Geographic and birth cohort associations of Kaposi's sarcoma among homosexual men in Canada

The authors conducted an analysis of all 677 cases of Kaposi's sarcoma among the 3,047 cases of acquired immunodeficiency syndrome diagnosed in homosexual/bisexual men in Canada between 1980 and 1989. The proportion with Kaposi's sarcoma declined from 32.2% during 1980-1985 to 15.0% in 1989. The proportion with Kaposi's sarcoma was significantly higher in primary epidemic centers (Vancouver, Toronto, and Montreal) and in men in the 1945-1954 birth cohort independent of year of diagnosis. These data are consistent with an environmental cofactor for Kaposi's sarcoma which is likely to be a sexually transmitted agent.     

AIDS in bisexual men in the United States: epidemiology and transmission to women.

BACKGROUND. Homosexual and bisexual men with acquired immunodeficiency syndrome (AIDS) differ, and bisexual men play an important role in the sexual transmission of human immunodeficiency virus (HIV) to women. METHODS. To describe AIDS in these groups, we examined AIDS cases reported nationally through June 1990. RESULTS. Among 65 389 men who reported having had sex with men since 1977, 26% were bisexual. More Black (41%) and Hispanic men (31%) than White men (21%) reported bisexual behavior. Bisexual men were twice as likely to report intravenous drug use (20%) as were homosexual men (9%), regardless of race or ethnicity. Among 3555 women with heterosexually acquired AIDS, 11% reported sexual contact with a bisexual man and no other risk factor, although in some states approximately half reported such contact. In 1989, the AIDS rate due to sex with a bisexual man was three and five times higher among Hispanic and Black women, respectively, than among White women. CONCLUSIONS. Differences between bisexual and homosexual men with AIDS and the relative importance of AIDS in women due to sexual contact with bisexual men should be considered in the development of HIV prevention programs.     

Homosexual and bisexual men''s perceptions of discrimination in health services.

Questionnaires were distributed to homosexual and bisexual male participants in the Multicenter AIDS Cohort Study and to homosexual and bisexual male patients with acquired immunodeficiency syndrome (AIDS) to determine whether the men believed they had been refused medical or dental treatment because of their sexual orientation or a condition related to the human immunodeficiency virus (HIV). Men with AIDS were significantly more likely (18%) to report being refused treatment by a doctor or dentist on the basis of a known or suspected HIV-related condition than were men who were seropositive (5%) or seronegative (1%). Significantly more respondents reported refusal of dental care than of medical care.     

Diagnosis and treatment of HIV-related Kaposi's sarcoma

A 42-year-old heterosexual man presented with bluish-purple spots on his skin and in his mouth cavity that had been present for a few months; a 48-year-old homosexual man had painful lymphadenopathy in the groins and left axilla. Both men appeared to have a Kaposi's sarcoma and to be HIV-positive. During highly active antiretroviral therapy (HAART) and radiotherapy or chemotherapy, both the AIDS parameters and the skin lesions improved. Kaposi's sarcoma is AIDS-defining in HIV-seropositive patients. Human herpesvirus-8 infection seems to play a role in the development of Kaposi's sarcoma. The incidence of Kaposi's sarcoma has declined since the introduction of HAART. Nowadays, Kaposi's sarcoma is frequently the presenting symptom of HIV-seropositivity. Patients present with purple cutaneous lesions and/or generalised lymphadenopathy. Visceral lesions are associated with a shorter median survival. The treatment of Kaposi's sarcoma is palliative, whereas immune restitution can lead to regression of the sarcoma.     

Evidence for a sexually transmitted cofactor for AIDS-related Kaposi's sarcoma in a cohort of homosexual men.

