Gay Male Patients Research Articles

The Health Needs of Gay Men with an Emphasis on the Psychosocial Needs—A Discussion of Literature, Using the VIPS Model

The aim of the study was to find areas that were important to highlight when collecting data for the nursing history and the nursing status of the gay male patient, with an emphasis on psychosocial issues. Literature was searched in the data-bases Psyc-Lit and CINAHL, and the results were presented using the VIPS model (Ehrenberg, Ehnfors, Thorell-Ekstrand 1996). Areas that need to be out in focus were: the coming out process, sexual behaviour and safer sex, lifestyle and significant other(s). To discuss issues related to sexuality is difficult both to patients and nurses, but could be relieved using the PLISSIT model (Annon 1977). When informing on safer sex, one must bear in mind the lifestyles like «the chosen family» (Henriksson 1995) and open relations. But also the «symbolic meaning» given to the unprotected anal intercourse by some, and where the cessation of the use of condoms symbolises trust and love, and that the relationship is for real-«risk factor love» (Henriksson 1995, Linder 1996).

Gay Men and the Health Care System

Because of the homophobia manifested by health care providers, gay men have had to exercise extra prudence in the selection of their physician to avoid "second class" medical care. The persistence of negative attitudes of caretakers towards gay men is evident in the interaction between the physician and her/his gay male patient. These negative attitudes are manifested in a range of behaviors, from overt rejection to benign neglect. To avoid this deleterious experience, some gay men will withold pertinent information which subsequently interferes with the physician's ability to make an appropriate diagnosis. The AIDS epidemic has led to a confrontation of the health system by gay activists and AIDS service organizations, ushering in the start of more positive attitudes and behaviors towards gay men with HIV or AIDS. Possible solutions to these shameful occurrences with the health system are discussed.

Coping Strategies, Substance Use, Sexual Activity, and HIV Sexual Risks in a Sample of Gay Male STD Patients1

The relationships of coping strategies with levels of substance use and sexual activity, and with HIV sexual risks, are examined in a sample of gay male STD clinic patients (n = 416). Previous research has suggested that use of problem‐focused coping strategies should be negatively related to levels of substance use, levels of sexual activity, and HIV sexual risks; use of emotion‐focused coping strategies should be positively related to these outcomes. It is argued that substance use and sexual activity clearly fit within a coping perspective, but that the HIV sexual risks/coping relationship is less clear. In multivariate analysis, the problem‐focused strategy of advice seeking is negatively related to the number of types of drugs used and to the number of sexual partners; the problem‐focused strategy of support seeking is negatively related to the number of days using drugs; and the use of emotion‐focused strategies is positively related to the number of types of drugs used. Problem‐focused coping strategies are less directly related to engaging in HIV sexual risks when measures of substance use and of sexual activity are included in the prediction; emotion‐focused coping strategies are more stably related to HIV risk. Indirect effects of coping on HIV risk are also identified through the effects of coping on the number of types of drugs used, number of sex partners, and number of times having sex. It is proposed that the relationships between coping and levels of substance use and sexual activity reflect the use of these activities as ways of relieving strain, but that relationships between coping and HIV sexual risks involve less clearly understood direct and indirect relationships.

Families of homosexual men: their knowledge and support regarding sexual orientation and HIV disease.

The number of homosexual men (gay) with the human immunodeficiency virus (HIV) who will become ill in the next few years is expected to rise dramatically. Many will need and desire support from their families of origin. Understanding the history of family relationships can be crucial for the optimal care of these patients and their families. Little is known, however, about the relationship between gay men and their families of origin. A convenience sample of gay men (n = 265) from three northern California cities was surveyed to determine family member knowledge of their sexual orientation and HIV status and perceived family supportiveness regarding issues of HIV disease and acquired immunodeficiency syndrome (AIDS). Fifty-five percent of the sample were HIV negative, 14 percent were HIV positive, 8 percent had received a diagnosis of AIDS, and 23 percent had not been tested. Approximately 70 percent of family members knew a son's or brother's sexual orientation. Fewer family members (50.9 percent) knew a son's or brother's HIV status than knew his sexual orientation. Untested gay men reported the least family knowledge of both sexual orientation and HIV status. There was, however, considerable variation in knowledge among members of the same family, with mothers and sisters knowing HIV status more frequently than fathers and brothers. The amount of supportiveness regarding issues of HIV disease within the family also varied considerably. It is important for the family physician caring for the gay male patient, his family, or both to understand that the pattern of knowledge and supportiveness among family members concerning sexual orientation and HIV status is selective, even within the same family. The physician needs to assess family members' knowledge and attitudes to plan an overall care strategy.

A Developmentally Keyed Scheme for the Placement of Gay Men into Psychotherapy Groups

Patients can meet their needs for intimacy and individuation within the context of long-term psychotherapy groups. This is especially true for gay male patients as they work toward the development of a positive gay identity. Coming out is a social phenomenon, which is why groups are especially suited to the tasks involved. Historically, mixed groups of gay and nongay men and women have not been a safe or neutral treatment atmosphere for gay men due to therapists' prejudicial assumptions and a lack of understanding of gay male development. A developmental scheme will be presented which is keyed to the particular needs of gay men depending on their developmental stage of functioning. This scheme should serve as a more rational and appropriate guide for the diagnosis, treatment planning, and assigning of gay men to long-term psychotherapy groups.

国内にて感染した日本人男性同性愛AIDS患者2例の臨床経過と剖検所見

This is a report on the clinical courses and pathological findings in two gay male patients with acquired immunodeficiency syndrome (AIDS) infected in Japan. Case 1. A 39 year-old Japanese homosexual male was diagnosed as amebic dysentery complicated with liver abscess on admission. He was placed on Metronidazole with complete relief. Serological tests was positive for AIDS. On second admission, he was found to have pneumocystis carinii pneumonia (PCP) and cytomegalo-viral uveitis. Administration of Pentamidine was partially effective, however the therapy with Azidothimidine was discontinued by bone marrow suppression. On his third admission, he suffered from cryptococcal meningitis and therapy-resistant fungusemia. Finally he died of recurrent pneumonia regardless of appropriate therapies. Autopsy proved extended cryptococcal infection in the brain, meninx, lungs, liver and kidney, and cytomegalo-infection in the lungs, liver and kidney. Furthermore, atypical mycobacteriosis was found in the lymph nodes. There was no active findings compatible with PCP. Case 2. A 44 year-old Japanese homosexual male was admitted with oral candidiasis and diagnosed as AIDS related complex. He suffered from pneumonia with marked improvement on sulfamethoxazole-Trimethoprim. On his second admission, he developed diarrhea and was found to be infected with Giardia lambia. In addition, cytomegalo-viral infection damaged his eye sight. He died of pneumonia and meningitis shortly there after. Autopsy proved a cytomegalo-viral infection in the lung and colon, old lesions possibly caused by PCP in the lungs, and suppurative meningitis in the meninx. These experiences confirm that AIDS patients can be exposed to several opportunistic infections at the same time in the multiple organs. Furthermore, it is suggested that homosexual patients with AIDS may have unique opportunistic infections such as amebic dysentery or Giardia lamblia unlike other AIDS patients related to hemophilia.