Effects of familial and non-familial warmth during childhood and adolescence on sexual-orientation disparities in alcohol use trajectories and disorder during emerging adulthood

BACKGROUND

We investigated sexual-orientation differences in typologies of self-reported familial and non-familial warmth in childhood (before age 11) and adolescence (ages 11-17); and tested whether warmth explained sexual minority emerging adults' (ages 18-25) heightened odds of having heavier alcohol use trajectories (AUTs) and heightened risk for past-year alcohol use disorder (AUD) compared to completely heterosexuals.

METHODS

Using self-reported data from the U.S.-based Growing Up Today Study cohort, latent class analyses identified typologies of familial and non-familial warmth during childhood and adolescence. Multivariable regression models tested our objectives.

RESULTS

Six warmth classes emerged, including: High-High (i.e., high familial and high non-familial warmth, respectively); High-Moderate; Moderate-Moderate; Moderate-Occasional; Occasional-Occasional; and Low-Low. Among women, sexual minorities had higher odds than completely heterosexuals of being in the Moderate-Moderate, Moderate-Occasional, and Occasional-Occasional versus the High-High warmth class. There were not significant associations between sexual orientation and warmth classes for men. Lower warmth classes were generally associated with greater past-year AUD, and mediated heightened disparities in AUD for sexual minority women versus completely heterosexual women (4.3% mediated), but not among men. Warmth classes were generally unassociated with AUTs, and did not mediate sexual-orientation differences in AUTs.

CONCLUSIONS

Lower warmth was associated with greater alcohol-related problems, but not alcohol use itself. Warmth explained a small proportion of AUD disparities for sexual minority women-but not for men.

Sexual-orientation differences in alcohol use trajectories and disorders in emerging adulthood: results from a longitudinal cohort study in the United States

AIMS

We estimated sexual-orientation differences in alcohol use trajectories during emerging adulthood, and tested whether alcohol use trajectories mediated sexual-orientation differences in alcohol use disorders (AUDs).

DESIGN

Longitudinal self-reported survey data from the Growing Up Today Study.

SETTING

United States.

PARTICIPANTS

A total of 12 493 participants aged 18-25 during the 2003, 2005, 2007 or 2010 surveys.

MEASUREMENTS

Stratified by gender, longitudinal latent class analyses estimated alcohol use trajectories (using past-year frequency, quantity and binge drinking from 2003 to 2010). Multinomial logistic regression tested differences in trajectory class memberships by sexual orientation [comparing completely heterosexual (CH) participants with sexual-minority subgroups: mainly heterosexual (MH), bisexual (BI) and gay/lesbian (GL) participants]. Modified Poisson regression and mediation analyses tested whether trajectories explained sexual-orientation differences in AUDs (past-year DSM-IV abuse/dependence in 2010).

FINDINGS

Six alcohol use trajectory classes emerged for women and five for men: these included heavy (23.5/36.9% of women/men), moderate (31.8/26.4% of women/men), escalation to moderately heavy (9.7/12.0% of women/men), light (17.0% for women only), legal (drinking onset at age 21; 11.1/15.7% of women/men) and non-drinkers (7.0/9.1% of women/men). Compared with CH women, MH and BI women had higher odds of being heavy, moderate, escalation to moderately heavy and light drinkers versus non-drinkers (odds ratios = 2.02-3.42; P-values < 0.01-0.04). Compared with CH men, MH men had higher odds of being heavy, moderate and legal drinkers versus non-drinkers (odds ratios = 2.24-3.34; P-values < 0.01-0.01). MH men and women, BI women and GLs had higher risk of AUDs in 2010 than their same-gender CH counterparts (risk ratios = 1.34-2.17; P-values < 0.01). Alcohol use trajectories mediated sexual-orientation differences in AUDs for MH and GL women (proportion of effect mediated = 30.8-31.1%; P-values < 0.01-0.02), but not for men.

CONCLUSIONS

In the United States, throughout emerging adulthood, several sexual-minority subgroups appear to have higher odds of belonging to heavier alcohol use trajectories than completely heterosexuals. These differences partially explained the higher risk of alcohol use disorders among mainly heterosexual and gay/lesbian women but not among sexual-minority men.

