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Life-long endurance-trained elderly men have high aerobic power, but have similar muscle strength to non-active elderly men.

The knee extensor and plantar flexor muscle groups of elderly men (age 70-100 years, N = 15), who since adolescence had maintained an extremely high level of endurance-based physical activity (maximal oxygen uptake 41.9 +/- 4.8 mL.kg-1min-1 in subjects < 80 years, (N = 8) and 27.1 +/- 5.4 mL.kg-1min-1 in those > 80 years, N = 5), were compared in terms of maximum voluntary isometric strength and twitch contractile properties with the muscles of elderly men of a similar age who did not undertake any regular physical exercise (68-92 years, N = 18) and of young control subjects who were recreationally active (21-36 years, N = 17). No difference was observed in the maximum voluntary strength of the knee extensors (338 +/- 130 N vs 341 +/- 137 N) or plantar flexor muscle groups (106 +/- 24 Nm vs 115 +/- 46 Nm) between the endurance-trained and elderly control subjects. This was still the case when the subjects were divided into those above and below 80 years of age, or when the data were expressed relative to body weight. Both groups of elderly subjects were markedly weaker than the young control subjects. In the plantar flexors, twitch time to peak tension (TPT) was significantly (p < 0.05) prolonged in both groups of elderly subjects vs the young control subjects. In the knee extensors, however, TPT was only prolonged in the endurance-trained athletes. Half relaxation time was prolonged in the knee extensors of both groups of elderly subjects, but only prolonged in the plantar flexors of the control subjects. The data raise the question of specificity of muscle usage, and its effect on skeletal muscle function, and suggest that endurance-based physical exercise may be of little value in maintaining muscle strength and speed of contraction in old age.

Adolescent↗

The determinants of bone mineral density in Chinese men--results from Mr. Os (Hong Kong), the first cohort study on osteoporosis in Asian men.

Mr. Os (Hong Kong) is the first study to address the risk factors for osteoporosis in Asian men. A standardized, structured interview and dual X-ray densitometry (DEXA) were performed on 2,000 Chinese men aged 65-92. By multiple regression, the following factors were found to be positively associated with BMD at both the total hip and the spine: body weight, grip strength and a history of diabetes mellitus. The following factors were found to be negatively associated with BMD at both the total hip and spine: cigarette smoking, a history of gastrectomy or bowel resection, current use of inhaled steroid and a history of fracture after 50 years. Moreover, a history of chronic obstructive pulmonary disease (COPD) was negatively associated with BMD at the total hip, and age, the use of an alpha-blocker, thiazide diuretic and nitrate were associated with a higher BMD at the spine. A total of 21.8% of the variance in total hip and 31.5% of the variance in total spine BMD was accounted for in the multivariate analysis.

Absorptiometry, Photon↗

Responses of old men to repeated bouts of eccentric exercise of the elbow flexors in comparison with young men.

A bout of eccentric exercise confers protection against subsequent bouts of the same exercise. This study investigated whether the protective effect would be produced similarly between old and young adults. Eight old men (70.5 +/- 4.1 years) and ten young men (20.4 +/- 2.0 years) performed two bouts of eccentric exercise of the elbow flexors (six sets of five eccentric actions) separated by 4 weeks. Changes in maximal isometric strength, range of motion (ROM), upper arm circumference (CIR), plasma creatine kinase (CK) activity, myoglobin (Mb) concentration, and muscle soreness (SOR) before, immediately after, and 1, 24, 48, 72 and 96 h following exercise were compared between bouts, and between groups by a two-way repeated measures ANOVA. Changes in the measures following the first bout were significantly (P < 0.05) smaller for the old than the young group. The young group showed significantly (P < 0.05) smaller changes in all measures following the second bout than the first bout; however, the old group had the protective effect only for ROM, Mb, and SOR. The magnitude of the effect observed for ROM and Mb concentration in the old group was significantly (P < 0.05) smaller compared with that of the young group. These results suggest that the protective effect conferred by the first bout was less for the old than the young group. This may be due to the less muscle damage after the first bout in the old subjects, but it is also possible that the protective effect of old adults does not last as long as that of young adults.

