Homosexual Patients Research Articles

Psychoanalysis and homosexuality: The relevance of homophobia and shame for all sexualities

This article will describe some contemporary developments in psychoanalytic thinking about sexuality, from a post‐heteronormative standpoint. Psychoanalytic theorising of homosexuality had been generally homophobic for decades, reflecting society stereotypes. Previously, many analysts prescribed treatment to convert “the homosexual patient” to “healthy heterosexuality”, which Freud had regarded as likely to be unsuccessful. The author argues that psychoanalysis, having been part of the “disease” of homophobia, and the lengthy shadow cast by shame, can also contribute to its “cure” by promoting a broader understanding of the conscious and unconscious nature of desire and identity. The author considers the central role played by the superego in maintaining shame’s dominance and explores the impact of shame on time and temporality, including shame’s unique après coup nature. The struggle for acceptance of non‐heteronormative sexuality is discussed and contemporary developments in theorising desire, internalised homophobia, and Oedipus are explored. Drawing on fictional composite clinical vignettes, the author describes current challenges that clinicians face in relation to homophobia and shame, illustrating the central importance for clinicians to address where shame and homophobia lie within their own internal worlds and object relationships.

Patient and Provider Opinions Regarding Chaperones for Sensitive Exams.

Recommendations for chaperone use during sensitive exams have been left mostly to individual institutions, despite a paucity of data providing guidance. The purpose of this study was to survey patients and medical providers on their attitudes toward chaperone use and explore factors that may influence these attitudes. A survey was administered at a single tertiary military medical center to providers and patients across multiple specialties, and further sub-analysis of the data were completed. For patients, sub-analysis was done for gender, age, history of sexual abuse, and clinic seen. For providers, sub-analysis was done for provider gender and training status. Before data collection, this study was deemed exempt from institutional review board approval by the Eisenhower Army Medical Center Human Research and Protections Office. A total of 319 patient surveys and 61 provider surveys were collected. Fifty seven percent of patients have no preference regarding chaperone use, 19% prefer having a chaperone, and 24% prefer to not have a chaperone. Female patients and patients with a history of sexual abuse are more likely to prefer a chaperone. Forty two percent of providers always use a chaperone, 79% are more likely to use a chaperone if a patient is of the opposite gender, and 43% select a chaperone based on the gender of the patient. Male providers and providers still in training are more likely to use a chaperone. The majority of patients do not have a preference regarding chaperone presence during sensitive exams; however, female gender and history of sexual abuse increase the likelihood of a patient preferring to have a chaperone present. These factors should be considered when creating an institutional policy regarding chaperone use. Future research should focus on homosexual and transgender patient preferences as this has yet to be explored.

(218) The Intimometer: A Brief Psychometric Self-Report Questionnaire

Abstract Introduction Erectile dysfunction (ED) or premature ejaculation (PE) can severely affect the quality of life and wellbeing of both couple members. Sexual health care providers, including andrologists and sexologists, should perceive ED/PE as a collaborative health issue for men and their sexual partners. Thus, this study was designed to better understand the contribution of sexual partners in the treatment of men with ED/PE. Objective We aimed to evaluate the advisability of female (or male, in the case of homosexual patient) partner involvement in the prescription of specific pharmacological therapies in ED/PE patients. Methods We developed a brief psychometric self-report questionnaire tool, Intimometer. This tool consists of two modules (patient and partner versions) for each sexual dysfunction (ED and PE). Each module has 6 items that evaluate the degree of comfort/discomfort about communication, sharing, and partner involvement during the process of drug prescription and intake. The tool can be administered during the first andrological visit to either a single individual (only patient version) or to both members of the couple. The single module can be administered in less than 3 minutes. Each item scores from 0 (extremely unlikely) to 4 (extremely likely), and the total score is computed by the sum of the modules’ items. The total score ranges from 0 to 24, with higher scores endorsing the partner's comfort during treatment of ED/PE. Also, color codes were assigned for responses, low scores (red light) and high scores (green light) or combination of single results (couple administration). Results We hypothesize one cut-off score to identify two categories of responses. A low score signifies that the patient feels uncomfortable sharing drug information, choice, and intake and the involvement of the partner could potentially be harmful during medical treatment. On the contrary, a high score shows the involvement of the partner could improve the treatment’s efficacy and/or compliance, with a high chance of success. The combination of the single results (red, yellow and green) helps to identify the best treatment choice. The red light indicates that prior to medical prescription, the couple undergoes a psycho-sexological assessment to unveil conditions to continue with medical treatment. Yellow light indicates contemporary to medical prescription, psycho-sexological assessment might manage relational issues that could worsen pharmacological treatment. And green light denotes that the instrument could be re-administered after 4 weeks since the first administration, to verify any changes in patient/partner’s perception of medical treatment. Moreover, a re-test is highly recommended in patients whose scores are low or medium. Nevertheless, patients and couples who are classified as “red” or “yellow” light could present any other psychological complications (performance anxiety, fear of rejection, anger towards partner) which can be evaluated by psycho-sexologists. Conclusions This instrument could be beneficial to physicians while prescribing medical therapy and prevent any possible patient dropout and resultant therapy failure, especially in PE and ED patients. The involvement of sexual partners in the diagnostic process, education, counseling, and treatment choice is pivotal in improving the overall quality of life and sexual experiences for couples. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: 2Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy.

