Search

Background Despite the success of combination antiretroviral therapy (cART) in reducing the incidence of Kaposi sarcoma, HIV-infected individuals who have responded to treatment continue to be diagnosed with Kaposi sarcoma. We examine factors associated with the incidence of Kaposi sarcoma among cART-treated HIV-infected homosexual men and changes in their survival after its diagnosis over calendar time. Methods Data were from HIV-infected homosexual men with well-estimated dates of HIV seroconversion (ie, change in status from being HIV negative to having HIV antibodies detected). Incidence of Kaposi sarcoma was calculated. We used Kaplan--Meier methods to determine survival after Kaposi sarcoma diagnosis in three calendar periods: before 1996, 1996-2000, and 2001-2006. Poisson models were used to examine the effect of risk factors such as current and nadir CD4 cell count (ie, the lowest CD4 cell count ever recorded for a person), duration of infection, and age at diagnosis for Kaposi sarcoma incidence in cART-treated men. All statistical tests were two-sided. Results Among the 9473 men, 555 were diagnosed with Kaposi sarcoma in the period 1986-2006, of whom 319 died. The percentage surviving 24 months after Kaposi sarcoma diagnosis rose statistically significantly during the study period from 35% (95% confidence interval [CI] = 29% to 42%) before 1996 to 84% (95% CI = 76% to 90%) in 1996-2000 and to 81% (95% CI = 70% to 88%) in 2001-2006 (P < .001). Seventy men were diagnosed with Kaposi sarcoma after starting cART. Current (ie, within 6 months) CD4 cell count was associated with incidence of Kaposi sarcoma among cART-treated men (rate ratios [RRs] = 18.91, 95% CI = 8.50 to 42.09, for CD4 level category Conclusions Among cART-treated HIV-infected homosexual men, current CD4 cell count was the factor most strongly associated with the incidence of Kaposi sarcoma. Survival estimates after Kaposi sarcoma diagnosis have improved over time. DOI: 10.1093/jnci/djq134

Objectives: In the industrialized world, lymphogranuloma venereum proctitis (LGVP) has been reported only in men who have sex with men. Factors responsible for the outbreak remain to be elucidated. GOAL: The goal of the present work was to elucidate risk factors associated with LGVP. Study Design: The study design comprised a cross-sectional study including 32 men with LGVP and 93 men without LGVP (22 with gonorrheal proctitis, 30 with a non-LGV chlamydial proctitis, and 41 with proctitis of unknown etiology). Factors associated with LGVP were analyzed by (multinomial) logistic regression. Results: Comparing men with LGVP with men without LGVP, factors significantly associated with higher risk of LGVP in multivariate analyses were as follows: anal enema use [odds ratio (OR): 7.8, 95% confidence interval (CI): 2.6-23.2], having sex on sex parties (OR: 5.7, 95% CI: 1.5-21.8), and having sex with human immunodeficiency virus-positive partners (OR: 3.2, 95% CI: 1.1-9.3). Evaluating the 4 proctitis groups separately in a multinomial logistic regression model, similar associations between anal enema use and LGVP were found. Men with non-LGV chlamydial proctitis showed less risk behavior than men with LGVP. No substantial difference in risk behavior was found, except for attending sex parties, between men with LGVP, and gonorrheal proctitis or proctitis of unknown etiology. Conclusions: Apart from men with LGVP, men with gonorrheal proctitis or proctitis of unknown etiology exhibit high risk behavior. Enema use seems to play a key role in transmission of LGVP, and needs further investigation.

Background and Objectives: In response to increases in sexually transmissible infections (STI) and HIV infection rates among men who have sex with men (MSM), the current study aimed to investigate the feasibility of a screening program at male-only saunas in Melbourne, Australia. Goal: The goal was to determine (1) the participation rate, and the proportion whom obtain test results; (2) the prevalence of gonorrhea and chlamydia; and (3) to evaluate risk factors for STI acquisition. Study Design: We used a cross-sectional design. Pharyngeal, rectal, and urethral specimens were collected from participants, and tested for Chlamydia trachomatis and Neisseria gonorrhoeae by polymerase chain reaction (PCR). Results: There was a participation rate of 24% (n = 521), and 70% obtained their test results. The infection rate in those who failed to collect their results was no different than those seeking theirs. The proportion of participants with PCR-detected gonorrhea and/or chlamydia infection was high, 10.7%. The presence of infection was associated with seeking sexual health care in the last year. Conclusion: The high prevalence rate of gonorrhea and chlamydia supports the concept of a screening program in Melbourne male-only saunas. The low participation rate has highlighted the need to consider alternative methods for making contact with men in the saunas or offering incentives to participate in future screening programs. Although anonymous participation encouraged participation for some men, future programs should attempt to obtain contact details for follow up of positive test results.