Adolescent↗

Psychosocial, behavioral, and cultural predictors of sexual risk for HIV infection among Latino men who have sex with men.

This study sought to replicate and extend an investigation by Diaz et al. (1999) on determinants of HIV risk among Latino gay and bisexual men living in San Francisco who were predominantly English-speaking. Compared to the Diaz et al. study, the current study sample consisted of predominantly Spanish-speaking MSM, who resided outside of HIV/AIDS epicenters and whose countries of origin were primarily Central & South American. The relationships of unprotected anal sex and multiple sexual partners with demographic, developmental, behavioral, cultural and psychosocial variables were examined. Data were collected in a convenience sample of 250 participants (primarily immigrants from El Salvador) residing in Virginia. Most men in the sample had more than one sexual partner in the last 3 months (62%) and more than a third had unprotected anal sex with a casual partner in the same time period. Communication about HIV, sexual attraction, machismo, and experiences of discrimination based on homosexual behavior were predictive of HIV risk behaviors. The findings support an integrative approach to investigating HIV risk among Latino MSM. Implications for prevention programs are discussed.

Adult↗

Alcohol and sexual HIV risk behavior among problem drinking men who have sex with men: An event level analysis of timeline followback data.

While heavy drinking among men who have sex with men (MSM) has been shown to be associated with an increase in sexual risk taking, a temporal relationship between drinking and an increase in subsequent HIV risk behaviors among adult samples has been less obvious. This study used an event level analysis to examine this relationship among HIV negative problem drinking MSM. Within subjects analyses show a higher probability of unprotected anal intercourse after drinking. Post-hoc analyses of within subjects data indicate that drinking increases risk taking when engaging in receptive anal intercourse but not for insertive anal intercourse. Findings from this study support evidence that drinking is a factor that increases risk taking among HIV negative problem drinking MSM, particularly for receptive anal intercourse.

Adult↗

Reasons for not taking an HIV-test among untested men who have sex with men: an Internet study.

The present paper focuses on reasons for not taking an HIV-test among untested men who have sex with men (MSM). From an MSM web-based survey, 1627 MSM who had never tested for HIV were selected for the reported analyses. Results show that fear of a positive test result and the perceived consequences thereof, are reported as the most important reasons for not taking an HIV-test among at-risk respondents. The most important reasons for not taking an HIV-test among no-risk respondents are related to perception of low risk for HIV-infection. Implications for future interventions to promote HIV-testing are discussed.

Adolescent↗

Self-identification as "down low" among men who have sex with men (MSM) from 12 US cities.

Men who have sex with men (MSM) who are on the "down low" (DL) have been the subject of considerable media attention, but few data on this population exist. This exploratory study (N=455) compared MSM who considered themselves to be on the DL with MSM who did not (non-DL MSM). 20% self-identified as DL. Blacks and Hispanics were more likely than Whites to self identify as DL. MSM who did not identify as gay were more likely than gay-identified MSM to describe themselves as DL. DL-identified MSM were less likely to have had seven or more male partners in the prior 30 days, but were more likely to have had a female sex partner and to have had unprotected vaginal sex. DL-identified MSM were less likely to have ever been tested for HIV than were non-DL MSM. Prevention agencies should expand existing programs for MSM to include specific efforts to reach DL MSM.

AIDS Serodiagnosis↗

Prevalence of treatment optimism-related risk behavior and associated factors among men who have sex with men in 11 states, 2000-2001.

Sustainable behavior change among men who have sex with men (MSM) may be threatened by optimistic beliefs about HIV treatments: treatment optimism has been associated with high risk sexual behaviors. We used data from behavioral surveys of MSM attending gay bars in 11 states from 2000-2001 to describe the prevalence and correlates of being less careful with sex or drugs because of treatment optimism (optimism-related risk behavior). Fifteen percent of 1477 HIV-negative or -untested MSM reported optimism-related risk behavior. Optimism-related risk behavior was reported more often by Black and Hispanic MSM (versus white), more often by MSM with a high school education or less (versus college), and less often by MSM in some states. HIV prevention programs should address treatment optimism and related behavioral risks by providing culturally appropriate information, accessible to MSM with lower educational attainment, about the limitations of current therapies.

