AIDS & STDS

HELPING PEOPLE WITH AIDS, DIEGO LOPEZ, PRACTICE DIGEST, 1984, VOL 7(1), P23-26.

ETHICAL ISSUES IN PSYCHOLOGICAL RESEARCH ON AIDS, COMMITTEE FOR PROTECTION OF HUMAN PARTICIPANTS IN RESEARCH IN COOPRATION WITH THE COMMITTEE ON GAY CONCERNS, AMERICAN PSYCHOLOGICAL ASSOCIATION, JOURNAL OF HOMOSEXUALITY 1986, VOL 13(1) P109-116.

COMPARISON OF GYNECOLOGIC HEALTH CARE PROBLEMS BETWEEN LESBIANS AND BISEXUAL WOMEN, A SURVEY OF 2,345 WOMEN, SUSAN R. JOHNSON, ELAINE M. SMITH, SUSAN M. GUENTHER, JOURNAL OF REPRODUCTIVE MEDICINE, 1987, VOL 32, P805-811.

A survey of reproductive system problems was conducted in a large group of lesbians (n = 1,921) and bisexual women (n = 424) in a nonclinical setting. Demographically the groups were similar: the majority of respondents were white, urban and well educated. A history of heterosexual coitus was common in both groups (bisexuals, 95%; lesbians, 77%). Bisexuals were more likely than lesbians to report an abnormal Papanicolaou smear, cystisis, genital herpes, gonorrhea and vaginal infections. When sexual orientation was controlled for, most, but not all, of these differences were associated with a difference in reported frequency of (prior) coitus. Despite the lower risk of certain problems, however, the lesbians who repoted no previous coitus did report the occurrence of vaginitis, abnormal Papanicolaou smears and genital herpes. There were no differences in past oral contraceptive use, endometriosis, menstrual dysfunction or breast disease. The lesbian group reported a greater percentage of hysterectomies. These data suggest that, overall, the sexual behaviors of lesbians are associated with a lower risk of most sexually transmitted diseases.

AIDS AND THE GENERAL PRACTITIONER: VIEWS OF PATIENTS WIH HIV INFECTION AND AIDS, MICHAEL B. KING, BRITISH MEDICAL JOURNAL, VOL 297, 16 JULY 1988.

ON BEING GAY, SINGLE, AND BEREAVED, MARGUERITE OERLEMANS-BUNN, AMERICAN JOURNAL OF NURSING, APRIL 1988, P472-476.

AIDS-PHOBIA, CONTACT WITH AIDS, AND AIDS-RELATED JOB STRESS IN HOSPITAL WORKERS, JOSEPH H. PLECK, LYDIA O'DONNELL, CARL O'DONNELL, JOHN SNAREY, JOURNAL OF HOMOSEXUALITY, 1988, VOL 15(3/4), P41-54.

In a survey of 237 hospital workers involved in the care of AIDS patients and AIDS inpatient-care facility, negative attitudes toward AIDS and AIDS patients (AIDS-phobia) and AIDS-related job stress (AIDS-stress) were common. In multivariate analyses, AIDS-phobia is significantly higher among older staff, those having low contact with AIDS patients (AIDS-contact), and those holding homophobic attitudes. AIDS-phobic attitudes and low AIDS-contact can be interpreted as predicting each other. Finally, AIDS-stress is predicted by low contact with AIDS and AIDS-phobic attitudes.

AIDS ON THE DEATH CERTIFICATE: THE FINAL STIGMA, MICHAEL B. KIND, BRITISH MEDICAL JOURNAL, VOL 298, 18 MARCH 1989.

TRICHOMONAS VAGINALIS INFECTION IN A LESBIAN, LETTER, GENITOURIN MED 1989, VOL 65, P399-400.

HISPANIC CULTURE, GAY MALE CULTURE, AND AIDS: COUNSELING IMPLICATIONS, ALEX CARBALLO-DIEGUEZ, JOURNAL OF COUNSELING & DEVELOPMENT, 1989, VOL 68, P26-30.

The AIDS epidemic is affecting Hispanics in disproportionately high numbers. High-risk sexual behavior conducive to HIV infection seems to continue taking place among Hispanic gay men. This article presents some necessary considerations when counseling this population.

