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Response to hepatitis-B vaccination in healthy homosexual individuals: retrospective case control study.

The aim of the study was to compare the responses of homosexual men (HM) receiving a standard course of recombinant hepatitis B vaccine with those of healthcare workers vaccinated in the same hospital over the same period. Boosters for inadequate responders and repeat courses for non-responders were given. Forty of 61 (75.4%) of HM completing full follow-up were successfully vaccinated, compared with 128 of 129 (99.2%) female and 94 of 96 (97.9%) male health care workers (P<0.001). The response to hepatitis-B vaccination in healthy homosexual men is poor and significantly lower than healthcare workers vaccinated and followed up according to the same protocol.

Adult↗

Understanding human sexuality--specifically homosexuality and the paraphilias--in terms of chaos theory and fetal development.

This paper considers human sexual orientation, specifically homosexuality and some paraphilias, to occur as a result of intrauterine development, itself a mathematically chaotic process. Parameter space, an example of state space in the phase diagram, has been used to illustrate different phenotypes. The crossing of a bifurcation boundary by the developing fetus is proposed as a mechanism by which it may be changed from one sexual orientation to another, e.g. from heterosexuality to homosexuality. The factors which push the fetus over a bifurcation boundary, which include a Y-chromosome, specific hormone administration, the lying contiguous to an opposite-sex fetus in multiple pregnancies, maternal stress and immune factors are described. The syndromes congenital renal hyperplasia and the androgen insensitivity syndrome and their relevance to this model are also discussed. Finally, chaos theory is used to encompass the complex interactions between fetal development and cultural factors in human sexuality.

Bisexuality↗

Gender differences in health and risk behaviors among bisexual and homosexual adolescents.

OBJECTIVE: This study explored gender differences in the health and risk behaviors of 394 self-identified bisexual and homosexual adolescents who participated in an anonymous, school-based survey. METHODS: Respondents included 182 girls and 212 boys; girls were significantly younger than boys (p < 0.001), so respondents were further grouped as younger (< or =14 years) and older (> or =15 years) for analysis. Chi-square was used to test for gender differences in health perceptions and risk behaviors. Items included general health perceptions and health care access, body image and disordered eating behaviors, sexual behaviors, alcohol use, and emotional health measures including mood, life satisfaction, and suicidal ideation and attempts. RESULTS: Both younger and older girls were significantly more likely than their male age mates to report a history of sexual abuse, dissatisfaction with weight, a negative body image, more frequent dieting, and an earlier age at onset of sexual intercourse. Both younger and older boys were significantly more likely than girls to have a positive body image, to rate themselves as healthier than peers, to report no regular source of health care, to be sexually experienced, and to drink alcohol more often and in greater quantity; a significantly greater proportion of older boys than older girls reported alcohol use before school (19.0% vs. 3.9%; p < 0.05). No significant gender differences were found for measures of emotional health, including suicidal ideation and attempts; however, nearly 1 of 3 older boys and girls reported at least one suicide attempt. CONCLUSIONS: Gender is a substantive source of variation in health and risk behaviors among bisexual and homosexual adolescents. Health care providers should incorporate gender-specific approaches to health promotion and risk reduction with young people who self-identify as gay, lesbian, or bisexual.

Adolescent↗

Seroprevalence of herpes simplex virus types 1 and 2 in HIV-infected and uninfected homosexual men in a primary care setting.

