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The socialization of homosexuality and heterosexuality in a non-Western society.

Data on the Sambia--a tribe living in Papua New Guinea--are presented to demonstrate how Sambia males develop a homosexual orientation in boyhood and adolescence, then switch to become heterosexuals in adulthood. Social learning theory is used to explain how sexual orientation in the Sambia change from homo- to heterosexual during the transition to adulthood. Whereas most learning analyses of sexual orientation are based on data from Western cultures, this manuscript extends that literature to deal with a non-Western culture. While including Pavlovian and operant conditioning, which is stressed in many learning analyses of sexual learning, the present analysis also includes detail on the social and cognitive learning principles that are important in understanding the learning of sexual orientation and behavior.

Adolescent↗

Syphilis, hepatitis A and hepatitis B seromarkers in homosexual men.

Two hundred homosexual men were investigated for prevalence rates of syphilis, hepatitis A (HAV) and hepatitis B (HBV). A reactive Treponema pallidum haemagglutination test (TPHA) was found in 56.3% of the participants. In 81.7% HBV seromarkers were detected. Hepatitis B surface antigen (HBsAG) was present in 6.6%. Anti-HAV was found in 51.0%. Risk factors for acquisition of these infections are discussed.

Berlin↗

Protozoal enteric infections in homosexual men.

The prevalence of enteric protozoal infections was examined in a group of 200 homosexual men. Entamoeba histolytica (E. histolyt .) was found in 22.8%, apathogen amoeba in 54.5% and Giardia lamblia (G. lamblia) in 9.1% of the participants. Antibodies against E. histolyt . were significantly higher in subjects carrying E. histolyt . than in the group with apathogen amoeba and in uninfected participants. Clinical symptoms were not associated with protozoal infection. The analysis of a number of variables showed that oral-anal sex and promiscuity were the two most important risk factors for protozoal infection. The clinical significance of protozoal enteric infections and their possible relation to the acquired immune deficiency syndrome (AIDS) is discussed.

Adolescent↗

[Manifestation of AIDS in HIV infected homosexual males with lymphadenopathy syndrome].

26 homosexual men with HIV-infection and lymphadenopathy syndrome were examined between 1982 and 1984 and prospectively observed over a period of 58 months (median, range 53-69 months). 16 (61.5%) developed full blown AIDS within a median period of 41 months (23-63 months). 12 of them died 50 months (median, range 29-67 months) after the first examination. 10 patients showed no symptoms of AIDS after a median observation time of 57 months (54-63 months). A panel of clinical symptoms, signs of concomitant infections, chemical and immunological analyses, including a lymphnode biopsy were correlated to the course of the disease. A decreased proportion of CD4-cells and a lower CD4/CD8 ratio in the lymphnode suspensions at the first examination in patients with disease progression were the only parameter which correlated significantly with the development of AIDS.

AIDS-Related Complex↗

Lymphadenopathy and antibodies to HTLV-III in homosexual men. Clinical, laboratory and epidemiological features.

The study provides information on the epidemiology of HTLV-III infection and the lymphadenopathy syndrome (LAP) in 374 German homosexual men. Sexual contacts in the USA and rectal enemas before receptive anal intercourse are the main risk factors associated with virus transmission. HTLV-III seropositivity is significantly correlated with LAP. Prominent clinical signs are infrequent. Immunological and haematological abnormalities are prevalent, and the retrovirus infection is frequently associated with serological markers of other viruses (hepatitis B, herpes group viruses). Lymphadenopathy as a manifestation of HTLV-III infection is discussed within the context of AIDS-related disorders.

Acquired Immunodeficiency Syndrome↗

[Follow-up in HIV-infected homosexual males with lymphadenopathy syndrome].