HUMAN IMMUNODEFICIENCY VIRUS INFECTION AND THE GAY COMMUNITY: COUNSELING AND CLINICAL ISSUES, DAVID J. MARTIN, JOURNAL OF COUNSELING & DEVELOPMENT, 1989, VOL 68, P67-72.

The gay community has been and continues to be disproportionately affected by the acquired immune deficiency syndrome (AIDS) and the human immunodeficiency virus (HIV) infection. Need for risk-reduction education, mental health service provision, and assistance in grieving the ongoing loss of loved ones continues to exist among members of the gay community. Clinicians who work with gay clients should be aware of the critical issues confronting gay men who are at risk for infection, those who may already be infected with HIV, and their loved ones. This article highlights critical issues in introducing prevention in therapy and counseling, in supporting asymptomatic seropositive gay men and gay men with AIDS-related complex (ARC) and AIDS in their attempts to cope, and in assisting in the grieving process for those who have lost loved ones to AIDS-related illnesses.

COMBATING HOMOPHOBIA IN AIDS EDUCATION, JAMES M. CROTEAU, SUSANNE MORGAN, JOURNAL OF COUNSELING & DEVELOPMENT, 1989, VOL 68, P86-91.

Homophobia is a central theme in response to the AIDS epidemic. In this article we review literature explicating the connection between homophobia and AIDS and then call for the integration of antihomophobia elements into AIDS education. We discuss negative messages in portrayals of gay and bisexual men and in discussions of safer sexual practices, as well as materials and educational strategies that explicitly contradict such homophobic messages. We then discuss the emerging trend to exclude lesbian women and gay men in education and programs, suggest guidelines for countering such exclusion, and give examples of creative approaches to inclusion.

LEARNING ABOUT AIDS AND HIV TRANSMISSION IN COLLEGE-AGE STUDENTS, JAMES STIFF, MARY MCCORMACK, ERIC ZOOK, TERRY STEIN, REBECCA HENRY, COMMUNICATION RESEARCH, 1990, VOL 17(6), P743-758.

Byrne's (1977) model of emotional reactions to sexual stimuli and Herek's (1988) conceptualization of attitudes toward gay men and lesbians provided the framework for studying the effects of such attitudes on adolescent learning about acquired immune deficiency syndrome (AIDS) and human immunodeficiency virus (HIV) transmission. A pretest-posttest control-group design was used to test several hypoetheses concerning the effectiveness of an educational presentation and the influence of extrme attitudes toward gay men and lesbians on learning and retention of information. Findigs indicated that educational presentation produced significant increases in knowledge about AIDS and HIV transmission. Further analyses indicated there was very little forgetting of this information. Consistent with our hypotheses, students with extreme positive attitudes toward gay men and lesbians learned more about AIDD than those with extreme negative attitudes. Practical and theoretical implications of these findings are discussed.

MANAGING RISK AND EXPERIENCING DANGER: TENSIONS BETWEEN GOVERNMENT AIDS EDUCATION POLICY AND YOUNG WOMEN'S SEXUALITY, JANET HOLLAND, CAROLINE RAMAZONOGLU, SUE SCOTT, GENDER AND EDUCATION, 1990, VOL 2(2), P125-143.

Much of the early panic relating to AIDS has focused on non-heterosexual sexualities and the identification of high risk groups. It can be argued that fear of the spread of HIV and AIDS into the heterosexual population was the spur for the development of government policy in this area. The protection of the population in general depends on changes in high risk sexual practices, and the part played in these changes by young women has been given scant attention. We argue here that the sexual knowledge and practice of young women are crucial factors in the spread of HIV and AIDS, and that information on these factors is limited and interpreted within a framework of patriarchal ideology which obscures the power relations embedded in sexual relations. These issues are discussed using data from an investigation of young women's sexual beliefs and behaviour (the Women Risk and AIDS Project - WRAP) in relation to government AIDS education campaigns.

A RHETORICAL PERSPECTIVE FOR HIV EDUCATION WITH BLACK URBAN ADOLESCENTS, SHERYL PERLMUTTER BOWEN, PAULA MICHAL-JOHNSON, COMMUNICAITON RESEARCH, 1990, VOL 17(6), P848-866.