Background: Spain has been the European country most affected by the AIDS epidemic, and sexual transmission now accounts for the majority of cases of HIV. Goal: The goal was to describe HIV prevalence and risk profiles among people tested for HIV in Barcelona in 1998 to 2001. Study Design: We studied cross-sectional HIV surveys among sexually transmitted infection clinic attenders. We performed quantification of risk factors for HIV infection through odds ratios (ORs) and logistic regression. Results: The prevalence of HIV among the 4993 persons tested was 1.8% (95% confidence interval, 1.5-2.2) without significant changes across the years. HIV prevalence in homo-/bisexual men was higher (P Conclusion: HIV prevalences were relatively low among all heterosexuals, but much higher among homosexual and bisexual men. The potential exists for ongoing sexual HIV transmission among homo-/ bisexual men in Barcelona.

Background: Recent increases in rates of sexually transmitted diseases (STDs) and decreases in safe sex behaviors among men who have sex with men (MSM) in several American and European cities have been noted by researchers. It has been suggested that these trends are the result of perceptions that HIV/AIDS is less serious because of the availability of highly active antiretroviral therapy (HAART). Goal: The goal of the study was to examine trends in STD rates and risk behaviors among MSM and men who have sex with women (MSW) visiting a public STD clinic in Denver and to determine whether there is an ecological association with the availability of HAART. Study Design: This is a two-part retrospective analysis of male visits to the Denver Metro Health Clinic (DMHC). The first part describes gonorrhea and early (primary and secondary) syphilis trends among MSM between 1982 and 2001. For the second part, data were grouped into two 6-year time periods to represent pre-HAART and post-HAART time frames, 1990 to 1995 and 1996 to 2001. Results: Gonorrhea and early syphilis cases among MSM declined precipitously between 1982 and 1988 and then stabilized at low rates. The proportion of male visits to the clinic made by MSM decreased from 14.1% in 1990 to 7.2% in 1995 and then increased to 13.0% in 2001. Gonorrhea positivity rates among MSM increased after 1995 and were significantly higher in the period 1996 to 2001 (12.9%) than in the period 1990 to 1995 (8.1%; P < 0.0001). Conversely, gonorrhea rates among MSW dropped from 11.2% in the first period to 6.9% in the second (P < 0.0001). Among MSM known to be HIV-infected, gonorrhea rates increased from 11.6% in the first time period to 24.0% in the second period (P < 0.0001). Reports of anal sex among MSM increased from 64.4% to 70.9% (P < 0.0001). Reporting more than one sex partner increased for MSM from 65.2% to 70.3% (P < 0.0001), but it significantly decreased from 52.6% to 46.2% for MSW (P < 0.0001). No or inconsistent condom use increased from 60.9% to 63.0% for MSM (P = NS) and decreased from 85.1% to 82.4% among MSW (P < 0.0001). Conclusions: These trends appear to reflect a change toward higher risk-taking behaviors among MSM but not MSW since the time HAART became available and raise concerns about the potential for increased HIV transmission in this group.

Background: Despite national ambitions to eliminate syphilis, occasional outbreaks continue to occur in many areas of the United States. Goal: The goal of the study was to describe and evaluate the public health interventions in response to an outbreak of syphilis in Los Angeles County among men who have sex with men. Study Design: Reported cases of primary, secondary, and early latent syphilis that occurred during an outbreak period from December 1999 to September 2000 were included in the study. The outbreak components of provider awareness, active surveillance, community-based organization recruitment, media campaign, community-outreach education and screening, and a correctional facility intervention were described. Screening results were reviewed, sexually transmitted disease (STD) hotline calls were counted, and a street-intercept survey was conducted. Results: A multifaceted outbreak response was initiated in March 2000. Of the 89 outbreak cases identified, 40% were detected by HIV/AIDS early intervention providers and 26% by private clinicians or health maintenance organizations. Other case identification sources included public STD clinics (10%), STD program case-management contacts (7%), mobile van screening (7%), and correctional facility screening (10%). Screening at high-risk venues detected a syphilis prevalence of Conclusions: A multifaceted outbreak response was launched to react to an outbreak of syphilis among men who have sex with men. Prompt provider awareness and a preexisting network of HIV/AIDS providers aided ease detection. Although the effectiveness of the response could not be scientifically determined, the diverse components of the response were associated with a faster decline in the outbreak than would have been expected. After 3 months, 89 cases had been identified. Outbreak preparedness should include a focus on communities of men who have sex with men, because the reintroduction of syphilis in this population may threaten national efforts toward syphilis elimination.

