Lynda S. Doll

Course of HIV-I infection in a cohort of homosexual and bisexual men: An 11 year follow up study

OBJECTIVE--To characterise the natural history of sexually transmitted HIV-I infection in homosexual and bisexual men. DESIGN--Cohort study. SETTING--San Francisco municipal sexually transmitted disease clinic. PATIENTS--Cohort included 6705 homosexual and bisexual men originally recruited from 1978 to 1980 for studies of sexually transmitted hepatitis B. This analysis is of 489 cohort members who were either HIV-I seropositive on entry into the cohort (n = 312) or seroconverted during the study period and had less than or equal to 24 months between the dates of their last seronegative and first seropositive specimens (n = 177). A subset of 442 of these men was examined in 1988 or 1989 or had been reported to have developed AIDS. MAIN OUTCOME MEASURES--Development of clinical signs and symptoms of HIV-I infection, including AIDS, AIDS related complex, asymptomatic generalised lymphadenopathy, and no signs or symptoms of infection. MEASUREMENTS AND MAIN RESULTS--Of the 422 men examined in 1988 or 1989 or reported as having AIDS, 341 had been infected from 1977 to 1980; 49% (167) of these men had died of AIDS, 10% (34) were alive with AIDS, 19% (65) had AIDS related complex, 3% (10) had asymptomatic generalised lymphadenopathy, and 19% (34) had no clinical signs or symptoms of HIV-I infection. Cumulative risk of AIDS by duration of HIV-I infection was analysed for all 489 men by the Kaplan-Meier method. Of these 489 men, 226 (46%) had been diagnosed as having AIDS. We estimated that 13% of cohort members will have developed AIDS within five years of seroconversion, 51% within 10 years, and 54% within 11.1 years. CONCLUSION--Our analysis confirming the importance of duration of infection to clinical state and the high risk of AIDS after infection underscores the importance of continuing efforts both to prevent transmission of HIV-I and to develop further treatments to slow or stall the progression of HIV-I infection to AIDS.

Bisexually active men: Social characteristics and sexual behavior

We describe social characteristics and sexual behavior of young, Black or White bisexually active men (N = 536, 52% Black, M age = 25). Bisexual activity appeared to be relatively stable over time: the recruitment criterion was any sex with a man and a woman in the previous three years, yet 60% were bisexually active during the past six months, and 56% began their bisexual activity at least five years prior to the study. Compared to Whites, Black respondents were more likely to self‐identify as bisexual, reported more female sex partners, and were less likely to have disclosed their bisexual activity to others. Few respondents participated in the gay community. Rates of unsafe sex were high: 31% reported unprotected anal intercourse with a man in the past six months, with no ethnic differences. Blacks reported more unprotected sex with women and were more likely to exchange sex for money. Of the men who had been HTV tested (74%), 10.5% of Blacks and 2.9% of Whites were HIV seropositive. The sexual risk of...

Prevalence of Human Immunodeficiency Virus Type 1 p24 Antigen in U.S. Blood Donors — An Assessment of the Efficacy of Testing in Donor Screening

Abstract Background. We performed a multicenter study in 1989 to determine whether screening whole-blood donors for human immunodeficiency virus type 1 (HIV-1) p24 antigen would improve transfusion safety by identifying carriers of the virus who are seronegative for HIV-1 antibody. Methods. More than 500,000 donations were tested at 13 U.S. blood centers with test kits from two manufacturers. Units found repeatedly reactive were retested in a central laboratory; if the results were positive, they were confirmed by a neutralization assay. A subgroup of units was also tested for HIV-1 by the polymerase chain reaction. Selected donors confirmed or not confirmed as having p24 antigen were contacted for follow-up interviews to identify risk factors and undergo retesting for HIV-1 markers. Results. Positive tests for p24 antigen were confirmed by neutralization in five donors (0.001 percent of all donations tested), all of whom were also positive for HIV-1 antibody and HIV-1 by polymerase chain reaction. Three ...

FEMALE PARTNERS OF BISEXUAL MEN What They Don't Know Might Hurt Them

Individual interviews with 350 behaviorally bisexual men aged 18-30 revealed that 71% of their female sexual partners and 59% of their steady female sexual partners in the past 6 months had not been aware of their homosexual activity. Rates of nondisclosure were higher for African-American than White men. Compared to nondisclosers, men who disclosed to all their female partners were less self-homophobic and perceived their friends, families, and neighbors as more accepting of their homosexual behavior. Compared to men who had disclosed, the nondisclosers had more female partners and used condoms less consistently with women.

Factors associated with Hispanic women's HIV-related communication and condom use with male partners

To determine factors influencing Hispanic womens HIV-related communication and condom use with their primary male partner, 189 Dominican, Puerto Rican, and Mexican women were interviewed regarding sexual behaviour and condom use, relationship characteristics, perceived risk for HIV, and HIV-related communication with the primary male partner. Level of HIV-related communication with the primary male partner was associated with the womans perceived risk for HIV and her rating of the openness with which she could communicate with her primary partner. Mexican women were less likely than Puerto Rican or Dominican women and women with multiple partners were less likely than those with one partner to communicate about HIV-related issues with their primary partner. Women reporting more condom use with their primary partner were younger, had discussed HIV-related issues more with the primary partner, and were less likely to expect negative reactions to requests for condom use than those reporting less condom use. These results suggest that prevention programmes that increase both general and HIV-specific communication between members of a couple may facilitate safer sex practices by the couple. Prevention programmes that encourage women to insist on condom use should consider the womans expectations about her partners reaction as a potential barrier to the initiation of safer sex practices.