Stability of Bisexual Behavior and Extent of Viral Bridging Behavior Among Men Who Have Sex with Men and Women

Bisexual men experience significant health disparities likely related to biphobia. Biphobia presents via several preconceptions, including that bisexuality is transitory, and that bisexual men act as viral bridges between men who have sex with men and heterosexual populations. We analyzed data from a prospective cohort of gay and bisexual men, the Multicenter AIDS Cohort Study, to test these preconceptions. Men reporting both male and female sexual partners (MSMW) between 2002 and 2009 (n = 111) were classified as behaviorally bisexual. We assessed five hypotheses over two domains (transience of bisexual behavior and viral bridging). No evidence was found supporting the transitory nature of bisexuality. Trajectories of bisexual behavior were not transient over time. We found little evidence to support substantial viral bridging behavior. Notably, HIV-positive MSMW reported lower proportions of female partners than HIV-negative MSMW. Our results provide no empirical support for bisexual transience and scant support for viral bridging hypotheses. Our results provide key data showing that male bisexual behavior may be stable over long time periods and that behaviorally bisexual men's risk to female sexual partners may be lower than expected.

Someone to count on: social support as an effect modifier of viral load suppression in a prospective cohort study

Though functional social support has been shown to serve as a protective factor for HIV viral load suppression in other populations, scant research has examined this relationship among men who have sex with men (MSM) in the United States. We assessed characteristics of social support, effects of social support on HIV viral load, and moderation by social support of the relationship between psychosocial indicators of a synergistic epidemic (syndemic) and HIV viral load. We analyzed longitudinal data from HIV-positive MSM using antiretroviral therapy who were enrolled in the Multicenter AIDS Cohort Study between 2002 and 2009 (n = 712). First, we conducted reliability assessments of a one-item social support measure. Then, we conducted a series of generalized longitudinal mixed models to assess our research questions. Moderation was assessed using an interaction term. A three-level (low/medium/high) social support variable demonstrated high reliability (intraclass correlation coefficients  = 0.72; 95% CI: 0.70, 0.75). Black and Hispanic MSM reported lower social support than their White counterparts (p < .0001). Recent sero-conversion was associated with higher social support (p < .05). Higher numbers of concomitant syndemic indicators (depression, polysubstance use, and condomless anal sex) were associated with lower social support (p < .0001). Medium and high social support levels were associated with greater viral load suppression and lower viral load means (p < .0001). Social support moderated the relationships between syndemic and HIV viral load (p < .05). HIV-positive MSM, particularly those of color, may benefit greatly from interventions that can successfully boost functional social support. Creating strengths-based interventions may also have particularly high impact among HIV-positive MSM with the highest psychosocial burdens.

High HIV incidence among young black men who have sex with men: constructing a retrospective cohort from a community health programme

OBJECTIVES

We sought to calculate HIV incidence in a retrospective cohort of young (13-29 years old) black men who have sex with men (YBMSM) accessing repeated HIV-antibody testing in a mid-size city in the USA.

METHODS

We aggregated site-specific HIV-antibody testing results from the project's inception among YBMSM who received an initial negative result and accessed at least one additional HIV-antibody test. From these data, we assessed number of seroconversions and person-years and calculated HIV incidence using a mid-P exact test to estimate 95% CIs.

RESULTS

Five seroconversions were documented over 42.3 person-years (the mean age at first onsite test: 19.7 years), resulting in an HIV incidence rate of 11.8% (95% CI 4.3% to 26.2%). The mean age at seroconversion was 20.4 (±3.0) years.

CONCLUSIONS

Even in mid-size cities with low HIV prevalence rates in the general population, HIV incidence among YBMSM may be high. Community-based HIV-antibody testing organisations serving YBMSM should be encouraged and trained to track repeated HIV testing and calculate HIV incidence rates. Increased resources should be deployed to develop and encourage regular HIV testing in community health sites serving YBMSM.

HIV infection and sexual risk among men who have sex with men and women (MSMW): a systematic review and meta-analysis

OBJECTIVES

To estimate the number of men who have sex with men and women who are HIV-positive in the United States, and to compare HIV prevalence rates between men who have sex with men and women, men who have sex with men only, and men who have sex with women exclusively.

METHODS

Following PRISMA guidelines, we conducted a systematic review and meta-analysis of reports referencing HIV prevalence and men who have sex with men and women. We searched PubMed and Ovid PsycINFO for peer-reviewed, U.S.-based articles reporting on HIV prevalence among men who have sex with men and women. We conducted event rate, effect size, moderation and sensitivity analyses.