26 homosexual men with antibodies to HIV and generalized lymphadenopathy were examined between 1982 and 1984. Lymphadenopathy was accompanied by clinical symptoms such as fever, diarrhoea and weight loss (50%), moderate leukopenia (15%), lymphocytosis (50%), hypoergy to intraepidermal skin test with recall-antigens (12%), elevated serum levels of IgG (62%), IgA (23%), IgM (19%), beta-2-microglobulin (76%) and neopterin (69%), diminished absolute numbers of CD4-helper cells in the peripheral blood (24%) and an inversion of the ratio CD4-helper cells/CD8-suppressor cells both in blood (64%) and in lymph nodes (36%). Mitogen induced lymphocyte proliferation was significantly lower and the serum levels of gamma-interferon were significantly higher than in healthy controls. Lymph node biopsy revealed only nonspecific reactive hyperplasia with follicular hyperplasia in 54%, a mixed pattern of both follicular hyperplasia and follicular involution with paracortical expansion in 25% and follicular involution with paracortical expansion in 21%. 22 patients were followed longitudinally for a median time of 37 months (33-51 months). 10 patients (46%) developed full-blown AIDS within a median period of 35 months (24-46 months) after first examination and 43 months (36-77 months) after the anamnestic onset of the lymphadenopathy syndrome. The parameters distinguishing these patients from those without progression of disease were higher serum levels of gamma-interferon, higher relative and absolute numbers of CD8-suppressor cells in the peripheral blood, a reduced number of CD4-helper cells in the lymph nodes, and a lower CD4/CD8 ratio as well in the peripheral blood as in the lymph nodes.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS-Related Complex↗

Is aggressive management of perianal ulcers in homosexual HIV-seropositive men justified?

A study was undertaken to assess the etiology, optimal diagnostic method, and incidence of healing of perianal ulcers in HIV-seropositive men. Between March 1990 and December 1991, 26 HIV-seropositive homosexual or bisexual males were referred with perianal ulcerations. According to CDC criteria, three (12 percent) were Class II, six (23 percent) were Class III, and 17 (65 percent) were Class IV. Eighteen patients had one ulcer, five had two ulcers, and two had three ulcers. In one patient the ulcer was circumanal. Patients with superficial erosions were not included. Biopsies were obtained in 23 patients for routine microscopy, HIV, cytomegalovirus, herpes simplex virus, and acid-fast bacilli. Biopsy revealed an immunoblastic lymphoma in one patient. A comparison of microscopy and culture results revealed culture to be more helpful in determining the etiology of these ulcers. Medical treatment included reverse transcriptase inhibitors (zidovudine, dideoxyinosine, and dideoxycytosine), oral and topical Zovirax (Burroughs Wellcome, Research Triangle Park, NC), ganciclovir, and oral broad-spectrum antibiotics. Surgical treatment included lateral internal sphincterotomy in three patients and seton placement in one patient. Follow-up for at least four weeks was obtained in 22 patients. Overall, healing occurred in 15 patients (68 percent): three (20 percent) were Class II, four (27 percent) were Class III, and eight (53 percent) were Class IV. Healing occurred in all four patients who underwent surgical treatment. In conclusion, aggressive diagnostic maneuvers allow the use of both medical and conservative surgical measures to successfully treat the majority of perianal ulcers in this patient population.

Adult↗

Cloacogenic carcinoma of the anorectum in homosexual men: an observation of four cases.

Cloacogenic carcinoma of the anorectum is an uncommon neoplasm which arises from the transitional zone (cloacogenic) epithelium. The transitional zone epithelium is derived from the embryonic cloacogenic membrane as is the epithelium of the vagina and uterine cervix in the female. Four cases of cloacogenic carcinoma in male homosexuals who have engaged in longstanding receptive and anal intercourse have been observed. This observation, along with the realization that the anorectal transitional zone shares a common embryologic origin with the uterine cervix, a site of cancer long known to be associated with factors related to sexual intercourse, leads to the serious question of the etiologic potential of receptive anal intercourse in the development of cloacogenic carcinoma.

Adult↗

Combined effects of HIV-infection status and psychosocial vulnerability on mental health in homosexual men.