Background: Bacterial sexually transmitted diseases (STDs) among men who have sex with men (MSM) have recently increased in Seattle. Goals: Serovar and auxotype typing of strains was used to assess the epidemiology of anorectal chlamydial and gonococcal infections among MSM attending an STD clinic. Study Design: The prevalences of anorectal chlamydial infection and gonorrhea among MSM attending an STD clinic during the period of 1994 to 1996 were compared with prevalences during 1997 to 1999. A retrospective case-control study of MSM attending an STD clinic between 1997 and 1999 was performed. Anorectal chlamydial isolates were characterized by serovar and gonococcal isolates were characterized by serovar and auxotype. Infected MSM were mapped by residence and strain type. Results: Prevalences of anorectal chlamydial and gonococcal infections increased from 4.0% and 6.3%, respectively, during 1994-1996 to 7.6% and 8.7%, respectively, during 1997-1999 (P = 0.004 and P = 0.013 for chlamydial infection and gonorrhea, respectively). Most chlamydial infections were caused by serovars G (47.9%) and D (29.6%), and most gonococcal infections were caused by auxotype/serovar classes Proto/IB-1 (43.3%), Proto/IB-3 (16.5%), and Proto/IB-2 (10.3%). MSM with anorectal chlamydial infection more often had chlamydial urethritis (P = 0.005) and were not white (P = 0.046), in comparison with controls. MSM with anorectal gonorrhea more often had pharyngeal gonorrhea (P < 0.001), had a history of gonorrhea (P = 0.003), and were younger than age 30 years (P = 0.039), in comparison with controls. Residences of MSM with anorectal gonorrhea were clustered in urban areas, whereas those of MSM with anorectal chlamydial infection were more dispersed. Conclusion: Prevalences of anorectal chlamydial infection and gonorrhea among MSM in Seattle have increased dramatically over the past 3 years. Serovar and auxotype analyses indicate these increases are not clonal but are due to the spread of unique distributions of strains that differ from those causing urogenital infections in the same community.

Background: To assess the prevalence and increase awareness of Neisseria gonorrhoeae and Chlamydia trachomatis infections among men who have sex with men, a screening program was conducted at three inner-city homosexual entertainment venues and one community function. Study Design: Each venue was accessed twice over a 3-month period between March and June 2000. First-catch urine specimens were collected for analysis by polymerase chain reaction (PCR), and throat swabs were collected for culture and PCR. Results: A total of 202 men were tested during the 7 screening nights, including 16 who were tested more than once. From the 186 men tested for the first time, 184 urine specimens were collected, of which 8 (4.3%; 95% CI, 1.9-7.8%) were PCR-positive for C trachomatis and 1 (0.5%; 95% CI, 0-2.1%) was PCR-positive for N gonorrhoeae. Of the 161 throat swabs collected, none were positive for C trachomatis or N gonorrhoeae. Conclusions: C trachomatis is a potentially significant pathogen in this population of urban homosexual men. Screening programs such as these are valuable as health-promotion exercises.

