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Viral subtype and heterosexual acquisition of HIV infections diagnosed in Scotland.

OBJECTIVE: As at December 1998, 87% of the estimated 33 million people living with HIV throughout the world resided in Africa and South East Asia. In Scotland (and the United Kingdom), a major public health concern has been that non-B subtypes of HIV which predominate in the regions above might enter the country and spread heterosexually among the indigenous population. The authors conducted an investigation to determine if, and to what extent, such transmission had occurred. METHODS: Stored blood samples from people who were diagnosed as HIV positive in central Scotland during 1995-7 and who were reported to have acquired their infection heterosexually, were identified. Sequence data were sought from each sample and, where obtained, viral subtype was assigned. For each case, viral subtype was linked to corresponding epidemiological details on heterosexual risk. RESULTS: Viral sequence was obtained from specimens for 53 of 59 cases. For 43 of the 53 cases, information on region of sexual contact was known. All 19 cases who had a sexual risk in Africa or Asia had a non-B subtype (A, C, or E) while 20 of 24 cases who did not report sexual contact in these regions had a B subtype (p < 0.0001). Of the remaining 10 cases, nine had a subtype B and one a subtype C virus. CONCLUSION: There is no evidence that non-B viral strains from developing countries have yet disseminated appreciably among indigenous heterosexual men and women within Scotland. Continuing to collect both demographic and molecular data from indigenous heterosexuals who are newly diagnosed with HIV would improve the chances of detecting rapidly any appreciable dissemination of non-B subtypes among this population if it were to occur. Such information would be helpful in informing HIV prevention strategies.

DNA, Viral↗

Heterosexually acquired human immunodeficiency virus infection in women in Copenhagen: sexual behavior and other risk factors.

In order to describe the risk pattern including sexual behaviour among HIV-infected women in Copenhagen we studied the charts of all women tested seropositive between January 1985 and August 1988 in the three main hospitals handling HIV/AIDS. One hundred and fifteen women were positive for HIV antibodies: 35 (31%) were infected by heterosexual contact and 63 (55%) were intravenous drug users. Among the heterosexually transmitted cases 25 (71%) had intercourse with a man from a high risk group and nine women had intercourse with a known HIV antibody positive man without known risk factors. Use of condoms was claimed by 31% of the heterosexually-transmitted women before the HIV test, and by 74% (P = 0.002) after the test. In 1988 73% of the women tested HIV positive were infected by heterosexual contact, in 1985 only 14%. We conclude that among HIV infected women in Copenhagen heterosexual transmission is a problem. These women seem to change sexual behaviour when informed about HIV positivity.

Contraceptive Devices, Male↗

The neuroendocrine response of luteinizing hormone to estrogen administration in heterosexual, homosexual, and transsexual subjects.

The neuroendocrine response of LH to estrogen administration may be related to sexual dimorphism of the brain, and therefore, homosexual and especially transsexual individuals may differ from heterosexual individuals in their responses. This study failed to find such differences among groups of female heterosexuals, homosexuals, and transsexuals. Specifically, after single dose estrogen administration, all subjects had an initial decline in serum LH levels, followed by a brisk rise of equal magnitude. Among males, the type of response was less uniform. After an initial fall in serum LH levels, the individual responses varied. In 12 of 23 male homosexuals, 10 of 15 male heterosexuals, and all 6 genetic male transsexuals studied, serum LH levels remained below pretreatment levels. In the remaining 11 male homosexuals and 5 of the heterosexuals, serum LH levels increased to values exceeding those before treatment, resembling the response found in the 3 groups of women. Those homosexual and heterosexual men with a rise in serum LH levels to above pretreatment values also had the greatest fall in testosterone levels after estrogen administration, while these same men had the lowest testosterone response to hCG stimulation. I conclude from these results that 1) the similarity of LH responses to estrogen administration in all groups of women studied does not support a theory of brain androgenization as a factor in the establishment of gender identity of sexual orientation; and 2) individual differences in men in the type of LH response to estrogen administration can be satisfactorily explained by endocrine factors, such as Leydig cell function, and need not be related to gender identity, sexual orientation, or other possible causes.

Adult↗

Sexual molestation and rape reported by homosexual and heterosexual women.