The present study examines psychiatric symptomatology and syndromal depression among 174 HIV+ and 760 HIV- homosexual men enrolled in the Pittsburgh site of the Multicenter AIDS Cohort Study (MACS). A central study goal was to determine whether men's psychosocial status in the areas of demographics, social supports, and coping, in combination with their HIV-infection status, was associated with mental health. Cross-sectional analyses indicated that HIV+ men had significantly higher levels of psychiatric symptomatology and syndromal depression than HIV- men. However, multivariate analyses showed that these associations only appeared among HIV+ men with certain psychosocial characteristics. HIV+ men who were younger, lacked full-time employment, claimed relatively high support from their relatives, and demonstrated high use of active behavioral coping strategies were at greater risk for psychiatric symptomatology and/or syndromal depression. Further, sense of mastery and frequent use of avoidant coping strategies were highly predictive of psychiatric outcomes irrespective of HIV status. The findings suggest that knowledge of an individual's HIV status per se will be inadequate for valid assessment of psychological risks. Rather, any association of HIV status and mental health will depend largely on other psychosocial characteristics that foster vulnerability or resistance to distress in these men.

Adaptation, Psychological↗

[Diversification in old age - the influence of sexual orientation, based on the situation of homosexual men].

This contribution provides an overview of the discussion on living arrangements and needs of homosexual men in old age. The term "living arrangements" refers to the scope of activities arising from the interaction between external, material/social resources and personal capacity as well as competence. External resources and personal competence change as a person ages and, depending on the given biographical constellation, influence the living arrangements of ageing people in different ways. Furthermore, these arrangements are also affected by social and by cultural shifts/developments, leading to increased differentiation of life situations in old age, and to individual experiences of ageing. The contribution therefore discusses research findings on biographical experience, living arrangements, needs and examples of self-help concepts arising within this particular group of ageing individuals. The aim is to foster understanding of requirements in ageing populations within the diversity of histories, sexualities and living arrangements.

Acquired Immunodeficiency Syndrome↗

Extreme skewing of X chromosome inactivation in mothers of homosexual men.

Human sexual preference is a sexually dimorphic trait with a substantial genetic component. Linkage of male sexual orientation to markers on the X chromosome has been reported in some families. Here, we measured X chromosome inactivation ratios in 97 mothers of homosexual men and 103 age-matched control women without gay sons. The number of women with extreme skewing of X-inactivation was significantly higher in mothers of gay men (13/97=13%) compared to controls (4/103=4%) and increased in mothers with two or more gay sons (10/44=23%). Our findings support a role for the X chromosome in regulating sexual orientation in a subgroup of gay men.

Case-Control Studies↗

Supplementary analyses regarding Langevin, Langevin, and Curnoe's (2007) findings on fraternal birth order in homosexual men.

A recent article by Langevin, Langevin, and Curnoe (2007) reported mixed results regarding the fraternal birth order effect, that is, the repeatedly observed finding that older brothers correlate with homosexuality in later-born males. Using a fraternal birth order index computed as older brothers minus younger brothers, Langevin et al. found that the "homoerotic" probands were born later among their brothers than were the "heteroerotic" probands in their full sample (N = 1194) and in their subsample over age 19 (N = 1122), but not in their subsample over age 31 (N = 698) or in their subsample with mothers over age 46 at the proband's birth (N = 727). The present writer concluded that the results obtained with the larger samples are more reliable, based on analyses demonstrating that (1) the larger samples are unlikely to be seriously affected by incomplete sibships, and (2) the smaller samples have poor statistical power. A separate analysis, based on an approximate reconstruction of Langevin et al.'s raw data, indicated that their heteroerotic probands reported a ratio of 104 older brothers per 100 older sisters, which is close to the normative population value of 106, whereas their homoerotic probands reported a ratio of 137, indicating a statistically significant excess of older brothers. These results suggest that Langevin et al.'s data showed significant evidence of a fraternal birth order effect and that their data were consistent with previous studies of this phenomenon.

Age Factors↗

Chemotherapy in advanced Kaposi's sarcoma. Implications for current cases in homosexual men.

Kaposi's sarcoma has recently appeared in an aggressive form in young, previously healthy, homosexual men. The disease in these patients corresponds most closely to disseminated Kaposi's sarcoma common in areas of Africa. This and the underlying acquired immune deficiency in the current patients in the United States affect the choice of appropriate therapy. Because Kaposi's sarcoma in these patients is rapidly progressive, it often requires aggressive systemic therapy, but this can be difficult given the patients' susceptibility to opportunistic infections. Reports from Africa suggest that Kaposi's sarcoma is very responsive to several chemotherapeutic agents, but these data must be interpreted cautiously because of problems in study design and differences between cases in Africa and the United States. This report reviews the clinical classification of Kaposi's sarcoma and the reported results of chemotherapy in patients with advanced disease. Implications of this experience in the treatment of recent cases in the United States are discussed.

