Seropositive Homosexual Men Research Articles

Prospective study of human herpesvirus 8 oral shedding, viremia, and serological status among human immunodeficiency virus seropositive and seronegative individuals in Sao Paulo, Brazil

ABSTRACTHuman herpesvirus 8 (HHV-8) is a gamma-herpesvirus and etiological agent of all forms of Kaposi sarcoma (KS). Saliva may play an important role in HHV-8 transmission in specific populations. Little is known about HHV-8 oral shedding pattern and the possible correlation with the HHV-8 serological profile and viremia. A prospective study was conducted of HHV-8 salivary excretion among human immunodeficiency virus HIV-seronegative (n = 47) and -seropositive (n = 44) homosexual men and HIV-seropositive women (n = 32) over a 6-month period with monthly HHV-8 serologies (immunofluorescence assays to identify antibodies to latent and lytic HHV-8 viral proteins, and a whole-virus HHV-8 enzyme-linked immunosorbent assay [ELISA]), monthly HHV-8 DNA serum/plasma detection, and daily self-collected oral rinses for HHV-8-DNA detection using real-time polymerase chain reaction. HHV-8 seropositivity was 51.1%, 63.6%, and 37.5%, in the three studied groups. There was no case of HHV-8 DNA detection in serum/plasma. Intermittent detection of oral HHV-8 DNA was observed during 5.1% (110/2,160) of visits among 28% (18/64) of HHV-8-seropositive individuals, all of whom were males and HHV-8 ELISA seropositive. In immunologically controlled populations of Brazil, HHV-8 oral shedding was limited to HHV-8-seropositive men, occurred infrequently and intermittently, and was not linked to HHV-8 viremia, suggesting a limited potential for oral or blood transmission.

Serostatus Disclosure, Stigma Resistance, and Identity Management Among HIV-Positive Gay Men in Ireland.

In this study, we examined how non-infectiousness due to antiretroviral therapy has affected HIV-positive gay men's experience of serostatus disclosure to casual sex partners. Interviews were conducted with 15 seropositive gay men living in Ireland. Using grounded theory, three constructions of non-disclosure were proposed-as self-protection, as a morally permissible act, and as a rejection of the HIV-positive identity. Each construction entailed an aspect related to the sexual exclusion of those living with HIV, and an aspect related to their social exclusion. The extent to which the lives of those interviewed were affected by stigma was starkly revealed, as was the extent to which they stigmatized others living with HIV and rejected the HIV-positive identity. The research highlights the failure to socially normalize HIV and that interventions are needed to reduce the distress associated with seropositivity.

The Second Closet: A Qualitative Study of HIV Stigma Among Seropositive Gay Men in a Southern U.S. City

ABSTRACTObjectives: Stigma connected with HIV/AIDS has decreased considerably since the early epidemic yet affects those living with HIV in many ways. Little research, particularly qualitative research, concerning HIV stigma from the perspective of gay men has emerged. The present qualitative study aimed to fill this evidence gap by examining how HIV stigma is perceived and experienced by gay men who have become HIV-infected and how they respond to this stigma. Methods: Thematic analysis of 19 gay men's narratives identified six main themes. Results: Encountering HIV stigmatization was common and was linked to the physical stigmata identifying respondents as HIV-positive. Overwhelmingly, they found stigmatization to be most intensely felt within gay communities. One profound theme was internalized HIV stigma, referring to respondents’ internalized negative feelings about their HIV status. A related theme was the closeted nature of HIV. Lastly, regarding how the men dealt with the HIV diagnosis and experiences of HIV stigma, a theme of adaptation became clear. Conclusions: Although exploratory, the results can serve as a beginning framework for understanding and assisting seropositive gay men who experience HIV stigma. The findings are important because it is realistic to expect that in a climate in which HIV has become increasingly invisible and closeted and in which infections are on the rise, gay and bisexual men will be increasingly affected and infected by HIV.

