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PubMed1983

Kaposi's sarcoma and variably acid-fast bacteria in vivo in two homosexual men.

Current epidemiologic data suggest that a possible infectious and contagious microbial agent is responsible for the recent outbreak of Kaposi's sarcoma and the acquired immunodeficiency syndrome affecting young homosexual men. In this histopathologic study, rare foci of acid-fast, and Giemsa-stained coccoid forms, and more rare foci of Gram-variable coccoid forms, were observed within the microscopic skin biopsy specimens from two young homosexual men with Kaposi's sarcoma. These findings, in addition to other previously reported histopathologic findings of similar bacteria in vivo in "typical" cases of Kaposi's sarcoma occurring in elderly Jewish men, suggest that bacteria may be implicated in the pathogenesis of Kaposi's sarcoma.

Acquired Immunodeficiency Syndrome↗
PubMed1982

Kaposi's sarcoma in young homosexual men: a histopathologic study with particular reference to lymph node involvement.

Recent reports indicate an increased incidence of Kaposi's sarcoma in young homosexual men. In contrast with the form of the disease seen in the elderly, in which skin involvement is usually confined to the lower extremities, lymph node involvement is rare, and disease progression is relatively slow, Kaposi's sarcoma in young homosexual men is characterized by diffuse skin and lymph node involvement and a fulminant disease course.

Adult↗
PubMedDate not supplied

Inverts, perverts, and Mary-Annes. Male prostitution and the regulation of homosexuality in England in the nineteenth and early twentieth centuries.

The paper examines the relationship between patterns of male prostitution and the changing definitions (and regulation) of homosexual behavior in the late nineteenth and early twentieth centuries. A series of problems is explored. First, an attempt is made to delineate the changing patterns of legal and ideological control in the nineteenth century. This leads to a discussion of the second problem, the ways in which the social and legal context dictated the close relationship between the homosexual subcultures and the cash nexus represented by the prostitution relationship. The third problem concerns the ambivalent nature of the "prostitution," the complex self-concepts that developed, and the factors inhibiting the development of a distinctive subculture of male prostitution. The differences between female and male prostitution are discussed. The paper concludes by underlining the ambivalence of "male prostitution".

England↗
PubMedDate not supplied

The pink triangle. The persecution of homosexual males in concentration camps in Nazi Germany.

Having analyzed the fragmentary records of Nazi concentration camps, the author reports on the number and treatment of male homosexual prisoners. The total number of inmates officially defined as homosexual is estimated at about 10,000, although the number incarcerated varied greatly from camp to camp and as the war progressed. Pink-triangle prisoners had low social status, often were isolated from other inmates, and as compared to political prisoners and Jehovah's Witnesses, more frequently were given the most difficult work assignments and less frequently were assigned to light duties. They had a higher death rate and a lower survival rate upon release. Suicide rates were not significantly different from those of the other inmate groups studied. Pink-triangle prisoners were not subjected to exceptionally cruel treatment in all camps and at all times, however, and were not the only group of prisoners subjected to extreme abuse.

Concentration Camps↗
PubMed1981

Viral hepatitis in homosexual men.

We studied 33 episodes of acute viral hepatitis in homosexual men to determine the type of hepatitis seen in this population. Seventy percent were caused by type A hepatitis, and 30% by type B hepatitis. None were due to non-A, non-B hepatitis. A high proportion of patients presenting with either type of acute hepatitis had evidence of previous infection with the other type: Seventy percent of patients with type B hepatitis had previous infection with type A, and 74% of patients with type A hepatitis had previous infection with type B. This study shows that, in homosexual men, hepatitis A, like hepatitis B, is a sexually transmitted disease.

Acute Disease↗
PubMedDate not supplied

Hepatitis B among homosexual men in The Netherlands.

In 1980-1981 a study for the presence of markers of hepatitis B virus was done among 2, 946 homosexual men living in The Netherlands, mainly in Amsterdam. Serologic evidence of a past or present hepatitis B infection was found in 60.3% of this group, and the prevalence differed significantly among the different age groups. Of the total population studied, 4.8% were positive for HBsAg. This prevalence is very high in comparison to that in the general Dutch population, among whom the prevalence of hepatitis B is low, as is shown by the fact that the prevalence of HBsAg was 0.22% among a large group of Dutch first-time blood donors. Another blood sample was collected two to 20 months after the first sample from 316 male homosexuals who were initially negative for hepatitis B markers. It was found that 36 persons had seroconverted, most of them without clinical manifestations of hepatitis. The annual attack rate of hepatitis B in this group was calculated as 27.6% and differed significantly among the different age groups.

Adult↗
PubMed1995

High grade anal dysplasia in visually normal mucosa in homosexual men: seven cases.