Acquired Immunodeficiency Syndrome↗

Primary central nervous system lymphoma in homosexual men. Clinical, immunologic, and pathologic features.

Primary central nervous system lymphoma constitutes one of the criteria for the acquired immune deficiency syndrome (AIDS), yet a paucity of information is currently available regarding the clinical, immunologic, or pathologic features of these patients. Six homosexual men presenting with primary central nervous system lymphoma were evaluated. Five of these patients presented with altered mental status. All lymphomas were intracranial. B cell immunoblastic sarcoma was found in five. Immune phenotyping studies performed in five patients revealed monoclonal lambda light chain in three, whereas one expressed only IgG heavy chain, and one demonstrated another B cell (LN-1) surface antigen. Hypodense, contrast-enhancing lesions were apparent on computed axial tomographic scanning of the brain, in sharp contrast to isodense or hyperdense lesions reported in primary central nervous system lymphomas without underlying immunodeficiency. Immunologic abnormalities in these patients were similar to those in AIDS presenting as Kaposi's sarcoma or with opportunistic infections. In spite of therapeutic interventions, survival was short, and only one patient is currently alive.

Adult↗

Hyperalgesic pseudothrombophlebitis. New syndrome in male homosexuals.

Five male homosexuals, four of whom had Kaposi's sarcoma, presented with painful swelling of the lower extremity. The overlying skin was erythematous and exquisitely tender. Deep vein thrombosis was strongly suspected in all patients. Venography, however, revealed no evidence of venous occlusion. This condition, which in this report is termed the hyperalgesic pseudothrombophlebitis syndrome, appears to be another unusual manifestation of the acquired immune deficiency syndrome. It should be considered among the entities known to mimic deep vein thrombosis and must be recognized in order to prevent unnecessary anticoagulation in these patients.

Acquired Immunodeficiency Syndrome↗

Small noncleaved B cell Burkitt-like lymphoma with chromosome t(8;14) translocation and Epstein-Barr virus nuclear-associated antigen in a homosexual man with acquired immune deficiency syndrome.

This case report describes new manifestations of the acquired immune deficiency syndrome (AIDS) in a promiscuous homosexual man. Investigation of upper gastrointestinal bleeding in the patient lead to discovery of a high-grade, small, noncleaved cell (Burkitt-like) gastroduodenal lymphoma with visceral and extralymphatic extension. Specific phenotyping of the lymphoma revealed that it was a monoclonal B cell lymphoma of mu kappa isotype. An in vitro cell line was established that was Epstein-Barr virus nuclear-associated antigen-positive. The lymphoma cells displayed a t(8;14) translocation similar to endemic African Burkitt lymphoma. Epstein-Barr virus genomes were identified in the lymphoma and an axillary lymph node biopsy specimen by molecular hybridization. These data strongly suggest that Epstein-Barr virus actively infected this patient. However, he showed normal Epstein-Barr virus-specific serologic responses, indicating an immune defect against the virus.

Acquired Immunodeficiency Syndrome↗

Steroid-related development of Kaposi's sarcoma in a homosexual man with Burkitt's lymphoma.

The development of Kaposi's sarcoma has been associated with either iatrogenic or disease-related immunodeficiency. This report describes a homosexual man who presented with Burkitt's lymphoma and later had pneumonitis, which was treated with a high dose of corticosteroids. Kaposi's sarcoma subsequently developed, and regressed completely when the chemotherapy and corticosteroid therapy were withdrawn. The evidence from the literature relating corticosteroid therapy to the development of Kaposi's sarcoma is discussed, as well as the possible multifactorial origin of the immunodeficiency in which setting this tumor occurs. The observations in this patient suggest that corticosteroids should be used with extreme caution in patients with acquired immunodeficiency and those at risk for its development.

Acquired Immunodeficiency Syndrome↗