Sexual risk taking and club drug use across three age cohorts of HIV-positive gay and bisexual men in New York City

This study examined club drug use (i.e., cocaine, ecstasy, ketamine, gamma-hydroxybutyrate [GHB], and methamphetamine) and unprotected anal intercourse (UAI) in an ethnically and racially diverse sample of 166 New York City-based seropositive, club drug-using, gay and bisexual men, ages 19–61, and considered these behaviors in relation to age category (20s, 30s, and 40 +) and number of years living with HIV. Club drug use was common across all age categories, with differences arising only in the type of club drug used. Multivariate logistic regression modeling indicated older participants (30s and 40 +) were more likely to use cocaine and methamphetamine and less likely to use GHB and ketamine than those in their 20s. We examined UAI with casual partners in relation to age category, the number of years living with HIV, and club drug use. The likelihood of engaging in UAI with seronegative casual partners was greater among those in their 20s than those in their 30s or 40+. Further, participants were equally likely to engage in unprotected receptive anal intercourse and unprotected insertive anal intercourse with each casual partner serostatus type. With regard to number of years living with HIV, those living longer with the disease were more likely to report UAI with casual partners with a seropositive status than with a negative or unknown serostatus. Our findings suggest that UAI and club drug use is common among seropositive gay and bisexual men regardless of age category, but that differential patterns of risk emerge in relation to the number of years one has been living with HIV and age. These findings are of significance as both the aging population of seropositive gay and bisexual men and HIV infection rates continue to grow, and demonstrate a need for differentiated and tailored prevention strategies across the age continuum.

Coping with the HIV epidemic 1982–2007: 25‐year outcomes of the Hershey Haemophilia Cohort

Coping with the HIV epidemic 1982–2007: 25‐year outcomes of the Hershey Haemophilia Cohort

Relationship between IL-2 receptor expression and proliferative responses in lymphocytes from HIV-1 seropositive homosexual men.

Previous studies have shown that exogenous IL-2 does not correct the reduction in phytohaemagglutinin (PHA)-induced proliferation of lymphocytes from HIV-1 infected (HIV+) individuals. We investigated the mechanism of this reduction to determine if reduced expression of the complete IL-2 receptor (IL-2R) was responsible. In a series of experiments, PHA-stimulated lymphocytes from a total of 89 HIV- and 93 HIV+ homosexual men from the Baltimore Multicentre AIDS Cohort Study (MACS) were studied to determine the expression of messages for the alpha and beta subunits of the IL-2R, the binding of 125I-IL-2 to high affinity IL-2R, and the effect of IL-2 on cell proliferation. Compared to HIV- donors, PHA-stimulated lymphocytes from most HIV+ donors demonstrated (i) a reduction in high affinity IL-2R expression that correlated with the reduction in the IL-2-induced proliferative response; and (ii) a reduction in expression of both IL-2R alpha- and beta-chain mRNA which may be responsible for decreased high affinity IL-2R expression. However, lymphocytes from some HIV+ individuals had borderline low IL-2-induced proliferation despite normal or elevated expression of high affinity IL-2R. These results suggest that decreased expression of IL-2R may account, at least in part, for the lower proliferative response of cells from HIV+ donors.

A Mediation Model to Explain HIV Antiretroviral Adherence Among Gay and Bisexual Men

Based on quantitative data describing a sample of 300 HIV seropositive gay and bisexual men living in New York City who were on antiretroviral drug therapy, variables of interest were collapsed into 4 latent constructs-SES (including health care provision), psychological states, drug use impairment, and HIV treatment adherence-and structural equation modeling was used to test the relations among them. Our model indicated a complex interplay between socioeconomic factors, drug use impairment, psychological states, and adherence. It is imperative for counselors and clinicians working with this population to understand the complex relationships between cultural, social, and psychological realities and adherence to HIV antiviral medications and to develop effective socially relevant and culturally nested interventions.

Responsibility for HIV Prevention: Patterns of Attribution Among HIV–Seropositive Gay and Bisexual Men

The Seroconversion Narratives for AIDS Prevention (SNAP) study elicited narratives from recently infected seropositive gay and bisexual men that described the circumstances of their own seroconversion. This analysis of the narratives explored participants' attributions of responsibility for HIV prevention before and after they became infected. Before becoming infected with HIV, responsibility for prevention was often attributed to HIV-negative individuals themselves. These retrospective attributions revealed themes that included feelings of negligence, a sense of consequences, followed by regret. After seroconversion, responsibility for HIV prevention was primarily attributed to HIV-positive individuals themselves. Themes within these attributions included pledges to avoid HIV transmission, a strong sense of burden related to the possibility of infecting someone, and risk reduction strategies that they implemented in an attempt to avoid HIV transmission. Greater understanding of ideas related to responsibility has the potential to increase the effectiveness of HIV prevention interventions.

