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PubMed1957

Problems of homosexuality.

Moral, religious and legal attitudes in attempts to control sexual behavior have interfered with a clear view of the medical and psychological aspects of homosexuality. This phenomenon is probably much less destructive of social aspects of our society and culture than is generally believed, since it is actually more widespread than is generally acknowledged. Homosexuality probably has hormonal and undoubtedly social and psychological factors, the latter of which are the only ones which can be worked with successfully in our present state of knowledge. A general practitioner's task is to aid those who wish and need help with this problem in finding psychiatric treatment in the same way that persons with any other emotional disturbance are referred. This should be carried out without bias just as with any other emotional disturbance.

Attitude↗

PubMedDate not supplied

Sexual patterns and human immunodeficiency virus infection among homosexuals in Taiwan.

Between 1988 and 1991, 64 homosexual men and 43 bisexual men were screened for human immunodeficiency virus (HIV) in Southern Taiwan; 5 of them were found to carry HIV antibodies. According to a self-administered questionnaire completed before screening, the average age of the men in the study group was 27 years, and the average duration of practiced homosexuality was 3.8 years. Occupations included student, merchant, laborer, officer, and soldier, and many of the men (45/107) had some junior college or university level education. A relatively high proportion (48/107) of these subjects reported having only 1 sexual partner, and there was a significant association between HIV antibody status and number of sexual partners (P = 0.025). Of the 107 subjects, 58 had practiced anal intercourse and more than a third of them (37/107) indicated that they had participated in receptive anal intercourse, 42 in insertive anal intercourse, and 21 in both of the above. All five carriers of HIV had practiced receptive anal intercourse, in which transmission of HIV from inserter to receptor was highly likely (P = 0.004). Of the men who came forward for HIV testing, the bisexual men tended to be older and often married.

Adult↗

PubMed1990

HIV-1, sexual practices, and contact with foreigners in homosexual men in Colombia, South America.

From October 1985 to November 1987, a sample of 294 Colombian homosexual men volunteered to answer a questionnaire on sexual practices and consented to HIV-1 testing. Testing for HIV-1 was performed using an ELISA and those positive were confirmed with envelope- and core-specific ELISAs. Statistical methods for data analysis included Mantel-Haenszel methods on contingency tables. The overall seropositivity rate was 21.1%. Subjects who reported a receptive role (either as predominantly receptive or as mixed receptive-insertive intercourse) had a seropositivity rate of 23.7%, which was significantly higher than the 10.3% found in those reporting predominantly insertive intercourse (RR = 2.30, 95% C.I. = 1.16-4.57). For subjects reporting receptive intercourse, sexual contact with foreign visitors was a significant risk factor for HIV-1 infection (RR = 1.84, 95% C.I. = 1.13-3.00). Factors of borderline significance included having had more than ten homosexual partners in the preceding year (RR = 1.53) and a history of international travel (RR = 1.43). These associations did not hold for those reporting predominantly insertive intercourse. The data indicate the need to monitor the spread of HIV-1 at the international level and provide information on subgroups of high transmission rates.

Adult↗

PubMed1989

Sexual practices and condom usage in a cohort of homosexual men in relation to human immunodeficiency virus status.

Between January 1, and October 31, 1987, 420 homosexual men who participated in a cohort study of infection with the human immunodeficiency virus (HIV) completed a questionnaire that examined their sexual practices during the previous six months. Of the subjects, 205 (48.8%) men were HIV-seropositive and 215 (51.2%) men were HIV-seronegative. Although there was an appreciable level of condom usage in both groups, 13.5% of the HIV-seronegative men had engaged in unprotected receptive anal intercourse and 6.3% of the HIV-seropositive men had engaged in unprotected insertive anal intercourse. Condom breakage was reported on approximately 6% of occasions by a minority of subjects. Among subjects who were in a relationship with a regular male sexual partner, the most commonly reported sexual practices were deep kissing, mutual masturbation and receptive oral intercourse without ejaculation. No HIV-seronegative man engaged in unprotected receptive and/or insertive anal intercourse, receptive oral intercourse with ejaculation or receptive and/or insertive "fisting" with a regular partner who was HIV-seropositive. No HIV-seropositive man engaged in unprotected insertive anal intercourse to ejaculation with an HIV-seronegative partner, although they did so with partners who were HIV-seropositive or of unknown status. On multivariate analyses the subject's antibody status was found to be associated with receptive anal intercourse with a condom (P = 0.007) and mutual masturbation (P = 0.001), with HIV-seronegative men being more likely to practise either; no significant independent effect was associated with the partner's antibody status. These findings provide important information on the types and levels of sexual practices in a group of homosexual men after the recognition of the acquired immunodeficiency syndrome in this country.