BACKGROUND: Anal cancer and anal human Papillomavirus (HPV) infection are increased in homosexual men. METHODS: We screened high risk homosexual men as part of a longitudinal study examining the effect of HIV infection on the risk of development of high grade anal intraepithelial neoplasia (AIN II, III). RESULTS: We found seven men who had histological evidence of AIN II-III with visually normal findings by anoscopy. Two men were HIV-seronegative, five were HIV-seropositive, and only one of the HIV-seropositive men had a low CD4 count < 200. Abnormal cytological results seen over follow-up periods of 3 months to 2.5 yr suggest the persistence of visually inapparent anal abnormalities. Two of the men had had small internal warts at earlier examinations, and three of the seven men subsequently developed visually abnormal anal findings. All men had HPV 16 DNA detected at some point. CONCLUSIONS: We hypothesize that high grade anal neoplasia may develop deep in the glands and can be detected by cytology before visible lesions are detected even with the aid of a colposcope. However, the implications of finding high grade anal cytology are not known at this time. Natural history studies are ongoing.

Adult↗
PubMed1995

Influence of a freshman-year panel presentation on medical students' attitudes toward homosexuality.

PURPOSE: To explore medical students' changes in group attitude toward homosexuality following mid-year exposure as freshmen to a panel presentation on the topic and, later, following clinical experiences. METHOD: At the beginning, middle, and end of 1991-92 and during the psychiatry clerkship in 1993-94, all 186 students in the class of 1995 at the Louisiana State University School of Medicine in New Orleans were asked to complete anonymously the Index of Attitudes toward Homosexuals. The two subsequent entering classes were also surveyed, at the beginning and in the middle of their freshman year. RESULTS: Group attitudes among the three consecutive classes were remarkably consistent. The original cohort displayed a decrease in group homophobic attitude over time, with the reduced mean score at mid-year continuing its downward trend at year's end, though rebounding somewhat by the junior year. However, the group mean score remained in the low-grade homophobic category throughout the three-year study. CONCLUSION: That the mean scores of the three classes remained at the low-grade homophobic level suggests the desirability of establishing an ongoing forum to enable students to examine all deeply held beliefs that may affect patient care.

Adolescent↗
PubMedDate not supplied

[Etiopathogenesis of true male homosexuality (androgenic insufficiency?)].

Clinical and experimental studies have suggested the author the possibility that an androgenic insufficiency, during embryogenesis or the perinatal period, may be a determinant factor in the pathogenesis of the anomalies of homosexual behavior. In the author's opinion, the androgenic anomalies seen in the genuine male homosexual have no pathogenic significance, but are a repetition of what occured during embryogenesis of the perinatal period, at the time when these anomalies had a pathogenic role.

Androgens↗
PubMed1994

Changes in AIDS survival time in two San Francisco cohorts of homosexual men, 1983 to 1993.

BACKGROUND: During the first decade since the recognition of the acquired immunodeficiency syndrome (AIDS), new therapies have been introduced and the frequency of clinical manifestations has changed. The impact of these changes on AIDS survival, however, has not been well characterized. DESIGN: A prospective cohort study of the outcomes of human immunodeficiency virus (HIV) infection. SETTING: Homosexual and bisexual men residing in San Francisco, Calif, recruited in 1983 and 1984 for two prospective studies and followed up for more than 9 years with clinical examinations. PARTICIPANTS: A total of 761 HIV-positive homosexual and bisexual men. MAIN OUTCOME MEASURES: Survival time from a CD4 lymphocyte count at 0.20 x 10(9)/L (200/microL) and from a clinical AIDS diagnosis to death. RESULTS: Median survival time from a CD4 lymphocyte count at 0.20 x 10(9)/L increased from 28.4 months in the October 1983 to November 1986 period to 40.1 months in the November 1986 to November 1988 period and is estimated at 38.1 months in the November 1988 to February 1993 period. Patients diagnosed with Pneumocystis carinii pneumonia (PCP) accounted for most of this increase with a gain in median survival time of 9.7 months (P = .0009), compared with a nonsignificant decline in the survival time of those patients without a PCP diagnosis. Multivariate analysis showed that rate of CD4 lymphocyte loss (P < .001) and receipt of both PCP prophylaxis and antiretroviral therapy (P = .04) were significantly associated with longer survival time, whereas antiretroviral therapy alone was not (P = .81). Time to death from a clinical AIDS diagnosis was 14.7 months in the 1983 to 1986 period, 19.1 months in the 1986 to 1988 period, and an estimated 15.7 months in the 1988 to 1993 period. CONCLUSIONS: Survival time from a CD4 lymphocyte count at 0.20 x 10(9)/L has improved significantly by about 1 year; yet survival time using the 1987 AIDS case definition has shown small improvement. The largest increase in survival time from a CD4 lymphocyte count at 0.20 x 10(9)/L was in patients diagnosed with PCP, suggesting that PCP prophylaxis and treatment were more important factors in longer survival time than antiretroviral therapy.

