Sexual practices and condom usage in a cohort of homosexual men in relation to human immunodeficiency virus status

Between January 1, and October 31, 1987, 420 homosexual men who participated in a cohort study of infection with the human immunodeficiency virus (HIV) completed a questionnaire that examined their sexual practices during the previous six months. Of the subjects, 205 (48.8%) men were HIV-seropositive and 215 (51.2%) men were HIV-seronegative. Although there was an appreciable level of condom usage in both groups, 13.5% of the HIV-seronegative men had engaged in unprotected receptive anal intercourse and 6.3% of the HIV-seropositive men had engaged in unprotected insertive anal intercourse. Condom breakage was reported on approximately 6% of occasions by a minority of subjects. Among subjects who were in a relationship with a regular male sexual partner, the most commonly reported sexual practices were deep kissing, mutual masturbation and receptive oral intercourse without ejaculation. No HIV-seronegative man engaged in unprotected receptive and/or insertive anal intercourse, receptive oral intercourse with ejaculation or receptive and/or insertive "fisting" with a regular partner who was HIV-seropositive. No HIV-seropositive man engaged in unprotected insertive anal intercourse to ejaculation with an HIV-seronegative partner, although they did so with partners who were HIV-seropositive or of unknown status. On multivariate analyses the subject's antibody status was found to be associated with receptive anal intercourse with a condom (P = 0.007) and mutual masturbation (P = 0.001), with HIV-seronegative men being more likely to practise either; no significant independent effect was associated with the partner's antibody status. These findings provide important information on the types and levels of sexual practices in a group of homosexual men after the recognition of the acquired immunodeficiency syndrome in this country.     

A potential source for the transmission of the human immunodeficiency virus into the heterosexual population: bisexual men who frequent "beats"

Fifty-four actively bisexual men with recent sexual experiences with both men and women were interviewed as part of a wider study of 176 homosexual men, many of whom frequented "beats" (public toilets, parks and isolated roads where men meet for homosexual encounters). Forty-six per cent of the bisexual men were engaging in unsafe sexual practices with at least one man and one woman. Three of these men knew that they were seropositive for the human immunodeficiency virus, with two of these men engaging in unsafe sexual practices with some of their partners. Fewer than one-quarter of the bisexual men identified with or participated actively in aspects of organized, overt "gay" culture. So-called "closeted" bisexual men are suggested to be a major, but neglected, target for educational efforts against the acquired immunodeficiency syndrome.     

Incidence and risk factors for human immunodeficiency virus seroconversion in a cohort of Sydney homosexual men

By means of prospective cohort data from the Sydney AIDS Project, we report on 55 homosexual or bisexual men who have become infected with human immunodeficiency virus (HIV), as measured by the development of serum HIV antibodies (seroconversion). We have compared the sexual practices, recreational drug abuse, history of sexually-transmissible diseases, and antecedent immunological findings of the men who seroconverted with those of 588 subjects who persistently remained seronegative in the same time-period. The cumulative incidence rate of HIV infection over the three years of observation was 8.5%. The cumulative incidence rate ranged from less than 1% for the six months before August 1, 1984, to a peak of 5% in the six months before August 1, 1985. Of those subjects for whom we had data for the period of seroconversion, all but two of the subjects who seroconverted admitted to a recognized high-risk sexual practice in the six months before the first visit at which they were found to be seropositive. Univariate analysis found that men who seroconverted were significantly more likely to have had a greater number of recent sexual partners (relative risk per partner, 1.02; P less than 0.001), to have engaged in receptive anal intercourse (incidence rate ratio, 3.1; 95% confidence interval [CI], 1.3-7.6; P = 0.01) and to have used nitrite inhalant (incidence rate ratio, 2.6; 95% CI, 1.2-5.9; P = 0.02) and amphetamine (incidence rate ratio, 4.8; 95% CI, 2.2-10.5; P less than 0.001) drugs. The men who seroconverted were significantly (incidence rate ratio, 2.7; 95% CI, 1.2-6.1; P = 0.014) more likely to have antecedent T-suppressor-cell counts of greater than 800 cells/microL. Factors that retained significance in multivariate analysis were the number of recent sexual partners, recent amphetamine abuse and a T-suppressor-cell count of greater than 800 cells/microL.     

The clinical effectiveness and cost-effectiveness of screening for anal squamous intraepithelial lesions in homosexual and bisexual HIV-positive men.