We examined factors associated with the subsequent development of AIDS-related Kaposi's sarcoma in a cohort of 353 homosexual men infected with human immunodeficiency virus (HIV). Cumulative incidence curves for the development of Kaposi's sarcoma and opportunistic infection were stratified over a wide range of variables at enrollment, including those related to demographics, sexual behavior, illicit drug use, and medical history. We found no strong associations between any of these variables and the development of opportunistic infection, but two were related to Kaposi's sarcoma: use of nitrite inhalants (relative risk, 2.3; 95% confidence interval, 1.0-5.0) and high numbers of sexual contacts during the period 1978-1982 in the AIDS epidemic centers of San Francisco, Los Angeles, and/or New York (relative risk, 3.5; 95% confidence interval, 1.6-7.6). The latter variables remained independently associated with risk of Kaposi's sarcoma even after multivariate adjustment for a number of classical HIV risk factors. These results are consistent with the hypothesis that Kaposi's sarcoma is caused by a sexually transmitted cofactor that has remained more prevalent in the original epidemic centers. The effect of nitrites could be due to an independent biological mechanism or to enhancement of transmission of the cofactor.     

青年男同性恋者/男双性恋者购买性商业同性性行为的社会文化因素

  目的   调查青年男同性恋者/男双性恋者购买性商业同性性行为, 分析影响购买性商业同性性行为的社会文化因素。   方法   于2016年在贵州省贵阳市、遵义市、安顺市和铜仁市釆取分类滚雪球抽样(classification snowball sampling, CSS)调查和艾滋病(acquired immunodeficiency syndrome, AIDS, 又称获得性免疫缺陷综合征)自愿咨询检测门诊调查相结合的方法, 对824例青年男同性恋者/男双性恋者进行AIDS危险性行为一对一面访匿名问卷调查。   结果   2016年购买性商业同性性行为总报告率为7.8%(95% CI:5.9%~9.6%), 其中, 青年男双性恋者报告率为13.0%, 高于男同性恋者的5.7%(P < 0.001)。对购买性商业同性性行为有影响的因素为月均收入(OR=6.54, P=0.005), 年龄(OR=3.59, P=0.011), 喜欢同性年龄(OR=2.85, P=0.004), 婚姻状况(OR=2.62, P=0.005), 户籍(OR=2.38, P=0.011), 口交增加危险性(OR=0.42, P=0.019), 感染AIDS可能性(P < 0.005), 公开性取向(OR=0.17, P=0.001)。   结论   青年男同性恋者/男双性恋者, 尤其是男双性恋者购买性商业同性性行为报告率较高。社会文化影响因素为喜欢同性年龄、口交增加危险性、感染AIDS可能性和公开性取向。     

Survival with AIDS in Massachusetts, 1979 to 1989.

OBJECTIVES. The goal of the study was to determine survival time after diagnosis of acquired immunodeficiency syndrome (AIDS) and to identify predictors of survival. METHODS. We conducted a population-based prospective survival analysis of all Massachusetts-resident adult AIDS patients diagnosed from January 1, 1979, through December 31, 1988. RESULTS. Median survival was 406 days, with a 5-year survival rate of 3%. Age older than 40 years (P = .001), a diagnosis other than Kaposi's sarcoma (P = .001), and a history of intravenous drug use (P < or = .01) were associated with shorter survival after confounding was controlled. Survival increased as year of diagnosis became more recent (P < .0001). This temporal effect was strongest for patients with Pneumocystis carinii pneumonia. Individuals with Kaposi's sarcoma, Hispanics, homosexual men who were concurrent intravenous drug users, and residents of the greater Boston standard metropolitan statistical area, excluding the city of Boston, did not experience increases in survival over time. CONCLUSIONS. With the exception of cases initially defined by Kaposi's sarcoma, recently diagnosed AIDS case subjects survive longer than those diagnosed earlier in the epidemic. Further work is needed to determine whether this effect is due to lead-time bias or better treatment after diagnosis.     