BACKGROUND: Genital herpes is usually caused by herpes simplex virus type 2 (HSV-2), with infections often being unrecognised by patients and/or clinicians. HSV-2 infections may be a risk factor for the transmission of human immunodeficiency virus (HIV) infection. Reliable tests for type-specific HSV antibodies are now readily available. OBJECTIVES: To determine the seroprevalence of HSV-1 and -2 in HIV-seronegative gay men in a primary care setting in Melbourne, Australia, and to compare it with the rate in HIV-infected gay men. To assess the utility in a clinical setting of a type-specific HSV enzyme linked immunosorbent assay (ELISA) as compared with western blot. STUDY DESIGN: We recruited a total of 300 HIV-seronegative homosexual men attending for HIV antibody testing, and HIV-infected men attending for CD4 lymphocyte count and viral load estimation. The subjects completed a questionnaire, and sera were sent for total IgG HSV testing and testing by Gull type-specific HSV ELISA assay. Selected serum samples were retested by western blotting and the results analysed. RESULTS: In total, 168 HIV-antibody negative men and 132 HIV-antibody positive men were recruited. Of all subjects, 73.3% had HSV-1 antibodies. This proportion did not differ between HIV-seronegative and seropositive men (P=0.48). About twenty percent of HIV-seronegative men and 61% of HIV-seropositive men had antibodies to HSV-2 (P<0.0001); 75.6% of HIV-seronegative men with antibodies to HSV-2 gave no history of genital herpes, as did 66.7% of HIV-seropositive men. Overall, in using the type-specific ELISA (Gull) assay, false negative, false positive or equivocal results were obtained in 33/300 (11%) of samples tested compared with western blot. CONCLUSIONS: High rates of HSV-2 infection were found in homosexual males, with the rate for HIV-seropositive men being over twice that for HIV uninfected men. Most subjects were not aware of their infection with HSV-2. HIV-infected individuals were also older and had higher numbers of sexual partners, but we were unable to unambiguously establish that these variables contributed to the difference in HSV-2 seroprevalence rates. The Gull type-specific assay for HSV antibodies has significant problems with sensitivity and specificity at a discrepancy rate of 11%. Caution is advised in using this type-specific commercial assay for clinical purposes.

Adult↗

The cause(s) of the fraternal birth order effect in male homosexuality.

It has been established that the probability that a man is homosexual is positively related to his number of older brothers, but not older sisters when the brothers are accounted for. This is known as the 'fraternal birth order' effect. In the past, efforts have been made to explain this phenomenon in terms of several alternative biological hypotheses and a psychosocial hypothesis. This note examines how well these hypotheses accommodate the fraternal birth order effect. It is concluded that: (1) the evidence for the hypothesis of maternal immunoreactivity to the male fetus is weak; (2) the evidence for the intrauterine hormone exposure hypothesis is also weak; (3) the evidence for the hypothesis of postnatal learning is stronger. Lastly, there seem likely to be causes common to male homosexuality and paedophilia. They may include sexual (or quasi-sexual) experience in childhood or adolescence.

Birth Order↗

Changing trends of gonococcal infection in homosexual men in Edinburgh.

In an attempt to explain the recent resurgence of homosexually-acquired gonorrhoea in the Lothian region of Scotland the number of infections and pattern of infection (urethral, rectal and pharyngeal) of all gonococcal isolates from homosexual men attending the Department of Genitourinary Medicine at Edinburgh Royal Infirmary between 1985 and 1990 were analysed. Serovar typing data were available from infections acquired between January 1986 and December 1990. A correlation between one serovar, Bacejk/Brpyust, and the overall pattern of gonorrhoea was observed. The number of infections caused by minor serovars also correlated with rates of gonococcal infection. The number of minor serovars isolated, which may represent strains from other geographical locations, is related to the total incidence of gonorrhoea. It is possible that the incidence of Bacejk/Brpyust may be determined by the size of the infected pool of gonorrhoea. The most likely explanation for the recent increase in gonorrhoea is a change in sexual behaviour and/or an influx of strains from other geographical areas.

Adult↗

Decreasing age at infection for homosexually acquired HIV in Italy: results of a back-calculation analysis.

The age-specific incidence of homosexually acquired HIV in Italy was examined, based on 3918 AIDS cases diagnosed by the end of 1994 and reported by the end of 1995 through the national surveillance system. Using a smoothed back-calculation analysis, the estimated median age at infection decreased over time, and HIV incidence among younger age groups peaked much later than among older age groups. These results support recent findings from other developed countries, and suggest that measures for preventing homosexual transmission of HIV are best targeted at younger age groups.