Adult↗

PubMed1994

Attitudes and experiences of psychoanalysts in analyzing homosexual patients.

In response to a survey, 285 psychoanalysts reported having analyzed 1215 homosexual patients, resulting in 23 percent changing to heterosexuality and 84 percent receiving significant therapeutic benefit. Various statistics and individual comments are reported. Virtually all of the respondents rejected the idea that a homosexual patient in analysis "can and should" change to heterosexuality, although 17 percent had changed their opinion during the last 10 years. Over a third believed that most other psychoanalysts hold this opinion even though they themselves do not. The contention of some gay activists that "traditionally trained" psychoanalysts harm and "abuse" their patients is examined and rejected.

Adult↗

PubMed1983

Nonbacterial thrombotic endocarditis in a male homosexual with Kaposi's sarcoma.

Nonbacterial thrombotic endocarditis (NBTE), or marantic endocarditis, was found at autopsy in a young male homosexual with Kaposi's sarcoma. Vegetations were seen in the mitral and aortic valves. Embolic phenomena and cytomegalovirus infection were noted in the brain, spleen, liver, lung, gastrointestinal tract, and bone marrow. To our knowledge, this is the first reported case of NBTE in a young immunosuppressed homosexual man with Kaposi's sarcoma.

Adult↗

PubMed1993

Relationship of CD4 counts to neurophysiological function in HIV-1--infected homosexual men.

OBJECTIVE: To explore the relationship of immune dysfunction to neurophysiological measures of brain-stem conduction time. DESIGN: Three-year longitudinal prospective cohort study; results of time 1 analyses reported. SETTING: San Francisco (California) General Hospital, Departments of Psychiatry and Epidemiology. PATIENTS: Volunteer sample of 55 human immunodeficiency virus (HIV)-positive and 37 HIV-negative homosexual men recruited from a larger cohort of homosexual men followed up since 1983 at San Francisco General Hospital as part of an ongoing study of the natural history and course of HIV type 1 infection. INTERVENTION: None. MAIN OUTCOME MEASURES: Auditory brain-stem responses and somatosensory evoked potentials for subjects stratified separately on HIV serostatus, Centers for Disease Control and Prevention symptom groupings, and absolute CD4 counts. RESULTS: The HIV-positive subjects had an increased wave III-V interpeak latency of the right ear auditory brain-stem response compared with the HIV-negative subjects (t test, P < .05). There were no significant differences among the three Centers for Disease Control and Prevention groupings on any evoked potential measure. When HIV-positive subjects were stratified on a measure of immune functioning, ie, CD4 counts, individuals with greater immune suppression were more impaired on speed of auditory brain-stem conduction time (Mann-Whitney U test, P < .05). Furthermore, 85% of subjects impaired on this evoked potential measure had CD4 counts of less than 0.40 x 10(9)/L (400/microL), whereas only 15% of those impaired on this measure had CD4 counts of greater than 0.40 x 10(9)/L. CONCLUSIONS: Asymptomatic HIV-positive subjects who do not have evidence of immune suppression do not appear to be at greater risk for neurophysiological impairment than HIV-negative subjects. The HIV-positive individuals who are immune suppressed (even while asymptomatic) appear to have an increased likelihood of central conduction time slowing as measured by evoked potential procedures.

Adolescent↗

PubMed1982

Disseminated Mycobacterium avium-intracellulare infection in homosexual men dying of acquired immunodeficiency.

Five homosexual men dying at UCLA Center for the Health Sciences, Los Angeles, with acquired immunodeficiency and Pneumocystis pneumonia, Kaposi's sarcoma, or cryptosporidiosis since May 1981 have all had mycobacteria of the Mycobacterium avium-intracellulare complex cultured from tissues taken just before death or at postmortem examination. Each man had histological evidence of disseminated mycobacterial infection. Acid-fast organisms were seen in macrophages in the lung, spleen, and lymph nodes in all cases and in a variety of additional organs in two cases. Other severe infections were always found at postmortem examination--cytomegalovirus, cryptosporidiosis, and Pneumocystis. Disseminated M avium-intracellulare infection has been so striking in homosexual males dying with acquired immunodeficiency at our institution that we believe a vigorous search for mycobacteria should be made in all such patients. Empiric therapy for mycobacterial infection may be justified in selected cases of immunodeficiency before a specific microbiological diagnosis.

Acquired Immunodeficiency Syndrome↗

PubMed1983

Lymphadenopathies in homosexual men. Relationships with the acquired immune deficiency syndrome.