Patterns of Sexual Arousal in Homosexual,Bisexual, and Heterosexual Men

The purpose of this study was to determine if self-identified bisexual, heterosexual, and homosexual men show differential genital and subjective arousal patterns to video presentations of bisexual, heterosexual, male homosexual, and lesbian sexual interactions. It was predicted that, relative to heterosexual and homosexual stimuli, bisexual men would show the highest levels of sexual arousal to bisexual erotic material, while this stimulus would induce relatively low levels of response in heterosexual and homosexual men. A sample of 59 men (19 homosexual, 13 bisexual, and 27 heterosexual) were presented with a series of 4-min sexual videos while their genital and subjective sexual responses were measured continuously. Bisexual men did not differ significantly in their responses to male homosexual stimuli (depicting men engaging in sex) from homosexual men, and they did not differ significantly in their responses to heterosexual (depicting two women, without same-sex contact, engaged in sex with a man) and lesbian (depicting women engaging in sex) stimuli from heterosexual men. However, bisexual men displayed significantly higher levels of both genital and subjective sexual arousal to a bisexual stimulus (depicting a man engaged in sex with both a man and a woman) than either homosexual or heterosexual men. The findings of this study indicate that bisexuality in men is associated with a unique and specific pattern of sexual arousal.     

AIDS-associated Kaposi's sarcoma: 22 cases

BACKGROUND: Kaposi's sarcoma is the most common acquired immune deficiency syndrome (AIDS)-associated malignancy. Our aim was to analyse the epidemiological, clinical, therapeutic findings in AIDS patients with Kaposi's sarcoma. METHODS: This was a retrospective chart review of AIDS patients with Kaposi's sarcoma diagnosed between 1991 and 2005. Epidemiological data, the stage of human immunodeficiency virus's (HIV) infection, clinical characteristics of Kaposi's sarcoma, treatment rendered and outcome were collected. The search of HHV8 was not done. RESULTS: Twenty two patients were included. They were 17 men and 5 females (sex-ratio=3.4/ 1) with a mean age of 33.6 years at the diagnosis of HIV infection. The Kaposi's sarcoma appeared after a period varying between 0 and 10 years. The Kaposi's sarcoma uncovered the infection in 5 cases. There were 6 homosexual men. The mean rate of CD4 was 216 21/mm3 at the diagnosis of Kaposi's sarcoma. All patients had skin lesions. Mucocutaneous lesions were isolated in 12 cases and associated with visceral involvement in 10 cases; lung (10 cases), gastrointestinal tract (5 cases), lymphadenopathy (5 cases), liver (4 cases), spleen (2 cases). Antiretroviral therapy was prescribed for 13 patients. Six patients received chemotherapy and 3 others radiotherapy. Outcome was favourable in 4 cases with a partial improvement of the skin lesions in 3 cases and a complete regression in 1 case. Twelve patients died. CONCLUSION: AIDS associated Kaposi's sarcoma is a severe condition because of visceral localisations and the field of immunodeficiency. It requires a precocious diagnosis and collaboration. The identification of HHV8 in the aetiopathogenic mechanism of Kaposi's sarcoma can lead to the development new therapeutic approaches.     

Patterns of change in sexual behavior among gay men in New York City

In the absence of a vaccine or effective treatment for AIDS, health education remains the most effective strategy for stemming the spread of the epidemic. Among homosexual and bisexual men, who continue to account for the majority of AIDS cases, sexual practices have been identified as the principal risk factor. Consequently, public health efforts aimed at this population have focused on raising awareness of the potential risks of HIV infection associated with certain sexual practices. A sample of 162 asymptomatic gay and bisexual men were studied to examine patterns of change and stability in sexual behavior. The data reveal that while the large majority (84%) had adopted at least modification in their sexual behavior, primarily in the form of reducing their total number of partners and their number of anonymous partners, a significant proportion (48%) continued to engage in risky sexual behavior; this, despite high levels of knowledge concerning risk-reduction guidelines. The findings suggest that the mere transfer of information concerning safer sex practices is not sufficient to induce the desired behavior changes in a substantial proportion of gay men. Alternative strategies for achieving behavior change are suggested.This research was supported in part by grants from the National Institute of Mental Health (MH39551) and the New York AIDS Institute (C00577). An earlier version of this paper was presented at the meetings of the American Sociological Association, New York City, August 1986.     