Acquired Immunodeficiency Syndrome↗

Gender-related traits of heterosexual and homosexual men and women.

Two studies investigated the relation between sexual orientation and gender-related traits. Analyzing data from an Internet survey, Study 1 found that gay men and lesbians differed from same-sex heterosexuals most strongly on gender diagnosticity (GD) measures, which assess male- versus female-typicality of occupational preferences (effect sizes were 1.14 for men and 0.53 for women) and least strongly on instrumentality (I) and expressiveness (E). Study 2 found that GD measures showed large differences between 289 gay and 200 heterosexual men (d = 0.95) and between 296 lesbian and 435 heterosexual women (d = 1.32), whereas I and E showed much smaller differences. In Study 2 homosexual-heterosexual diagnosticity measures, computed from men's and women's occupational preferences, correlated very strongly with GD measures (r = 0.88 for men and 0.89 for women), indicating that occupational preference items that distinguished men from women also tended to distinguish heterosexual from homosexual individuals. LISREL 8 analyses showed that self-ascribed masculinity-femininity did not mediate the strong relation between sexual orientation and GD for men or for women.

Adolescent↗

HIV risk among homosexual, bisexual, and heterosexual male and female youths.

Variations in sexual risk acts and the social-cognitive mediators of sexual acts were examined among young homosexual, bisexual, and heterosexual males and females (N = 478; 13-21 years of age) from four community-based agencies in New York City, San Francisco, and Los Angeles (29% African American, 36% Latino, 36% White/other). The prevalence and frequency of sexual risk acts varied be gender but were similar across youth of different sexual orientations, ethnicities, and ages. Condom use and the social-cognitive mediators of risk varied by sexual orientation and gender. Homosexual youths reported a gap between their positive attitudes toward HIV prevention and their skills to implement safer sex acts, particularly under social pressure. Bisexual youths appeared at greatest risk; their reports of sexual risk were the highest, yet their perceived risk for HIV was relatively low and skills and knowledge were moderate (relative to their peers). Heterosexual youths appear at high risk for HIV based on reports of low rates of condom use and HIV-related beliefs and attitudes. However, heterosexual youths demonstrated the highest level of condom skills. The number of sexual partners was not associated with any HIV-related social cognitive mediator, suggesting that alternative theoretical models must be proposed for partner selection. Longitudinal research with similar subgroups of youths is needed.

Acquired Immunodeficiency Syndrome↗

Growing up hidden: notes on understanding male homosexuality.

Beginning with Freud and briefly reviewing some contemporary approaches to the treatment of gay men, this paper explores theoretical attempts to understand and explain homosexuality. The author finds covert and not-so-covert remnants of pathologizing in most theoretical approaches that contribute to the phenomenon of being hidden even in psychoanalysis. Further, the author emphasizes the nonmonolithic structure of homosexuality and the consequent need to look at each case individually. The author advocates a nonjudgmental, sustained empathic approach to the understanding and treatment of gay men. Clinical examples illustrate the individual meanings of homoerotic longings.

Adult↗

Coming out experiences and psychological distress of Chinese homosexual men in Hong Kong.

This study adopted a cognitive-behavioral conceptual framework based on the Theory of Reasoned Action (TRA) in understanding coming out experiences and psychological distress of 187 Chinese gay men. Results showed that participants' coming out experiences were characterized by same-sex sexual fantasy at teenage years, followed by awareness of homosexual tendency, same-sex sexual contact, and then self-identification and disclosure of homosexual orientation in young adulthood. Regarding targets of disclosure, participants tended to disclose their sexual orientation to their gay friends first, followed by heterosexual friends, siblings, parents, and coworkers. This study also supported the extension of the TRA conceptual framework to Chinese societies. Results showed that a low level of psychological distress in Chinese gay men was linked to their coming out experiences, which were in turn related to TRA components of involvement and identification with gay communities and positive attitudes toward coming out. Limitations and implications were also discussed.