Questionnaire returns for 225 homosexual and 233 heterosexual adult women revealed 115 cases of rape or attempted rape. Data from 78 follow-up questionnaires are summarized. About the same proportion of lesbians and heterosexuals, age 16 or over, were the object of rape. The lesbians tended to reject all men as sexual partners or companions, while the heterosexuals tended to blame themselves for not being careful. Some of the heterosexual women, age 16 to 18, interpreted the rape as a compliment to their sexual attractiveness. Girls under 16 whose assailant was a stranger are, as adults, as frequently homosexual as heterosexual. Sixteen of the 17 girls, age 4 to 16, molested or seduced (6 for a long time) by a relative or close family friend are lesbians as adults. The subjects' attitudes about the incient were highly determined by parental reactions. Inferences are drawn about the rapists' attitudes toward women.

Adolescent↗

The impact of exposure group on the progression rate to acquired immunodeficiency syndrome. A comparison between intravenous drug users, homosexual men and heterosexually infected subjects.

The objective was to study the impact of exposure group on the progression rate to the acquired immunodeficiency syndrome (AIDS). 289 subjects in Oslo, Norway, infected with the human immunodeficiency syndrome (HIV) and without major clinical signs of HIV infection (102 intravenous drug users, 151 homosexual men and 36 heterosexually infected subjects) were recruited to the Oslo HIV Cohort Study from 1989 and followed until 1 January 1995. 15 (14.7%) of the intravenous drug users, 56 (37.1%) of the homosexual men and 5 (12.5%) of the heterosexually infected subjects developed AIDS during a mean time of 47 months (p < 0.001, log rank test). When controlling for possible confounding variables (age, number of CD4+ lymphocytes, antiviral therapy at study entry, gender and year of HIV diagnosis), the relative risk of AIDS progression was 2.2 [1.1-4.5, 95% confidence interval (CI)] for homosexual men and 0.5 (0.2-1.3, 95% CI) for heterosexually infected subjects as compared to intravenous drug users. In a subgroup with known time of seroconversion (n = 60), 47% (18/38) of the homosexual men, 20% (3/15) of the intravenous users and none (0/7) of the heterosexually infected subjects developed AIDS (p = 0.04, log rank test). The results suggest that homosexual men have more rapid progression to AIDS than intravenous drug users and heterosexually infected subjects.

Acquired Immunodeficiency Syndrome↗

Brain differentiation and preferred partner characteristics in heterosexual and homosexual men and women.

OBJECTIVES: The current study examined and compared the preferred partner characteristics of heterosexual and homosexual men and women in relation to speculated patterns of brain differentiation underlying the preferences. Further, the study compared the preferences of butch versus femme homosexual women. METHODS: Two hundred twelve heterosexual and homosexual men and women completed questionnaires on which they rated themselves and their idealized sexual partners on various morphological and behavioral characteristics. RESULTS: Results of within-subjects multivariate analyses of variance (MANOVAs) showed that the pattern of preferred partner characteristics of heterosexual women is most consistent with the theorized brain differentiation underlying those preferences. There was varying support for the theory as it applies to the other three groups. Between-subjects MANOVAs provided evidence to support some of the predictions generated by theory on the differences in brain differentiation between heterosexual and homosexual men and women and between homosexual women categorized as butch and femme. CONCLUSION: The overall pattern of preferred partner characteristics among and between heterosexual and homosexual men and women does not support theory that holds that underlying brain differentiation between the groups is discrete and categorical. Rather, it supports theory that holds that differentiation manifests itself on a continuum leading to a variety of patterns of sexual orientation, and by extension, preferred partner characteristics.

Adolescent↗

Epidemiology of women with AIDS in the United States, 1981 through 1990. A comparison with heterosexual men with AIDS.

In the United States, women account for an increasing number and percentage of adults with the acquired immunodeficiency syndrome (AIDS). Overall, 51% of women with AIDS were infected through intravenous drug use and 29% through heterosexual contact; the proportion of intravenous drug users decreased, while the proportion attributed to heterosexual contact increased, between 1986 and 1990. Most women with AIDS were black or Hispanic (72%); residents of large metropolitan areas (73%), especially cities along the Atlantic coast; and of reproductive age (15 to 44 years) (85%). However, the proportion of women with AIDS reported by smaller cities and rural areas has increased from 22% in 1986 to 28% in 1990. The male-to-female ratio of heterosexuals with AIDS has remained about 2.4:1 since 1987. A comparison of women with AIDS to heterosexual men with AIDS showed that these two groups were similar by age, race, and geographic distribution. Also, survival times from AIDS diagnosis to death for women and heterosexual men with AIDS were not significantly different.