Prevalence of homosexual and bisexual orientation in patients with borderline personality disorder and associated factors - a systematic review and meta-analysis.

This meta-analysis aimed to quantitatively evaluate the association between homosexual and bisexual orientation and borderline personality disorder (BPD), including factors contributing to the association and clinical outcomes of homosexual and bisexual patients with BPD. We systematically searched PUBMED, PsycINFO, Cochrane Library, MEDLINE, EMBASE and Web of Science for cross-sectional or cohort studies comparing the prevalence of homosexual and bisexual orientation amongst patients with BPD and controls. Our search identified 7 eligible studies, with a total sample case of 636 subjects with BPD and 535 subjects without BPD. Patients with BPD had a significantly higher likelihood of homosexual and bisexual orientation (Risk ratio [RR] 3.39, 95%CI 1.88-6.12) with a pooled prevalence of 28% (95% CI 0.24-0.31; I2 73%; 7 studies, 1171 participants). Subgroup analyses validated that BPD was independently associated with higher prevalence of both homosexual (RR 8.51, 95% CI 3.36-21.54) and bisexual orientation (RR 3.82, 95% CI 1.81-8.04), but no gender difference was yielded. Childhood sexual abuse (CSA) was associated with the development of homosexual and bisexual orientation in patients with BPD. Poorer clinical outcomes, including physical and mental health, were associated with BPD status. Further studies are necessary to evaluate the feasibility and efficacy of sexual minority-specific treatment for these patients. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=538356, identifier CRD42024538356.

Blurry Diagnosis of Ocular Syphilis

The incidence of syphilis is on the rise worldwide which may be due to increased diagnosis.Given the wide variety of presenting symptoms, syphilis can pose many diagnostic and therapeutic difficulties for doctors. In turn, these difficulties frequently leadto a noticeable delay in patient care. Here we present a case of ocular syphilis in ahomosexual male patientpresenting with uveitis with no prior symptoms except for an itchy rash in the pelvic area. The patient was treated with IV penicillin after which full vision was restored. By presenting this case, we hope to stress the importance of adding syphilis in the differential diagnosis of men who have sex with men (MSM)who present with otherwise unexplained rash and/or uveitis.