Generalized, persistent lymphadenopathies were observed in homosexual men and considered a possible prodrome of acquired immune deficiency syndrome (AIDS). To evaluate these lymphadenopathies, 25 lymph node biopsy specimens from homosexual men with lymphadenopathy (18), lymphadenopathy associated with AIDS (five), and lymphadenopathy associated with non-Hodgkin's lymphoma (two) were reviewed and correlated with the clinical symptoms. In the absence of opportunistic infections, the lymph node lesions were essentially uniform and represented acute inflammatory processes resembling those commonly seen in viral lymphadenitides. This suggests that a lymphotropic agent, probably a virus, causes AIDS as a result of its destructive effects on certain populations of lymphoid cells.

Acquired Immunodeficiency Syndrome↗

PubMed1975

Clinical and sign prediction: the draw-a-person and female homosexuality.

The validity of predicting female homosexuality from empirical signs from the Draw-A-Person (DAP) was compared to the validity of psychologists' "blind" predictions from the same DAP protocols. Four specific DAP signs significantly predicted homosexual drawings from those of heterosexual controls; patterns derived from these signs were even better predictors. Two of four clinicians predicted sexual orientation greater than chance; one predicted as well as the optimal sign pattern. In view of the expected shrinkage involved in cross-validating the empirical signs and patterns, clinical prediction probably would equal or surpass the accuracy of statistical prediction. Individual differences in clinical prediction and the process of clinical prediction were discussed.

Adolescent↗

PubMed1990

The relationship between life events and mental health in homosexual men.

In a study to determine the extent to which stigmatization influences mental health in homosexual men, 80 homosexual men were administered the General Health Questionnaire and the Gay Affect and Life Events Scale. Data indicated that there were significant associations between life events and mental health; events related to AIDS had the highest correlations. However, general life event scales that included Finances and Work also were associated significantly with mental health, as previously reported in the general population. These data suggest that the impact of life events may be amplified by stigmatization and that degree of life change is associated closely with psychological dysfunction. It is concluded that life events that are related to both stigmatization and life change and related emotional distress are significant predictors of psychology dysfunction.

Acquired Immunodeficiency Syndrome↗

PubMed1987

Thrombotic thrombocytopenic purpura in a human immunodeficiency virus (HIV)-seropositive homosexual man.

A case of thrombotic thrombocytopenic purpura (TTP) in a human immunodeficiency virus (HIV)-seropositive homosexual man is reported. The patient improved after corticosteroid and plasma exchange therapy was instituted. The case demonstrated most of the classic features of TTP, including histologic evidence of fibrin thrombi in small blood vessels. Atypical features included reduced number of megakaryocytes in the bone marrow and only partial resolution of thrombocytopenia after therapy was begun. An autoimmune thrombocytopenia has been well-characterized in HIV-antibody-seropositive homosexual men. Physicians caring for HIV-seropositive persons should also be aware of a possible association with TTP.

Acquired Immunodeficiency Syndrome↗

PubMed1985

Herpes simplex virus type 2 encephalitis in two homosexual men with persistent lymphadenopathy.

Within a 5-month period, 2 homosexual men with persistent lymphadenopathy developed clinical findings consistent with herpes simplex virus (HSV) encephalitis. These signs included abrupt change in mental status, seizures, cerebrospinal fluid pleocytosis, and localized electroencephalographic abnormalities showing temporal lobe involvement. Initial computed tomographic scans were unremarkable. Treatment with adenine arabinoside was instituted and temporal lobe biopsies were performed. Although virus-specific antigens were detectable in only 1 patient, cultures of biopsy tissue from both patients yielded HSV type 2 organisms. Spiking fevers persisted and the patients failed to improve, prompting administration of acyclovir. Both patients recovered gradually after their second course of antiviral therapy and survived with severe neurological deficits. These patients should raise concerns about an increased incidence of type 2 encephalitic illness among homosexual men with persistent lymphadenopathy or acquired immune deficiency syndrome. In addition, the importance of using HSV type 2 antibody in the immunofluorescence test of brain biopsy tissue for rapid diagnosis of the disease is emphasized.

Adult↗

PubMed1985

Recovery of herpesviruses from cerebrospinal fluid of immunodeficient homosexual men.

Over a one-year period the cerebrospinal fluid (CSF) obtained from a series of homosexual men immunocompromised with either Hodgkin's disease or acquired immune deficiency syndrome (AIDS) was cultured to assess the frequency with which infectious viruses could be recovered. Of 58 patients examined, 4 (6.9%) had CSF cultures that showed a cytopathology consistent with a virus infection. All isolates proved to be herpesviruses. Cytomegalovirus (CMV) and varicella-zoster virus were isolated from CSF obtained from 2 patients with neurological features consistent with a subacute encephalitis common among AIDS patients. CMV was also recovered from the CSF of an AIDS patient who developed an ascending myelitis of herpesvirus origin. Finally, a CSF sample obtained from an immunodeficient homosexual man who showed no detectable neurological abnormalities consistently yielded herpes simplex virus type 1 in culture. These results suggest that seeding of the CSF with infectious virus is an uncommon event in this patient population. However, our experience should not dissuade attempts to culture viruses from CSF in similar cases. Successful isolations may prove beneficial in the diagnosis of an accompanying neurological illness and facilitate treatment with antiviral therapy when indicated.