Acquired Immunodeficiency Syndrome↗

Hepatitis B virus transmission between heterosexuals.

To determine if heterosexual activity was a risk factor for acquiring hepatitis B virus (HBV) infection, we studied attendees at a sexually transmitted disease (STD) clinic and students at a large university. Responses to self-administered questionnaires were used to exclude persons with factors known to be related to the acquisition of HBV and to determine the number of recent (past four months) and lifetime sexual partners. Serum samples were tested for hepatitis B surface antigen, antibody to hepatitis B surface antigen, and antibody to hepatitis B core antigen. For white heterosexuals in the STD group, the prevalence of HBV infection was 6% for those with fewer than five recent partners vs 21% for those with five or more partners, and 5% for those with fewer than 50 lifetime partners vs 20% for those with 50 or more partners. For black heterosexuals in the STD group, no association was found between prevalence of HBV infection and number of recent or lifetime sexual partners. For the heterosexual student group (all white), the prevalence of HBV infection was 1.5% for fewer than three recent partners vs 14% for three or more partners, and 2% for fewer than ten lifetime partners vs 7% for ten or more partners. For white heterosexuals, the risk of acquiring HBV infection increases with increasing amounts of sexual activity and may reach a level similar to that of other groups previously recognized to be at high risk of acquiring hepatitis B.

Adult↗

Children from anonymous donors: an inquiry into homosexual and heterosexual parents' attitudes.

This study compared two groups of homosexual and heterosexual parents with respect to their attitudes towards the donor-origin of their children. All couples had applied at the Fertility Clinic for artificial insemination with anonymous donor sperm (AID). Both groups had used anonymous donors in order to conceive. However, the sexual orientation of the parents and the presence or absence of a social father was different in the two groups. By comparing such different families it was hoped to obtain insight into those factors which influence parents' attitudes concerning donor insemination. Twenty-five lesbian and 25 heterosexual parents were interviewed. The open-ended questionnaires solicited information on the following issues: attitudes towards secrecy/disclosure of the use of a donor, views on anonymity/identity registration of the donor, parents' cognitive and emotional representation of the donor. Response rates differed between the groups: all homosexual parents consented to the interview and 44% of the heterosexual parents did so. Parents' attitudes depended on several variables. The different family structures were related to different motivations for AID treatment. For heterosexual couples, the use of a donor offered them the opportunity to become a 'normal family'. For homosexual couples, creating a two-mother family unit meant going one step further in 'being different'. Attitudes towards the use of a donor were consequently different: heterosexual couples chose secrecy and donor anonymity. Homosexual parents intended to inform their children. Of these homosexual parents, 40% would prefer the identity of the donor to be registered. This evolution towards removal of the anonymity seemed to be encouraged by the openness surrounding the use of a donor itself. In both groups it remained difficult to reduce the donor to an anonymous sperm cell, fantasies and questions about the donor continued to exist over the years.

Adult↗

[Epidemiologic and clinical characteristics and clinical course of the HIV positive patient infected by heterosexual transmission].

We reviewed the features of patients with human immunodeficiency virus (HIV) infection, whose only way of acquisition was heterosexual contacts, analyzing differences with others risk groups. Epidemiological features (age, gender, family situation, socioeconomic status and sexual behavior), clinical manifestations immunological status, and evolution of 40 patients with HIV infection through heterosexual contact are studied, and compared with others risk groups. All were attended in our center from 1985 to October 1991; 15 were in stage IV. Along the study period, the proportion of heterosexual patients has steadily increased to represent 40% on total number of acquired immunodeficiency syndrome (AIDS) cases diagnosed in 1991. This study allow to establish two groups of patients depending on the gender. All men had had occasional sexual contacts with prostitutes, most had no stable partner, they mainly were between their fourth and sixth decade of life, and they were stable partners of seropositive patients or prostitutes, they had an averaged age significantly lower than men, and they were diagnosed in earlier stages. Two groups with different features can be established among the patients infected through heterosexual contacts. Men are adults, and acquired HIV infection through contacts with prostitute; they are diagnosed in late phases of the disease. On the contrary, women are younger, with no homogeneous patterns of behavior and they are diagnosed in earlier stages. Complications throughout the evaluation were similar in the heterosexual and in the other groups.

Adult↗

AIDS and heterosexual anal intercourse.

