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PubMed1991

The homosexual analyst. Clinical considerations.

Some aspects of the work of the homosexual analyst with gay and heterosexual patients are discussed. The author examines the reasons most homosexual patients prefer to work with gay therapists, why it is usually beneficial for them to do so, and the related question of the appropriateness of revealing sexual orientation to one's patients. Manifestations and elaborations of transference and countertransference when the gay analyst works with homosexual and heterosexual patients are also discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Pedophilia and heterosexuality vs. homosexuality.

In the context of a search for testable etiological theories of pedophilia, the relationship of pedophilia to partner sex preference was investigated. The proportional prevalences of gynephilia and androphilia were compared with the proportional prevalences of sexual offenders victimizing female children and of such offenders against male children. Since pedophilia either does not exist at all in women, or is extremely rare, only men were included in the study. We derived the proportional prevalence of androphilia from a review of the main pertinent studies, including Gebhard's reassessment of the study by Kinsey et al. particularly of the section on gynephilia vs. androphilia. The numbers of heterosexual vs. homosexual offenders against children were derived from the studies by Mohr et al., by Gebhard et al., and from a group of 457 sex offenders against children seen in the course of several years at the Department of Behavioural Sexology of the Clarke Institute of Psychiatry. There was a large difference between the proportion of prevalences of heterosexual vs. homosexual offenders against children on the one hand and the proportional prevalences of gynephilia vs. androphilia, on the other. This difference suggests that the development of erotically preferred partner sex and partner age are not independent of each other and that in pedophilia, the development of heterosexuality or homosexuality is brought about by factors different from those operative in the development of androphilia or gynephilia.

Adult↗
PubMed1997

Hepatitis A among homosexual men and injection drug users: more evidence for vaccination.

As agencies develop guidelines for administering the newly developed hepatitis A virus (HAV) vaccine, information is needed regarding the occurrence of HAV infection in groups putatively at risk for the infection. We tested serum samples from 300 injection drug users (IDUs), 300 homosexual males, and 300 blood donors for the presence of total antibody to HAV (anti-HAV). Anti-HAV was detected in 66% of IDUs, 32% of homosexual males, and 14% of blood donors. Anti-HAV was not significantly associated (P > .10) with high-risk drug-using behaviors but was more prevalent among IDUs with annual incomes of <$5,000 (P = .018). The occurrence of anti-HAV increased among homosexual males as the number of sexual partners increased (P < .001) but was similar to the age-adjusted prevalence (30.6%) estimated for the general United States population. IDUs are at increased risk for HAV infection; however, our data suggest that factors related to low socioeconomic status contribute more to the occurrence of HAV infection among IDUs than does injection drug use. IDUs and persons at risk for injection drug use should receive HAV vaccine.

Baltimore↗
PubMedDate not supplied

Community-acquired bacterial pneumonias in homosexual men: presumptive evidence for a defect in host resistance.

Over a three year period, we encountered seven homosexual men who developed pneumonias due to S. pneumoniae or H. influenzae in the absence of apparent risk factors. When compared to heterosexual controls, the homosexual group had a much higher frequency of bacteremia, complicated primary infections, multilobar involvement, required longer antibiotic therapy, and took longer to defervesce. Three of our seven homosexual patients fulfilled criteria for the acquired immunodeficiency syndrome (AIDS); two of the others had generalized lymphadenopathy and the other two likely AIDS-related abnormalities. Overall they presented with a spectrum of clinical findings. Two of the patients developed other opportunistic infections associated with AIDS. Since recovery from these pyogenic pneumonias requires an appropriate antibody response, our patients may have had a defect in B-cell function. Moreover, these observations suggest that functional B-cell abnormalities may occur in AIDS and syndromes premonitory of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Human T cell leukemia virus type I and Epstein-Barr virus antibodies in homosexuals and hemophilia patients from Venezuela.

