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Longitudinal study of persistent generalised lymphadenopathy in homosexual men: relation to acquired immunodeficiency syndrome.

42 homosexual or bisexual men with persistent generalised lymphadenopathy not attributable to an identifiable cause have been followed longitudinally since February, 1981. Lymphadenopathy was accompanied by fatigue, low-grade fever and/or night sweats (57%), splenomegaly (29%), leucopenia (40%), hypergamma - globulinaemia (76%), and diminished proportion and absolute numbers of helper T cells (95%). Of the 26 patients who had lymph node biopsy, all showed benign reactive hyperplasia. After 15-30 (median 22) months, 8 patients have met criteria for the diagnosis of acquired immunodeficiency syndrome (AIDS). This outcome was associated with previous heavy nitrite inhalant use, with the presence of night sweats, with leucopenia, and with the triad of constitutional symptoms, splenomegaly, and leucopenia. In addition, a lower mean absolute helper T cell count and an increased frequency of anergy to mumps intradermal antigen and of herpes simplex virus isolation distinguished these patients from those remaining in the cohort, who seem to be stable and in some cases to have improved.

Acquired Immunodeficiency Syndrome↗

Three-year prospective study of HTLV-III/LAV infection in homosexual men.

170 symptom-free homosexual men were recruited in London in 1982-83 and 133 were evaluable in 1983-85. Of the 33 who were seropositive to HTLV-III/LAV at entry, 4 (12%) progressed to AIDS, 16 (48%) progressed to persistent generalised lymphadenopathy (PGL), and 13 (40%) remained symptom-free. A further 15 men seroconverted during the study (7% per annum), of whom 8 progressed to PGL. Serial estimations of T lymphocyte subsets showed progressive reduction in T4 numbers in the seropositive groups, but these indices also varied widely in the seronegative group. Counts of T4 and T8 cells or T4/T8 ratio at entry were not of prognostic value. Seronegative subjects were as likely as seropositives to have abnormal immunological tests. Serial measurement of T lymphocyte subsets seems to be of little prognostic or clinical value in the monitoring of populations infected with the HTLV-III/LAV virus. The strongest association with prognosis was an episode of sexually transmitted disease in the six months before entry to the study. This supports the hypothesis that intercurrent infection may be an important co-factor in the acquisition of HTLV-III/LAV infection, and in subsequent disease progression.

Acquired Immunodeficiency Syndrome↗

Estimates of alcohol use and clinical treatment needs among homosexually active men and women in the U.S. population.

Concerns about dysfunctional alcohol use among lesbians and gay men are longstanding. The authors examined alcohol use patterns and treatment utilization among adults interviewed in the 1996 National Household Survey on Drug Abuse. Sexually active respondents were classified into 2 groups: those with at least 1 same-gender sexual partner (n = 194) in the year prior to interview and those with only opposite-gender sexual partners (n = 9,714). The authors compared these 2 groups separately by gender. For men, normative alcohol use patterns or morbidity did not differ significantly between the 2 groups. However, homosexually active women reported using alcohol more frequently and in greater amounts and experienced greater alcohol-related morbidity than exclusively heterosexually active women. Findings suggest higher risk for alcohol-related problems among lesbians as compared with other women, perhaps because of a more common pattern of moderate alcohol consumption.

Adolescent↗

Attitudes toward homosexuality among U.S. residents of Mexican descent.

This study examined attitudes toward lesbians and gay men in a sample of northern California residents of Mexican descent (N = 616), using 3-item versions of the Attitudes Toward Gay Men (ATG) and Attitudes Toward Lesbians (ATL) scales presented simultaneously in Spanish and English. Males attitudes toward homosexual men were significantly more negative than females attitudes, whereas females expressed relatively negative attitudes toward lesbians. Overall, respondents expressing negative attitudes endorsed more traditional gender attitudes than respondents with positive attitudes, tended to be older and less educated, had more children, were more likely to belong to a fundamentalist religious denomination and to attend religious services frequently, were more conservative politically, and were less likely to have personal contact with gay people. Further analyses revealed that associations between attitudes and education, number of children, personal contact, and religious attendance occurred mainly among respondents who spoke and read English (rather than Spanish) or identified with U.S. culture (rather than Mexican culture).

Adult↗

Maintenance of behavioral change in a cohort of homosexually active men.

