“Sometimes We are Prejudiced against Ourselves”:

The painful experiences of an adolescent boy treated in analytically oriented psychotherapy are used as a lens through which we can consider the effects of homophobia, their internalization, and their entanglement with intrapsychic processes. Controversies in the psychoanalytic literature on internalized homophobia are also considered. Homophobia within the developmental literature and the nascent state of conceptualizations of healthy homosexual development are addressed as concerns for treatment and pedagogy. I examine elements of my countertransference, including an overly cautious attitude toward exploring contradictory or complex aspects of my patient's sexuality due to a concern not to replicate homophobic attitudes. I also discuss some of the implications for coming out at a young age, as this boy did.     

Comparison of General and Detailed HIV Risk Assessments Among Methamphetamine Abusers

Investigators have long focused on refining the accuracy of HIV risk assessment. One concern is that HIV risk measures either cover general risk behaviors or assess a few specific behaviors. We compared a standardized general measure (Risk for AIDS Behavior, RAB) and a recently developed behaviorally detailed measure (Behavioral Questionnaire-Amphetamine, BQA) in three samples of methamphetamine-dependent individuals in drug treatment in Southern California (76 gay men, 57 heterosexual men, and 33 heterosexual women). Our results indicate that RAB depicted gay men at significantly higher risk than either heterosexual men or women. However, RAB Total score failed to discriminate between HIV-infected and HIV-uninfected gay men. By contrast, BQA discriminated between HIV-infected and HIV-uninfected men as measured by significantly more instances of unprotected anal receptive intercourse. General measures, e.g., RAB, may have utility for describing broad risk factors across heterogeneous groups of substance users. More detailed measures, e.g., BQA, may be necessary for distinguishing behavioral risk differences within high-risk populations such as substance-abusing gay men.     

Perceptions of lesbian, gay and bisexual people of primary healthcare services

AIM: This paper reports a study exploring people's perceptions of disclosure about lesbian, gay and bisexual identity to their primary healthcare providers. BACKGROUND: Disclosure of sexual identity to healthcare professionals is integral to attending to the health needs of lesbian, gay and bisexual populations, as non-disclosure has been shown to have a negative impact on the health of these people. For example, an increased incidence of suicide, depression and other mental health problems have been reported. METHOD: From April to July 2004, a national survey of lesbian, gay and bisexual persons was carried out in New Zealand. Participants were recruited through mainstream and lesbian, gay and bisexual media and venues, and 2,269 people completed the questionnaire, either electronically or via hard copy. The 133-item instrument included a range of closed-response questions in a variety of domains of interest. RESULTS: In this paper, we report results from the health and well-being domain. More women than men identified that the practitioner's attitude toward their non-heterosexual identity was important when choosing a primary healthcare provider. Statistically significantly more women than men reported that their healthcare provider usually or always presumed that they were heterosexual and in addition more women had disclosed their sexual identity to their healthcare provider. CONCLUSION: Nurses need to reconsider their approach to all users of healthcare services by not assuming everyone is heterosexual, integrating questions about sexual identity into health interviews and ensuring that all other aspects of the assessment process are appropriate and safe for lesbian, gay and bisexual people.     

Male to female: The role transformation of transsexuals

Twelve male transsexuals were found to have acquired a succession of gender roles from childhood to adulthood — ambivalent, homosexual, drag queen, and transsexual. These roles constituted different stages of their lives during which they were clarifying their psychosocial gender role as transsexuals. Their transition through these roles suggests that these individuals are a subset of the transsexual phenomenon, for many — probably most — other transsexuals do not adopt these roles prior to becoming adult transsexuals. The social interaction of these transsexuals with significant others differed from the ways in which sociological role theories view this process: the significant others in their lives (apart from their mothers) primarily influenced their role changes by withdrawing from and/or rejecting these individuals — not by inducing them to conform to their role expectations. As permanently cross-dressed transsexuals, these individuals continued to associate with the institutions of the gay world, which alone was tolerant of them and where they could draw on the emotional support of other transsexuals in this last presurgery role. At this point they had become their own reference group.     

A comparison of professionally employed lesbians and heterosexual women on the MMPI

The hypothesis tested is whether lesbianism implies psychopathology. The MMPI was given to 26 nonpatient lesbians who were professionally employed full time, and the results were compared to those for a group of 29 similarly employed heterosexual women. With the exception of the Sc scale, no difference was found on the clinical scales. The lesbian group achieved a significantly higher elevation than the nonlesbians on the Mf and Sc scales. Further analysis of the data on the Sc subscales indicated no difference on the pathological part of the scale, but rather a difference in degree of social alienation. Analysis of the data according to a second variable, living status, found significant differences and has important implications for future studies of the lesbian population. Single women, regardless of sexual orientation, scored significantly higher on scales K and Pa and on the Pa subscale naivete. A significant interaction between sexual orientation and living status was achieved on one scale, the F scale.     