Erectile Dysfunction and Premature Ejaculation in a Cohort of Homosexual and Bisexual Men from Five Ibero-American Countries

There is limited information about the behaviour of erectile dysfunction and premature ejaculation in homosexual and bisexual men. Our objective is to evaluate the clinical and sexual characteristics of the homosexual and bisexual population that consults for sexual dysfunctions in five Ibero-American countries. We reviewed the clinical records of homosexual and bisexual patients over 18 years of age who consulted a specialized institution during 2018. Of 26,650 consultations, 41 patients reported a bisexual sexual orientation (0.15%), and 256 were homosexual (0.96%). The mean age was 42.7 years (+/-13.5). The mean evolution time for premature ejaculation was 7.6 years, and for erectile dysfunction, it was 5.7 years (+/- 6 months). 46.9% patients reported that these pathologies deteriorated their relationship, and 81.8% reported that they affected self-esteem and confidence. A differential attention should be considered in the sexual health consultation for this population group

Central retinal vein occlusion associated with use of amyl nitrite “poppers”

To report a case of central retinal vein occlusion in a young patient after use of amyl nitrate "poppers."Description of the patient's clinical history, ophthalmic examination, retinal imaging, and treatment.A thirty-eight-year-old male presented with a central retinal vein occlusion in his right eye after inhaling amyl nitrite "poppers." There appeared to be a definitive temporal association between poppers use and both the onset of the vein occlusion, and the patient's visual scotomata, which recurred immediately after drug use multiple times. Optical coherence tomography displayed cystic macular edema, which was treated with intravitreal bevacizumab. The patient's hypercoagulable laboratory work up was negative.This is the first report of a central retinal vein occlusion associated with poppers inhalation. A high index of suspicion for poppers use should be maintained in young patients who present with vein occlusion, particularly in homosexual patients with a normal lab workup that fails to reveal a hypercoagulable etiology.

Epidemiological data on HIV-infected patients and the importance of education regarding the infection rate. An analytical cross-sectional study.

Sexually transmitted diseases (STIs) are an important public health problem in all countries. Knowledge of their relationship with the various socioeconomic levels is necessary for an understanding of their epidemiology and behavior in society. To investigate the epidemiology of human immunodeficiency virus (HIV)-positive patients and to correlate education with history of sexually transmitted diseases, especially for syphilis. Analytical cross-sectional study carried out in the city of Juiz de Fora, Minas Gerais, Brazil. The medical records of HIV/acquired immunodeficiency syndrome (AIDS) patients who started antiretroviral therapy (ART) between January 2010 and July 2018 were assessed. These patients were attended at the specialized assistance service for HIV/AIDS) of the Department of Sexually Transmitted Diseases (STD/AIDS) of the city of Juiz de Fora. In total, 335 patients were selected. In our sample, 73.13% were male; 57.36% were aged between 25 and 45 years and 24.23% were over 45 years of age. Regarding sexual orientation, 61.78% were homosexual. Regarding education, 52.88% had "unskilled education", while 47.12% had "qualified education". Analysis on the relationship between schooling and syphilis, a positive relationship between qualified schooling and syphilis was observed: odds ratio = 3.588; 95% confidence interval: 1.090-11.808. Homosexual male patients are most affected by HIV. Furthermore, this disease is not limited only to individuals with low education. Syphilis should be suspected in all individuals.

Infectious proctitis and perianal disease: a gaze beyond inflammatory bowel disease

Infectious proctitis by sexually transmitted diseases are increasing in incidence and should be considered in homosexual patients with rectal symptoms. In this case, we show a patient with proctitis and perianal disease caused by Chlamydia trachomatis that could be diagnosed as another anorectal disease such as inflammatory bowel disease if the clinical history is not taken into account. A high level of suspicion is crucial, in order to avoid an incorrect diagnosis, delayed antibiotic therapy and the development of complications.

Erosive acute colitis associated with intestinal spirochetosis

BackgroundAlthough usually believed to be harmless, intestinal spirochetosis may active erosive colitis associated with intestinal spirochetosis that may mimic idiopathic chronic inflammatory bowel disease. Case presentation. A 49-year-old homosexual male patient sought medical assistance due to asthenia, rectal bleeding, tenesmus, and diarrhea for one month. He had been using corticosteroids for nine months to treat sciatic nerve pain. Colonoscopy showed rectum and distal sigmoid with diffuse erythema with many surface erosions. Rectal biopsy showed inflammatory changes including chronic changes such as architectural distortion and basal plasmacytosis, and active inflammation including crypt microabscesses. In all large bowel sample, dense colonization of intestinal spirochetosis was observed. Patient also had a positive PCR testing for Chlamydia trachomatis. The patient was treated with metronidazole for 14 days, ciprofloxacin for 14 days and azithromycin (single dose). Symptoms improved and the patient is asymptomatic after two months of follow-up.ConclusionIn some high-risk groups, intestinal spirochetosis may cause colonic manifestations with overlapping features with intestinal bowel diseases. Awareness of this association is importance since proper antibiotic therapy against Brachyspira (metronidazole) is highly effective. Coinfection with other sexually transmitted infections is common and proper treatment is required.

