the authors identify three separate domains of homosexuality: attraction, fantasy and self-identification. This knowledge is important in understanding an adolescent struggling with homosexual thoughts. CONCLUSION: The development of an homosexual identity is a process connected with serious health hazards related to both physical and mental health. Most adolescents are not given adequate support because heterosexuality is considered the norm in most cultures.

Adolescent↗
PubMed1984

Functional integrity of T, B, and natural killer cells in homosexual subjects with prodromata and in patients with AIDS.

We have examined the numbers of the total T (T11+) cells, T-helper (T4+) cells, T-suppressor (T8+) cells, NK cells (Leu7+), and the functional integrity of T, B, and NK cells in healthy male heterosexuals and compared the data to those obtained from AIDS patients and male homosexuals at risk. The absolute number of total T (T11+) and T-helper (T4+) cell populations were significantly reduced among most of the asymptomatic homosexual males and even more decreased in the AIDS patients. By contrast, the absolute numbers of T-suppressor cells (T8) remained virtually unaltered in the three study populations. The absolute numbers of circulating natural killer cells were similar in the controls and the homosexual subjects, but significantly reduced in the AIDS patients. Proliferative responses to T-cell mitogen (PHA) and T-cell dependent B-cell mitogen (PWM) were severely impaired in prodromal subjects and more so in the AIDS group. Response to PWM was unrelated to the total number of T-suppressor cells, but was associated with a significant decrease in T-helper cell number. Furthermore, all AIDS patients exhibited a significantly depressed NK-cell activity that could not be normalized by addition of alpha IFN or IL-2 and in most cases correlated with the reduced absolute number of NK (Leu7+) cells as well as T-helper cells (T4) and T4/T8 ratios. Three distinctive subgroups with normal (N-NK), significantly heightened (H-NK), and markedly lowered (L-NK) NK activity could be readily identified among the homosexual male population at risk. The N-NK and L-NK groups displayed marginal to no response to in vitro treatment with alpha IFN and interleukin-2. The NK-cell activity, however, in the H-NK group was moderately to strongly inhibited by inclusion of the two immunomodifiers.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Homosexual men in London: lymphadenopathy, immune status, and Epstein-Barr virus infection.

By November 7, 1983, 24 cases of AIDS in the United Kingdom had been reported to the Communicable Disease Surveillance Centre. At the same time an increasing number of homosexual men with unexplained lymphadenopathy syndrome (LAS) have been seen in our department. Between December 1982 and July 1983, 14 homosexual men with LAS and 11 healthy homosexual men were studied. Patients with LAS had a high number of lifetime episodes of sexually transmitted diseases, a history of recent sexual activity in the United States (9 of 14), sexual contact with British AIDS patients or other persons with LAS (7 of 14), and hypergammaglobulinemia. Low T-helper/T-suppressor ratios (less than 0.8), due mainly to a decrease in T-helper cells, were found in both groups. Lymph node biopsies showed follicular hyperplasia and hypocellular pattern. All 25 patients studied had antibodies to Epstein-Barr virus capsid antigen (anti-VCA) and 11 had antibodies to early antigen (anti-EA); 13 of 17 were excreting the virus; and two showed no Epstein-Barr-virus-specific regression. Peripheral blood immunoglobulin-producing B-cells from six patients with hypergammaglobulinemia were negative for the Epstein-Barr virus nuclear antigen (EBNA). Five lymph node biopsies showed no EBNA-positive cells. Epstein-Barr virus reactivation is common in the patients with LAS and healthy homosexual men in London, but would not seem to be the cause of the polyclonal B-cell activation or lymphadenopathy.

Adult↗