Background: Previous data indicating wide racial disparities in HIV seroprevalence, associations between sentinel sexually transmitted diseases (STDs) and HIV infection, and recent reports of STD outbreaks among men who have sex with men (MSM) have raised concerns that HIV may be resurgent among MSM. Goal: To measure trends in HIV seroprevalence and describe racial disparities among MSM presenting to New York City Department of Health STD clinics, 1990-1999 (n = 4076). Study Design: This blinded HIV-1 serosurvey used remnant serum originally drawn for routine serologic tests for syphilis. Demographic, risk factor, clinical and laboratory data were abstracted from clinic charts of patients whose medical records documented sexual contact with men or with both men and women ('bisexual' men). Data were matched to the specimens, and all personal identifiers were removed before testing. Patients were not interviewed. Results: The sample was 41% black, 20% Hispanic, 31% white, and 9% of other or mixed race/ethnicity. Sixty-one percent of the patients were >30 years of age; 21% were [greater than or equal to] 40 years of age. One-third had sex with women as well as men. For 60%, laboratory-confirmed STD diagnosis was made on the serosurvey visit. Overall, HIV seroprevalence declined from 47% in 1990 to 18% in 1999 (P < 0.01). Seroprevalence declined from 34% to 11% among white men (n = 1250), from 47% to 19% among Hispanic men (n = 795), from 56% to 28% among black men (n = 1656), and from 43% to 14% among men who had sex with both men and women (n = 1447). Seroprevalence among MSM with gonorrhea (n = 507) declined but remained high (57-34%; P < 0.05). In contrast, seroprevalence among MSM with non-gonococcal urethritis (n = 953) declined from 36% to 16% (P < 0.01), and seroprevalence among MSM who had no STD (n = 1650) dropped from 48% to 12% (P < 0.01). Gonorrhea was diagnosed almost twice as frequently among seropositive versus seronegative MSM (19% versus 10%; P < 0.05). Black MSM were not more or less likely to have been tested for HIV or to be diagnosed with acute STD than were MSM in the other-race/ethnicity group. Positive serostatus was associated with black race/ethnicity (odds ratio [OR], 2.5; 95% CI, 2.1-2.9), age >25 years (OR, 2.5; 95% CI, 1.9-3.1), and a diagnosis of gonorrhea (OR, 2.4; 95% CI, 2.0-2.8). Sixty percent of seropositive MSM knew their serostatus from confidential or anonymous HIV testing at this or a previous visit. Two thirds of the known seropositive men had a new STD diagnosed at the serosurvey visit. Conclusion: Seroprevalence in this racially diverse sample of MSM declined significantly during the study period. However, wide racial disparities in seroprevalence were observed that were not attributable to disparities in risk factors such as STD, bisexuality, or acceptance of HIV testing. This finding suggests that the observed differences may reflect racial differences in the background seroprevalences, such as those seen in all New York City serosurvey samples and the population-based AIDS case rates. High prevalence associated with gonorrhea and new STD in known seropositive men of any race suggests that continued efforts to control the incidence of STD, increased encouragement of MSM to accept HIV counseling and testing, and prevention-focused counseling of seropositive men are needed.

A critical examination of the recent literature connecting battering victimization and HIV in men who have sex with men is presented and the implications for clinical practice are discussed.

Hepatitis B infection, a sexually active homosexual lifestyle, and injection drug use increase the risk of hepatitis G infection (HGV) in HIV patients. Hepatitis G virus is thought to be transmitted by the same routes as HIV. Researchers tested 157 HIV-infected patients for genetic evidence of HGV, and found that 22% were infected. Forty-nine percent of patients who tested positive for the hepatitis B surface antigen (HBsAg) were infected with HGV. Homosexuality was as likely to be associated with HGV infection as injection drug use, as both increase the risk of disease transmission.

HIV-positive homosexual men may be at higher risk for anal squamous intraepithelial lesions (ASIL) and possibly for anal cancer than HIV-negative homosexual men. ASIL are cellular changes that may develop into cancer. Researchers examined 346 HIV-positive and 262 HIV-negative homosexual men for evidence of anal diseases. Twenty percent of HIV-positive men developed high-grade intraepithelial lesions, compared to 8% of HIV-negative men, during the two years they were studied. Infection with human papillomavirus increased the risk of ASIL, regardless of HIV status.

HIV-positive homosexual men may be at higher risk than HIV-negative men of developing cellular changes in the anus that could lead to anal cancer. Researchers examined 346 HIV-positive and 262 HIV-negative homosexual and bisexual men for evidence of anal squamous intraepithelial lesions (ASIL). ASIL was detected in 36% of men with HIV and 7% of men without HIV infection. Anal infection with human papillomavirus and a history of receptive anal intercourse increased the risk of ASIL, regardless of HIV status. Screening of homosexual men for ASIL may prevent anal cancer.

Many gay men remain at high risk for HIV infection, especially blacks and Hispanics in rural and non-metropolitan areas. Overall, the incidence of AIDS in gay men dropped 29% between 1990 and 1995. However, most of this drop occurred in whites and the incidence in Hispanics actually rose 5%. The incidence of AIDS dropped more substantially in metropolitan areas.