Impact of HIV infection on mortality and accuracy of AIDS reporting on death certificates.

To assess the impact of HIV infection on mortality and the accuracy of AIDS reporting on death certificates, we analyzed data from 6704 homosexual and bisexual men in the San Francisco City Clinic cohort. Identification of AIDS cases and deaths in the cohort was determined through multiple sources, including the national AIDS surveillance registry and the National Death Index. Through 1990, 1518 deaths had been reported in the cohort and 1292 death certificates obtained. Of the 1292 death certificates, 1162 were for known AIDS cases, but 9% of the AIDS cases did not have HIV infection or AIDS noted on the death certificate. Only 0.7% of the decedents had AIDS listed as a cause of death and had not been reported to AIDS surveillance. AIDS and HIV infection was the leading cause of death in the cohort, with the highest proportionate mortality ratio (85%) and standardized mortality ratio (153 in 1987), and the largest number of years of potential life lost (32,008 years). The devastating impact of HIV infection on mortality is increasing and will require continued efforts to prevent and treat HIV infection.

Homosexual men who engage in high-risk sexual behavior. A multicenter comparison.

To describe homosexual men who continue to engage in unprotected oral and anal sex, 601 men who attended three urban STD clinics and who had engaged in these behaviors with a male partner in the previous 4 months were interviewed regarding their sexual and drug-use behaviors. Although approximately one fourth of participants had engaged in 1 to 2 episodes of unprotected anal sex, more than 20% reported engaging in greater than 23 episodes. Higher frequency of anal sex was associated with lower condom use rates. Although 50% had primary relationships, less than 22% had sex with just one partner, and less than 10% were in relationships concordant for HIV-antibody status. Multiple regression analyses showed that number of drugs used each month, sex in a steady relationship, and Hispanic ethnicity were the most consistent predictors of risk behavior across sites. Careful evaluation of the diverse nature and characteristics of these men is essential to target risk-reduction programs for this population.

Targeted and general population interventions for HIV prevention: towards a comprehensive approach.

The best available strategies for preventing the transmission of HIV aim to modify behaviors that place persons at risk for infection and transmission. However, there is considerable debate among HIV researchers, public health practitioners, policy-makers, and writers in the popular press about the appropriate audience for behavioral interventions. A major topic of debate concerns whether behavioral interventions should target individuals who are at the greatest risk for infection or a broader range of individuals within a general population [1–14].

HIV risk behavior among Peace Corps Volunteers

ObjectiveTo describe HIV risk behaviors among Peace Corps Volunteers (PCV) and to examine correlates of sexual risk behaviors. MethodCross-sectional data were collected from 1242 randomly selected PCV serving in 28 countries in 1991. PCV reported the frequency of specific risk behaviors in self-administered questionnaires, which were completed anonymously and returned to the Centers for Disease Control and Prevention. ResultsNon-sexual HIV risk behaviors were rarely reported by PCV. Sixty-one per cent of the 1080 PCV who answered questions about sexual behavior during their Peace Corps service reported having at least one sex partner. Sixty per cent of PCV had another PCV partner, 39% had a host-country national partner, and 29% had a non-PCV expatriate partner. Overall, less than one-third (32%) of unmarried PCV used condoms during every episode of sexual intercourse; more frequent use was reported in relationships with non-steady and (for male PCV) host-country national partners. Among male PCV, condom use was positively related to lower alcohol use and the belief that HIV was a problem in the host country. Female PCV reporting more condom use with male partners were younger and had fewer partners than those reporting less use. ConclusionThese data indicate that PCV are at risk for acquiring HIV through unprotected vaginal intercourse. All persons who become sexually active with new partners while travelling or living abroad should be encouraged to use condoms consistently.

High-risk sexual behavior and knowledge of HIV antibody status in the San Francisco City Clinic Cohort.

To evaluate the effectiveness of human immunodeficiency virus (HIV) testing and counseling among homosexual and bisexual men participating in the San Francisco City Clinic Cohort, compared behavioral data from 181 men who learned their HIV antibody status between 1985 and 1987 with data from 128 men who were tested but declined to receive their results. Overall, significant declines in risk indices for unprotected receptive and insertive anal intercourse occurred between 1983-1984 and 1986-1987, but these declines were independent of both knowledge of HIV status and actual serostatus. Those who chose to learn their HIV status were also no more likely to report depression or to learn their HIV status were also no more likely to report depression or anxiety subsequent to testing. Regression analyses showed no relationship between length of time since learning ones HIV status, mental health symptoms, and the persistence of high-risk behavior in 1986-1987. Although these results do not negate the value of HIV testing and counseling, they suggest that other motivating factors such as frequent access to risk-reduction information may provide sufficient impetus for behavioral change.