P–509 Patients’ Uses and Experiences of Medically-Assisted Reproduction in France in 2020

Abstract Study question What are the uses and real-life experiences of patients currently treated in France in medically-assisted reproduction (MAR) centers? Summary answer One in four patients is in a situation of significant pain in relation to MAR; half are not optimistic about the outcome of their treatment. What is known already Internationally, work on the quality of life and impact of treatments has been completed in the field of endometriosis (Culley et al. 2017). In the field of MAR in France, one study underlines an important level of general well-being, with nearly 4 people out of 5 who say they are rather content (Coudrière et al. 2020). A better understanding of this result is however still lacking, especially in respect to whether patients actually believe in the success of their treatments, or how dependent satisfaction is on variables, like age, secondary infertility or the number of years engaged in fertility treatments. Study design, size, duration We conducted an online self-administered questionnaire by means of a two-step process: a first survey dedicated to patients’ uses was carried out from January 15, 2020 to February 26, 2000; the following and complementary survey about real-life experience was conducted from March 3, 2020 to April 10, 2020. The initial sample included 1503 people before selecting relevant participants. Participants/materials, setting, methods The final sample of 967 patients targets patients that were enrolled in a French procreative medical center at the time of the study. Were excluded from the sample: ex-patients, patients who have not started treatment or are not followed in France, solo and homosexual care patient trajectories. The questionnaire was composed of 178 questions. In the questionnaire dealing with MAR uses, six fields were examined; in the case of real-life experience, eight themes were questioned. Main results and the role of chance The study shows that one in four patients suffers significantly in relation to MAR care; nearly half are pessimistic about treatment outcome and 65% claim that MAR prevents full enjoyment of everyday life. Further findings include: MAR is globally satisfying regarding the quality of care provided by practitioners and staff (80%), general administration of patients (77 to 87%), first encounters with staff and center (78 to 91%), quality of dialogue (81%), physical state of the premises (82 to 97%), continuum with professional activity (73%). Where centers/practitioners need to pay attention: one out of two patients wanted more means of communication; time management was an issue; 41% state that infertility prevents entrepreneurial outreach and general success; treatments strongly disrupt work for 83% and reduce performances for 79%; work rights, while known, were not respected in ¼ cases. Discoveries made: young women are not very positive, men are not well-identified in such medical trajectories, women’s body image is completely transformed for 95%, 85.5% of women are depressed by seeing a pregnant woman, and 15% do not think about wanting a child daily. Limitations, reasons for caution This research, carried out online, was distributed mainly through a grassroot organization, potentially biasing representativeness. Also, the study finished at the start of the first French confinement. Previous studies show that the general context does not impact results, but this limitation cannot be ignored (Fisher, Bayhem, 2019). Wider implications of the findings: These findings underline the need for a comprehensive conception of MAR, including more than medical support. It highlights anew the need to better take men into account in future research as well as people in their twenties as knowledge of these categories of people is still lacking. Trial registration number Not applicable

S2214 Unusual Initial Presentation of HIV With Disseminated Kaposi Sarcoma (KS) as Rectal Bleeding