The presence of serum antibodies to human T-cell leukemia/lymphoma Virus-I (HTLV-I) and to Epstein-Barr Virus (EBV) was studied in homosexuals and hemophilia patients from the State of Zulia (Venezuela), a highly endemic area for HTLV-I infection. No serum antibodies to HTLV-I were detected despite the presence of alterations in peripheral blood lymphocyte subsets. Anti-EBV antibodies in homosexuals were indicative of persistent infection with this virus. Our results suggest that HTLV-I does not play a role in the immunological alterations in homosexuals or hemophiliacs in an area of high prevalence for this virus.

Antibodies, Monoclonal↗
PubMed2000

Strong decline in herpes simplex virus antibodies over time among young homosexual men is associated with changing sexual behavior.

The objective of this study was to evaluate whether the change in sexual behavior among homosexual men observed after the start of the acquired immunodeficiency syndrome epidemic resulted in a change in herpes simplex virus (HSV) seroprevalence in this group over time. In a cross-sectional study, the prevalence of herpesvirus types 1 (HSV1) and 2 (HSV2) was determined at study entry in 1984-1985 and 1995-1997 among 532 young (aged < or = 30 years) homosexual men participating in the Amsterdam Cohort Studies on HIV/AIDS. Risk factors for the presence of HSV antibodies, including human immunodeficiency virus infection, were evaluated, and their influence on HSV prevalence over time was assessed. A strong decrease in HSV1 and HSV2 seroprevalence, from 80.6% to 59.0% and from 51.3% to 19.0%, respectively, was observed between the two time periods. This decrease was not markedly influenced by various demographic and socioeconomic factors. After data were controlled for several markers of sexual activity (such as number of sex partners, human immunodeficiency virus infection, and past episode(s) of gonorrhea), it appeared that the decline in HSV seroprevalence was explained by a concurrent decrease in the presence of these markers. The authors conclude that among young homosexual men in this study, the strong decrease in HSV seroprevalence was associated with a concurrent shift in sexual behavior. Furthermore, these data suggest an increasing sexual component in HSV1 transmission over time.

Adult↗
PubMed1993

Safer sex maintenance and reduction of unsafe sex among homosexually active men: a new therapeutic approach.

To date, publicly funded HIV/AIDS prevention efforts for homosexually active men have largely been limited to two traditional public health strategies: mass media information campaigns and HIV testing/contact notification programs. Health educators using either of these strategies have addressed the spread of HIV as they would many other infectious diseases and have relied heavily upon fear tactics or moral arguments to 'sell' the concept of safer sex. Grass-roots gay community efforts to prevent HIV transmission have also largely relied upon these two strategies, as well as upon more informal individual and group counseling activities. In general, however, strategies used by the gay community have tried to present more positive approaches to AIDS prevention, including eroticizing safer sex practices. This article reviews the efficacy of traditional public health approaches as well as the educational models underlying them, and argues that a major shift in focus is needed. A comprehensive health care and sexuality education model for homosexually active men based on the 'PLISSIST' sex therapy model is described and advocated. This model is presented as a more useful one for identifying populations at risk, reducing unsafe sexual behavior and promoting safer sex maintenance. The model identifies five sub-populations among homosexually active men and recommends specialized interventions appropriate to each. Adequate funding for the services included in this model is also advocated.

Community Networks↗
PubMed1995

An outbreak of hepatitis A among homosexual men in Amsterdam, 1991-1993.

BACKGROUND: When in August 1992 it became evident that an outbreak of hepatitis A virus infections (HAV) was taking place in the male homosexual community in Amsterdam a case-control study was conducted to validate the assumption that the outbreak was associated with sexual practices involving oro-anal and digital-anal contact and frequent visits to gay saunas and darkrooms. METHODS: In all, 37 cases reported to the Amsterdam Municipal Health Service (AMHS) in the period December 1991 to March 1993 and 68 anti-HAV negative controls completed an anonymous questionnaire concerning the practice of different sexual techniques and the number of visits to gay saunas and darkrooms in the 2 months preceding the onset of illness or date of interview. Controls were recruited from healthy homosexual men participating in a prospective study on HIV/AIDS conducted by the AMHS. RESULTS: In univariate analysis a statistically significant association was found between visits to gay saunas and darkrooms, the number of visits to these locations (OR = 8.2) and HAV infection. In the logistic regression analysis the association for visits to saunas and darkrooms remained significant (OR = 10) whereas high-risk sexual techniques could not be included in the model. CONCLUSIONS: These results indicate that to prevent future outbreaks of HAV in male homosexuals in Amsterdam there is a need to stress in the 'safe sex' campaigns, directed at the prevention of HIV infection or in additional campaigns, the prevention of other sexually transmitted disease including HAV infection with emphasis on routes associated with certain sexual techniques and on visits to gay saunas and darkrooms.