AIDS-Related Opportunistic Infections↗
PubMed1993

The relationship between T-cell levels and CMV infection in asymptomatic HIV-1 antibody-positive homosexual men.

To investigate the relationship between cytomegalovirus (CMV) infection and progression of HIV-1 disease, a group of 234 asymptomatic, HIV-1 antibody-positive homosexual men were examined for CMV isolation and levels of CMV IgM antibodies, CMV IgG antibodies, and CD4+ and CD8+ T-lymphocytes. CMV IgG antibodies were present in 100% and CMV IgM antibodies in 22% of the men. CMV was isolated from the semen of 45% of the men. No relationship was observed between CMV IgM antibodies and CMV in semen or CD4+ levels. CD4+ cell levels were significantly lower in those from whose semen CMV was isolated. In addition, an inverse relationship was observed between the concentration of CMV in semen and CD4+ levels. We postulate that the seminal tract may be a reservoir for systemic CMV infection in HIV-infected homosexual men. Reinfection from this or other sources may result in recurrent stimulation of HIV-1 replication and lead to a further decline in CD4+ cells. Clarification of whether persistent CMV infection is secondary to HIV-1-induced immunodeficiency or, conversely, promotes a more rapid decline in immunocompetency will require follow-up studies.

AIDS-Related Opportunistic Infections↗
PubMed1993

Immune function and neuropsychological performance in HIV-1-infected homosexual men.

This study explores the relationship of immune dysfunction to the neuropsychological performance of individuals infected with HIV-1. Fifty-five HIV-positive homosexual men and 37 negative homosexual controls were evaluated using neuropsychological measures, physical exams, and measures of immune functioning. There were no significant differences favoring HIV-negative subjects over HIV-positive subjects. HIV-positive subjects, in fact, performed slightly better on attention and memory procedures. The HIV-positive subjects were then stratified according to the Centers for Disease Control symptom groupings (Group II, asymptomatic, n = 19; Group III, lymphadenopathy, n = 17; and Group IVA or C-2, symptomatic, non-AIDS, (n = 19). There were no significant neuropsychological differences among the three CDC groups. The HIV-positive subjects were also stratified on two measures of immune functioning: absolute CD4 counts (< 200, 201-400, > 400) and beta 2-microglobulin (beta 2M) (> or = 5.0, 3.0-5.0, < 3.0). Individuals with greater immune compromise, as measured by beta 2M, were more impaired on measures of attention and memory and had greater overall neuropsychological impairment (p < 0.05). Furthermore, 57% of the subjects who were abnormal on beta 2M were also impaired on measures of attention and memory, whereas only 14% of those with normal beta 2M were impaired on these same measures (p < 0.05). These results suggest that HIV-positive asymptomatics without evidence of immune compromise do not appear to be at greater risk of cognitive impairment than HIV-negative controls. However, for those HIV-positive individuals who are immune-compromised (even while asymptomatic), there is increased risk of neuropsychological impairment. These results also suggest that knowledge of serostatus and the use of the CDC classification system alone are insufficient in exploring the development of neuropsychiatric changes in HIV-1 infection.

Adolescent↗
PubMed1994

[A sexo-analytic view on homosexuality].

After having defined the terminology, the author attempts to identify homosexuality through the sexual individuation process and to trace its different ontogenic inconsistencies. A typology based on non conformity of gender and the heterophobia is suggested. Two clinical case examples will be given to further illustrate the sexoanalytic treatment of egodystonic homosexuality.

Adult↗
PubMed1993

[HIV infection and unsafe sexual behavior among young homosexual men in Amsterdam, 1992].

OBJECTIVE: To determine the prevalence of sexual behaviour with the risk of HIV transmission among young homosexual men in Amsterdam. DESIGN: Point prevalence study. SETTING: Amsterdam. METHODS: Participants were recruited through advertisements and in gay bars and a STD clinic in the period October 1991-1992. A questionnaire regarding sexual behaviour was completed, and blood samples were drawn to test for presence of serological markers of HIV infection, hepatitis B and syphilis. RESULTS: Enrolled in the study were 154 men (mean age: 25 years). The prevalence of antibodies against HIV was 5% and that of hepatitis B 22%. Receptive anogenital intercourse with steady partners in the previous six months was reported by 60% (74% sometimes without a condom), with non-steady partners by 41% (40% without a condom). The figures for insertive anogenital intercourse were: steady partners: 45% (74%); non-steady partners: 49% (41%). Overall 43% (66/153) reported at least one unprotected anogenital contact in the previous six months. The presence of HIV antibodies was correlated with the number of partners with whom anogenital sexual intercourse was practised. CONCLUSION: The HIV prevalence (5%) was relatively low. Considering the high prevalence of unsafe sexual behaviour further spread of HIV infection among young homosexual men is to be expected.