RESULTS

We estimate that 1.0% of U.S. males are bisexually-behaving, and that 121,800 bisexually-behaving men are HIV-positive. Men who have sex with men and women are less than half as likely to be HIV-positive as men who have sex with men only (16.9% vs. 33.3%; OR = 0.41, 95% CI: 0.31, 0.54), but more than five times as likely to be HIV-positive as men who have sex with women exclusively (18.3% vs. 3.5%; OR = 5.71, 95% CI: 3.47, 9.39). They are less likely to engage in unprotected receptive anal intercourse than men who have sex with men only (15.9% vs. 35.0%; OR = 0.36, 95% CI: 0.28, 0.46). Men who have sex with men and women in samples with high racial/ethnic minority proportions had significantly higher HIV prevalence than their counterparts in low racial/ethnic minority samples.

CONCLUSIONS

This represents the first meta-analysis of HIV prevalence in the U.S. between men who have sex with men and women and men who have sex with men only. Data collection, research, and HIV prevention and care delivery specifically tailored to men who have sex with men and women are necessary to better quantify and ameliorate this population's HIV burden.

HIV risk among substance-using men who have sex with men and women (MSMW): findings from South Florida

Compared with men who have sex with men only (MSMO), men who have sex with men and women (MSMW) consistently report higher rates of two HIV risk behaviors: transactional sex (TS) and concurrent substance use and sex (CSS). Within MSMW, little is known about how synergistic epidemics ("syndemics") affect TS and CSS. Using a sample of substance-using MSM (n = 515) in South Florida, we compared TS and CSS among MSMO and MSMW; examined whether, within MSMW (n = 86), TS and CSS predict unprotected anal intercourse with partners of serodiscordant/unknown HIV status (SU-UAI); and tested whether syndemics predict TS and CSS. MSMW reported higher rates of engaging in both TS and CSS (AOR = 1.7; 95 % CI 1.0-3.0). Within MSMW, engagement in both TS and CSS predicted SU-UAI (AOR = 3.3; 95 % CI 1.2-9.6); and syndemics predicted TS and CSS involvement (p < 0.01). Substance-using MSMW may benefit from interventions targeting TS, CSS, and background syndemics.

Labor force participation and health-related quality of life in HIV-positive men who have sex with men: the Multicenter AIDS Cohort Study

Too many people with HIV have left the job market permanently and those with reduced work capacity have been unable to keep their jobs. There is a need to examine the health effects of labor force participation in people with HIV. This study presents longitudinal data from 1,415 HIV-positive men who have sex with men taking part in the Multicenter AIDS Cohort Study. Generalized Estimating Equations show that employment is associated with better physical and mental health quality of life and suggests that there may be an adaptation process to the experience of unemployment. Post hoc analyses also suggest that people who are more physically vulnerable may undergo steeper health declines due to job loss than those who are generally healthier. However, this may also be the result of a selection effect whereby poor physical health contributes to unemployment. Policies that promote labor force participation may not only increase employment rates but also improve the health of people living with HIV.

Ferromagnetic order in aged Co-doped TiO2 anatase nanopowders

This paper reports on the ferromagnetic properties of aged Ti(1-x)CoxO(2-delta) anatase nanopowders with different Co contents (0.03 < or = x < or = 0.10). It is shown for the first time that aged Co:TiO2 anatase samples retain rather high values of magnetization (M), remanence (Mr) and coercivity (Hc) which provide strong evidence for a preserved long-range ferromagnetic order. Room temperature M, Mr and Hc values were measured in the ranges of [0.05, 0.79] microB/Co, [0.044, 0.096] microB/Co and [366.7,494.8]Oe, respectively, which are in the same range as in general reported either for newly prepared thin films or nanoparticles.

Middle-aged and older men who have sex with men exhibit multiple trajectories with respect to the number of sexual partners

This study aimed to examine trajectories with respect to the number of sexual partners among older men who have sex with men and to determine characteristics associated with trajectory groups. Nagin's group-based modeling was used to identify trajectories for 237 men from the Pitt Men's Study with respect to the number of male intercourse partners from age 50.0 to 59.5. Three distinct trajectory groups were identified. Most men (69.2%) had a median of two sexual partners in the past 6 months across the age range of the study. A smaller group (19.4%) had low or no sex partners. The smallest group (11.4%) had 30 or more sexual partners in the past 6 months at age 50. The groups were statistically different with respect to race, HIV status, drug use (marijuana, poppers, crack cocaine, and Viagra), the number of unprotected anal sex partners, and personal attitudes towards sex.