The risk of HIV infection among male IV drug users and crack smokers appears more substantially related to sexual habits than to the use of injectable drugs. The risk of HIV infection is 24 times as high among gay drug users and 3-4 times as high among IV drug users in HIV-endemic areas, compared to non-injectors.

Non-Hodgkin's lymphoma (NHL) is common among HIV-positive gay men, but the risk of developing the cancer is lower among the most sexually active and the most allergic. HIV infection increases the risk of NHL 20-fold. Gay men who had had the most receptive anal intercourse or who had hay fever had lower rates of the disease, perhaps because of immunosuppression by semen contact or allergic responses.

The experience of San Francisco illustrates how a city can mobilize to effectively fight the AIDS epidemic. San Francisco was one of the first cities to report HIV infection in 1980. The city has a large gay population and by 1995, about one-third had contracted HIV. However, the incidence of HIV infection in the city peaked in 1992 and has been dropping since then. In San Francisco, the gay community took an active role in shaping public policy and has worked openly with the local government. There is still much work to be done to educate young gays and gays of color.

Background: The acute clinical events surrounding the acquisition of human immunodeficiency virus (HIV) have not been well characterized. Objective: To further define the clinical and epidemiologic presentation of primary HIV infection. Design: Descriptive cohort study. Setting: University research clinic. Patients: 46 adults (43 men and 3 women) with primary HIV infection who enrolled in the study a median of 51 days after HIV seroconversion. Measurements: Documentation of recent HIV seroconversion. Standardized collection of demographic characteristics and sexual contact history, results of tests for HIV RNA, HIV culture, and T-cell subsets. Results: 41 of 46 patients (89%) developed an acute retroviral syndrome. Primary HIV infection was infrequently diagnosed at the initial medical encounter, even in persons enrolled in routine HIV screening programs. Median numbers of sexual partners 6 months and 1 month before acquisition of HIV were three and one, respectively; 21 patients (46%) reported having had only one partner in the month before seroconversion. Of the 12 patients who could identify the precise date of and activity leading to seroconversion, 4 reported having only oral-genital contact. Conclusions: Primary HIV infection causes a recognizable clinical syndrome that is often underdiagnosed, even in persons enrolled in a program of routine surveillance for HIV infection. Frequency of sexual contact and overall numbers of sexual partners in this group of homosexual men who acquired HIV were markedly lower than those seen a decade ago. Acquisition of HIV does occur, even in persons with relatively few sexual partners. Increased attention to oral-genital contact as a means of acquiring HIV appears to be warranted., Many physicians may miss the diagnosis of HIV infection, especially in people who do not engage in risky sexual behavior. Of 46 patients who contracted HIV infection, 41 had symptoms so severe they sought medical attention. Some were even hospitalized. Yet only 25% were accurately diagnosed. Almost half had only one sexual partner in the months before infection. Misdiagnosis occurs because HIV infection initially causes symptoms that are similar to other diseases. Oral-genital contact may be a substantial risk factor for acquiring HIV.

Kaposi's sarcoma (KS) in gay and bisexual men may be caused by a sexually transmitted agent, but no sexual practice has been identified conclusively as a means of transmission. A study of 1,075 Australian gay and bisexual men showed that KS as an AIDS-defining diagnosis was less common among men reporting oral-genital sex than men not reporting this practice. Little association was found between oral-anal contact ('rimming') and incidence of KS, nor did oral-fecal contact appear to be a means of transmission. No particular sexual practice appears to predict a diagnosis of KS, although relative risk for KS was higher among men practicing insertive oroanal intercourse and receptive fisting. The percentage of men with an AIDS-defining diagnosis of KS fell from 54% between 1984-85 to 24% between 1989-90.