Risk factors for Kaposi's sarcoma among HHV‐8 seropositive homosexual men with AIDS

Kaposi's sarcoma (KS) is a frequent complication of the acquired immunodeficiency syndrome (AIDS) in homosexual men. Risk factors for developing this malignancy are uncertain, other than immunosuppression and coinfection with human herpesvirus 8 (HHV-8). We therefore examined factors associated with KS in a cross-sectional analysis of 99 cases among 503 HHV-8 seropositive homosexual men with AIDS. Data were collected by computer-assisted personal interviews and medical chart reviews. HHV-8 seroreactivity was determined by enzyme-linked immunosorbent assay for antibodies against HHV-8 K8.1 glycoprotein. KS was significantly less common in blacks compared to whites [risk ratio (RR) = 0.4; 95% CI = 0.2 =0.8] and more common in subjects who had completed college (RR = 1.7; 95% CI = 1.1-2.7) or had annual income greater than dollar 30,000 (RR = 1.5; 95% CI = 1.1-2.2). KS was less common in cigarette smokers (RR = 0.6; 95% CI = 0.5-0.9) and users of crack cocaine (RR = 0.4; 95% CI = 0.1-0.8). KS was less common in bisexual men compared to men who were exclusively homosexual (estimated RR = 0.6; 95% CI = 0.4-0.9) and inversely associated with number of female partners. KS was also less common in men who had received pay for sex (RR = 0.6; 95% CI = 0.4-1.0). These cross-sectional associations could be biased by potential differences in relative timing of HHV-8 and HIV infection, a postulated determinant of KS risk. Alternatively, our findings may reflect factors protective against KS in individuals infected with HHV-8. Future research should focus on identifying practical measures for countering KS that do not increase the risk of other diseases.

Alcohol use and stigmatized sexual practices of HIV seropositive gay and bisexual men

HIV seropositive (HIV+) gay and bisexual men continue to report unprotected sexual practices. Although numerous research studies have examined the relationship between alcohol use and unsafe sex, few have examined this from a qualitative perspective. In this paper, we examined the impact of alcohol use on stigmatized sexual practices among HIV+ gay and bisexual men with alcohol-use disorders. An ethnically diverse sample (81% men of color) from the New York City metropolitan area was recruited from a variety of settings frequented by gay and bisexual men. Using a qualitative interview, contextual issues regarding sexual activities under the influence of alcohol were examined. Qualitative analysis revealed that alcohol use facilitates engagement in sexual practices that are perceived as stigmatic while sober. Interventions targeting alcohol use and unsafe sex should be sensitive to the role which alcohol plays in the sexual practices among HIV+ gay and bisexual men.

Self regard and concealment of homosexuality as predictors of CD4+ cell count over time among hiv seropositive gay men

Living with HIV can challenge core features of a person’s sense of identity and ultimately lead to a diminished sense of self regard. Self-regard has been defined as the extent to which a person experiences an integrated sense of identity. Gay men with HIV may also face struggles related to their identity in deciding whether to disclose or conceal their homosexuality. This study examined whether concealment of homosexuality and a person’s sense of self regard would be associated with CD4+ cell count over time among HIV seropositive gay men. 53 HIV seropositive gay men completed questionnaires at one time point. CD4+ cell counts were measured at the time of questionnaire completion and 24 months later. Greater self regard at baseline was associated with higher CD4+ counts at 24 months. The association between baseline self regard and CD4+ count at 24 months was strongest among persons with less concealment of homosexuality.