Heterosexual anal intercourse is rarely discussed in the scientific literature. Review of the literature suggests the silence is linked to ethnocentric discomfort about it among researchers and health care providers, coupled with the misconception that anal sex is a homosexual male practice, not heterosexual. Review of surveys of sexual practices suggest that heterosexual anal intercourse is far more common than generally realized, more than 10% of American women and their male consorts engaging in the act with some regularity. Sexually transmitted disease (STD) data, especially where only the rectum is infected with gonorrhea or other STD agents, buttresses survey data. Considerably more heterosexuals engage in the act than do homosexual and bisexual men, not all of whom participate in anal coitus. Anal intercourse carries an AIDS risk for women greater than that for vaginal coitus, just as receptive anal intercourse carries a very high risk for males. Infection with the AIDS virus is increasingly documented in women engaging in anal coitus with infected males, in America, Europe, and Latin America. Women in Western countries are less likely to continue HIV infectivity chains than are males engaging in same-gender anal intercourse.

Acquired Immunodeficiency Syndrome↗

Comparing breast cancer risk between lesbians and their heterosexual sisters.

PURPOSE: The purpose of this study was to explore the similarities and differences between lesbians and their heterosexual sisters in the established risks for developing breast cancer. METHODS: The design for this study was a matched (lesbian with heterosexual sister) cross-sectional, mail-back, anonymous survey. We distributed the surveys throughout the state of California to English-speaking women who identified themselves as lesbians, age 40 and older, and their sisters. Using the modified Gail Breast Cancer Risk model as well as other well-established factors associated with the development of breast cancer, we compared the breast cancer risk potential for 324 sister pairs (N = 648). Data were analyzed using paired t-tests, analysis of covariance (ANCOVA), McNemar's chi(2), or the Bowker statistic, as appropriate for the level of data. MAIN FINDINGS: The lesbians had significantly higher 5-year (p <.0001) and lifetime (p =.001) risk for developing breast cancer. The reasons for lesbians' predicted rate of breast cancer were most likely their higher scores on all pregnancy-related variables and the relatively high number of breast biopsies they reported. The lesbians had used birth control pills less (p <. 0001), had significantly fewer pregnancies (p <.0001), children (p <.0001), abortions (p <.0001), and miscarriages (p <.0001) as well as significantly more breast biopsies (p =.02) than did their heterosexual sisters. CONCLUSIONS: A lesbian who comes out to her clinician is relying on the clinician to be informed and be open to discuss her life. When a lesbian has a lump or a suspicious mammogram, she needs her clinician to advocate for her within the health care system because she is at higher risk for having cancer than a heterosexual woman.

Adult↗

Anthropometric analysis of homosexuals and heterosexuals: implications for early hormone exposure.

Early exposure to sex steroids is thought to be important in mediating the differentiation of male-typical sexual orientation. Bone morphology is a marker of childhood sex steroid exposure, because estrogens and androgens control sexual dimorphism in skeletal size. Anthropometric analysis of heterosexuals and homosexuals indicates that those bones, which become sexually dimorphic in childhood, but not those which become sexually dimorphic after puberty, are different in length in homosexuals and heterosexuals. Persons with a sexual preference for males have less long bone growth in the arms, legs and hands, than those with sexual preference for females. The data support the hypothesis that male homosexuals have had less steroid exposure during development than male heterosexuals and that female homosexuals have had greater steroid exposure during development than their heterosexual counterparts.

Adult↗

Sexual partner age preferences of homosexual and heterosexual men and women.

The sexual age preferences of 192 adults (equal groups of heterosexual men, heterosexual women, homosexual men, and homosexual women) were examined. Participants rated the sexual attractiveness of pictures of 15 male and 15 female faces arranged into five apparent average age categories ranging from 18 to 60 years. It was predicted that homosexual and heterosexual men would prefer younger partners of their preferred sex than would homosexual and heterosexual women and that age preference would not vary with participant age. Both predictions were supported, although homosexual women preferred older partners than expected. Results suggest that age and sex preferences develop independently.

Adolescent↗

Heterosexuals attitudes toward bisexual men and women in the United States.

This paper examines heterosexual adults attitudes toward bisexual men and women using data from a 1999 national RDD survey (N = 1,335). Ratings on 101-point feeling thermometers were lower (less favorable) for bisexual men and bisexual women than for all other groups assessed--including religious, racial, ethnic, and political groups--except injecting drug users. More negative attitudes toward bisexuals were associated with higher age, less education, lower annual income, residence in the South and rural areas, higher religiosity, political conservatism, traditional values concerning gender and sexual behavior, authoritarianism, and lack of contact with gay men or lesbians. White heterosexual women expressed significantly more favorable attitudes than other women and all men. A gender difference was observed in attitudes toward bisexuals and homosexuals: Heterosexual women rated bisexuals significantly less favorably than they rated homosexuals, regardless of gender, whereas heterosexual men rated male targets less favorably than female targets, regardless of whether the target was bisexual or homosexual.