Adaptation, Psychological↗

Optimal scaling of HIV-related sexual risk behaviors in ethnically diverse homosexually active men.

As HIV-related behavioral research moves increasingly in the direction of seeking to determine predictors of high-risk sexual behavior, more efficient methods of specifying patterns are needed. Two statistical techniques, homogeneity analysis and latent class analysis, useful in scaling binary multivariate data profiles are presented. Both were used to analyze reported sexual behavior patterns in two samples of homosexually active men, one sample of 343 primarily White gay men attending an HIV workshop and one sample of 837 African American gay men recruited nationally. Results support the existence of a single, nonlinear, latent dimension underlying male homosexual behaviors consistent with HIV-related risk taking. Both statistical methods provide an efficient means to optimally scale sexual behavior patterns, a critical outcome variable in HIV-related research.

Adolescent↗

Elevated physical health risk among gay men who conceal their homosexual identity.

This study examined the incidence of infectious and neoplastic diseases among 222 HIV-seronegative gay men who participated in the Natural History of AIDS Psychosocial Study. Those who concealed the expression of their homosexual identity experienced a significantly higher incidence of cancer (odds ratio = 3.18) and several infectious diseases (pneumonia, bronchitis, sinusitis, and tuberculosis; odds ratio = 2.91) over a 5-year follow-up period. These effects could not be attributed to differences in age, ethnicity, socioeconomic status, repressive coping style, health-relevant behavioral patterns (e.g., drug use, exercise), anxiety, depression, or reporting biases (e.g., negative affectivity, social desirability). Results are interpreted in the context of previous data linking concealed homosexual identity to other physical health outcomes (e.g., HIV progression and psychosomatic symptomatology) and theories linking psychological inhibition to physical illness.

Adaptation, Psychological↗

Organizing and activating effects of sex hormones in homosexual transsexuals.

The cause of transsexualism remains unclear. The hypothesis that atypical prenatal hormone exposure could be a factor in the development of transsexualism was examined by establishing whether an atypical pattern of cognitive functioning was present in homosexual transsexuals. Possible activating effects of sex hormones as a result of cross-sex hormone treatment were also studied. Female-to-male and male-to-female transsexuals were compared with female and male controls with respect to spatial ability before and after treatment. The data were consistent with an organizing effect, but there was no evidence of an activating effect. Homosexual transsexuals, who prior to hormone treatment scored in the direction of the opposite sex, may have reached a ceiling in performance and therefore do not benefit from activating hormonal effects.

Adolescent↗

Nursing staff and nursing students' attitudes towards HIV-infected and homosexual HIV-infected patients in Sweden and the wish to refrain from nursing.

BACKGROUND: Two decades after the emergence of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), the infection remains enigmatic and shameful. In Sweden, many HIV-infected persons still encounter attitudes of avoidance. AIMS: The aims were to investigate differences between attitudes of nurses, assistant nurses, nursing students and assistant nursing students towards HIV-infected and homosexual HIV-infected patients; to measure their fear of contracting HIV; and to investigate whether nurses, assistant nurses, nursing students and assistant nursing students wanted to refrain from caring for HIV-infected patients. ETHICAL ISSUES: The participants were informed of the study orally and in writing. Completing and returning the anonymous questionnaires indicated the participants' tacit consent. RESEARCH METHOD: The study had a descriptive, comparative quantitative design. The AIDS Attitude Scale was used, along with a questionnaire specially designed for the study. The participants were nurses and assistant nurses from one infectious disease clinic in central Sweden [response rate was 67% (n = 57)]. Students enrolled in a university nursing programme and students of upper secondary assistant nurses' training [response rate was 62% (n = 165)] were also included. FINDINGS: In general, both the nursing staff and the nursing students expressed empathic attitudes towards HIV-infected and homosexual HIV-infected patients, as well as a low degree of fear of HIV contagion. The findings also showed, in the professional groups, that 36% would refrain from caring for HIV-infected patients if that possibility existed. The corresponding figure for the student groups was 26%. LIMITATIONS: The chosen sample was small and not randomly selected therefore precludes a generalization in a wider context. Furthermore, the questionnaire was untested for reliability and validity, and may have influenced the findings with respect to the wish to refrain from nursing HIV-infected patients. CONCLUSION: Suggested guidelines for nursing, mentor-ship by AIDS-dedicated nurses, and educational interventions, are given in 'Implications for nursing and nursing education'.