This essay encourages communication researchers to understand better the rhetorical situation that challenges acquired immune deficiency syndrome (AIDS) educators working with out-of-school, African American adolescents in urban centers. Using Bitzer's (1968) schema and research from public health and allied fields, the authors identify those culturally based experiences and attitudes that rhetors (health educators) must integrate into lines of argument and appeals for AIDS prevention campaigns for this particular pool of perceivers. They illustrate the factors that impinge on channel selection, credibility and effectiveness of the rhetor, and message construction.

SEXUALLY TRANSMITTED DISEASES IN LESBIANS, ANNE EDWARDS, R. NICOL THIN, INTERNATIONAL JOURNAL OF STD & AIDS, 1990, VOL 1(3), P178-181.

The limited published data support the assumption that lesbians are a low risk group fo sexually transmitted diseases (STDs). However there are vitually no contemporary data and the older papers do not take into account genital wart virus infection, now the third most prevalent STD in Britain. One of the dangers in assuming that lesbians are a 'safe group' for STD and allied disorders is that patients may not attend for regular cervical cytology and could be at risk of developing cervical cancer.

In an unselected series of 27 lesbians attending a genitourinary medicine clinic, the most important findings were a relatively high prevalence of the viral STDs, herpes simplex and human papilomavirus. Additionally, 10 patients had abnormal cytology ranging from inflammation to dyskaryosis.

There is a need for more information about the true prevalence of STDs in this group and evaluation of the risk factors for female-to-female transmission of infections. Lesbians should continue to have regular cervical smears, especialy as many have had earlier heterosexual intercourse.

EPIDEMIOLOGY OR REPORTED CASES OF AIDS IN LESBIANS, UNITED STATES, 1980-1989, SUSAN Y. CHU, JAMES W. BUEHLER, PATRICIA L. FLEMING, RUTH L. BERKELMAN, AMERICAL JOURNAL OF PUBLIC HEALTH, 1990, VOL 80(11), P1380-1381.

EPIDEMIOLOGY OF REPORTED CASES OF AIDS IN LESBIANS, UNITED STATES 1980-1989, SUSAN Y. CHU, JAMES W. BUEHLER, PATRICIA L. FLEMING, RUTH L. BERKELMAN, AMERICAN JOURNAL OF PUBLICH HEALTH, VOL 80(11) NOVEMBER 1990, P1380-1381.

LESBIAN EXCLUSION FROM HIV/AIDS EDUCATION, TEN YEARS OF LOW-RISK IDENTITY AND HIGH-RISK BEHAVIOR, REBECCA COLE, SALLY COOPER, SIECUS REPORT, DECEMBER 1990/JANUARY 1991, P18-23.

CAN ATTITUDES OF COLLEGE STUDENTS TOWARDS AIDS AND HOMOSEXUALITY BE CHANGED IN SIX-WEEKS?: THE EFFECTS OF A GAY PANEL, CHWEE LYE CHNG, ALAN MOORE, HEALTH VALUES, 1991, VOL 15(2), P41-49.

This study investigated the relationship between attitudes towards AIDS and homosexuality among a selected sample of college students who listened to a panel of speakers comprised of gay and lesbian individuals. There were 52 subjects, 20 males and 32 females, who completed, at three successive administrations, a questionnaire seeking demographic information and attitudes toward homosexuality using the Index of Homophobia (IHO). At the third testing, an attitudes-toward-AIDS questionnaire was also administered using the Fear of AIDS Scale (GFS). A repeated measures design suggested that homophobia scores were highly correlated over time. The Fear of AIDS scores were moderately correlated with scores on all three adminstrations of the IHP, and most correlated (r = 0.61) with test 3 homophobia scores. Male subjects were found to be more homophobic than females. T-tests of the differences between white and black subsamples reveal that black subjects were significantly more homophobic than whites at test 2, but at no other time.

AIDS AND HOMOPHOBIA AMONG NURSES, YVONNE K. SCHERER, YOW-WU B. WU, BRENDA P. HAUGHEY, JOURNAL OF HOMOSEXUALITY, VOL 21(4), 1991, P17-27.