CONTEXT: Homosexual and bisexual men infected with human immunodeficiency virus (HIV) are at increased risk for human papillomavirus-related anal neoplasia and anal squamous cell carcinoma (SCC). OBJECTIVE: To estimate the clinical benefits and cost-effectiveness of screening HIV-positive homosexual and bisexual men foranal squamous intraepithelial lesions (ASIL) and anal SCC. DESIGN: Cost-effectiveness analysis performed from a societal perspective that used reference case recommendations from the Panel on Cost-Effectiveness in Health and Medicine. A state-transition Markov model was developed to calculate lifetime costs, life expectancy, and quality-adjusted life expectancy for no screening vs several screening strategies for ASIL and anal SCC using anal Papanicolaou (Pap) testing at different intervals. Values for incidence, progression, and regression of anal neoplasia; efficacy of screening and treatment; natural history of HIV; health-related quality of life; and costs were obtained from the literature. SETTING AND PARTICIPANTS: Hypothetical cohort of homosexual and bisexual HIV-positive men living in the United States. MAIN OUTCOME MEASURES: Life expectancy, quality-adjusted life expectancy, quality-adjusted years of life saved, lifetime costs, and incremental cost-effectiveness ratio. RESULTS: Screening for ASIL increased quality-adjusted life expectancy at all stages of HIV disease. Screening with anal Pap tests every 2 years, beginning in early HIV disease (CD4 cell count >0.50 x 10(9)/L), resulted in a 2.7-month gain in quality-adjusted life expectancy for an incremental cost-effectiveness ratio of $13,000 per quality-adjusted life year saved. Screening with anal Pap tests yearly provided additional benefit at an incremental cost of $16,600 per quality-adjusted life year saved. If screening was not initiated until later in the course of HIV disease (CD4 cell count <0.50 x 10(9)/L), then yearly Pap test screening was preferred due to the greater amount of prevalent anal disease (cost-effectiveness ratio of less than $25,000 per quality-adjusted life year saved compared with no screening). Screening every 6 months provided little additional benefit over that of yearly screening. Results were most sensitive to the rate of progression of ASIL to anal SCC and the effectiveness of treatment of precancerous lesions. CONCLUSIONS: Screening HIV-positive homosexual and bisexual men for ASIL and anal SCC with anal Pap tests offers quality-adjusted life expectancy benefits at a cost comparable with other accepted clinical preventive interventions.     

Sexual transmission efficiency of hepatitis B virus and human immunodeficiency virus among homosexual men

The relative sexual transmission efficiency of hepatitis B virus (HBV) and human immunodeficiency virus type 1 (HIV-1) was investigated by a prospective study of homosexual men in Pittsburgh, Pa, from the Multicenter AIDS Cohort Study. During the 30-month follow-up, 19.8% and 7.8% of the initially seronegative HBV and HIV-1 groups were estimated to seroconvert to HBV and HIV-1, respectively. The significantly higher cumulative HBV seroconversion rate occurred despite a much lower prevalence of hepatitis B carriers (7% were hepatitis B surface antigen positive) compared with HIV-1 carriers (22% were HIV-1 antibody positive). The sexual exposure profile of HBV and HIV-1 seroconverters was similar during the 6 months prior to seroconversion, supporting the link between anal intercourse and acquisition of either infection. However, insertive, not receptive, anal intercourse was the major risk factor identified for HBV seroconversion, suggesting that transurethral exposure is an important mode of transmission. These data suggest that HBV is transmitted 8.6-fold more efficiently than HIV-1 among homosexual men studied and underscore the benefits of both HBV immunization and use of condoms during intercourse to prevent HBV infection.     

Decreased population of Leu-7+ natural killer cells in lymph nodes of homosexual men with AIDS-related persistent lymphadenopathy.

Natural killer (NK) cells were studied in the lymph nodes of homosexual men with the persistent lymphadenopathy syndrome (PLS) and other signs of the disease complex related to the acquired immune deficiency syndrome (AIDS). The NK cells were identified by their Leu-7+ phenotype and enumerated in frozen sections of lymph nodes in conjunction with the quantification of T-lymphocyte subsets. Lymph nodes from patients with AIDS-related PLS contained 91% and 81% fewer NK cells than normal lymph nodes and lymph nodes from patients with non-AIDS-related hyperplastic lymphadenopathy respectively. This decrease in NK cells in PLS is consistent with the immune dysregulation leading to persistent infection and neoplasia in AIDS.     