Alternative behavioral approaches to the treatment of homosexuality

Radical changes in attitudes toward homosexuality in American society are integrated into a new perspective for the therapist confronted by a client who engages in homosexual behavior. The traditional mandatory attempt to eradicate homosexual behavior has been expanded into three options, any one of which may be pursued by the therapist at the client's request: (1) modification of homosexual in favor of heterosexual behavior, (2) enhancement of homosexual behavior, and (3) ignoring of homosexual behavior if it is functionally unrelated to the presenting symptoms. Therapists' negative attitudes toward clients who engage in homosexual behavior are such as to abrogate expanded options and may result in therapeutic efforts at modification of homosexual behavior in defiance of the client's expressed wishes. Contrary to current professional belief, careful analysis and the use of appropriate techniques such as systematic desensitization, orgasmic reconditioning, and training in heterosocial skills generally obviate the necessity for aversive procedures in those instances where homosexual behavior is to be modified in favor of heterosexual behavior. Three case histories are presented illustrating the use of each of the expanded options described above.     

Culture-proven cytomegalovirus retinitis in a homosexual man with the acquired immunodeficiency syndrome

A 35-year-old homosexual man with cytomegalovirus viremia developed retinitis. He also had a new syndrome consisting of a persistent T-lymphocyte deficit, pneumocystis pneumonia, recurrent Candida albicans esophagitis, skin ulcerations caused by herpes simplex virus, Type 2, disseminated Mycobacterium avium-intracellulare infection, and molluscum contagiosum. Histopathologic examination revealed bilateral necrotizing retinitis with virions in retinal, choroidal, and optic nerve tissues. Postmortem cultures of retina and vitreous were positive for cytomegalovirus.     

Public Issue: Discrimination's Impact on Public Health Practice

Whereas Pap smear screening has reduced cervical cancer mortality, minority status imposes barriers that limit access not only to screening but also to public health messages. Lesbians are a unique minority group due to multiple factors, and dispelling myths about their health risks has been hindered by a lack of research, knowledge, and outreach, as well as by homophobia. Recent research has bolstered the hypothesis that lesbians require Pap testing just as their heterosexual counterparts do. However, providers and lesbians continue to be largely unaware of this need. Media outreach in Seattle—a project of the Seattle City Council, the Seattle–King County Health Department, and the Seattle Commission for Sexual Minorities—attempted to correct this deficiency. Radio ads urged lesbians to have yearly exams, but complaints of the use of the word lesbian caused the ads to be pulled. The project illuminates the impact of discrimination on good public health strategies and the imperative to manage discrimination as a public health issue. The article describes the campaign and its outcomes.     

Mortality risk among new onset injection drug users

AIMS: To characterize mortality experience among those who only recently started injection. DESIGN: Prospective study. SETTING: Independent study clinic within high drug use neighborhoods. PARTICIPANTS: In 1988-1989, we enrolled 256 adult injection drug users (IDUs) recruited through street outreach who had initiated injection within the prior 2 years. MEASUREMENTS: Consenting participants underwent venipuncture for HIV antibody testing and interviews. We prospectively ascertained date and cause of death through follow-up contact and registry linkages. Analyses included standardized mortality ratios (SMRs) with local, state and national mortality data, adjusted for age, gender and race. FINDINGS: Baseline median age was 30 years, 70% were male, 95% were African-American and 90% injected within the prior 6 months. We identified 69 deaths through October 2000; mortality rate was 3.3/100 person-years. The adjusted SMR with the USA (and Baltimore) as the reference for IDUs was 4.40 (2.43) for 1991-1992, which increased to 8.12 (4.13) by 1993-1994, decreased to 4.43 (2.13) by 1997-1998 and increased slightly to 5.35 (2.79) during 1999-2000. Excluding HIV-related mortality, SMRs remained elevated. Decline in SMRs was not linked to drug abuse treatment. CONCLUSIONS: These data demonstrate excess mortality among new-onset IDUs compared with demographically similar peers in the general population, indicating the need for interventions to prevent premature death among young IDUs.     

Cytomegalovirus retinitis in a young homosexual male with acquired immunodeficiency

A case is reported of histopathologically documented CMV retinitis. It is part of a recently appreciated syndrome in young homosexual men, in which cellular immune deficiency has been documented and in which CMV infection may play a role. This case demonstrates that CMV retinitis is not excluded by negative CMV serology or cultures.