INTRODUCTION: Kaposi's sarcoma (KS) is a cancer that develops from the cells that line lymph or blood vessels. It usually appears as tumors on the skin or on mucosal surfaces such as inside the mouth, but these tumors can also develop in other parts of the body, such as in the lymph nodes, the lungs or digestive tract. KS involvement of GI tract may remain asymptomatic in the beginning or may present with mild non-specific abdominal symptoms, unlikely to be diagnosed in late stage. Here we are presenting a case of disseminated KS presented with rectal bleed in homosexual undiagnosed HIV patient. CASE DESCRIPTION/METHODS: A 33 yr old male with no significant past medical history, presented with 3-month history of constipation and progressive unintentional weight loss (40 lbs in 3 months). Lately, patient noticed his stool mixed with blood and mucus, early satiety and fatigue. Patient has family history significant for breast cancer and biliary cancer in mother. Patient is sexually active with 5 male partners. On presentation, vitals were stable and physical examination revealed multiple purple non-blanchable lesions on his extremities and trunk, a mass on the hard palate, supraclavicular and inguinal lymphadenopathy, external hemorrhoids, and a palpable mass in the rectum. Labs showing normocytic anemia with Hb of 10.3, ESR of 95 and CRP of 9.88. Patient was found to be positive for HIV with viral load of 118,255 and CD4 count of 236. Patient also had high IgG titers for Chlamydia trachomatis and CT abdomen and pelvis showed rectosigmoid mass with perirectal lymphadenopathy, inguinal adenopathy, and mild retroperitoneal lymphadenopathy. CT chest showed pulmonary metastasis and colonoscopy showed mild non-specific ileitis, nodule in descending colon and neoplasm in the rectum. Biopsy from the descending colon and rectal mass showed ulcerated Kaposi’s sarcoma and positive immunostaining for human herpes virus -8 (HHV-8). Patient was diagnosed with disseminated KS and started on anti-retroviral therapy (ART) and systemic chemotherapy. DISCUSSION: AIDS-associated disseminated KS is a rare entity. ART has resulted in marked decline in the incidence of KS. Due to the rapid and progressive nature of AIDS related KS, early diagnosis and institution of ART is crucial to achieving favorable prognosis. In addition, co-infection of HHV-8 with HIV promotes the oncogenicity of HHV-8 leading to rapid onset and progression of KS. Above patient responding well to the ART and Chemo going for surveillance Colonoscopy.Figure 1.: Kaposi Sarcoma on Hard Palate.Figure 2Figure 3.: Kaposi Sarcoma in Rectum.

Pilot study about the relationship between body perception and sexuality using the DAS59

The idea of this study stemmed to understand if sexuality can be a factor that affects the perception of one’s body and can be a feature that makes the subject more inclined to undergo esthetic surgery. A total of 51 male subjects participated in this study by filling out the Italian version of the DAS59 consisting of 59 items, which took approximately 35 min, under the supervision of a research assistant who did not interfere with the privacy of the patient. The data was entered in SAS version 8.4 (SAS Institute, Cary, NC, USA). The reliability of the scale was tested by Cronbach’s alpha coefficient and the correlation coefficient. Retest reliability was also tested using Spearman’s correlation coefficient between items and the total scale score. Analysis of variance was performed between the two groups. Differences between the homosexual and heterosexual subjects were assessed using the Mann–Whitney test of discriminant validity. Adult homosexual male patients without a personal history of esthetic procedures were recruited. We enrolled 26 adult homosexual male patients aged 18–42 years old and 25 male heterosexual adults aged 18–43 years. Any subject had personal history of esthetic procedures. We analyzed direct and indirect indicators of “esthetic concern,” the number of answers given by each subject accuracy, the attention to the questionnaire, and the effect on age on accuracy between the two groups. We confirmed that there are many differences between the two groups. Nevertheless, the greater attention to esthetics and concern for appearance is much more present in the homosexual group than in the heterosexual group, and its relationship with age in the homosexual group is a strong indication of an important and essential phenomenon in development. The absence of such a relationship in the heterosexual group leads instead to think that the esthetic concern is in this group a phenomenon of local type and much less fundamental than the personality. The DAS59, used in a homogeneous study group, has shown that esthetic sensibility may depend on emotional and psychological factors within a homogeneous social dimension that does not create a difference. This pilot study is the first to introduce the importance of the role of sexuality in the perception of the esthetics of one’s body. Level of evidence: Not ratable.

Could educational programs in sexology have an influence on attitudes towards same-sex marriage and parenting?