Correlates of sexual risk-taking behaviour among HIV seropositive gay men in concordant primary partner relationships

This study sought to understand how person, perceived health risks, psychosocial, and mental health factors relate to unprotected anal intercourse (UAI) among 91 HIV seropositive (HIV + ) gay men in concordant primary partner relationships. The data was drawn from a larger sample of 464 HIV + men-who-have-sex-with-men (MSM) from mainstream gay venues, AIDS service organizations, and public sex environments in New York City and San Francisco. The findings from this study suggest that UAI is a common behaviour among HIV + gay men in seroconcordant couples, which may compromise their health due to the possibility of HIV reinfection and the transmission of other sexually transmitted diseases. Results from our analyses indicated that lower perceived risk of HIV reinfection, lower behavioural intentions for condom use, and higher CD4 counts were predictive of HIV + gay men engaging in UAI with their HIV + primary partner. In situations where there is discordance in HIV strain type or in dyads where monogamy is not maintained, the practice of UAI may present health risks for the men in HIV + seroconcordant relationships.

An Exploration of Perceptions of Masculinity among Gay Men Living with HIV

An ethnographic investigation was undertaken to explore the social construct of masculinity. Fifteen HIV seropositive gay men in New York City were interviewed via electronic medium in order to characterize behaviors and associated meanings attached to the conception of masculinity as physicality. Structured interviews were utilized to ascertain these data in order to illustrate how some men define masculinity in terms of their physical appearance and sexual adventurism. The data indicate that men who possess this ideological stance regarding masculinity seek to remain healthy, appear physically strong, and attract sexual partners. This hegemonic standard of masculinity is a result of both the men's HIV infection as well as their perceptions of gay community norms. Emphasis on physical strength and sexual prowess as means of defining masculinity has become a standard in the last two decades for some seropositive gay men.

Part 1

There is a growing rift between HIV-positive and HIV-negative gay men, which finds expression in social, economic, structural and political divisiveness that, if not resolved, may ‘kill’ the “gay liberation movement”. While disasters generally tend to create organizational solidarity, the AIDS crisis has operated in reverse, spawning a variety of competitive AIDS service organizations, alienating seropositive gays from the mainstream gay community, and in turn disenfranchising sero-negative gay men as human and financial resources are redirected toward persons living with HIV and AIDS. Serostatus has become a social marker of societal status, operating in a bimodal discriminatory manner. Seronegative gay men experience discrimination from within the gay community as funding for and services to this sector diminish. Seropositive gay men (and the organizations that provide for some of their needs) have culturally, economically and socially dismissed the socio/psychological needs of seronegative gay men (survivor guilt, safer sex education, etc.) in favour of providing social and resource-based services to seropositive gay men. As the disparities in service and advocacy increase, the social distance between the gay movement and the AIDS movement correspondingly increases. If this trend continues, the social gap will serve further to push HIV-positive and HIV-negative gay men into polarized camps, resulting in a wider separation of the gay movement and the AIDS movement. The stigmatization of HIV-positive people will subsequently increase both within and outside the gay movement, and any ability to present a unified Gay Liberation front will correspondingly diminish. Additionally, the emergent notion within and without the gay communities that to be gay is to be HIV-positive will solidify. This will (a) further stigmatize all gay men in the eyes of the non-gay population, and (b) exacerbate the rift between HIV-positive and HIV-negative gay men within the gay community, reversing the stigma of HIV such that to be HIV-negative will be a marker of non-gay identity. In short, seropositivity will become the defining element of gayness.

LAYERS OF GRIEF: COUNSELING THE SEROPOSITIVE GAY MALE

Seropositive gay men experience multiple losses in their lives resulting in layers of grief. Models of grief were not developed for people experiencing multiple losses therefore lack the capacity to help crisis workers with this population. Counseling strategies developed specifically for seropostive gay men also may not be adequate because are not crisis oriented. This paper suggests the use of the Tirage assessment Form as a means of assessing the multiple losses experienced by this population. Used in conjunction with models of grief and counseling approaches for seropositive gay men, the Triage Assessment Form helps crisis workers identify and monitor the layers of grief experienced by this population.