四川、重庆地区男男性接触者婚姻状况及其对艾滋病相关行为的影响

目的 了解四川、重庆地区男男性接触者（men who have sex with men,MSM）婚姻分布状况,分析婚姻对该人群艾滋病相关知识、态度及健康服务接受情况,艾滋病高危行为及HIV和STD感染率的影响。方法 采用非随机抽样的方法共招募重庆及四川地区1240名男男性接触者,采用匿名问卷调查的方法了解其婚姻及艾滋病相关知识、态度及健康服务接受情况,艾滋病相关高危性行为状况等。采用金标准快速诊断法和酶联免疫吸附试验进行HIV抗体检测。采用检验进行组间率的比较。年龄及艾滋病相关知识了解情况采用秩和检验进行组间比较。结果 在婚组与非在婚组的年龄、户口类型、文化程度、就业情况和个人平均月收入的差异均有统计学意义（P<0.05）。非在婚组及在婚组艾滋病相关知识得分分别为9±4和8±5（中位数±四分位间距）,两组间差异具有统计学意义（P<0.05）。在婚组MSM仅有53.8%的人认为本地区男男性接触者艾滋病感染比率高,非在婚组58.0%的人认为本地区男男性接触者艾滋病感染比率高;在婚组中绝大部分认为艾滋病对自己及家人威胁很大,比例远高于非在婚组,差异有统计学意义（P<0.05）。在婚组MSM人群有40.5%没有做过艾滋病检测,未检测率远高于非在婚组中的34.3%（P<0.05）。艾滋病高危性行为方面,统计学差异无意义。HIV检测方面,在婚组MSM感染率为30.9%,远高于非在婚组感染率的21.1%,两者有统计学差异（P<0.05）。结论 婚姻并不能降低MSM人群艾滋病高危性行为的频率,而在婚组MSM艾滋病感染率的过高,提示艾滋病由MSM人群向一般人群传播的风险更大。     

Hepatotoxicity from paracetamol self-poisoning in western Sydney: a continuing challenge.

OBJECTIVE: To determine the annual incidence of admissions for paracetamol overdosage in the years 1985 to 1990, morbidity and mortality rates, predictors of poor prognosis and the most appropriate use of N-acetylcysteine (NAC). DESIGN: A retrospective review of case records of all patients with a discharge diagnosis of paracetamol overdosage. SETTING: A 900-bed tertiary referral teaching hospital in western Sydney with a busy accident and emergency department. PATIENTS: 306 patient records were reviewed and details of the overdose and admission were recorded. INTERVENTIONS: NAC infusion in patients with possible paracetamol hepatotoxicity. MAIN OUTCOME MEASURES: Blood paracetamol levels; elevated alanine aminotransferase levels; prolonged prothrombin time; severe liver injury; and NAC side effects. RESULTS: Annual admission rate was constant at circa 55 per annum. Female to male ratio was 2:1. Predictors of liver injury included paracetamol dose over 10 g, presentation more than 10 hours after the overdose and chronic ingestion of more than 80 g alcohol per day. There were no deaths. Fifty-five patients (18%) had toxic paracetamol levels, 51% received treatment with NAC, including 40% of those with non-toxic levels, and 11% of those treated with NAC experienced side effects. CONCLUSION: Paracetamol overdosage continues to be a significant cause of hospital admissions in western Sydney. Severe hepatic damage occurs infrequently and the prognosis for liver injury, when it occurs, is good. Treatment with NAC should be reserved for patients with definite indications for the drug.     

Atypical lesions of the anal mucosa in homosexual men

Recent studies suggest that there is an increased incidence of squamous cell carcinoma of the anus in male homosexuals, but a precursor lesion has not been identified. We retrospectively analyzed in a blind fashion all anal tissue removed surgically during 1984. Twelve (6.7%) of the 180 specimens from men contained lesions with foci of epithelial atypia. Only one (0.85%) of 118 specimens from women harbored similar atypia. Of seven additional file cases exhibiting atypical anal mucosa, six were from men. Of 14 men with atypical anal lesions whose sexual orientation was known, 11 (79%) were homosexuals. In the 20 cases found to have atypical mucosal lesions, three patterns of atypia were identified, with more than one often occurring in the same specimen. Anal intraepithelial neoplasia (dysplasia) was identified in seven cases (35%) and occurred primarily at the anorectal junction and in anal ducts. Atypical condyloma was found in three cases (15%). A third lesion histologically indistinguishable from Bowen's disease or bowenoid papulosis was found in 12 cases (60%). In ten of these the lesion was adjacent to a condyloma. Although the natural history of these lesions of the anal mucosa is presently unknown, it may resemble that of similar lesions in other anatomic locations.     