Adult↗

Delayed application of condoms, withdrawal and negotiation of safer sex among heterosexual young adults.

The aim of this study was to examine delayed application of condoms and withdrawal among heterosexual young adults. Seven focus group discussions were conducted with heterosexual men and women aged 18-25 in Melbourne, Australia. The data revealed that delayed application of condoms and withdrawal are widespread. Delayed application of condoms can be divided into two categories--condom use 'after limited unprotected penetration' and condom use 'for ejaculation only'. The data reveal parallels between withdrawal and condom use 'for ejaculation only'. These two behaviours share the goal of avoiding unprotected ejaculation inside a partner, while allowing some unprotected intercourse. They are both more likely to occur in regular relationships than casual encounters, both are likely to be negotiated and both occur when there is no perceived risk of STI infection. In contrast, condom use 'after limited unprotected penetration' was likely to occur in casual encounters, and was likely to be unplanned and not negotiated. There is a need to ensure that heterosexual young adults use condoms and use them correctly. There is also a need to ensure that heterosexual young adults have the required skills to negotiate sexual activity and to negotiate condom use.

Adolescent↗

Virologic and immunologic determinants of heterosexual transmission of human immunodeficiency virus type 1 in Africa.

More than 80% of the world's HIV-infected adults live in sub-Saharan Africa, where heterosexual transmission is the predominant mode of spread. The virologic and immunologic correlates of female-to-male (FTM) and male-to-female (MTF) transmission are not well understood. A total of 1022 heterosexual couples with discordant HIV-1 serology results (one partner HIV infected, the other HIV uninfected) were enrolled in a prospective study in Lusaka, Zambia and monitored at 3-month intervals. A nested case-control design was used to compare 109 transmitters and 208 nontransmitting controls with respect to plasma HIV-1 RNA (viral load, VL), virus isolation, and CD4(+) cell levels. Median plasma VL was significantly higher in transmitters than nontransmitters (123,507 vs. 51,310 copies/ml, p < 0.001). In stratified multivariate Cox regression analyses, the risk ratio (RR) for FTM transmission was 7.6 (95% CI: 2.3, 25.5) for VL > or = 100,000 copies/ml and 4.1 (95% CI: 1.2, 14.1) for VL between 10,000 and 100,000 copies/ml compared with the reference group of <10,000 copies/ml. Corresponding RRs for MTF transmission were 2.1 and 1.2, respectively, with 95% CI both bounding 1. Only 3 of 41 (7%) female transmitters had VL < 10,000 copies/ml compared with 32 of 93 (34%) of female nontransmitters (p < 0.001). The transmission rate within couples was 7.7/100 person-years and did not differ from FTM (61/862 person-years) and MTF (81/978 person-years) transmission. We conclude that the association between increasing plasma viral load was strong for female to male transmission, but was only weakly predictive of male to female transmission in Zambian heterosexual couples. FTM and MTF transmission rates were similar. These data suggest gender-specific differences in the biology of heterosexual transmission.

Adolescent↗

Heterosexual transmission of HIV in Greece.

To provide further evidence for the heterosexual transmission of the acquired immunodeficiency syndrome (AIDS) in Greece we examined 53 Greek female steady heterosexual partners of 53 anti-HIV-positive men. Human immunodeficiency virus (HIV) transmission was estimated by the detection of anti-HIV antibodies. Our results showed that 27.8% (5 of 18) of the female partners of bisexuals, 33.3% (2 of 6) of intravenous drug abusers (IVDA), and 100% (4 of 4) of those who had lived for a long time in Africa were found anti-HIV positive. In contrast, only 4% (1 of 25) of the studied sexual partners of hemophiliac carriers were found to be HIV seropositive. The use of condoms seemed to be the most important factor in reducing HIV transmission. According to our results the duration of sexual relationships and the practice of anal intercourse did not increase the possibility of seroconversion. These results confirm the heterosexual transmission of HIV. However, further studies should be conducted to evaluate the relative role of various risk factors and the overall importance of heterosexual spread of HIV infections.

Acquired Immunodeficiency Syndrome↗