A comparison of acquired immunodeficiency syndrome and Kaposi''s sarcoma incidence rates, Atlanta, 1983-86.

Recent temporal trends in incidence rates for acquired immunodeficiency syndrome (AIDS) and Kaposi's sarcoma were compared in metropolitan Atlanta, Georgia. From 1983 through 1986 the age-adjusted incidence rate of Kaposi's sarcoma among White males ages 25-49 increased 11-fold (2.2-24.4/100,000 person years). The annual incidence rate of AIDS increased ten-fold (11.3-113.3/100,000). These findings do not support earlier reports that the proportion of AIDS patients with Kaposi's sarcoma has decreased over time.     

Projections of the HIV/AIDS epidemic for homosexual/bisexual men in France,the Federal Republic of Germany and the United Kingdom

Projections of the spread of the acquired immunodeficiency syndrome (AIDS) and of its etiologic agent, the human immunodeficiency virus (HIV), are presented for homosexual/bisexual men in the three European countries with the largest caseloads. The results suggest that the HIV epidemic for French, German, and British homosexual/bisexual men has peaked around 1985 and declined rapidly thereafter. By the end of the century, and for a median incubation period of AIDS equal to 8 years, the total numbers infected in these groups are predicted to be about 31,200, 10,400 and 9,800, respectively. (These estimates more than double if the median incubation period is 12 years). In all cases the annual incidence of AIDS will reach its maximum in the early to mid-1990s. However, the AIDS epidemic will be protracted because of the long incubation period.     

Cancer in a population-based cohort of men and women in registered homosexual partnerships

Cancer patterns among broad populations of homosexual men and women have not been studied systematically. The authors followed 1,614 women and 3,391 men in Denmark for cancer from their first registration for marriage-like homosexual partnership between 1989 and 1997. Ratios of observed to expected cancers measured relative risk. Women in homosexual partnerships had cancer risks similar to those of Danish women in general (overall relative risk (RR) = 0.9, 95% confidence interval (CI): 0.6, 1.4), but only one woman developed cervical carcinoma in situ versus 5.8 women expected (RR = 0.2, 95% CI: 0.0, 0.97). Overall, men in homosexual partnerships were at elevated cancer risk (RR = 2.1, 95% CI: 1.8, 2.5), due mainly to human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)-associated Kaposi's sarcoma (RR = 136, 95% CI: 96, 186) and non-Hodgkin's lymphoma (RR = 15.1, 95% CI: 10.4, 21.4). Anal squamous carcinoma also occurred in excess (RR = 31.2, 95% CI: 8.4, 79.8). After exclusion of Kaposi's sarcoma, non-Hodgkin's lymphoma, and anal squamous carcinoma, no unusual cancer risk remained (RR = 1.0, 95% CI: 0.8, 1.3). With anal squamous carcinoma and HIV/AIDS-associated cancers as notable exceptions in men, cancer incidence rates among homosexual persons in marriage-like partnerships are similar to those prevailing in society at large.     

The San Francisco Men''s Health Study: continued decline in HIV seroconversion rates among homosexual/bisexual men.

The incidence of infection by the human immunodeficiency virus (HIV) has been monitored since 1984 in an area probability sample of homosexual/bisexual men drawn from a six-kilometer square area of San Francisco where the epidemic of acquired immunodeficiency syndrome (AIDS) has been most severe. Annualized HIV seroconversion rates in previously uninfected cohort members have declined by 88 per cent from 5.9 per cent during the first six months of 1985 to 0.7 per cent during the last six months of 1987. Concurrent declines of approximately 80 per cent in the prevalence of sexual behaviors associated with HIV transmission were also observed in the sample.     