Adolescent↗
PubMed1993

[Demonstration of Chlamydia trachomatis IgG using ELISA in transsexuals and homosexuals].

In this study, 27 sera samples collected from transsexuals and homosexuals have been searched for Chlamydia trachomatis IgG antibodies with ELISA. Anti-Chlamydia IgG have been found positive in 18 cases (66.7%). In our study group there were no clinical symptoms except one case of transsexuals. Seropositivity rate of homosexuals (8/15) and transsexuals (10/12) were found to be important for transmitting the disease.

Adult↗
PubMed1993

[Clinical comments on female homosexuality].

In psychoanalytic theory, homosexual women are regarded as being possessed by violent hatred of the mother. They are held to identify with the male or the phallic and to display an absence of "normal" femaleness. Their attendant immaturity makes them incapable of love. The author takes issue with the assumption that normality is synonymous with mature, reciprocal heterosexuality. With reference to a case study of a homosexual woman, she traces the structure of a lesbian love relationship. The patient is the involuntary witness of sexual intercourse between the parents. The mixture of alarm and excitement which this arouses sparks off female desires that revive early libidinous experiences with the mother. The girl desires her mother, without however identifying with the father. In her later relationships with women she does not relate to her partners as a disguised man but as a woman. Identification with the father serves as a defence against the desire for-and the fear of-identification at a female level.

Adult↗
PubMedDate not supplied

[Counseling male adolescents with homosexual orientation and their parents].

In counseling of adolescents with a homosexual orientation and their parents we are not only confronted with the typical conflicts of this developmental phase as those between autonomy and dependence. Moreover we are concerned with specific problems which--because of the coming out--result for the adolescent himself as well as for the whole family system. It is important in such counseling that the following three questions are considered: the characteristic tendencies of separation of the adolescent and the parental reactions to it, the parental acceptance of the homosexual orientation of their son, and the coming out process for the adolescent and the family as a whole.

Adaptation, Psychological↗
PubMed1996

Racial differences in rate of CD4 decline in HIV-1-infected homosexual men.

OBJECTIVE: To determine whether racial differences exist in the rate of CD4 lymphocyte decline in HIV-1-infected homosexual men. DESIGN: Prospective cohort study. STUDY POPULATION: Non-Hispanic white (n = 321) and black (n = 102) HIV-1-seropositive homosexual and bisexual men were recruited from the Baltimore/Washington, DC metropolitan areas between 1984-1985 and 1987-1990, and evaluated semiannually. MAIN MEASUREMENTS: Changes in CD4 lymphocyte count and CD4 percentage over time were analysed using linear regression methods for the 271 white and 69 black participants who had at least four semiannual CD4 lymphocyte measurements. RESULTS: Rate of decline in CD4 lymphocyte count over 6 months was much slower among black than white seroprevalent men at all levels of baseline CD4 count (baseline 201-400 x 10(6)/l: + 0.24 versus -17.7 x 10(6)/l; 401-600 x 10(6)/l: -11.3 versus -23.9 x 10(6)/l; 601-800 x 10(6)/l: -15.1 versus -35.2 x 10(6)/l; > 800 x 10(6)/l: -4.3 versus -42.7 x 10(6)/l for black versus white, respectively), although this was only statistically significant for the lowest and highest strata of baseline CD4 count. These racial differences persisted after adjustment for recruitment period (1984-1985 or 1987-1990), follow-up duration, age and zidovudine therapy or Pneumocystis carinii pneumonia prophylaxis. Similar findings were observed among the 70 white and 11 black seroconverters. Black participants were also less likely than a subgroup of white participants matched on baseline CD4 lymphocyte count to be HIV-1 p24 antigen-positive. However, after acid dissociation of samples initially p24 antigen-negative, there were no significant differences in the prevalence of p24 antigenemia at enrollment or after 1 year of follow-up. CONCLUSIONS: This analysis suggests a more gradual decline in CD4 lymphocyte count among black than white Americans. The clinical significance of and reasons for this are unclear, but the lower prevalence of p24 antigenemia due to immune complexing among black Americans suggests that racial differences in the immune response to HIV may exist. Additional studies are needed to validate these findings in a larger cohort of non-whites, and to assess their relationship with other measures of cell-mediated immune function.

Adult↗