The purpose of this research was to study nurses' attitudes toward homosexuality and caring for homosexual patients. The results reported in this article are a component of a larger study of nurses' knowledge about the attitudes toward caring for patients with AIDS. The sample comprised 581 Registered Nurses residing in Erie County, New York. Data were gathered by mailed questionnaires.

Results of the study indicate that issues concerning the care of patients with AIDS may be complicated by the fact that many of these individuals are homosexuals. The results of this research provide data for developing intervention strategies to help nurses cope with their concerns about caring for homosexual patients with AIDS.

UPDATE: EPIDEMIOLOGY OF REPORTED CASES OF AIDS IN WOMEN WHO REPORT SEX ONLY WITH OTHER WOMEN, UNITED STATES, 1980-1991, S.Y.CHU, T.A. HAMMETT, J.W. BUEHLER, AIDS, 1992, VOL 6(5), P518-519.

WOMEN USUALLY TAKE CARE OF THEIR GIRLFRIENDS: BISEXUALITY AND HIV RISK AMONG FEMALE INTRAVENOUS DRUG USERS, STEPHEN MAGURA, JOANNE O'DAY, ANDREW ROSENBLUM, THE JOURNAL OF DRUG ISSUES, 1992, VOL 22(1), P179-190.

Thirty-eight percent of a random sample of 39 female IVDUs disclosed recent homosexual behavior. The women were interviewed in jail, but their homosexual relationships were formed and occurred primarily outside of jail. Ethnographic methods identified twice as much homosexuality as a structured research interview. The women who disclosed homosexual behavior, which reportedly had recent onset for most of them, usually did not self-label themselves as "gay" or "lesbian", perhaps "bisexuality" best characterizes their sexual histories. These bisexual women were more likely to share needles and works than the heterosexual women, placing themselves and others at higher risk of HIV transmission; their sexual partners were usually other IVDUs. No precautions were being taken to prevent possible female-to-female sexual HIV transmission. Failure to take precautions against AIDS may be attributable to unjustified feelings of "safety" in often serially monogamous homosexual relationships, as well as sheer fatalism about HIV infection.

NO EVIDENCE FOR FEMALE-TO-FEMALE HIV TRANSMISSION AMONG 960,000 FEMALE BLOOD DONORS, LYLE R. PETERSEN, LYNDA DOLL, CAROL WHITE, SUSAN CHU, AND THE HIV BLOOD DONOR STUDY GROUP, JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, 1992, VOL 5(9), P853-855.

The frequency of female-to-female HIV transmission was assessed among 960,000 female blood donors at 20 large U.S. blood centers during 1990. Of 144 HIV-seropositive women identified, 106 were interviewed. None of the interviewed women reported sex exclusively with women since 1978. Three seropositive women reported sex contact with women as well as with either bisexual men or men who had used i.v. drugs. In this large population, we identified no woman who was infected with HIV from sexual contact with another woman.

LESBIANS EVOLVING HEALTH CARE: CANCER AND AIDS, JACKIE WINNOW, FEMINIST REVIEW, 1992, SUMMER, NO 41, P68-76.

FIERCE LOVE AND FIERCE RESPONSE: INTERVENING IN THE CULTURAL POLITICS OF RACE, SEXUALITY, AND AIDS, D. ROMAN, JOURNAL OF HOMOSEXUALITY, SPECIAL ISSUE: CRITICAL ESSAYS: GAY AND LESBIAN WRITERS OF COLOR, 1993, VOL 26(2/3) P.195-219.

In their performances of Fierce Love, the Pomo Afro Homos (Postmodern African American Homosexuals) enact some of the experiences of black gay men. Through performance, the trio intervenes in the prevailing mythologies around black and gay identities, but especially black gay identities, in the age of AIDS. This essay begins by examining two dominant productions in recent U.S. culture that display and proliferate anxieties about black gay bodies: John Guare's play Six Degrees of Separation and Magic Johnson's unsettling HIV disclosure. The Pomo Afro Homos address the phenomenon of containing black gay sexuality by insisting that the theatre and its inherent role in offering representations be seen as a viable site for contestation for black gay men.