Analysis of Variance↗
PubMed1982

Acid-labile human leukocyte interferon in homosexual men with Kaposi's sarcoma and lymphadenopathy.

Some immunologic parameters in homosexual patients with Kaposi's sarcoma (KS) or unexplained lymphadenopathy resemble findings in patients with autoimmune diseases such as systemic lupus erythematosus (SLE). Many patients with SLE have an unusual acid-labile form of human leukocyte interferon (HuIFN-alpha) in their serum. Sera from 91 homosexual men were tested for the presence of HuIFN. Of 27 patients with KS, 17 had significant titers of HuIFN in their serum. Ten of 35 patients with lymphadenopathy and three of four patients with other clinical symptoms also had circulating HuIFN. In contrast, only two of 25 apparently healthy subjects had serum HuIFN. All 32 samples of HuIFN had antiviral activity on bovine cells, a characteristic of HuIFN-alpha, and all of 14 representative samples tested were neutralized by antibody to HuIFN-alpha. In addition, the HuIFN-alpha in six of eight representative patients was inactivated at pH 2 and therefore appears to be similar to the HuIFN-alpha found in patients with SLE. These findings suggest that an autoimmune disorder may underly lymphadenopathy and KS in homosexual men.

Homosexuality↗
PubMed1984

The spectrum of immunologic abnormalities and clinical findings in homosexually active men.

Clinical and laboratory evaluations of 181 men were performed; the population studied included 131 homosexual or bisexual men (who were stratified into one of three groups on the basis of symptomatology and abnormal findings on physical examination), 39 heterosexual men (who served as controls), and 11 men with acquired immunodeficiency syndrome (AIDS). The presence of specific symptoms and/or lymphadenopathy in homosexual men was associated with perturbation of immunoregulation. A large percentage of asymptomatic, homosexually active men had abnormalities in lymphocyte numbers, subpopulations, and subclasses. Symptomatic individuals had clinical findings, immunologic alterations, and abnormalities of hematopoiesis similar to those found in patients with AIDS. These data suggest that clinical evaluation in conjunction with laboratory studies may serve to identify individuals at increased risk of developing AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Lymphocyte subsets and urinary excretion of cytomegalovirus among homosexual men attending a clinic for sexually transmitted diseases.

A significantly higher frequency of urinary excretion of human cytomegalovirus (HCMV) was noted in homosexual men (29 [18%] of 161) than in heterosexual men (3 [4%] of 77) attending a clinic for sexually transmitted diseases. However, differences were not significant when only persons with antibody to HCMV were compared (29 of 157 vs. 3 of 33). The homosexual men who excreted HCMV had a significantly lower mean ratio of T-helper (OKT4+) to T-suppressor (OKT8+) cells (1.13 +/- 0.09) than did the homosexuals who did not excrete HCMV (1.67 +/- 0.1) or than did the heterosexual men (2.28 +/- 0.2). The abnormal ratio resulted from both a decrease in the percentage of OKT4+ and an increase in percentage of OKT8+ lymphocytes. The urinary excretion of HCMV by asymptomatic individuals who exhibit serological evidence of previous infection by this virus may be an indicator of impaired immune competence.

Adolescent↗
PubMed1986

Association of HTLV-III with Epstein-Barr virus infection and abnormalities of T lymphocytes in homosexual men.