Background: To compare the prevalence of human immunodeficiency virus (HIV)-related clinical symptoms among male intravenous drug users and homosexual men stratified by HIV serostatus and CD4 cell levels. Methods: A cross-sectional sample using concurrent longitudinal studies of the natural history of HIV-1 infection among intravenous drug users (N=539) and homosexual men (N=932) was recruited in Baltimore, Md. Participants were administered a risk behavior interview and physical examination, and had hematologic tests evaluated in a similar calendar period. Results: Both risk groups demonstrated an inverse relationship between frequency of symptoms and CD4 cell count. Fever, night sweats, and lymphadenopathy were not evaluated because pilot data suggested a confounding association with drug injection. Among those with mild to moderate immune suppression, intravenous drug users were significantly more likely than homosexual men to experience fatigue, weight loss, diarrhea, and shortness of breath; to have oral candidiasis, palpable spleen, and lower mean weight on physical examination; and abnormal hematocrit, platelets, and total lymphocyte counts. However, participants in either risk group with CD4 cell levels below 0.2X [10.sup.9]/L experienced similar frequency of all clinical symptoms. Self-reported oral candidiasis increased fourfold with HIV infection and was as likely in both groups at all CD4 cell levels. Duration and recency of intravenous drug use was not significantly associated with the higher frequency of most clinical symptoms. Conclusion: Social factors are an important consideration in evaluating the association between clinical symptoms and HIV immunosuppression. Except for oral candidiasis, there are limitations for the use of clinical symptoms as intermediate outcome measures for HIV infection among intravenous drug users. (Arch Intern Med. 1993;153:1806-1812)

* Background.--A previous study of men with proctitis, proctocolitis, or enteritis showed an association of anal human papillomavirus (HPV) infection with human immunodeficiency virus (HIV) infection. Because anorectal abnormalities may confound an observed association between anal HPV DNA and HIV seropositivity, the present study was undertaken among consecutive homosexual men seeking HIV serologic testing who were unselected for anorectal symptoms. Methods.--Consecutive homosexual men underwent a standardized interview, physical examination, and collection of specimens for HIV serologic testing and detection of anal HPV DNA. Results.--Anal HPV DNA was detected in eight (31 %) of 26 HIV-seropositive men and in 10 (8%) of 119 HIV-seronegative men (odds ratio, 5.8; 95 % confidence interval, 1.1 to 30.1, adjusted for history of sexually transmitted disease, current anorectal symptoms, and age). When men with anorectal symptoms were excluded from the analysis, anal HPV DNA was detected in 27% of seropositive men compared with 8% of seronegative men (odds ratio, 4.4; 95 % confidence interval, 1.4 to 13.4). There was no difference between HIV-seropositive and HIV-seronegative men with respect to distribution of type of HPV DNA. Men with group II or III and group IV HIV disease were 4.1 and 10.9 times, respectively, more likely than HIV-seronegative men to have anal HPV DNA detected. Conclusions.--Because HIV-seropositive men appear to be at increased risk for the detection of anal HPV DNA, the natural course of anal HPV infection should be compared among HIV-seropositive and HIV-seronegative homosexual men. (Arch Intern Med. 1992;152:1673-1676)

The incidence of AIDS in homosexual and bisexual men not using intravenous drugs and living in New York City (NYC), Los Angeles (LA), and San Francisco (SF) leveled off by 1987, but in the same population living in other areas of the US, the incidence continued to increase. This study examined the geographic and ethnic diversity of the incidence of AIDS in this population of men. Data were obtained from the Centers for Disease Control (CDC) for all AIDS cases diagnosed in homosexual and bisexual males who did not use intravenous drugs for the 1983 to 1990 period covering. Incidence rates by racial and geographic factors were calculated. The increase in incidence of AIDS for those from the study group living in NYC, LA and SF began to slow in 1986 and leveled off by the end of 1987. In NYC, the incidence decreased further in 1989 and 1990. In other metropolitan areas with populations greater than 1,000,000, the increase in incidence began to slow in 1987 and leveled off by June 1989. In smaller metropolitan areas and rural areas, the increase in incidence did not begin to slow until 1990. Although the incidence had peaked for white, Hispanic, and black ethnic groups in NYC and LA, the plateau was reached a year earlier among whites. Outside of NYC, LA, and SF, the incidence of AIDS continued to increase for Hispanic and black ethnic groups, but appeared to have leveled off in white ethnic groups. Because a number of factors, including medical interventions, have contributed to the leveling off seen in some areas and groups and because HIV seroconversions continue to occur in this population of homosexual and bisexual men, these figures should not lead to complacency. Prevention efforts geared toward this population of men must be continued and strengthened. (Consumer Summary produced by Reliance Medical Information, Inc.)