LESBIANS AND HIV: CLINICAL, RESEARCH, AND POLICY ISSUES, PATRICIA E. STEVENS, AMERICAN JOURNAL OF ORTHOPSYCHIATRY, APRIL 1993, VOL 63(2), P289-294.

Sources of risk for HIV infection in members of the lesbian community are surveyed, together with factors that adversely affect access to appropraite health care by women in general and lesbians in particular. Issues of clinical practice, research, and public policy are examined with a view to promoting more effective prevention and treatment strategies.

THE RELATIONSHIP BETWEEN AIDS-RELATED INFORMATION SOURCES AND HOMOOPHOBIC ATTITUDES: A COMPARISON OF TWO MODELS, B. MAGRUDER, L.B. WHITBECK, M. ISHII-KUNTZ, JOURNAL OF HOMOSEXUALITY, 1993, VOL 25(4), P47-68.

Using a sample of 914 college students from the Midwest and West Coast, this research compared two possible relationships between information sources about AIDS and homophobic attitudes. The first model examined the effects of various information sources on students' accuracy of knowledge regarding AIDS transmission, subsequent beliefs that homosexuals are responsible for AIDS, and overall homophobia. The second model tested the alternative hypothesis that pre-existing homophobic attitudes affected the selection of information sources. This assortive process, in turn, was hypothesized to affect accuracy of knowledge about AIDS and beliefs that homosexuals are responsible for AIDS. The findings indicated the models had similar explanatory power, suggesting that information sources have diverse impacts on students' knowledge about AIDS and that homophobic attitudes affect selection of informtion sources. The authors conclude that while certain information sources about AIDS tend to increase homophobic attitudes, homophobic individuals are also more likely to select these information sources.

THE RELATIONSHIP BETWEEN HOMOPHOBIA AND SELF-ESTEEM IN GAY MALES WITH AIDS, G. LIMA, C.T. LO PRESTO, M.F. SHERMAN, S.A. SOBELMAN, JOURNAL OF HOMOSEXUALITY, 1993, VOL 25(4), P69-76.

Fifty-seven participants from various mental health centers and volunteers responding to an ad in a gay newspaper completed questionnaires designed to assess homophobia and self-esteem. Results indicated a significant relationship between homophobia and self-esteem. Moreover, it was found that gay males with AIDS displayed higher levels of homophobia and lower levels of self-esteem than healthy gay males. Results were interpreted employing attribution theory and self-theory.

MALE COUNSELORS' DISCOMFORT WITH GAY AND HIV-INFECTED CLIENTS, J.A. HAYES & C.J. GELSO, JOURNAL OF COUNSELING PSYCHOLOGY, 1993, VOL 40(1), P86-93.

This study examined male counselors' reactions to gay and human immunodeficiency virus (HIV)-infected clients in light of counselors' homophobia and death anxiety. After completing measures of homophobia and death anxiety, 34 male counselors viewed a videotaped, male client-actor in 1 of 4 conditions: either gay or heterosexual and either HIV negative or HIV positive. The dependent variable, counselor discomfort, was assessed through (a) the ratio of avoidance to approach verbal responses to the taped client, (b) self-reported state anxiety, and (c) recall of certain words used by the client. As hypothesized, counselors experienced greater discomfort with HIV-infected than HIV-negative clients, and counselors' homophobia predicted their discomfort with gay male clients. However, client sexual orientation did not afffect counselor discomfort, and death anxiety was unrelated to discomfort with HIV-infected clients. Implications regarding countertransference and counseling were discussed.

BARRIERS TO HUMAN IMMUNODEFICIENCY VIRUS RELATED RISK REDUCTION AMONG MALE STREET PROSTITUTES, PATRICIA M. SIMON, EDWARD V. MORSE, PAUL M. BALSON, HOWARD J. OSOFSKY, H. RICHARD GAUMER, HEALTH EDUCATION QUARTERLY, 1993, VOL 20(2), P261-273.