AIDS Serodiagnosis↗

Inconsistent condom use with steady and casual partners and associated factors among sexually-active men who have sex with men in Bangkok, Thailand.

HIV/STD risk behavior has not been examined in community samples of men who have sex with men (MSM) in Thailand. The sexually-active sample (n=927) was recruited from bars, saunas, and parks; 20% identified as bisexual and 17% tested HIV-positive. Inconsistent (<100%) condom use was reported by 45% of those with steady partners and 21% of those with casual partners in the prior three months. 21% had heard of effective HIV treatments (n=194), among whom 44% believed HIV was less serious and 36% said their risk behavior had increased after hearing about the treatments. In multivariate analysis, HIV-positive status, gay-identification, getting most HIV information from the radio, believing HIV can be transmitted by mosquito bite, and concern about acquiring an STD were associated with inconsistent condom use during anal sex; slightly older age (25-29 vs. 18-24 years) was associated with more consistent condom use. HIV/STD risk-reduction strategies for MSM in Bangkok should clearly state sexual risk to individuals in this population.

Adolescent↗

Experiences of social discrimination among men who have sex with men in Shanghai, China.

In China, men who have sex with men (MSM) are at increasingly high risk for HIV. However, prevention efforts targeting this population may be hindered because of the stigma associated with homosexuality in traditional Chinese culture. We conducted qualitative interviews with 30 MSM in Shanghai to better understand the types and sources of stigma and discrimination and how MSM respond to them. The stigma associated with homosexuality can be traced back to four culturally based factors: social status and relationships, the value of family, perceptions of immorality and abnormality, and gender stereotypes of masculinity. In particular, the centrality of the family and the importance of maintaining key relationships caused stress and anxiety, contributing to more frequent encounters with felt stigma. In response, MSM often evaded the scrutiny of family members through various tactics, even prompting some to leave their rural homes. Implications of these findings on HIV/AIDS prevention are discussed.

Adult↗

Sexual risk behavior of HIV-positive methamphetamine-using men who have sex with men: the role of partner serostatus and partner type.

This study examined the role of partner serostatus and partner type in relation to the sexual risk behaviors and disclosure practices of HIV-positive methamphetamine (meth)-using men who have sex with men (MSM). The sample consisted of 132 HIV-positive meth-using MSM who reported having both serodiscordant (i.e., HIV-negative and unknown serostatus) and seroconcordant (i.e., HIV-positive) partners. HIV-positive meth-using MSM engaged in significantly fewer acts of anal sex with serodiscordant partners as compared to seroconcordant partners. However, mean levels of unprotected anal and oral sex were high, and mean levels of protected sex were low for both seroconcordant and serodiscordant partners. Oral sex was practiced twice as often as anal sex; however, both types of sex were primarily unprotected. This pattern of risky sexual behavior was reported for steady, casual, and anonymous partners, regardless of partner serostatus. Despite high rates of unprotected sex, rates of HIV serostatus disclosure were consistently high for HIV-positive and HIV-negative steady, casual, and anonymous partners. However, rates of disclosure to unknown serostatus partners were low, particularly in relation to anonymous partners. Future research should address the reasons why HIV-positive meth-using MSM engage in risky sexual activity with serodiscordant partners, and HIV prevention programs for this population should emphasize the risks associated with unprotected sex with seroconcordant partners.

Adult↗

Prevalence and correlates of substance use among young Asian Pacific Islander men who have sex with men.