The polymerase chain reaction (PCR) is a genetic method that helps to identify DNA, the genetic material of the cell. In the PCR, a segment of DNA is amplified or copied several times in sufficient amounts for analysis and identification. The PCR was used to identify regions of specific genes of the human immunodeficiency virus type 1 (HIV-I), which causes AIDS. This technique was used to test 5 of 38 homosexual men at high risk of developing AIDS. HIV antibodies, or immune proteins directed against HIV, had not been detected in any of these subjects. Patients with positive PCR results had increased numbers of immune T suppressor cells and decreased numbers of immune T helper cells, a characteristic pattern of HIV infection. The function of immune B cells, which produce antibody, was impaired in patients with HIV DNA detected by PCR. The detection of HIV DNA and antibodies in patients with initially negative results on HIV antibody tests was associated with changes in the function and physical appearance of the T and B cells. The progression of HIV infection to AIDS is indicated by changes in the function and physical characteristics of immune cells, the presence of HIV DNA, and the detection of p24 antigen, an indicator of HIV infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Since mid-1987, the number of AIDS cases among homosexual and bisexual men, hemophiliacs and other recipients of transfusions has decreased. However, the number of AIDS cases among intravenous drug users and those who acquired the disease through heterosexual contacts has increased. Further analysis of these demographic groups showed that the incidence of AIDS has decreased among white gay men from urban areas such as New York City, Los Angeles and San Francisco, while there was no change in the incidence among nonwhite gay men from suburban or rural areas. The trends in the change in incidence were related to access to medical care and the use of the drug zidovudine by gays, hemophiliacs and recipients of transfusions. Zidovudine began to be nationally distributed during mid-1987. Data from the study support the theory that zidovudine use, and perhaps the use of other therapies, such as pentamidine prophylaxis against pneumonia caused by Pneumocystis carinii, and suppression of the herpes virus, contributes to the decreased incidence of AIDS in some groups and not others. It is important that zidovudine and other therapies become available to other groups, especially intravenous drugs users and those infected through heterosexual relationships, including minorities, women and those living outside of urban areas. It is felt that these groups do not have adequate access to treatment and that a decreased incidence of AIDS would also be seen in these groups if these treatments were available. (Consumer Summary produced by Reliance Medical Information, Inc.)

It is known that hepatitis B virus (HBV) and human immunodeficiency virus type 1 (HIV-1) are transmitted in similar ways and target similar populations in the United States. While HBV was once commonly seen in persons at risk for HIV-1 infection, it is now also commonly seen to develop after/simultaneously with diagnosis of HIV-1. Because of compromised immune response that accompanies HIV infection, HIV-1-infected patients with HBV have more difficulty fighting the HBV. To better understand the course of HBV infection in HIV-1-infected and HIV-1-negative men, a study was conducted using participants in a hepatitis B vaccine trial for data collection. In HIV-1-negative men it was found that the vaccination worked effectively against HBV infection or severity and its value increased with repeated vaccinations. Those previously infected with HIV-1 had a poorer response to the vaccine and HBV infection tended to be more serious than in non-HIV-1-infected men. Interestingly, it was found that HIV-1-infected men who were vaccinated tended to develop the most severe HBV-related symptoms of all groups, suggesting that the HBV vaccine may temporarily impair immune response to HBV infection in these men. (Consumer Summary produced by Reliance Medical Information, Inc.)