Two hundred eleven male street prostitutes between the ages of 18 and 51 years were interviewed and tested for antibodies to the human immunodeficiency virus (HIV). Economic, social, and emotional barriers to the reduction of HIV-related risk behavior were examined within the context of several concepts present in the Health Belief Model (HBM). Three lifestyle factors were found to function as barriers to engaging in risk reduction behaviour. Subjects who were more economically dependent on prostitution, perceived less control over the hustling encounter, and reported increased pleasure from sexual activitiy with their customers were more likely to engage in risk-taking behavior. Prostitutes' perception of the severity of HIV infection was not significantly associated with their risk behavior. Unexpected findings indicated that increases in perceived susceptibility to HIV and perceived benefit of condom use for HIV prevention were significantly related to increased risk-taking behavior. Practical applications of findings in the design and implementation of future HIV-related preventive health education programs are discussed.

RISKS OF HUMAN IMMUNODEFICIENCY VIRUS INFECTION AMONG ADOLESCENTS ATTENDING THREE DIVERSE CLINICS, ANNA-BARBARA MOSCICKI, SUSAN G. MILLSTEIN, JEANETTE BROERING, CHARLES E. IRWIN, JOURNAL OF PEDIATRICS, 1993, VOL 122(5 PART1), P813-820.

This study was performed to identify specific high-risk behaviors, such as unprotected oral, anal, and vaginal intercourse and substance abuse, associated with human immunodeficiency virus infection among adolescents attending three diverse clinics located in a localized geographic area: a university-based clinic, a Planned Parenthood clinic, and an inner-city public health clinic (PHC). Six hundred seventy-one female and 207 male adolescents attending one of the three clinics completed a structured questionnaire. Similarities among patients at the clinic sites inclued high rates of anal intercourse (21%), unprotected vaginal sex (95%), oral sex(73%), and poor communication skills (42%). Some differences appeared as well, including higher rates of homosexual experiences, no birth control use, and having multiple partners among adolescents attending the PHC (p <0.001). In contrast, adolescents attending either the university-based clinic or the Planned Parenthood Clinic had higher rates of substance abuse around sexual activity than those who attended the PHC (p <0.001). We conclude that adolescents attending general medical clinics in the San Francisco Bay area engage in high-risk behaviors that place them at risk for transmission of human immunodeficiency virus even though many have had previous education about acquired immunodeficiency syndrome and sexually transmitted disease. Specific risk factors include unprotected receptive anal intercourse, unprotected vaginal intercourse with new and unknown partners, experience in homosexual behavior, high rates of oral sex, multiple partners, poor communication skills, and frequent use of illicit substances in conjunction with sex. The differences found among sites indicate the need for health careproviders and prevention programs to provide emphasis on practices specific to the adolescents in their service area.

HIV RISK ACTIVITY AMONG PERSONS WITH SEVERE MENTAL ILLNESS: PRELIMINARY FINDINGS, FRANCINE COURNOS, KAREN MCKINNON, HEINO MEYER-BAHLBURG, JEANINE R. GUIDO, ILAN MEYER, HOSPITCAL AND COMMUNITY PSYCHIATRY, 1993, VOL 44(11) P1104-1107.

AN ESSAY: AIDS AND THE SOCIAL BODY, N. SCHEPER-HUGHES, SOCIAL SCIENCE AND MEDICINE, 1994, VOL 39(7), P991-1003.

THE SEXUAL EXPERIENCES OF MEN WITH LEARNING DISABILITIES HAVING SEX WITH MEN - ISSUES FOR HIV PREVENTION, DAVID THOMPSON, SEXUALITY AND DISABILITY, 1994, VOL 12(3), P221-242.

Only recently have both outreach work and police operations found men with learning difficulties having sex in public toilets. This paper will descibe the men's experience and understandings of such encounters based on discussions with nineteen men with learning difficulties receiving a specialist sex education service. The work demonstrates how commonly men with learning difficulties engage in sexual acts which are emotionally and physically painful. A major aim of the work with the men was to enable them to negotiate safer sex. However, even after intense work, confidence for the men to avoid unsafe sex remains limited because of their passivity. Service providers are encouraged to be more sensitive to issues of power for sex between men and to examine the extent of their responsibilities in protecting men with learning difficulties from HIV infection.

HIV PREVENTION EDUCATION FOR LESBIASN AND BISEXUAL WOMEN: A CULTURAL ANALYSIS OF A COMMUNITY INTERVENTION, PATRICIA E. STEVENS, SOC.SCI.MED., 1994, VOL 39(11) P1565-1578.