OBJECTIVES: To assess associations of perceptions of sexual behavior change with actual risk behaviors and psychosocial variables, and to determine whether perceptions of behavior change predict subsequent behavior. DESIGN: Cohort study of homosexually active men. SETTING: Community health center in Boston, Massachusetts, USA. PATIENTS, PARTICIPANTS: Two hundred and sixty-two cohort members who participated in follow-up in 1989 and who had at least one subsequent visit. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Composite risk behavior variable, based on unprotected anogenital contact and number of partners. RESULTS: Of the 96% who had effected behavior change, 47% perceived that they were able to maintain those changes consistently and 58% wanted to make more changes. Perceptions of consistent maintenance were associated with lower risk behavior, lower perceived riskiness of behaviors and susceptibility to AIDS, and fewer barriers to behavior change. Desire for more change was associated with increased behavioral effort, fewer barriers to condom use, and greater perceived riskiness of current behavior. Among those with lower risk behaviors, perceived inconsistent maintenance predicted relapse to more risky behavior at the following visit. CONCLUSIONS: Perceived maintenance of behavior change is potentially useful in identifying individuals at risk of relapse from safer sex.

Acquired Immunodeficiency Syndrome↗

Disease manifestation among homosexual men with acquired immunodeficiency syndrome: a possible role of nitrites in Kaposi's sarcoma.

To identify risk factors that determine the major manifestations of the acquired immunodeficiency syndrome (AIDS), the authors analyzed data from three epidemiologic studies conducted by the Centers for Disease Control. The authors compared patients by outcome of disease. Eighty-seven homosexual patients (47 with Kaposi's sarcoma, 20 with Pneumocystis carinii pneumonia, and 20 with both) had participated in the earlier studies, and their interviews and laboratory test results were available. Compared with patients who have Pneumocystis carinii pneumonia only, patients with Kaposi's sarcoma and those with both diseases reported more different sexual partners, more recreational drug use, higher incomes and higher rates of non-B hepatitis. Multivariate analysis showed that the variable most strongly associated with Kaposi's sarcoma was the use of large quantities of nitrite inhalants. A multifactorial model is postulated to explain the various disease manifestations of AIDS. This study suggests that the use of nitrite inhalants may be a cofactor in the development of Kaposi's sarcoma. By identifying other cofactors, investigators may be able to define additional opportunities for prevention of the development of AIDS.

Acquired Immunodeficiency Syndrome↗

Homosexual men who engage in high-risk sexual behavior. A multicenter comparison.

To describe homosexual men who continue to engage in unprotected oral and anal sex, 601 men who attended three urban STD clinics and who had engaged in these behaviors with a male partner in the previous 4 months were interviewed regarding their sexual and drug-use behaviors. Although approximately one fourth of participants had engaged in 1 to 2 episodes of unprotected anal sex, more than 20% reported engaging in greater than 23 episodes. Higher frequency of anal sex was associated with lower condom use rates. Although 50% had primary relationships, less than 22% had sex with just one partner, and less than 10% were in relationships concordant for HIV-antibody status. Multiple regression analyses showed that number of drugs used each month, sex in a steady relationship, and Hispanic ethnicity were the most consistent predictors of risk behavior across sites. Careful evaluation of the diverse nature and characteristics of these men is essential to target risk-reduction programs for this population.

Adult↗

Factors influencing condom use in a sample of homosexually active men.

A sample of 502 homosexually active men were recruited from genitourinary medicine clinics and non clinic sources and interviewed in relation to their sexual behaviour and factors that might influence their use of condoms. Three hundred and eighty three men (76%) reported penetrative anal sex in the previous year. Ninety four (25%) had not used condoms in penetrative sex. Failure to use condoms was associated with unfavourable attitudes to them, not knowing close friends or partners who had HIV-related health problems, having fewer sexual partners and being in a closed monogamous relationship. On the other hand levels of awareness about the risks of unprotected anal sex and involvement in gay networks and social groups were not predictors of condom use.

Acquired Immunodeficiency Syndrome↗

The pattern of sexual politics: feminism, homosexuality and pedophilia.