Development of AIDS in a cohort of HIV-seropositive homosexual men in Australia

The Sydney AIDS Prospective Study is a cohort study of 1057 homosexual men enrolled between February 1984 and January 1985. By June 30, 1989, 111 (26.8%) of the 414 men who were seropositive for antibodies to human immunodeficiency virus (HIV) at enrollment had developed the acquired immunodeficiency syndrome (AIDS). On univariate analysis the following baseline factors were significantly associated with subsequent development of AIDS: splenomegaly; a lymphocyte count less than 1500 x 10(6)/L; a percentage of CD4+ cells less than 20% of the total lymphocyte count; an absolute number of CD4+ cells less than 200 x 10(6)/L; and a CD4+: CD8+ ratio less than 1.00. In a proportional hazards model the following factors retained significance: a lymphocyte count less than 1500 x 10(6)/L; an absolute number of CD4+ cells less than 200 x 10(6)/L; and a CD4+: CD8+ ratio less than 1.00. A CD4+ cell count less than 200 x 10(6)/L carried the greatest relative risk (3.99) for the development of AIDS. This study has confirmed that the appreciable rates of progression to AIDS demonstrated in overseas cohorts of HIV-infected persons also apply in the Australian context. A number of laboratory variables was found to be predictive for the subsequent development of AIDS. As we were not able to determine accurately whether subjects were receiving antiretroviral treatment or prophylaxis for opportunistic infections the observed rates in this study should be seen as minimum estimates. These findings have important implications for HIV-infected persons and for public health planning, and emphasise the need for regular clinical monitoring and T-cell subset enumeration in HIV-infected persons.     

Thiamin status of a sample of homeless clinic attenders in Sydney

Thiamin is one of the marginally adequate nutrients in the Australian diet. The incidence and prevalence of Wernicke-Korsakoff syndrome in this country may be the highest in the world. Homeless men could be at risk for low intakes of thiamin in association with irregular high alcohol intakes. A sample of 107 homeless men from two hostels and one clinic for homeless persons in inner Sydney was investigated for nutritional status; their thiamin status is reported here. By means of 24-hour recall methods, their mean dietary thiamin intake--0.76 mg per day--was less than the National Health and Medical Research Council's recommended dietary intake of 1.1 mg per day; at 0.076 mg/MJ it was even less than the minimal requirement of 0.08 mg/MJ. It was much lower than the mean intake of 1.38 mg per day that was found in the 1983 National Dietary Survey of adults and the distribution of thiamin intakes in this study was skewed positively, with the largest intake being in the range of 0-0.1 mg per day. On clinical examination we found a high prevalence of signs that were consistent with thiamin deficiency. Twenty-four per cent of the subjects showed three-or-more of the signs of the Wernicke-Korsakoff syndrome (ophthalmoplegia, nystagmus, ataxia, peripheral neuropathy and global confusion). In assaying for red-cell transketolase levels, this subgroup showed higher thiamin pyrophosphate effects than did the whole sample. Thirty-six per cent of the whole sample showed subnormal thiamin status by the thiamin pyrophosphate effect. Thus, in this sample, homeless men showed a high prevalence of dietary, biochemical and clinical features to indicate subclinical or early clinical thiamin deficiency.     

Transmission of HTLV-I and HIV among homosexual men in Trinidad

Risk for human T-cell lymphotropic virus type (HTLV-I) and human immunodeficiency virus (HIV) infection was evaluated in 100 homosexual or bisexual men from Trinidad. High seropositivity for HTLV-I (15% vs 2.4% in the general population) was linked to duration of homosexuality and numbers of partners, suggesting that HTLV-I, like HIV, can be transmitted by homosexual sex. Forty percent of homosexuals compared with 0.19% of the general population were seropositive for HIV, and sexual contact with US homosexual men and prior history of gonorrhea were major risk factors. The seroprevalence of HIV was three times higher than that for HTLV-I, suggesting that HIV is more efficiently transmitted, especially since HIV appears to have been recently introduced into Trinidad. Altered immune status was prominent in individuals infected with HIV and coinfected with HIV and HTLV-I. Whether HIV/HTLV-I coinfection amplifies clinical effects is a hypothesis that will require further evaluation.     