Sexual, behavioral, and quality of life characteristics of healthy weight, overweight, and obese gay and bisexual men: findings from a prospective cohort study

While there have been attempts to explore the association of obesity and risky sexual behaviors among gay men, findings have been conflicting. Using a prospective cohort of gay and bisexual men residing in Pittsburgh, we performed a semi-parametric, group-based analysis to identify distinct groups of trajectories in body mass index slopes over time from 1999 to 2007 and then correlated these trajectories with a number of psychosocial and behavioral factors, including sexual behaviors. We found many men were either overweight (41.2%) or obese (10.9%) in 1999 and remained stable at these levels over time, in contrast to recent increasing trends in the general population. Correlates of obesity in our study replicated findings from the general population. However, we found no significant association between obesity and sexual risk-taking behaviors, as suggested from several cross-sectional studies of gay men. While there was not a significant association between obesity and sexual risk-taking behaviors, we found high prevalence of overweight and obesity in this population. Gay and bisexual men's health researchers and practitioners need to look beyond HIV and STI prevention and also address a broader range of health concerns important to this population.

Intimate partner violence among HIV-positive persons in an urban clinic

While the intersection of HIV/AIDS and intimate partner violence (IPV) has gained increased attention, little focus has been given to the relationship among minority men and men who have sex with men (MSM). This pilot study, conducted at an urban clinic, explores the IPV experiences of HIV-positive persons involved in both heterosexual and homosexual relationships. Fifty-six HIV-positive individuals were interviewed to assess for verbal, physical, and sexual IPV, and for HIV-related abuse and attitudes regarding routine IPV screening. Approximately three quarters (73%) of the sample reported lifetime IPV and 20% reported current abuse. Physical IPV (85%) was cited the most by abused participants. IPV rates were highest among African-Americans and MSM. More than one-fourth (29%) of those abused felt the abuse was related to their HIV status. A majority of participants favored IPV screening by providers, but felt it might increase risk of IPV. IPV and its association to HIV are significant issues among this sample. Findings support the need for developing new programs that address these epidemics simultaneously.

Lower HIV prevalence among Asian/Pacific Islander men who have sex with men: a critical review for possible reasons

We conducted a critical literature review for possible reasons that may explain the lower HIV prevalence observed among API MSM compared to MSM of other races/ethnicities. Trends emerging from the literature suggest that traditional individual-level factors-unprotected anal intercourse, substance use, STD prevalence, rates and frequency of HIV testing, and utilization of HIV prevention services-do not appear to be related to the lower HIV prevalence among API MSM. Some evidence suggests that socio-cultural and structural factors might be the more critical forces in determining racial/ethnic disparities of HIV among MSM. For API MSM, these factors include structures of sexual networks, access to and reception of medical care and treatment among HIV-positive MSM, and influences of different levels and types of acculturation. Moreover, emerging risk reduction strategies, such as seroadaptive behaviors, could play a role. Future research should address these factors in intervention design. In addition, better theories of resilience and measurement of strengths and protective factors are needed to enhance the efficacy of HIV interventions.

A Twenty-Two-Year-Old Community Advisory Board: Health Research as an Opportunity for Social Change

Conducting health research often requires a partnership between marginalized communities and researchers. Community organizers can broker this partnership in a way that not only produces important scientific discoveries but also brings needed resources to the communities. This article is a description of a community advisory board established in 1984 to advise researchers on a longitudinal study of the natural history of AIDS among gay men. The Board successfully guided the recruitment of more than 3,000 gay and bisexual male volunteers and, at the same time worked as a powerful change agent. An analysis of minutes from all Board meetings between 1984-2006 indicates that significant social change as well as important research findings resulted from Board actions. Community organizers who work to create a mutually beneficial partnership between communities and researchers may find new opportunities to support community growth and social justice.