Until recently sex and gender issues were thought to be biological or natural rather than political. The feminist movement largely changed perceptions of gender, and the gay and lesbian movements significantly altered conceptions of sex, so that what were once seen as permanent moral standards are now viewed as historical and political constructions. As views of these groups have moved towards social constructionism, perceptions of child sexuality have become more absolutist. Current attitudes towards child sexuality and representations of it resemble historical attitudes towards women and homosexuals. This article argues that there is a two-phase pattern of sexual politics. The first is a battle to prevent the battle, to keep the issue from being seen as political and negotiable. Psychological and moral categories are used to justify ridicule and preclude any discussions of the issue, and standard Constitutional guarantees are seen as irrelevant. The second phase more closely resembles traditional politics as different groups argue over rights and privileges. Feminist and gay/lesbian politics have recently entered the second phase, while pedophilia is in the first.

Adolescent↗

Attitudes toward homosexuality in Shreveport-Bossier City, Louisiana.

Two anonymous questionnaires assessing attitudes toward gay issues were administered to adults living in the Shreveport/Bossier City, Louisiana area. In both, demographic data were obtained regarding gender, education, religion, age and marital status. In the second questionnaire, family groups were given the questionnaire. In the first survey, the results generally supported previous findings that religiosity, gender, and education at or below the high school level appeared to be associated with negative attitudes toward gay and lesbian issues. The variable most frequently associated with positive attitudes toward gay and lesbian issues was whether or not the individual had at least one gay friend, relative, or acquaintance. In the second study, the questionnaire was analyzed in terms of the entire group of subjects, family groups, and family positions. This second questionnaire indicated that similarities are most likely to exist among mothers and daughters, and same sex siblings. In regard to family members, wives/mothers and daughters had more positive attitudes toward homosexuality than sons, fathers, grandparents, other relatives, and in-laws.

Attitude↗

Attitudes of psychologists and psychologists-in-training to homosexual women and men: an Australian study.

Homophobic reactions of Australian psychologists (n = 43), postgraduate psychology students (n = 17) and undergraduate psychology students (n = 44) were compared using Van de Ven's (1994) measures of cognitive, affective and behavioral dimensions of homophobia. Results suggested that undergraduates were significantly more homophobic than psychologists in their thinking, intentional behavior and feelings of fear or discomfort in relation to lesbians and gay men. No other significant group differences were found. Gender differences were found only in relation to one affective dimension of homophobia. Low levels of positive affective response to homosexuals were observed across groups and gender. The study underscores the importance of assessing homophobic response multidimensionally. Implications for the training of Australian psychologists are discussed.

Adult↗

Japan's progressive sex: male homosexuality, national competition, and the cinema.

This essay serves as a broad investigation of the origins of what came to be called the "gay boom" in 1990's Japanese cinema: a culmination of print media, television, and especially films which made the gay male not merely a visible (political) subject but also the site of displaced contestations of gendered (female) desire. The most visible transnational signifier of the "gay boom" was the 1992 film Okoge, a film which, in keeping with a Japanese trend which relocates the gay male as a safe displacement of female desire, posits the heterosexual female as the audience's point of identification in a film about the lives of gay Japanese men. Using this as a starting point, this essay seeks to explore how male homosexuality and gender construction operate within both Japanese nationalism and the transnational discourse of Japanese cinema's dissemination.

Art↗

Children of the closet: a measurement of the anxiety and self-esteem of children raised by a non-disclosed homosexual or bisexual parent.

This research examined whether a parent's non-disclosure of his or her homosexual or bisexual orientation within the family unit negatively affects self-esteem and anxiety in children, as measured in adulthood. Thirty-six subjects indicated that they had not known of their parent's sexual orientation until an average age of sixteen for the children of lesbian or bisexual mothers, and twenty-two for the children of gay or bisexual fathers. This group's scores on the Rosenberg Self-Esteem Scale, the Marlowe Crowne Social Desirabilty Scale and the State-Trait Anxiety Scale were compared to scores obtained by sixty-three participants who did not have a homosexual/bisexual parent. The number of years a secretive environment surrounded the child was measured, as were participants' attitudes about the secret sexual identity. Although the study did not find that adults previously raised with a closeted parent had significantly higher levels of anxiety or lower levels of self-esteem, results indicated that those who had been raised as children with non-disclosed lesbian mothers showed a significantly higher level of self-esteem than participants with heterosexual parents. Implications of the findings for the targeted population are discussed.

Adolescent↗

Sexually transmitted diseases and the use of condoms in a cohort of homosexual men followed since 1983 in Finland.