434名男男性行为者艾滋病知识和行为调查

目的了解芜湖市男男性行为者（MSM）艾滋病相关知识知晓率、性行为学特征及其影响因素,为开展有效干预措施提供依据。方法采用分类滚雪球的抽样方法对MSM进行匿名问卷调查。结果共对434名男同性恋者进行了调查,艾滋病相关知识知晓率为80．4％。经Logistic回归分析发现,寻找性伴的场所档次和文化程度越高,其知晓率越高,年龄越高知晓率越低。最近6个月所有MSM均与同性发生过性行为,36．9％与同性发生性行为时每次都使用安全套。最近6个月,10．8％的调查对象与同性发生过商业性性行为,25．1％的调查对象与异性发生过性行为。样本来源、艾滋病知识知晓率、是否进行过性病诊疗和最近1年是否做过AIDS检测对最近6个月MSM性行为时每次都用安全套有影响。结论在MSM中存在知识与行为脱离现象,应针对不同年龄组的MSM采取不同的干预措施。     

Persistent generalized lymphadenopathy in homosexual men: clinical, pathological and immunologic characteristics

Eighteen homosexual men who had had lymphadenopathy in two or more extrainguinal sites for more than 5 months but had no evidence of other illnesses or infections were studied. All had extreme malaise, and 90% had additional symptoms (fever, night sweats, weight loss or gastrointestinal dysfunction). They were compared with 10 healthy homosexual and 10 healthy heterosexual male controls. The mean numbers of circulating T8 (suppressor) lymphocytes were increased equally in the two homosexual groups, but the mean number of T4 (helper) lymphocytes was decreased only in the group with lymphadenopathy. The response to testing for recall anergy was diminished in both homosexual groups but was significantly lower in the group with lymphadenopathy. The serum immunoglobulin and complement concentrations and the numbers of circulating B lymphocytes were normal in each group. Seven of nine lymph node biopsy specimens showed characteristic hyperplasia and confluence of follicles. Thus, idiopathic persistent, generalized lymphadenopathy in homosexual men without opportunistic infections or malignant diseases appears to be a distinct syndrome; it may also be related to the acquired immune deficiency syndrome.     

Empirical therapy for the management of acute proctitis in homosexual men

An effective empirical treatment regimen would provide a more rapid and less expensive approach to the management of homosexual men with acute proctitis. We conducted a randomized trial in 129 homosexual men who presented with acute proctitis, comparing treatment with an empirical regimen (4.8 million U of aqueous penicillin G procaine intramuscularly and 1.0 g of probenecid orally, followed by 100 mg of oral doxycycline twice daily for seven days) with specific therapy for each infection as it was recognized. Therapy with the empirical regimen resulted in more rapid resolution of the symptoms of proctitis, the objective signs of proctitis, and the infecting microorganisms. However, nearly one fourth of the patients, primarily those with unrecognized herpes simplex virus proctitis, did not respond to empirical therapy. We recommend empirical therapy coupled with appropriate pretreatment diagnostic testing for the initial management of acute proctitis in homosexual men with no clinical evidence of acquired immunodeficiency syndrome or AIDS-related complex.     

The Vancouver Lymphadenopathy-AIDS Study: 6. HIV seroconversion in a cohort of homosexual men.

In an ongoing prospective study of homosexual men conducted since November 1982 in Vancouver, we identified 345 men who did not have antibody to human immunodeficiency virus (HIV) at the time of enrolment and for whom results of follow-up serologic testing were available. A total of 66 cases of seroconversion were documented among the 345 men between November 1982 and October 1985. Methods of survival data analysis that take into account the varying durations of follow-up were used to study the epidemiologic features of seroconversion in this group. The probability of seroconversion during the entire observation period was 23.1%. The seroconversion rates remained stable, at 10.5% and 10.0% during the last 2 years of the observation period. Cox regression analysis revealed the following variables to be independently associated with risk of seroconversion: frequent receptive anal intercourse, elevated number of male sexual partners in the year before enrolment, use of illicit drugs, a history of gonorrhea and age less than 30 years in November 1982. Multivariate analysis failed to reveal any role of oral sexual activity in the transmission of HIV. Oral ingestion of semen was not associated with seroconversion in either univariate or multivariate analysis. The observation that younger men were more likely to seroconvert suggests that young homosexual men were less likely than older men to modify their sexual behaviour.