Coexistence of universal and topological anomalous hall effects in metal CrO2 thin films in the dirty limit

The scaling exponent of 1.6 between anomalous Hall and longitudinal conductivity, characteristic of the universal Hall mechanism in dirty-metal ferromagnets, emerges from a series of CrO2 films as we systematically increase structural disorder. Magnetic disorder in CrO2 increases with temperature and this drives a separate topological Hall mechanism. We find that these terms are controlled discretely by structural and magnetic defect populations, and their coexistence leads to apparent divergence from exponent 1.6, suggesting that the universal term is more prevalent than previously realized.

Impact of early sexual debut on gay men's tobacco use

Young men's sexual experiences with men are different from their sexual experiences with women because of homophobia. Early sexual debut with another man could lead to tobacco use as a result. The study assessed 691 HIV-negative gay men recruited from southwestern Pennsylvania. Early sexual experiences with men and women were associated with participants' smoking behaviors. It is thought that the early sexual debut with men may place these individuals at risk for homophobia as well as for being socialized in environments that will influence their smoking behavior. To be effective, tobacco control programs need to be culturally competent regarding issues that affect gay men.

Recruiting minority men who have sex with men for HIV research: results from a 4-city campaign

We describe the efforts of a 4-city campaign to recruit Black and Hispanic men who have sex with men into an established HIV epidemiological study. The campaign used community organizing principles and a social marketing model that focused on personnel, location, product, costs and benefits, and promotion. The campaign was developed at the community, group, and individual levels to both increase trust and reduce barriers.The proportion of Hispanic men recruited during the 2002-2003 campaign doubled compared with the 1987 campaign, and the proportion and number of White men decreased by 20%. The proportion of Black men decreased because of the large increase in Hispanic men, although the number of Black men increased by 56%. Successful recruitment included training recruitment specialists, involving knowledgeable minority community members during planning, and having an accessible site with convenient hours.

The impact of gender-role nonconforming behavior, bullying, and social support on suicidality among gay male youth

This study hypothesized that gender-role nonconformity is associated with suicidality, and bullying mediates this relationship. Gay males retrospectively answered questions pertaining to elementary, middle, and high school. Support for the hypotheses was found. Results can help screen gay youth for suicidality and support the need for policies prohibiting harassment based on sexual orientation.

Adolescents define sexual orientation and suggest ways to measure it

Researchers disagree on how to assess adolescent sexual orientation. The relative importance of various dimensions (e.g. attraction, relationships, behavior, self-labeling) is unknown, which calls into question the validity of studies assessing adolescent sexual orientation. To address this issue, 50 male and female adolescents of varied sexual orientations participated in focus groups and interviews. Two types of sexual attraction-one a physiologic reaction and the other a cognitive response-were central to adolescent sexual orientation. Participants did not perceive sexual behavior and self-identification as necessarily relevant. Preliminary items to measure sexual attraction were developed based on these adolescents' perceptions.

Mental health case management as a locus for HIV prevention: Results from case-manager focus groups

HIV infection among people with severe mental illness (SMI) is a growing concern, and interventions have been designed to address HIV prevention among these individuals. However, little is known about the preparedness of mental health providers to support these interventions. This study concentrated on mental health case management as a locus for HIV-prevention services. Focus groups of case managers were conducted to learn participants' motivation to adopt HIV-prevention services and barriers/facilitators to such adoption. Participants reported they would be motivated to offer HIV prevention if services were to be presented in the context of existing client relationships and case-management tasks. Barriers and facilitators were discussed at client, provider, and community levels, and recommendations for training were offered. Findings have implications for diffusion of HIV-prevention services in case management, and the line of questioning in focus groups provides a basis for learning about other behavioral health service contexts as loci for disease prevention.

Prevalence of chlamydia and gonorrhoea among a population of men who have sex with men

OBJECTIVES

Few data are available on the prevalence of sexually transmitted diseases (STDs) in men who have sex with men (MSM), making it difficult to develop STD screening guidelines for this population. The objective of the study was to determine the prevalence of urethral infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae within a large, community based population of MSM, and to assess the feasibility of rectal screening in this population.

METHODS

This was a cross sectional study of 566 MSM, who were predominantly middle aged, white, asymptomatic, and engaged in sex with multiple partners. All provided a urine sample to screen for chlamydial and gonorrhoea infections using a PCR assay; rectal screening was performed on 48 participants.