We examined patterns of substance use among young Asian Pacific Islander (API) men who have sex with men (MSM). Participants (N = 496) were recruited from sampled venues and were interviewed on substance use, sexual behaviors, and attendance at MSM social venues. Substance use prevalence was highest for alcohol (94% lifetime, 89% past 6 months), marijuana (61% lifetime, 44% past 6 months), and methylenedioxymethamphetamine or ecstasy (58% lifetime, 47% past 6 months). During the past 6 months, 24% used an illicit substance weekly or more often, 51% used club drugs, and 44% used 3 or more illicit substances. Multivariate models identified common and unique correlates of frequent drug use, club drug use, and polydrug use. Associations between substance use and sexual risk behaviors also emerged. These findings suggest a need to improve substance use and HIV prevention intervention efforts for young API MSM.

Adolescent↗

Associations between methamphetamine use and HIV among men who have sex with men: a model for guiding public policy.

Among men who have sex with men (MSM) in Los Angeles County, methamphetamine use is associated with high rates of HIV prevalence and sexual risk behaviors. In four separate samples of MSM who differed in the range of their intensity of methamphetamine use, from levels of recreational use to chronic use to those for MSM seeking drug abuse treatment, the association between methamphetamine use and HIV infection increased as the intensity of use increased. The lowest HIV prevalence rate (23%) was observed among MSM contacted through street outreach who mentioned recent methamphetamine use, followed by MSM who used at least once a month for six months (42%), followed by MSM seeking intensive outpatient treatment (61%). The highest rate (86%) was observed among MSM seeking residential treatment for methamphetamine dependence. The interleaving nature of these epidemics calls for comprehensive strategies that address methamphetamine use and concomitant sexual behaviors that increase risk of HIV transmission in this group already at high risk. These and other data suggest that MSM who infrequently use methamphetamine may respond to lower intensity/lower cost prevention and early intervention programs while those who use the drug at dependence levels may benefit from high intensity treatment to achieve goals of reduced drug use and HIV-risk sexual behaviors.

Amphetamine-Related Disorders↗

Sexually Transmitted Diseases in Men Who Have Sex with Men: An Epidemiologic Review.

The introduction of highly active antiretroviral therapy (HAART) has led to dramatic reductions in morbidity and mortality due to HIV infection. However, the resulting optimism and improved health status produced by HAART appears to have contributed to unanticipated consequences in men who have sex with men (MSM): loss of fear of acquiring and transmitting HIV, an increase in high-risk sex, decreased use of condoms, and a resurgence of gonorrhea and syphilis. Other factors, such as lack of knowledge of sexually transmitted diseases (STDs), use of the Internet as a venue to find sex partners, the increasing use of Viagra (Pfizer, New York, NY) as a recreational drug, and the apparent expanding role of oral sex in STD transmission are fueling these trends. Since ulcerative and inflammatory STDs facilitate HIV transmission, a new wave of HIV infection in MSM may be on the horizon. The rising STD rates and relapses in high-risk sexual behaviors in MSM, both HIV-infected and -uninfected MSM, have profound implications for public health and the clinical management of these patients. Clinicians should be aware of this turn of events, and implement new screening and counseling guidelines that have been issued in response to these alarming reports.

Journal Article↗

Electrocardiographic abnormalities and mortality among middle-aged black men and white men of Evans County, Georgia.

The distribution of electrocardiographic (ECG) abnormalities and the relationship between ECG abnormalities and mortality after 20 years of follow-up were examined among 40-64-year-old black men and white men enrolled in the Evans County Heart Study. Major or minor ECG abnormalities, as defined in the Pooling Project, were present at entry for 53% of blacks (164 of 308) and 31% of whites (159 of 511). For both races, the presence of ECG abnormalities was directly related to age, blood pressure, and Quetelet's index at baseline. After adjustment for these and other risk factors, major ECG abnormalities were similarly predictive of all-cause mortality for blacks [rate ratio (RR) = 1.7 (1.1.2.8)] and whites [RR = 2.2 (1.4, 3.4)]. Associations of similar magnitude were observed in relationship to deaths from all cardiovascular diseases and deaths from coronary heart disease. These results are consistent with the hypothesis that ECG abnormalities convey risk for blacks as well as whites.

Adult↗

Obesity, adipose tissue distribution and health in men--the study of men born in 1913.