Homosexual men were studied for associations among human T-lymphotropic virus type III (HTLV-III) infection, Epstein-Barr virus (EBV) infection, and T cell abnormalities. The presence of IgG antibody to EBV capsid antigen and antibody to EBV early antigen was significantly associated with augmented counts of suppressor T cells in healthy HTLV-III-seronegative men. HTLV-III-seropositive asymptomatic subjects had significantly enhanced titers of antibody to EBV and lower ratios of helper to suppressor T cells compared with HTLV-III-seronegative homosexual men. Of three men who seroconverted to HTLV-III, two had a greater than fourfold increase in titer of IgG antibody to EBV capsid antigen after seroconversion. These results suggest that the interaction of HTLV-III and EBV and their immunologic perturbations are significant in the natural history of this retrovirus infection in homosexual men.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Human immunodeficiency virus type 1 (HIV-1) genomic sequences and distinct changes in CD8+ lymphocytes precede detectable levels of HIV-1 antibodies in high-risk homosexuals.

Polymerase chain reaction (PCR) identified regions of the gag, LTR, and env genes of human immunodeficiency virus type 1 (HIV-1) in 5 (13%) of 38 high-risk homosexual men who were negative for HIV-1 antibodies by Western blot (WB). Significant increases in CD8+ cells, particularly those bearing activation CD8+CD38+ and CD8+Ia+ antigens, and marked reductions in CD4+ cells were detected in WB-PCR+ subjects compared with 33 WB-PCR- homosexuals. WB-PCR+ subjects had impaired B cell but not T cell functions. Immunologic characteristics of WB-PCR+ homosexuals were indistinguishable from those of 17 WB+PCR+ subjects. Subjects progressing from WB-PCR- to WB-PCR+ to WB+PCR+ showed sequential phenotypic and functional alterations in their B and T cell compartments. These changes and the presence of HIV-1 genomic sequences were the first indications of HIV-1 infection and together with p24 antigenemia signified an inevitable progression to AIDS.

Adult↗
PubMed1996

Detection of the hepatitis G virus genome among injecting drug users, homosexual and bisexual men, and blood donors.

The recently identified hepatitis G virus (HGV) is parenterally transmitted; the impact of sexual transmission is unknown. Moreover, it is unclear what proportion of HGV-infected persons may develop persistent viremia. Sera from injecting drug users (IDUs), non-drug-injecting homosexual and bisexual men with high levels of sexual risk behavior, and blood donors were tested for HGV RNA and hepatitis C virus (HCV) RNA by reverse transcriptase-polymerase chain reaction and for antibodies to human immunodeficiency virus, hepatitis B virus, and HCV. HGV RNA was detected in 33% of IDUs (n = 130), 11% of homosexual and bisexual men (n = 101), and 2% of blood donors (n = 90). HGV RNA seroprevalence significantly decreased with increasing time since first drug injection, whereas the seroprevalences of both HCV RNA and anti-HCV antibody increased. Thus, a high proportion of HGV-infected persons may clear the virus and develop protective antibodies. The relatively high HGV RNA prevalence among non-drug-injecting homosexual and bisexual men indicates that sexual contact may be another important route of HGV transmission.

Adult↗
PubMed1993

Racial and ethnic differences in human immunodeficiency virus type 1 (HIV-1) seroprevalence among homosexual and bisexual men. The Multicenter AIDS Cohort Study.

To determine whether the excess prevalence of human immunodeficiency virus type 1 (HIV-1) infection in US black and Hispanic homosexual men relative to white men can be explained by differences in sociodemographic factors, history of sexually transmitted diseases, or sexual and drug-use behaviors, the authors conducted a cross-sectional analysis of baseline HIV-1 seroprevalence and HIV-1 risk factors among 4,475 non-Hispanic white, 234 Hispanic white, and 194 black homosexual men from four centers in the United States (Baltimore/Washington, DC, Pittsburgh, Chicago, and Los Angeles). HIV-1 seroprevalence was significantly higher in Hispanic men (50%; odds ratio (OR) = 1.83, 95% confidence interval (CI) 1.41-2.39) and black men (47%; OR = 1.62, 95% CI 1.21-2.16) compared with white men (35%). Both Hispanic and black men more frequently reported a history of sexually transmitted diseases. Overall, Hispanics had the highest risk profile and blacks the lowest risk profile with respect to certain high-risk sexual behaviors (e.g., receptive anal intercourse and use of anonymous sexual partners) and recreational drug use. After multivariate adjustment, black race remained a significant independent risk factor for HIV-1 seropositivity (OR = 1.60, 95% CI 1.13-2.26), but Hispanic ethnicity was no longer statistically significant (OR = 1.17, 95% CI 0.82-1.69). Most of the excess HIV-1 prevalent infection among Hispanics was explained by their predominant recruitment from Los Angeles--the study center with the highest HIV-1 seroprevalence--and their greater prevalence of a history of sexually transmitted diseases and certain high-risk sexual practices. By contrast, adjustment for these same risk behaviors failed to explain the observed black-white differences in HIV-1 seroprevalence, and further studies are needed to elucidate the reasons for these unexplained racial differences. HIV-1 educational programs for homosexual men should take into account the behavioral differences that exist between white and minority racial/ethnic groups.