AIDS is increasing almost four times as fast among women, yet lesbians and bisexual women are among the least studied, least understood and most elusive populations affected by the AIDS epidemic. This paper reports the results of community-level HIV prevention research designed: (a) to examine the knowledge, perceptions, social contingencies and political constraints affecting the HIV risk taking of lesbians and bisexual women; and (b) to offer them context specific HIV prevention education. The study was a peer educator-based intervention project situated in San Francisco's women's bars, dance clubs, and sex clubs to reach socially and sexually active lesbians and bisexual women in natural settings. Between June 1992 and May 1993, ethnographic interviews were conducted with 626 women attending the bars and clubs; group presentations at the locales reached 1315 women. The structure of the intervention was effective in prompting interest in HIV prevention information and intent to change behavior. The resultant cultural analysis details risk behaviors lesbians and bisexual women participate in, myriad constraints they face in trying to enact safer behaviors, gaps in knowledge, difficulties comprehending the relevenac of HIV prevention, and risk reduction strtegies commonly employed.

THE CHALLENGE OF HIV PREVENTION AMONG HIGH-RISK ADOLESCENTS, T. RICHARD SULLIVAN, HEALTH & SOCIAL WORK, 1996, VOL 21(1), P58-65.

This article reports findings from an exploratory study of HIV knowledge and risk behaviors among 60 teenagers and young men engaged in the street life of Hollywood, California. The sample was composed largely of youths of homosexual or bisexual orientation who were substance abusers, prostitutes, or both. The data suggest that although community-based education efforts may be associated with lower-risk behavior among this population, the overall risk profiles of these socially marginalized youths remained high. Inferences are drawn about the cofactors of risk that must be addressed and the education needed to enhance the health prospoects of these youths.

UNPUBLISHED PAPERS

LESBIANS AND AIDS, DIANE RICHARDSON, PAPER GIVEN AT CONFERENCE 'HOMOSEXUALITY, WHICH HOMOSEXUALITY?' CONFERENCE IN AMSTERDAM, 1987.

EXTRACT FROM INTRODUCTION: What does AIDS have to do with lesbians? This is a question which you could be forgiven for asking. After all, very few lesbians are known to have got AIDS and, generally speaking, lesbians are considered to be at low-risk for AIDS and other sexually transmitted diseases.

Nevertheless, AIDS does affect lesbians, both personally and politically, in a number of ways. As health care workers and as workers in AIDS projects, lesbians are involved in the care of people with AIDS. Similarly, many lesbians have been affected by AIDS-related deaths or illnesses of gay men they know. Others, who are ill-informed, may be anxious about going to mixed gay clubs or bars because they are afraid they might get AIDS. Lesbians are also affected by the increased homophobia which the disease or, more accurately, its portrayal in the mass media has led to. The association of the fear of AIDS with the fear of homosexuality may affect the rights of lesbians, as well as gay men, in areas of housing, employment, insurance coverage, etc. In particular they may experience greater violence towards them because of AIDS. Also of concern to lesbians are the problems that AIDS raises for those considering donor insemination. Finally, lesbians are involved because, like other women, they too can get AIDS.

BOOKS

Chapter on AIDS and stds, ALIVE AND WELL, A LESBIAN HEALTH GUIDE, CUCA HEPBURN WITH BONNIE GUTIERREX, THE CROSSING PRESS, 1988.

WOMEN AND HIV/AIDS, A BIBLIOGRAPHY, ROSIE ILETT, GLASGOW WOMEN'S LIBRARY, 1993, 109 TRONGATE, GLASGOW, GL5HD, 041.552.8345.

LESBIANS & AIDS PAMPHLETS

* HIV & AIDS, INFORMATION FOR LESBIANS, TERRENCE HIGGINS TRUST.

* LESBIANS HIV & SAFER SEX - LOW RISK ISN'T NO RISK, LESBIAN & GAY SWITCHBOARD.

* LESBIANS AND AIDS, WHAT'S THE CONNECTION? SAN FRANCISCO AIDS FOUNDATION, JULY 1986.

* LESBIANS AND AIDS, HEALTHY OXFORD 2000.