Factors associated with AIDS and AIDS-like syndrome among homosexual and bisexual men in Minas Gerais, Brazil

A case-control study to determine factors associated with AIDS and AIDS-like syndrome among homosexual/bisexual men was conducted in the State of Minas Gerais (Brazil). Eighty-three per cent (45 patients) of all AIDS/AIDS-like syndrome cases in homosexual/bisexual men reported in Minas Gerais between February, 1986 and June, 1987 were compared to 133 seronegative controls seen at the same clinic. Blood samples were tested by ELISA and confirmed by Western blot. Sex with men from the USA, sex with someone who developed AIDS, number of male partners (greater than or equal to 100 lifetime), age (greater than or equal to 30 years old) and ethnicity (white) were independently associated with AIDS/AIDS-like syndrome (Odds Ratios = 5.5, 4.3, 3.9, 3.5 and 2.7, respectively). Thirty-nine per cent of cases and 44% of controls reported bisexual activity during the previous two years. From these, a high proportion reported anal intercourse with women in the same period (53% of bisexual cases and 33% of bisexual controls). Bisexual men had more male partners than female partners in the previous two years (median male partners = 20 for cases and five for controls; median female partners = three for both cases and controls). This explains in part why the epidemic has increased more rapidly among men then among women in Minas Gerais, despite the large proportion of bisexuals with the disease.     

有自杀意念的男同性爱者/双性爱者滋病高危行为研究

目的 探讨男同性爱者(gay)与双性爱者(Bi)中有自杀意念者的艾滋病高危行为特征,并分析其与自杀意念相关的危险因素.方法 采用定向抽样法对gay/Bi人群进行横断面调查.从有效问卷中获取有自杀意念者,并依照自杀意念组的年龄情况在无此意念者中选取比较组进行比较.结果 调查的gay/Bi中有自杀意念者占20.2％.自杀意念组性向为同性、婚姻状况为未婚者多于比较组(P＜0.05).自杀意念组在曾经向同性买性、近一年性交时曾出过血、曾去外地与陌生同性性交、16岁前曾遭受成年同性性虐待、有性施虐与受虐行为、有过主动或被动吻肛行为、有过主动或被动指交行为、每周饮酒至少一次或更多、曾因性向和/或同性性活动受到gay伤害、曾因性向和/或同性性活动受到异性爱者伤害等方面的比例显著高于对照组(P＜0.05).多因素logistic回归模型提示曾因性向和/或同性性活动受到gay( Waldx2=6.637,P=0.010)及异性爱者(Waldx2=5.835,P=0.016)伤害是导致自杀意念产生的危险因素.结论 有自杀意念的gay/Bi与艾滋病相关的高危性行为显著多于无此意念者.减少社会对gay与Bi人群的歧视及伤害可能对遏制艾滋病的流行有一定作用.     

Immunologic markers of progression to acquired immunodeficiency syndrome are time-dependent and illness-specific.

Since prevalent cohorts may be biased by the duration of human immunodeficiency virus (HIV) infection (onset bias), it is useful to assess the potential predictive value of markers in incident cohorts of HIV-positive subjects for whom the date of seroconversion is known or can reliably be estimated. Of 131 homosexual men with HIV-1 seroconversion from New York City and Washington, DC, who were evaluated annually beginning in 1982, 60 developed acquired immunodeficiency syndrome (AIDS) by the end of 1989. The prognostic significance of immunologic markers (proportion of CD4+ T-lymphocytes, neopterin, beta 2-microglobulin, serum interferon, and anti-p24 antibody) and of a virologic marker (HIV p24 antigen) was determined using measurements made at defined time intervals after the known or estimated date of HIV seroconversion. When measurements made 3 years after seroconversion were used, all markers except anti-p24 antibody were found to be significant estimators of AIDS risk in univariate analyses. In multivariate Cox regression modeling, the maximum information was obtained by including neopterin, interferon, and the CD4+ T-lymphocyte proportion. The predictive value of markers after HIV seroconversion could change considerably from one interval to another. Elevated levels of beta 2-microglobulin and neopterin significantly predicted the development of Kaposi's sarcoma. These two markers were highly correlated (r = 0.74). The authors conclude that immunologic markers can be important for an HIV staging system for estimating prognosis and facilitating early therapeutic intervention in HIV-positive patients.     