Summary Research on LGBT health services is urgent as well as effective actions. Some studies investigating the attitudes of mental Health Care Professionals (HCPs), social workers, medical trainees and professionals, students, and resident assistants towards Lesbian and Gay (LG) people showed a significant negative role of sexism affecting attitudes towards LGBT people, marriage and parenting. This study aimed to investigate the influence of Educational Programs in Sexology (EPS) on sexism, homophobia, and attitudes towards same-sex marriage and parenting. Data were collected on 552 Health Care Professionals (HCPs). The EPS group was composed by professionals who attended an accredited training in sexology, while the control group by HCPs without a specific formation on sexual issues. The EPS group reported lower levels of sexism and homophobia and more positive attitudes toward same-sex families (adoption for homosexual couples, artificial insemination and in vitro fertilization for lesbians). Having a specific training on sexology appeared to be associated to more positive attitudes based on equal rights. Healthcare system should be prepared to meet sexual minorities needs. Having a specific training on LGBT issues appears to be functional to a better patients’ taking care. Professionals who attended EPS seem to be the best references (for their formation and their personal attitudes) for sexual education programs, as well as for clinical work with homosexual patients complaining about sexual, marital, and/or parenting problems. Implications for research, clinical and health promotion are discussed.

Giant Condyloma Acuminata with Maggots in Perianal Area of HIV Infected Male Running Head: A Case Report of Giant Condyloma Acuminata

We report a case of 28-year-old HIV-positive male with giant condyloma acuminata in anogenital region. This homosexual patient presented with a large foul smelling growth along with maggots in a perianal region refractory to treatment at presentation. The patient was successfully managed with excision and there was no recurrence of lesion at last follow-up at 2-months. The case highlights the rare presentation and management of difficult-to-treat case of giant condyloma acuminata with maggots of anogenital region in HIV-positive patients.

Factors associated with homophobia in medical students from eleven Peruvian universities

BackgroundThe consequences of homophobia can affect the integrity, mental and physical health of homosexual individuals in society. There are few studies in Peru that have evaluated homophobia in the medical student population. ObjectiveTo establish the social, educational and cultural factors associated with homophobia among Peruvian medical students. MethodsA cross-sectional analytical study was conducted in 12 medicine schools in Peru. Homophobia was defined according to a validated test, which was associated with other variables. Statistical associations were identified. ResultsThe lowest percentages of homophobic students (15–20%) were found in the four universities in Lima, while universities in the interior of the country had the highest percentages (22–62%). Performing a multivariate analysis, we found that the frequency of homophobia was lower for the following variables: the female gender (PRa=0.74; 95% CI, 0.61–0.92; p=0.005), studying at a university in Lima (PRa=0.57; 95% CI, 0.43–0.75; p < 0.001), professing the Catholic religion (PRa=0.53; 95% CI, 0.37–0.76; p < 0.001), knowing a homosexual (PRa=0.73; 95% CI, 0.60–0.90; p=0.003) and having treated a homosexual patient (PRa=0.76; 95% CI, 0.59–0.98; p=0.036). In contrast, the frequency of homophobia increased in male chauvinists (PRa=1.37; 95% CI, 1.09–1.72; p=0.007), adjusted by four variables. ConclusionsHomophobia was less common in women, in those who study in the capital, those who profess Catholicism and those who know/have treated a homosexual. In contrast, male chauvinists were more homophobic.

Attitude of Medical Students in Paraguay Towards Homosexuality

The attitude of medical students towards homosexuality may affect the quality of care for homosexual patients. This study aimed to describe the attitude of medical students at the National University of Asuncion, Paraguay towards homosexuality. This observational, cross-sectional study was conducted in June 2016 in consecutive medical students from the National University of Asunción (Santa Rosa del Aguaray branch), Paraguay. The 10-item attitude towards homosexuality scale (EAH-10) was used to assess participants' acceptance/ rejection of homosexuals as individuals, homosexuality as a sexual orientation, and public manifestations of homosexuality. A total of 48 female and 29 male participants (mean age, 21 ± 2 years) were included. Most were Catholic (71.4%), followed by non-Catholic Christian (10.4%), agnostic (9.1%), atheist (2.6%), and other (6.5%). 71.4% reported having at least one homosexual friend. The mean EAH-10 score was 27.23 ± 9.379. 42.9% of participants were indifferent or undecided in their attitude towards homosexuality and 28.6% were discriminatory. Having homosexual friends was associated with a lower EAH-10 score (t = -3.447 [75], p = 0.001). Education about health issues of homosexuals is needed for medical students in Paraguay.