αIFN AND HIV-1 PROTEASE INHIBITORS (PI) INHIBIT HHV-8 INFECTION: POSSIBLE THERAPEUTIC APPROACHES FOR KAPOSI'S SARCOMA (KS)

25 Background. αIFN is currently used for the therapy of all forms of KS. αIFN can induce the regression of the lesions or slow disease progression. Recently it has also been reported that therapy of AIDS-KS patients with HIV-1 PI can result in KS regression. KS pathogenesis is associated with infection by HHV-8, a human herpesvirus that we have found to infect not only B cells, but also monocyte-macrophages. However, little is known on the effects of αIFN and PI on HHV-8 infection. Methods. In vitro studies were done with cultured PBMC from KS patients and a primary effusion lymphoma-derived cell line (BCBL-1) latently infected by HHV-8. Cultured cells were analyzed by PCR, in situ hybridization, Northern and Southern blot, or electron microscopy (EM) to evaluate the effects of αIFN and HIV PI on HHV-8 infection. In vivo studies were performed by amplifying HHV-8 DNA from the PBMC of homosexual men with AIDS or AIDS-KS undergoing or not therapy with HIV-1 PI. The HHV-8 serological status of the patients whose PBMC were negative by PCR was determined by an immunofluorescence assay (IFA) on BCBL-lcells. Results. The addition of αIFN neutralizing antibodies (NAb) to cultured PBMC from KS patients induced the rescue and maintenance of HHV-8 DNA. In situ hybridization showed that this was associated with expression of T0.7 latency RNA, but not with the lytic VP23. Reactivation of HHV-8 lytic infection in TPA-induced BCBL-1 cells was inhibited by more than 80% by pre-treatment with αIFN. EM studies showed that the addition of αIFN NAb to TPA-induced BCBL-1 cells increased both the cytopatic effect and virus yield. Analysis of PBMC from HIV-1 infected, HHV-8 seropositive homosexual men with AIDS or AIDS-KS showed that PI therapy results in the loss of HHV-8 DNA to levels undetectable by PCR. One patient treated since only 3 weeks was, however, still positive for viral DNA amplification. In addition, inflammatory cytokines (IC), that are able to increase HHV-8 load in cultured PBMC from KS patients (see Ensoli et al.), failed to rescue viral DNA in cultured PBMC from patients treated with PI. The effect of PI was confirmed by culturing PBMC from 2 patients not undergoing therapy with PI (I with AIDS and I HIV-negative). PBMC from these patients showed a 10-fold reduction of HHV-8 DNA load or a loss to undetectable levels, respectively, when cultured in the presence of PI. This inhibitory effect was observed only in cells cultured with IC. Conclusions. αIFN and HIV-1 PI may have therapeutic effects on KS because of their ability to inhibit HHV-8 infection. In particular, the ability of HIV-1 PI to induce KS regression is associated to a decrease of HHV-8 load in PBMC from treated patients. Although further investigation is required, the data show that HIV-1 PI can inhibit HHV-8 infection in vitro. This occurs when infected cells are cultured in the presence of IC. Therefore, in addition to improve the immune response to HHV-8 by inhibiting HIV, HIV-1 PI may have direct effects on HHV-8 infected cells stimulated by IC. As patients with all forms of KS and KS risk groups have high levels of IC, this opens new perspectives for the management of KS in HIV-negative individuals.

Sexual Behavior and Depression Among HIV-Positive Gay Men

As a result of medical advances seropositive men may expect to have a longer and healthier life span than in the past. It is therefore increasingly important to determine which factors are related to the mental health of seropositive gay men, as well as those associated with a satisfying, yet safe sexual lifestyle. This study examined sexual behavior, indicators of mental health, and determinants of AIDS-preventive behavior among a group of seropositive gay men and a control group of seronegative gay men in the Netherlands. Most seropositive men consistently practiced AIDS-preventive behavior. Nevertheless, if the definition of potentially unsafe sexual behavior is broadened to include oral sex to ejaculation, a sizable proportion of seropositive men had to be categorized as having had unsafe sex. Depression scores were higher among seropositive men than among the general population, but not significantly higher than among seronegative controls. Depression was not related to unprotected anal sex. The attitudes and the intention toward condom use were positive. Seropositive men used recreational (noninjection) drugs relatively often, but this was generally not associated with unprotected anal sex. Seropositive men attached more value to anal sex than seronegative controls, but again, this preference was not related to practicing unprotected anal sex. In the relatively few cases that unprotected anal sex among seropositive men did occur, it appeared to be related to lower behavioral control and to a weaker safe-sex intention. Perceived barriers to condom use and low perceived risk were also associated with unprotected anal sex among seropositive men. Although depression was not directly related to unprotected anal sex, seropositive men with higher depression levels were less motivated to use condoms and perceived more barriers to condom use.

