Determinants of condom use among gay and bisexual men in Jamaica - abstract

Ano-genital intercourse plays a major role in the homosexual transmission of HIV. A random sample of 101 gay and bisexual men aged 15-61 years was surveyed using a questionnaire. This study sought to assess age, knowledge and beliefs (identified in the Health Belief Model) as determinants of condom use. Ninety-seven per cent identified AIDS as a very serious problem and 92 percent endorsed consistent use as an effective measure to reduce the risk of HIV infection. Only 45.5 percent perceived themselves to be at risk of HIV infection. Eighty-seven per cent of the respondents reported being engaged in ano-genital sex in the past year. The levels of consistent condom use (always) for insertive and receptive ano-genital sex were 52.6 percent and 50 percent, respectively. Age and knowledge along with health beliefs relating to personal susceptibility to HIV infection, severity of AIDS, effectiveness of condom use, and cues to action, such as seeing or knowing someone with AIDS, did not predict condom use. Subjects who reported feeling "uncomfortable" or "afraid" when they asked their partner to wear a condom were more likely than those who reported "comfortable" to have never used condoms (P<0.0001). Perhaps those subjects who reported never using condoms lack the skills to negotiate condom use. Intervention programmes should therefore focus more on developing and enhancing skills and self-esteem (AU)

The Impact of the AIDS epidemic among homosexual men - abstract

Information was collected from 148 homosexual men to examine their current sexual practices, knowledge of acquired immune deficiency syndrome (AIDS), perception of risk for this disease and change in sexual behaviour. The data were analysed to investigate the relationship of these variables to the degree of worry and concern about AIDS expressed by most respondents. Overall, a decline in high risk sexual behaviour was reported. Also, measures of worry and concern were significantly related to the subjects' perception of risk for AIDS compared to heterosexuals, reduction in risk behaviour and occupational level. However, the measures of Health Locus of Control and knowledge about AIDS did not significantly predict the degree of worry and concern. The data are discussed in light of the current AIDS epidemic, and suggestions for future research are made (AU)

Pneumocystis pneumonia in the acquired immune deficiency syndrome (AIDS) - abstract

We present a retrospective analysis of Pneumocystis carinii pneumonia (PCP) in patients with AIDS at our institution. Data were collected by chart and radiological review. Since February 1983 we have treated 24 patients with AIDS and PCP. All except three were homosexual males, with seventeen (17 percent) having PCP as the initial manifestation of AIDS. All patients had CXR changes on presentation. Three had atypical changes including lobar consolidation and multiple cavities. Arterial pO2 on room air ranged from 33 to 83 (av. 59). Diagnosis was made in 28 of 30 episodes (93 percent) using bronchoalveolar lavage. One patient was positive on induced sputum, and one had a positive open lung biopsy. Other respiratory pathogens were also isolated in 20 of 30 episodes (67 percent). Therapy was initiated with trimethoprim-sulpha (T-S) or pentamidine (P). Seven of 21 episodes (33 percent) were successfully treated with T-S alone vs one of nine (11 percnet) with P alone. Eight of 21 (38 percent) experienced adverse effects with T-S vs six of nine (67 percent) with P. Adjunctive steriod therapy was required in 11 of 30 episodes (37 percent) with four deaths subsequently. Overall, six of 30 episodes (20 percent) resulted in death, three in association with concomitant CMV infection. Six of 24 patients (25 percent) had two or more episodes of PCP occurring within 5-17M. (av. 9M) of successful therapy. Our experience parallels that reported from other centres in North America (AU)

HIV and HTLV-I infection among homosexual men in Kingston, Jamaica - abstract

From August 1985 through January 1986, 123 homosexual or bisexual men from the Kingston area were enrolled in a study to determine the prevalence of human immunodeficiency virus (HIV) and the human T-lymphotrophic virus type I (HLTV-I) and the levels of risk factors for these infections. Eighteen men (15 percent) were sero-positive for HIV and 11 (9 percent) were sero-positive for HTLV-I. Only one man was positive for both viruses. The median age was 27 years (range 17 to 70). Overall, the level of promiscuity was lower than that reported in studies of homosexual men in the U.S.A. and in Europe. However, almost a third of the men reported having had homosexual encounters with foreign visitors or whilst travelling outside Jamaica. The presence of lymphadenopathy (p<0.05) was higher in HIV sero-positive patients, as was the percentage who reported having sex with men from the U.S.A. (p=0.16). Men who were sero-positive for HTLV-I tended to be more promiscuous than their sero-negative counterparts; the proportion with a history of gonorrhoea and the mean number of homosexual acts per week were both increased (p<0.05). A history of receptive anal intercourse and the mean number of homosexual partners per month were increased in positive subjects but the difference did not reach statistical significance. These results suggest that HTLV-I is an endemic, sexually transmitted infection. In contrast, HIV appears to have entered this population through homosexual contact with foreigners; the lack of association between HIV infection and promiscuity may be due to the small number of positives and the sporadic nature of transmission early in an epidemic (AU)

Progression to AIDS in homosexual men infected with HIV in Trinidad: a 3«-year follow-up - abstract

One hundred healthy homosexual or bisexual men were enrolled in a study at a venereal disease clinic in Port-of-Spain in 1983 and 40 percent were found to be HIV sero-positive as compared to 0.19 percent in a comparison group from the general population. Sexual contact with men from the USA was found to be the most significant risk factor; prior history of gonorrhoea, a marker of sexual promiscuity, was also associated with HIV sero-positivity; 15 percent were sero-positive for HTLV-I, a six-fold increase over the rate in a comparison group from the general population. The duration of homosexuality and the number of sexual partners were both associated with HTLV-I sero-positivity, suggesting that this virus, like HIV, is transmitted by homosexual activity. Six subjects were co-infected with HIV and HTLV-I; markers of altered immune status were found to be most perturbed in this group when compared with those infected with HIV alone. Prospective evaluation of the cohort has revealed that, out of 34 men who were HIV positive alone, 3 (9 percent) have progressed to AIDS in 3« years. However, of the 6 men who were co-infected, 3 (50 percent) have progressed to AIDS in the same time. Trend analysis (Kaplin and Meier) of the dates of diagnosis of AIDS among study participants (n=40) revealed a significantly increased risk of development of AIDS among individuals co-infected with HIV and HTLV-I (50 percentñ20.4 percent) as compared with those infected with HIV alone (8.8 percentñ4.9 percent). This clinical finding supports the in-vitro observation that HTLV-I infection facilitates the expression of HIV in lymphocytes infected with both retroviruses (AU)

Transmission of HTLV-1 and HIV among homosexual men in Trinidad

Risk for human T-cell lymphotropic virus type I (HTLV-I) and human immunodeficiency virus (HIV infection was evaluated in 100 homosexual or bisexual men from Trinidad. High seropositivity for HTLV-I (15 percent vs 2.4 percent in the general population) was linked to duration of homosexuality and numbers of partners, suggesting that HTLV-I, like HIV, can be transmitted by homosexual sex. Forty percent of homosexuals compared with 0.19 percent of the general population were seropositive for HIV, and sexual contact with US homosexual men and prior history of gonorrhea were major risk factors. The seroprevalence of HIV was three times higher than that for HTLV-I, suggesting that HIV is more efficiently transmitted, especially since HIV appears to have been recently introduced into Trinidad. Altered immune status was prominent in individuals infected with HIV and coinfected with HIV AND HTLV-I. Whether HIV/HTLV-I coinfection amplifies clinical effects is a hypothesis that will require further evaluation (AU)