RESULTS

Urethral C. trachomatis infections were detected in 1/566 participants (prevalence 0.2%, 95% CI 0.004% to 1.0%), and rectal C. trachomatis infections were detected in 2/48 men (prevalence 4.2%, 95% CI 0.5% to 14.2%). No gonorrhoea infections were detected, and none of the 117 HIV positive men had either infection.

CONCLUSIONS

Chlamydial and gonorrhoea infections were uncommon in this sample of MSM, even among those with multiple sexual partners or HIV infection. These data call into question recommendations to screen all MSM based on their individual sexual behaviours or HIV. Additional data are needed on the prevalence of these infections in MSM from different settings.

Lignanamides and other phenolic constituents from the bark of kenaf (Hibiscus cannabinus)

Two new acyclic phenylpropane lignanamides, grossamide K and erythro-canabisine H, and the naphthol glucoside 2,5-dimethyl-3-O-beta-D-glucopyranosylnaphthol, along with six known compounds were isolated from the acetone extract of bark of Hibiscus cannabinus. All structures were established by spectroscopic methods including 2D NMR techniques, which allowed the correction of certain previously reported 13C NMR assignments of grossamide.

Phenolic constituents from the core of kenaf (Hibiscus cannabinus)

Four lignans, boehmenan H [2-(4-hydroxy-3-methoxyphenyl)-5-[3-(4-hydroxy-3-methoxycinnamoyloxy)propyl]-3-hydroxymethyl-7-methoxybenzodihydrofuran], boehmenan K [2-(4-hydroxy-3-methoxyphenyl)-5-[3-(4-hydroxycinnamoyloxy)-1-propenyl]-3-(4-hydroxy-3-methoxycinnamoyloxymethyl)-7-methoxybenzodihydrofuran], threo-carolignan H [threo-1-(4-hydroxy-3-methoxyphenyl)-2-[4-[3-(4-hydroxy-3-methoxycinnamoyloxy)propyl]-2-methoxyphenoxy]-1,3-propanodiol], and threo-carolignan K [threo-1-(4-hydroxy-3-methoxyphenyl)-3-(4-hydroxy-3-methoxycinnamoyloxy)-2-[4-[3-(4-hydroxycinnamoyloxy)-1-propenyl]-2-methoxyphenoxy]-1-propanol] as well as several other lignans, aldehydes and a tyramine derivative were isolated from the acetone extract of core of kenaf (Hibiscus cannabinus). All the structures were established by spectroscopic methods. The hitherto unreported 13C NMR spectra of some compounds are also presented and discussed. 2D NMR techniques have allowed the revision of certain previously reported 13C NMR assignments of some scarce naturally occurring compounds.

A participant observation study using actors at 30 publicly funded HIV counseling and testing sites in Pennsylvania

OBJECTIVES

This study was designed to augment an evaluation of Pennsylvania publicly funded HIV counseling and testing sites, particularly of the staff-client interaction.

METHODS

Actors were trained as research assistants and sent to 30 randomly chosen sites to be tested and counseled for HIV disease. Instruments based on Centers for Disease Control and Prevention (CDC) guidelines were designed and used to evaluate them.

RESULTS

Data were generated that identified the range of compliance with CDC guidelines and state policy. Among the findings were that 10 of 30 sites required signed consents despite a state policy allowing anonymous testing. Only 17% of providers developed a written risk reduction plan, even though 69% of all sites surveyed by mail asserted that such plans were developed. Only 2 of 5 HIV-positive actors were offered partner notification services, even though 100% of sites visited by an interviewer claimed to offer such services.

CONCLUSIONS

The findings suggest that although evaluation methods such as mail surveys and site visits are useful for evaluating the existence of appropriate policies and protocols and gathering baseline data, they might not be sufficient for assessing actual staff-client interaction.

Structural characterization of the lignin from the nodes and internodes of Arundo donax reed

Milled wood lignin (MWL) and dioxane lignin (DL) from different morphological regions (nodes and internodes) of Arundo donax reed were subjected to a comprehensive structural characterization by (13)C, (1)H NMR, FTIR, and UV spectroscopies and functional analysis. The permanganate and nitrobenzene oxidation methods were also applied to the in situ lignins. Both node and internode lignins are HGS-type lignins, with a significant amount of H units (including p-coumaric acid type structures). The S/G ratio (1.13-1.32), the weight-average molecular weight (20,400-24,500), the methoxyl group content (0.90-0.98), the phenolic hydroxyl group content (0.23-0.27), and the aliphatic hydroxyl group content (1.00-1.09) are not very different in the lignins from nodes and internodes. However, some structural differences between node and internode lignins were observed. The former has much more phenolic acids (p-coumaric and ferulic), 8.8% in node versus 1.2% in internode and less beta-O-4 (0. 32 and 0.49 per aromatic unit in node and internode, respectively). In situ node lignin is more condensed than internode lignin.