Disclosing HIV status and sexual orientation to employers

Seropositive gay and bisexual men who reveal their sexual orientation or HIV/AIDS status to their employer risk discriminatory reprisals. However, non-disclosure may limit potential social, emotional, and tangible support. Among our sample of 389 seropositive gay and bisexual men employed in the US, 52% were 'out' to their employer and 35% had disclosed their serostatus to him or her. Among gay men, employer awareness of their sexual orientation was related to their being European American (vs Latino or African American), being HIV-seropositive for more than 4 years, and having a gay or bisexual employer. Disclosure of HIV infection in the total sample was related to being European American, HIV-seropositive for more than 4 years, symptomatic (vs asymptomatic), 'out' at work, and having a gay or bisexual employer. Men who had informed their employers of their HIV status reported consequences that were substantially more positive than those anticipated by men who had not disclosed. Policy and research implications for improving the work environment for gay and bisexual men living with HIV are considered.

Social relationships and immune processes in HIV seropositive gay and bisexual men.

This three-year longitudinal study assessed the association between social relationships and human immunodeficiency virus (HIV) progression in individuals at risk for morbidity and mortality due to acquired immune deficiency syndrome (AIDS). Two-hundred five HIV seropositive men without AIDS completed measures of social integration and loneliness at baseline. Blood samples used to assess CD4 T-lymphocyte levels were collected at baseline and at six-month intervals for a three-year follow-up period. Contrary to expectation, lower levels of baseline loneliness predicted more rapid declines in CD4 levels over the follow-up period. This association was independent of baseline CD4 values, negative affect, and health practices. A series of mediational analyses revealed that sexual behavior, medication use, bereavement, coping, and a number of other variables were not mechanisms through which loneliness affected the immune system. Loneliness was not associated with time to AIDS diagnosis or time to AIDS-related mortality. These findings are consistent with the emerging view that social relationships can have deleterious, as well as protective, influences on health outcomes.

UNUSUAL CASES OF BREAST CANCER IN HIV INFECTED WOMEN

BACKGROUND: HIV infected persons are at risk for various malignancies, including lymphoma, KS and cervical cancer, which are AIDS-defining. The incidence of additional cancers has significantly increased in HIV seropositive gay men in recent years, when compared to seronegative controls (Lyter, Proc ASCO, 1996). Although the incidence of breast cancer has not increased in HIV infected women, it remains the second most common cancer affecting women in the U.S. Further, the eventual immune deficiency inherent to HIV could predispose to the development of neoplastic disease of the breast. We therefore evaluated all diagnosed cases of breast cancer occurring in HIV positive and negative participants of the national WIHS study. METHODS: We identified each woman enrolled in the WIHS study who reported a history of breast cancer during the baseline study evaluation, and in subsequent 6-monthly visits. Permission for chart review was obtained from all, and pathology reports, clinical records and HIV status were examined. RESULTS: At entry, 11 of 2069 (0.5%) HIV seropositive women and 2 of 574 (0.3%) HIV seronegatives reported a history of breast cancer. In follow-up (6-12 months), 2 of 1699 (0.1%) additional HIV positives and no seronegative reported a new dx of breast cancer. Two cases (1 HIV+; 1 HIV neg) were subsequently unconfirmed at path review, and 5 HIV cases are yet to be reviewed. Of the 7 HIV+ cases with pathologic confirmation to date, the median age at dx of cancer was 47 years(32-64). Median CD4 count at entry to WIHS was 196 (93-205). Pathologic types of ca in HIV+ women included: infiltrating ductal and intraductal, grade III (high), with neuroendocrine features; invasive non comedo intraductal with prominent mucin production and dissection of mucin into stromal tissue; metaplastic carcinoma with histiocyte-like giant cells; poorly differentiated invasive adenocarcinoma; adenocarcinoma; infiltrating ductal; and ductal carcinoma in situ, with focal invasion. Of interest, follicular hyperplasia was seen in adjacent lymph nodes. CONCLUSIONS: Unusual pathologic types of breast cancer have been diagnosed in HIV positive women, whose median age at diagnosis is relatively young. Further evaluation over time will be important to ascertain the true significance of this observation.