Black or African American↗
PubMed1989

Counselling and selection of homosexual couples in fertility treatment.

Artificial insemination with anonymous donor sperm (AID) is a widespread practice for heterosexual couples in which the male partner appears to be infertile. The Centre for Reproductive Medicine of the Brussels University teaching hospital has been one of the first to extend this form of therapy to lesbian couples. In the course of the past 7 years, 27 lesbian couples have come to the centre with a request for AID. The question of whether children can be brought up within such a frame of reference cannot be dissociated from the question of attitudes towards homosexuality as such. Such attitudes still solicit a whole range of controversial reactions. This paper will deal with the most important findings from investigations thus far carried out on the issue of homosexual parenthood. It also sets out the selection criteria used in the evaluation of applicants. A profile of the homosexual couples selected will be presented, with particular attention to their social status, their psychosexual development and their motivation towards parenthood.

Counseling↗
PubMed1997

Independent epidemics of heterosexual and homosexual HIV infection in South Africa--survival differences.

Survival with HIV infection is shorter in sub-Saharan Africa than in developed countries. The pattern of HIV transmission in our region has changed from homosexual to heterosexual, with viral subtypes similar to those in North America/Europe and Central Africa, respectively. We compared survival for the two transmission patterns after AIDS, and after the first CD4+ lymphocyte counts < 200/microliter and < 50/microliter, for adults presenting 1988-1993. Antiretroviral therapy was excluded. There were 180 homosexuals (63% White, 56% employed) and 314 heterosexuals (67% Black, 34% employed). Extrapulmonary tuberculosis was the AIDS-defining diagnosis in 36/90 heterosexuals and 5/58 homosexuals (p < 0.0001). Survival after AIDS was longer in heterosexuals (p = 0.0015), but AIDS occurred earlier as shown by their higher CD4+ count at AIDS onset (median 98/microliter vs. 40/microliter; p = 0.036). Survival was similar in the two groups after first CD4+ count < 200/microliter and < 50/microliter. Race, socioeconomic status and morbidity are markedly different in the two transmission groups. AIDS occurs with less severe immune suppression in heterosexuals, with correspondingly longer survival. Survival after defined CD4+ counts, however, is remarkably similar.

AIDS-Related Opportunistic Infections↗
PubMed1987

Medical students' attitudes toward AIDS and homosexual patients.

More than most diseases, acquired immune deficiency syndrome (AIDS) appears to elicit highly negative, fearful, and prejudicial attitudes. In the study reported here, medical students read one of four patient vignettes. The vignettes were identical in content except that the patient was identified as having either AIDS or leukemia as either homosexual or heterosexual. The students then completed a set of objective measures that assessed their attitudes toward the patient portrayed in the vignette. Multivariate and univariate analyses of variance of their responses revealed that the students held negative and prejudiced attitudes toward both the AIDS and homosexual patients. This finding suggests that medical educators should recognize that many students have stigmatizing, negative attitudes toward homosexuals and patients with AIDS. These educators should promote greater sensitivity, knowledge, and understanding among medical students of those at risk for AIDS and AIDS patients.

Acquired Immunodeficiency Syndrome↗