Composition of suberin extracted upon gradual alkaline methanolysis of Quercus suber L. cork

The monomeric composition of suberin extracts obtained by gradual alkaline methanolysis of Quercus suber cork was determined by gas chromatography-mass spectrometry (GC-MS). Results show that 1-alkanols and alkanoic and alpha,omega-alkanedioic acids are preferentially removed upon mild alkaline conditions, whereas mid-chain-modified omega-hydroxyalkanoic acids are preferentially removed under stronger alkaline conditions. Saturated omega-hydroxyalkanoic acids are found to be abundant in all suberin extracts. These results are consistent with two distinct suberin fractions with different locations in cork cell walls and/or esterification degrees. It is proposed that these fractions correlate with the two main suberin peaks in the solid state (13)C NMR spectra of cork and suberin extracts. Quantitative GC-MS analysis showed that suberin monomers comprise approximately 30% (w/w) of the suberin extracts, the remaining comprising nonvolatile structures with high M(n) values, as measured by vapor pressure osmometry. The presence of a large fraction of high molecular weight aliphatic structures in suberin extracts is supported by the corresponding NMR spectra.

Gay male, lesbian and bisexual health-related research funded by the National Institutes of Health between 1974 and 1992

Health-related problems among lesbians, bisexuals, and gay men require research before solutions to them can be identified. This paper describes NIH sponsored research listing homosexuality as a primary or secondary issue between 1974 and 1992. Homosexual projects unrelated to HIV and excluding capitol funding averaged only $532,000 per year compared to about $20 million per year since 1982 for HIV projects. Considering the range of health threats to these communities and the amounts needed to deal with HIV alone, current funding is clearly inadequate. Community members, scientists, experts, and others need to take action if appropriate research is to be done and the health needs of these groups are to be addressed.

Cork suberin as a new source of chemicals. 1. Isolation and chemical characterization of its composition

Extractive-free cork from Quercus suber L. was submitted to a solvolysis treatment with methanolic NaOH which yielded 37% (o.d. cork) of suberin. This mixture of compounds was thoroughly characterized by FTIR, 1H- and 13C-NMR, gas chromatography coupled with mass spectrometric (GC-MS) analysis, vapour pressure osmometry (VPO), mass spectrography (MS) and gel permeation chromatography (GPC). After derivatization, the main components of the volatile fraction, representing less than half of the total, were found to be omega-hydroxymonocarboxylates, alpha, omega-dicarboxylates, simple alkanoates and 1-alkanols, all with chain lengths ranging from C16 to C24. A second fraction, with an average molecular weight about three times higher, was detected by VPO, MS and GPC. The presence of this important fraction in cork suberin had not been recognized in earlier studies. Both fractions constitute interesting precursors for the elaboration of new materials.

Anal sphincter structure and function in homosexual males engaging in anoreceptive intercourse

OBJECTIVES

To evaluate the structure and function of the internal (IAS) and external (EAS) anal sphincters in anoreceptive homosexual men and to determine whether anoreceptive intercourse (ARI) is associated with a higher risk of incontinence in this population.

METHODS

We studied 14 anoreceptive homosexual males and 10 age-matched non-anoreceptive heterosexual males in a controlled, prospective cohort study. Subjects underwent evaluation of resting and maximum squeeze anal canal pressures (maximum squeeze pressure obtained over resting pressure) by station pull-through technique, using a manometric perfusion catheter followed by endoanal ultrasonography to evaluate the structure of the IAS and EAS. Manometry also was performed in age-matched male controls. All subjects completed a questionnaire that assessed sexual practices and bowel habits, including fecal incontinence.