Acquired Immunodeficiency Syndrome↗

PubMed1986

Strategy for lymph node biopsy in homosexual men suspected of having LAV/HTLV-III related disease.

Since January 1985 we have changed our policy regarding lymph node biopsy in male homosexuals presenting with lymphadenopathy. Before that date all such patients underwent biopsy if there was no apparent cause. We no longer perform biopsy in male homosexuals presenting with uncomplicated persistent generalized lymphadenopathy (enlargement to more than 1 cm of lymph nodes in more than one extra-inguinal site for more than 3 months with no apparent cause) provided that the patient is positive for the antibody to lymphadenopathy associated virus/human T-lymphotropic virus type III. Such a policy should reduce the need for open biopsy procedures in this group of patients.

Adult↗

PubMed1990

Surgical management of anorectal disease in HIV-positive homosexuals.

One thousand and ninety human immunodeficiency virus (HIV)-positive homosexual or bisexual males were seen in one hospital for management of HIV disease over a 9-year period. One hundred and fifty-five patients were referred by acquired immunodeficiency syndrome (AIDS) physicians for general surgical management. The most frequent reason for surgical referral (64 patients) was anorectal disease which occurred in 5.9 per cent of all HIV-positive patients. One or more diagnoses were reached in 61 of the 64 patients referred with anorectal disease: warts (38 per cent of diagnoses), anorectal ulceration (26 per cent), perianal sepsis (15 per cent), neoplasia (14 per cent) and haemorrhoidal disease (8 per cent). Anorectal symptoms were relieved in 68 per cent of patients and the median survival of those treated was 17.5 months from the time of surgical referral. Both warts and perianal sepsis were associated with in situ neoplasia, but no case of progression from in situ to invasive anal squamous carcinoma was detected. The aetiology of anorectal ulcers was not clear, but surgical excision of anal ulcers and skin tags can produce healing. Palliation of anorectal symptoms in HIV-positive homosexual patients is possible but some conditions are unusual and surgeons should be familiar with their presentation and management.

Abscess↗

PubMed1995

Human immunodeficiency virus infection and genital warts as risk factors for anal intraepithelial neoplasia in homosexual men.

The incidence of anal intraepithelial neoplasia (AIN) was studied in a group of 210 homosexual and bisexual men. The presence of genital warts and human immunodeficiency virus (HIV) infection was assessed as risk factors for the development of AIN. In all, 74 (35 per cent) of the group had histological evidence of AIN. The relative risk of being positive for HIV on AIN (relative to being negative for HIV) was 1.58 (95 per cent confidence interval (c.i.) 1.01-2.48). The relative risk of anal warts on AIN (relative to absence of anal warts) was 4.70 (95 per cent c.i. 1.81-12.20). Logistic regression analysis showed no significant interactive effect between HIV and anal warts on the risk of AIN. It is concluded from the results of a Mantel-Haenzel analysis that the presence of anal warts and HIV infection are independent risk factors for the development of AIN in homosexual and bisexual men.

Anus Diseases↗

PubMed1999

Influence of human immunodeficiency virus infection on chronic hepatitis B in homosexual men.

The aim of this study was to assess the influence of human immunodeficiency virus (HIV) infection on chronic hepatitis B. In a series of 132 (65 anti-HIV positive) homosexual non-drug addicted men with chronic hepatitis B, the liver function was assessed with biochemical tests; the degree of hepatitis B virus (HBV) replication was assessed with serum HBV DNA level and with immunoperoxidase staining of hepatitis B core (HBc) antigen on liver specimens; and the severity of liver lesions was assessed with an histology activity index. Anti-HIV-positive and anti-HIV-negative patients were not different for serum aspartate transaminase activity, bilirubin, prothrombin, and histology activity index. Anti-HIV-positive patients had lower serum alanine transaminase activity levels (P =.0001), lower serum albumin levels (P =.0009), and higher serum HBV DNA levels (P =.01). There was a higher prevalence of cirrhosis in anti-HIV-positive patients (P =.04). In homosexual men with chronic hepatitis B, HIV infection is associated with a higher level of HBV replication and a higher risk for cirrhosis without increased liver necrotico-inflammatory process.

Alanine Transaminase↗