High rates of sexually transmitted diseases (STDs) were recorded among 235 homosexually active men at the start of a prospective follow-up study in June 1983 in Finland. The vast majority (88.5%) reported at least one STD, the most common of them being pubic lice (64.7%) followed by gonorrhoea (42.9%) and non-gonococcal urethritis (26.4%). Those 31 (13.2%) who were seropositive for HIV at the end of the study, had experienced more episodes of STDs than the seronegative individuals (p = 0.0027). Nine HIV seroconversions were noted during the follow-up of 5-40 months, all in individuals who had practised "unsafe" sex. The study participants were repeatedly given detailed advice for avoiding HIV infection, and a tendency towards "safer" sexual practises resulting in a decrease in incidence of most STDs, was noted during the course of the study. However, further spread of HIV is to be expected because 57% of the men still reported practising and sex at the end of the follow-up, and 42% of them without condoms.

Adolescent↗

Malignant lymphoma presenting as Kaposi's sarcoma in a homosexual man with the acquired immunodeficiency syndrome.

A homosexual man had Kaposi's sarcoma of the skin and lymph nodes. After a brief response to interferon, the patient developed new skin lesions. Massive bleeding in the gastrointestinal tract prompted endoscopy, which showed tumor involvement of the stomach, believed to be Kaposi's sarcoma. At autopsy, a diffuse lymphoma was found involving the skin and gastrointestinal tract, forming collision tumors in regions that contained Kaposi's sarcoma. Lymphomatous tissue, but not uninvolved lymph node or spleen, contained Epstein-Barr virus DNA, as shown by DNA hybridization studies. Epstein-Barr virus may play a role in the development of lymphoma in immunosuppressed patients. Unusual manifestations of tumors, such as the massive gastrointestinal bleeding seen in this case, may indicate the development of a second neoplasm.

Acquired Immunodeficiency Syndrome↗

Generalized lymphadenopathy in homosexual men.

The cases of 90 homosexual or bisexual men with generalized lymphadenopathy were studied by epidemiologic, clinical, pathologic, immunologic, and genetic methods. The patients ranged in age from 20 to 52 years and had histories of multiple sexually transmitted diseases and both recreational and prescription drug use. Histologically, their lymph nodes showed three patterns: explosive follicular hyperplasia; follicular involution with expansion of the paracortical area; and a mixed pattern of follicular hyperplasia and follicular involution in the same lymph node. The frequency of HLA-DR5 was significantly increased in these patients (p less than 0.005) compared with that in controls. All patients had impaired cell-mediated immunity. Opportunistic infections, lymphomas, or Kaposi's sarcoma subsequently developed in 15 patients who had had severe immune dysfunction for the previous 3 to 13 months. We suggest that generalized lymphadenopathy is part of the spectrum of a disorder manifested by acquired immunodeficiency, opportunistic infections, Kaposi's sarcoma, and malignant lymphomas.

Adult↗

AIDS prevention in homosexual and bisexual men: results of a randomized trial evaluating two risk reduction interventions.

This study evaluates two AIDS risk-reduction interventions targeted at homosexual and bisexual men. Participants were randomized into two peer-led interventions: both involved a lecture on 'safer sex', and one provided a skills-training component during which men could discuss and rehearse the negotiation of safer sexual encounters. Follow-up data collection assessed self-reported changes in sexual behavior at 6 and 12 months. Skills training increased condom use for insertive anal intercourse. In sessions providing skills training, condom use increased, on average, by 44% between pre-test and second follow-up compared with only 11% on average in sessions which did not provide such training.

Acquired Immunodeficiency Syndrome↗

Sustaining safe sex: a longitudinal study of a sample of homosexual men.

OBJECTIVE: TO assess the maintenance of safe sexual practice. (We use the term 'safe' sex throughout the paper, since 'safe' is the term adopted by the Australian National Committee on AIDS). DESIGN: Maintenance was assessed by comparing sexual behaviour with both regular and casual partners reported in a 1986/1987 survey (time 1) with behaviour reported in a second survey in 1991 (time 2). METHOD: The 145 homosexually active participants were a non-clinical sample recruited in 1986/1987 by advertisement and followed-up in 1991. A structured questionnaire was administered at both times. Items included questions about the nature of the men's sexual relationships and their sexual practices. RESULTS: Our findings indicate that the majority of men had sustained safe sex practices. HIV prevention strategies adopted included condom use, avoidance of anal intercourse and negotiated safety (i.e., the negotiated practice of unprotected anal intercourse within regular partnerships of concordant serostatus). CONCLUSIONS: Negotiated safety is not the same as relapse.

AIDS Serodiagnosis↗