RESULTS

Resting pressures were significantly lower in subjects engaging in ARI (70.7 +/- 3.2 mm Hg vs. 91.4 +/- 5.2 mm Hg; mean +/- SEM, p < 0.003), whereas there was no significant difference in the mean maximum squeeze pressures, compared with controls (177.1 +/- 14.1 mm Hg vs. 151.8 +/- 19.6 mm Hg; mean +/- SEM, p = 0.32). No disruptions of the IAS or EAS were identified in either the anoreceptive or control group. Anoreceptive men tended to have thinner anal sphincters than controls, but the difference was not statistically significant. Furthermore, there were no complaints of fecal incontinence by the study subjects.

CONCLUSIONS

Passive ARI is associated with decreased resting anal canal pressures, but total pressures are normal. There were no IAS or EAS defects, as well as no fecal incontinence, in our subjects. Better relaxation of the ARI subjects during anal canal manometry may explain the lower resting pressures.

Brokering: a process for establishing long-term and stable links with gay male communities for research and public health education

The success of efforts to prevent continued transmission of the human immunodeficiency virus (HIV) and to increase compliance with HIV prophylactic interventions among homosexual and bisexual men will depend in part on health care professionals' understanding of and ability to establish linkages with these men. In order to recruit men into a research project and an educational program, staff at the Pitt Men's Study, an epidemiological investigation of HIV infection, developed a process described here as "brokering," which was based on community organizing and marketing principles. Brokering is a dynamic process by which researchers and public health professionals exchange goods and services with formal and informal leaders of the gay community in order to establish strong, long-term linkages. To date, this process yielded 2,989 homosexual and bisexual recruits into the study, which began in 1983. After 8 years, 79% of those still alive continue to return for follow-up. While recruitment techniques will need to vary from city to city, the importance of establishing linkages with the local indigenous leadership remains of major importance.

Factors associated with participation in HIV antibody screening and results disclosure

The Centers for Disease Control reported in October 1991 that many people at risk for human immunodeficiency virus (HIV) infection had not been tested for antibodies to HIV. This study identifies differences among 110 gay and bisexual men in three small cities in Pennsylvania who decided whether to be tested for antibodies to HIV and, if so, whether to return for results. These men were given self-administered questionnaires and were offered free and confidential HIV antibody tests. Fifty percent of the men refused testing. Of those tested, only 35 percent returned to obtain test results. Contrary to other health prevention data, education was significantly and inversely related to being tested and to returning for results. Men who most often participated in the institutionalized gay community were least likely to be tested. The findings suggest that gay men who are most aware of the potential psychosocial problems associated with HIV antibody testing are more likely to avoid testing.

Changes in HIV rates and sexual behavior among homosexual men, 1984 to 1988/92

Data were collected from 1614 homosexual and bisexual men in 1984 through 1985 and from 1988 to 1992 in Pittsburgh. Of the men entering the study since 1988, 16% reported engaging in unprotected anal receptive intercourse with more than one partner during the 6 months before their visit. Approximately 7% of the younger men and 18% of the men over 22 years of age in the recent cohort were already infected with the human immunodeficiency virus, the same rates as those described 8 years ago. Aggressive risk-reduction programs are needed in high schools and existing networks in the gay community.

Guidelines for disclosing HIV-antibody test results to clients

Because of new preventive therapies, HIV-antibody testing of asymptomatic individuals now has clear clinical benefits. Consequently, greater numbers of individuals are expected to seek testing. This article, based on the authors' experiences with disclosing HIV-antibody test results to a high-risk group of men, makes recommendations for how best to present HIV-antibody results. Disclosing HIV-antibody results provides an educational opportunity as well as a psychological challenge for clinicians. Some unusual client reactions are detailed in the case studies.

Factors related to seroconversion among homo- and bisexual men after attending a risk-reduction educational session

Thirteen homosexual men, volunteers in a study of the natural history of HIV, who seroconverted to HIV after participating in an educational program on HIV prevention, were interviewed about the circumstances leading to their seroconversion. Six men had participated in unprotected anal intercourse with at least one partner whom they believed was HIV-negative. Four men attributed their conversion to mental health problems or to drug and alcohol use. Two men's seroconversions could not be ascertained and one man attributed seroconversion to a condom break. Most men who had learned how to avoid infection, and had successfully done so for a time, had knowingly engaged in unsafe behaviors because of strong emotional responses to certain partners or because of mental health or drug and alcohol-related problems. Skills training for dealing with partners who pressure men to behave unsafely is needed, as is mental health and drug and alcohol counseling for men at risk for HIV infection.