The correlation between demography and clinical status based on WHO staging in MSM HIV patients at Bali Medical Centre

Background: HIV stands for human immunodeficiency virus which is in the category of lentivirus (a subgroup of retrovirus) that causes HIV infection and can lead to acquired immunodeficiency syndrome (AIDS). HIV affects specific cells of the immune system, called CD4 cells, or T cells. Over time, if left untreated, HIV can destroy so many of these cells that the body would not be able to fight off infections and disease. However, with proper medical care, HIV can be controlled. Treatment for HIV is called antiretroviral therapy (ART). It involves taking a combination of HIV medicines (called an HIV regimen) every day. Today, a person who diagnosed with HIV before the disease is far advanced and who gets and stays on ART can live a nearly normal lifespan.Aim: This study aims to investigate and analyze the predictors that influence WHO staging of homosexual MSM HIV patients treated at the BMC hospital in Bali. Indonesia, and to determine the factors that lead to differences in the WHO staging in MSM patients with HIV.Method: This study used a retrospective cohort method using secondary data from BMC Hospital. The sample population for this research is MSM HIV patients treated at the BMC hospital in Bali. Using the total sampling method yielded 271 samples.Result and Conclusion: the HIV incidence is a serious matter in Indonesia. One of the underlying factors for the delayed diagnosis of HIV is the lack of knowledge about the improved prognosis of early ARV treatment and a fear of being stigmatized by the community. Increased availability of HIV testing at hospitals, combined with enhanced knowledge of the prognosis of HIV treatment among crucial affected population, and the community at large and may improve earlier testing.

Sexual orientation in psychotherapy. On the specifics of the therapeutic relation with homosexual and bisexual patients

ZusammenfassungDie Sozialisation homo- und bisexueller Menschen birgt innerhalb der heteronormativen Mehrheitsgesellschaft einige Besonderheiten, die in Bezug auf die therapeutische Beziehung reflektiert werden müssen. Sie sehen sich häufig Erfahrungen von Stress, Problematisierung und Diskriminierung ausgesetzt. Es fehlt überdies oft an positiven Rollenvorbildern. Der vorliegende Beitrag reflektiert diese Besonderheiten etwa in Bezug auf das Coming-out als lebenslangen Prozess oder die Überwindung einer oftmals internalisierten Homonegativität. Hierbei steht als Zielsetzung der Einsatz für eine bessere, barriere- und diskriminierungsarme Gesundheitsversorgung und Behandlung durch kompetente und wertschätzende Fachkräfte im Mittelpunkt.

Bilateral Peripheral Facial Paralysis Combined with HIV Meningitis During Acute HIV-1 Infection: A Case Report

Here we reported a Chinese case of bilateral peripheral facial paralysis (PFP) in human immunodeficiency virusc (HIV) infected population. A 38-year-old homosexual male patient was referred to our hospital for bilateral facial paralysis. 21 days prior to admission he had developed high fever, chills, headache, fatigue, general malaise, nausea and vomiting. Neurological examination revealed bilateral ptosis of lower lip and cheeks, as well as failure of bilateral eyes closure. Analysis of cerebrospinal fluid (CSF) revealed pleocytosis, a marked rise of micro total protein and a marked rise of intrathecal lgG synthesis. The result of HIV-1 serology was positive by ELISA and that was confirmed by western blot. His CD4 + cell count was 180 cells/mm 3. HIV-1 viral load in CSF was almost 10 times higher than that in plasma. The patient's condition improved steadily and experienced complete resolution of bilateral PFP after 2 months.