Recent studies suggest that cardiovascular disease is associated with abdominal distribution of adipose tissue rather than obesity in terms of total body fat. A number of other variables, known to be associated with obesity, were therefore examined in a cohort of randomly selected middle-aged men in relation to abdominal distribution of adipose tissue, measured as the ratio of the circumferences of the waist and hips (WHR), as well as to degree of obesity, measured as body mass index (BMI). These variables included anthropometric variables, cardiovascular risk factors as well as socioeconomic factors and physical health. Increased WHR, independent of BMI, was negatively associated with height, and hip circumference. Positive associations were found with blood pressure, cholesterol, triglycerides, fibrinogen and smoking. In addition positive associations were found with low social class and social group, illness in terms of sick leave, frequent use of health facilities such as X-rays, as well as diseases such as peptic ulcer. In sharp contrast to this, BMI, independent of WHR, was not associated with physical health variables or social class. Generalized obesity seemed to be associated with good health in the variables measured. There were positive associations to various anthropometric variables, including lean body mass. High BMI was also associated with elevated blood pressure and triglycerides. Several of the indicators of poor health traditionally associated with obesity thus do not seem to be characteristic for obesity in middle-aged men selected at random from the population but rather for an abdominal fat distribution, independent of obesity.

Abdomen↗

A comparison of alcohol and drug use patterns of homosexual and heterosexual men: the San Francisco Men's Health Study.

Very high prevalence rates for problem drinking and/or alcoholism have been estimated for homosexual male populations. Populations characterized by high prevalence rates for problematic drug or alcohol use are of special interest since study of such groups may help to provide insights regarding the processes associated with problematic substance use. However, prevalence estimates for problematic substance use within gay male populations have most typically relied on convenience samples and generally contain an over-representation of bar patrons. This study reports data from a large scale random household sample of homosexual and heterosexual men who live in an urban district of San Francisco, California. Few differences were noted in the drinking patterns of these men, although important differences were found in the prevalence of drug use over a 6-month period. Differences in the prevalence of at least weekly drug use were comparatively minor, however. Health policy implications of these findings are discussed.

Adult↗

Testicular and adrenocortical function in healthy men and in men with benign prostatic hyperplasia.

The influence of aging upon serum concentrations of testicular steroids, sex hormone binding globulin (SHBG) and pituitary hormones and on adrenal steroid levels and adrenal steroid response to ACTH was studied in 81 healthy men aged 20-87 years. These endocrine variables were also compared in 43 patients with benign prostatic hyperplasia (BPH), aged 58-89 years and in a subgroup of 41 men, aged 58-87 years, from the above mentioned reference population. The normal endocrine aging was characterized by a rise in SHBG levels, decreasing levels of testicular steroids and non-SHBG-bound testosterone (NST) and increasing gonadotropin levels and decreasing concentrations of total estrone. Adrenal androgen levels decreased in the presence of unchanged levels of cortisol and the adrenal steroid response to ACTH changed by decreasing increments in dehydroepiandrosterone (DHA) and increasing increments in 17 alpha-hydroxyprogesterone (17OHP). With the exception of the alterations in SHBG and adrenal androgens, all these changes were finished before the seventh decade of life. BPH patients had elevated levels of testosterone and NST in the presence of normal SHBG and gonadotropin levels, elevated levels of DHA and DHA sulfate (DHAS) in the presence of normal cortisol levels, a "younger" pattern of adrenal steroid response to ACTH as judged from the increments in DHA and 17OHP, elevated ratios between estrone and 4-androstene-3,17-dione suggesting an increased peripheral aromatization and subnormal prolactin levels. BPH patients may be considered as "endocrinologically younger" than healthy subjects. DHA and especially its proximate metabolite 5-androstene-3 beta, 17 beta-diol exert powerful estrogenic effects on the receptor level. Thus the elevated levels of DHA and DHAS in the BPH patients may create an hyperestrogenic condition in addition to the slight hyperandrogenicity caused by the elevated NST levels. Both endocrine aberrations may play a role in the etiology of BPH, in accordance with the dual sex steroid sensitivity of the periurethral glands.

Adrenal Cortex↗