Sexual behavior and status for human immunodeficiency virus type 1 among homosexual and bisexual males in Mexico City.

The authors examined sexual behaviors, the seroprevalence of human immunodeficiency virus type 1 (HIV-1), and condom use among 2,314 homosexual and bisexual men tested during 1988-1989 at the AIDS (acquired immunodeficiency syndrome) National Center in Mexico City. Bisexuals constituted 24% of the sample; the seroprevalence rate was lower for bisexuals than homosexuals (21 vs. 34%). In logistic regressions, HIV-1 seropositivity was independently related to age, education, pattern of insertive/receptive behavior in anal sex, lifetime number of male sex partners, having sex with someone with AIDS, homosexual versus bisexual behavior, and a history of condyloma. The same logistic regressions were found to fit bisexuals and homosexuals. The rate of HIV-1 was reduced in individuals who indicated always requiring their partners to use a condom when practicing receptive anal sex (1% of the total). The most common practice for both homosexuals and bisexuals was "mixed" behavior (i.e., both insertive and receptive anal sex); this was also the practice with the highest risk. Bisexuals practiced both vaginal and anal sex with women and reported little condom use. The substantial seroprevalence among bisexuals, their frequent sexual contact with women, and their low rate of condom use imply a continuing role as a bridge of infection to females. Whether this risk will lead to a sustained heterosexual epidemic remains to be determined.     

Estimating the AIDS incubation period from a prevalent cohort

Data from a cohort study of 177 homosexual or bisexual men enrolled in Los Angeles in 1982 and 1983 are used to estimate the incubation period distribution of acquired immunodeficiency syndrome (AIDS). The statistical method used is parametric modeling of the joint distribution of the date of human immunodeficiency virus infection and the time from infection to the onset of AIDS. With this method, the unknown dates of infection and the fact that individuals who developed AIDS prior to the enrollment date are excluded from the sample is taken into account. The estimated proportion of individuals who develop AIDS within 4 years of infection is 0.10 (95% confidence interval 0.05-0.21) and that within 8 years of infection is 0.45 (95% confidence interval 0.30-0.60). These proportions are consistent with those obtained from other cohort studies and through other statistical approaches.     

Sex habits,recent disease,and drug use in two groups of Danish male homosexuals

Interviewed to obtain the first quantitative data from Scandinavia on lifestyle factors of possible importance for their health were 259 Danish male homosexuals. The frequency of various sex acts, frequency of change in partner, visits to the United States, sexual contacts with victims of the immune suppression syndrome, education, smoking and drug habits, and recent medical problems were recorded. Of those interviewed, 170 were from the Danish capital, Copenhagen, and 89 were from a smaller provincial town, Aarhus. Sexual habits and most other factors were very similar in men from the two cities. Furthermore, the sex habits of those who had visited a venereal disease clinic were similar to those of the group as a whole except for a frequent change of partners. Our data on level of sexual activity resemble those available for the San Francisco Bay area of 1970. The Copenhagen men, however, had more partners per year, had more sexual contact with U.S. citizens and immune suppression syndrome victims, and more had used nitrite inhalation than the men in Aarhus. The frequency of venereal disease was the same in the two groups, but the Danish cases of Kaposi's sarcoma and the acquired immune deficiency syndrome all have come from the Copenhagen area. Two of those interviewed have developed AIDS subsequent to homosexual contact with a case of Kaposi's sarcoma.