Adolescent↗

Predictors of recent HIV testing in homosexual men in Australia.

OBJECTIVES: To describe time trends and other predictors of recent HIV testing among homosexual men enrolled in behavioural surveillance studies in Australia. METHODS: Repeated cross-sectional studies during the period 1996-2001 in Australian capital cities. Men were recruited from a variety of community-based settings, including gay community outdoor events, sex on premises venues, and social venues. They underwent a brief self-administered questionnaire in which they reported their HIV status, HIV-testing history, sexual behaviour and demographic information. RESULTS: Questionnaires were returned for 22,161 HIV-negative or status-unknown participants. While 85.3% had ever tested for HIV, 57.6% had tested in the last 12 months. Recent testing was greater in those living in Sydney, in younger men, in gay-identified men, in gay community-attached men, in those who reported unprotected anal intercourse and a higher number of sexual partners, and in partners of HIV-positive men. Although recent testing declined from 1996 to 2001, this trend was no longer significant when adjusted for other testing predictors. CONCLUSIONS: In Australia, HIV testing among gay men decreased slightly from 1996 to 2001, but the trend was not significant when adjusted for other predictors. Testing levels were highest among those at highest risk of HIV infection, and lowest among non gay-identified and non gay-community attached homosexual men.

Adult↗

Depressive disorders and unprotected casual anal sex among Australian homosexually active men in primary care.

OBJECTIVE: To examine the relationship between depressive disorders and unprotected anal intercourse with casual partners, among homosexually active men attending for primary care. METHODS: The first 460 homosexually active men enrolling in an Australian integrated primary care programme were screened for current depressive disorders using the Primary Care Evaluation of Mental Disorders (PRIME-MD) and completed questionnaires on their sexual behaviour in the prior 6 months. One hundred and sixty-two (35%) were HIV positive, 283 (62%) were HIV negative and 15 (3%) were untested. RESULTS: The prevalence of major depressive episode (MDE), as measured by the PRIME-MD, on enrollment was 28% (129/460), while the prevalence of dysthymic disorder (DD) was 26% (121/460). These include 84 men (18%) who met the criteria for both disorders ('double depression'). Neither disorder was associated with HIV status. Men with MDE were less likely to have been sexually active than the remainder of the cohort (90/129 [70%] vs. 291/331 [88%]; OR: 0.32 [95% CI: 0.19-0.52]; P<0.0001). Men with DD alone, however, were significantly more likely than men with neither disorder to report having had unprotected anal intercourse with a casual partner (11/38 [29%] vs. 43/292 [15%]; OR: 2.36 [95%CI: 1.09-5.10]; P=0.035). CONCLUSIONS: Depressive disorders were highly prevalent in this cohort and independent of HIV status. MDE was associated with reduced sexual activity. Among men without MDE, the presence of DD was independently associated with an increased likelihood of reporting unsafe anal sex with a casual partner in the prior 6 months.

Adult↗

The effect of luteinizing hormone releasing hormone (LRH) on pituitary gonadotropins in male homosexuals.

Basal serum LH and FSH values were found to be within normal limits in 9 homosexual men. The mean LH and FSH responses following the intravenous administration of 100 microgram of LRH were not significantly different from that of heterosexual controls. In addition, the mean basal plasma serum testosterone was similar in the two groups. There is thus no definite implication of endocrine factors in the genesis of male homosexuality.

Adult↗