The human immunodeficiency virus (HIV) can be transmitted sexually and is present in sperm. Changes in the genital system of infected males have been found. The testis and epididymis (the excretory duct from the testis, which carries sperm) were examined in 31 patients who died from AIDS. Abnormalities in the testis were seen in the majority of the patients. The testis contained abnormal fibrous material in 22 cases and thickening of the membranes of the tubules in 21 cases. The epididymis was normal in the majority of the patients, but was blocked in five cases, two of which showed the presence of the cytomegalovirus, a common opportunistic infection in AIDS. All the cases showed abnormal maturation of sperm, with maturation arrested at one of two particular stages, leading to infertility. No evidence of chronic inflammation was found, which has been found in other studies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Kaposi's sarcoma (KS, a skin disorder associated with multiple skin tumors) takes several forms; the most recently recognized form is that associated with AIDS (epidemic KS, or EKS). EKS is typically found in male homosexual patients with HIV (human immunodeficiency virus) infection, where it takes a very aggressive form. In these cases, other organs may be affected, and the patient often deteriorates. The case history of a bisexual man without HIV infection who developed EKS is presented. The patient's initial symptoms were red-brown and purple nodules on the trunk and extremities. Biopsy specimens of a nodule on the back revealed basal cell carcinoma and KS. Additional examinations showed that the digestive tract was affected. Tests for HIV infection were negative. Treatment with a drug used against certain tumors was begun, but new lesions continued to form. The patient began a trial of interferon therapy, which is ongoing. His overall condition remains good. This is the sixth reported case of EKS in a homosexual or bisexual man who does not appear to be HIV-infected. It is possible that a transmissible agent, widespread among homosexuals, causes KS. Such cases as the one described should not be considered AIDS cases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hope or hopelessness is thought by some to influence psychiatric status, as well as endocrine and immunologic function. For purposes of this study, hope was defined as ''the expectation that something worthwhile lies ahead.'' For terminally ill patients, hope is not necessarily a feature of denial of illness. In addition, some studies have found a correlation between a hopeful state of mind and enhanced physical and mental health. However, there have been conflicting results of investigations of hope as a factor that can alter the course of illness. Most studies have been conducted with cancer patients, but recently, AIDS and AIDS-related complex (ARC) patients have received attention, since loss of hope has been reported as a common feature of these patients. To investigate the impact that social and personal variables may have on the level of hope in patients with human immunodeficiency virus (HIV), the agent that causes AIDS, 124 seropositive and 84 seronegative homosexual men were studied. Most of the men were well-educated, white, and financially successful. Interviews, self-reported rating scales, and neurological and medical examinations were conducted on the subjects. Other specific areas that were focused upon were correlations between illness status, both physical and psychological, and levels of hope in the individual. Results indicated that, on the whole, these men had high levels of hope and relatively low levels of psychiatric and physical symptoms. Levels of hope were generally independent of the subject's HIV status; only slightly lower levels of hope were reported by the HIV-positive men than by the HIV-negative men. A positive correlation was found between hopefulness and perceived social supports. Fewer symptoms of depression were reported in subjects with a strong sense of control over the events in their life. (Consumer Summary produced by Reliance Medical Information, Inc.)

Kaposi's sarcoma is characterized by the formation of several areas of cell overgrowth, initially in the skin, but later affects other body sites. It is the most common cancer associated with AIDS and most often occurs in homosexual men. AIDS-related Kaposi's sarcoma (AIDS-KS) is associated with human immunodeficiency virus (HIV) infection and impaired immune function. A diagnosis of AIDS-KS is based on examination of microscopic tissue from lesions, blood tests for HIV, and measures of immune function. The prevalence of Kaposi's sarcoma among homosexual men has decreased over the past six years. Studies suggest that the development of AIDS-KS may be controlled by one or more factors associated with the homosexual lifestyle and a unique strain of virus. Changes in homosexual behavior such as the practice of safer sex and reduced use of nitrate inhalants (which can be carcinogenic) may explain the decline in the incidence of AIDS-KS. The identification of factors that may influence the progression of AIDS-KS would help in the development of methods for preventing and treating AIDS-KS. (Consumer Summary produced by Reliance Medical Information, Inc.)

Objectives: We hypothesized that men in a relationship would engage in less risky sexual activity with their casual partners compared to men with only casual partners. Study: Cross-sectional data were collected between 1999 and 2003 in a study of young human immunodeficiency virus-seronegative gay men in Vancouver, British Columbia. We assessed the substance use and sexual behaviors of 156 men and compared those having casual partners in addition to 1 regular partner for the duration of the previous year (n = 43) to those reporting only casual partners during the previous year (n = 113). Results: Men with just 1 regular partner were not significantly different from men without a regular partner with regard to sexual behaviors reportedly engaged in with casual partners, self-reported sexually transmitted infections diagnosed within the previous year, or demographic characteristics. Only previous use of poppers and higher frequencies of marijuana use were found among men without a regular partner. Conclusions: In our cohort, young gay men in a relationship do not appear less likely to engage in risky sex with casual partners than men with casual partners only.

Sex Transm Infect 2003;79:484-486 Objectives: To compare a nucleic acid amplification test (ligase chain reaction) with culture for detecting rectal and pharyngeal gonorrhoea in men who have sex with men [...]

Community nurses are in a position to support families caring for HIV/AIDS victims. This is particularly so when the disease strikes gay men, as often families are unaware that their sons are gay until the patient announces he has contacted the disease. As well as facing the fact that their children will die, there are many prejudices to overcome from the wider circle of family and the community. Nurses in contact with HIV/AIDS patients face many ethical, moral and medical issues, and the fear of infection, despite precautions.

STD Quarterly Syphilis rate on the increase in gay, bisexual men in the U.S. Stats show upswing in disease among men who have sex with men Get ready to tackle [...]