* EVERYTHING YOU EVER WANTED TO KNOW ABOUT LESBIANS AND HIV BUT WERE AFRAID TO ASK, SALI WALKER, LONDON LESBIAN & GAY SWITCHBOARD.

* LESBIANS, HIV & AIDS, LESBIANS & SAFER SEX...ARE YOU SERIOUS? SHEFFIELD AIDS EDUCATION PROJECT.

BITS AND PIECES

Gynaecological and reproductive health - extract from Nancy Shaw, Research into Lesbian Health Issues, Paper given at the conference 'Homosexuality, Which Homosexuality?' Amsterdam, 1987.

The Lancet, July 4, 1987.

Lesbians and Aids, Spare Rib, March 1987.

We Shoot Drugs and We are Your Sisters, Risa Denenberb, Outlook, Summer, 1991, p30-36.

How do I get it? off our backs, Sep, 1991,p72-78.

Does Lesbian Sex Transmit AIDS? Beth Elliott, off our backs, Nov 1991, and various responses in subsequent issues.

Lesbians HIV and AIDS Conference, Manchester Town Hall, April 1991, Report

Is HIV a lesbian issue? Lisa Power, Pink Paper, 30.8.92.

Setting the Record Straight, Lesbian London, November 1992, Da Choong - Women's Development Officer, Robin Gorna - Health Education Section Manager

CROSS REFERENCES

ALCOHOL

THE IMPACT OF AIDS ON A GAY COMMUNITY: CHANGES IN SEXUAL BEHAVIOR, SUBSTANC USE, AND MENTAL HEALTH, JOHN L. MARTIN, LAURA DEAN, MARC GARCIA AND WILLIAM HALL, AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY, 1989, VOL 17(3), P269-293.

This report describes progress made to date on a study of the impact of the AIDS epidemic on the gay community of New York City. Using a model of the life stress process described by Barbara Dohrenwend and her colleagues, the AIDS epidemic was conceptualized as a community stressor resulting in two key stress-inducing events: death of loved ones due to AIDS and potential illness and death of oneself due to infection with human immunodeficiency virus (HIV). It was hypothesized that these stressors would be significantly related to three domains of health outcomes: sexual behavior, drug and alcohol use, and psychological distress. Descriptive trends over time are provided for both the health outcome variables and the stressor variables. Cross-sectional analyses for 3 years of data provide evidence in support of the main hypothesis. The implications of these findings are discussed from the standpoints of methodology, public health, and the psychology of stress processes in community settings.

SEXUAL RISK FOR HIV TRANSMISSION AMONG GAY/BISEXUAL MEN IN SUBSTANCE-ABUSE TREATMENT, JAY P. PAUL, RON STALL, FRANK DAVBIS, AIDS EDUCATION AND PREVENTION, 1993, VOL 5(1), P11-24.

A sample of San Francisco gay/bisexual men in substance-abuse treatment (N = 314) was compared to the San Francisco Men's Health Study (SFMHS) cohort to compare levels of sexual behaviors that are high-risk for HIV transmission. Quantitative data were supplemented by analyusis of transcripts of focus group discussions with gay men in treatment at the same agency. Sexual risk for HIV infection was significantly higher for gay/biseuxal men in substance-abuse treatment than among the community-based (SFMHS) sample of gay/bisexual men. Among those entering outpatient alcohol/drug treatment, 21% reported unprotected insertive anal sex, 23% reported unprotected receptive anal sex, and 32% reported unprotected insertive and/or receptive anal sex during the previous 6 months. Substance abusers in focus groups identified a number of factors that made it difficult to reduce their sexual risk behavior, including the perceived disinhibiting effects of alcohol and other drugs, learned pattterns of association between substance use and sex (especially methamphetamine use and anal sex), low self-esteem, lack of assertiveness and negotiating skills, and perceived powerlessness.

CORRELATES OF SEXUAL RISK-TAKING AMONG GAY MALE SUBSTANCE ABUSERS, JAY P. PAUL, RON D. STALL, G. MICHAEL CROSBY, DONALD C. BARRETT, LORAINE T. MIDANIK, ADDICTION, 1994, VOL 89, P971-983.

This paper examines sexual risk-taking within a sample of sexually active gay and bisexual men entering substance abuse treatment (n = 383), and identifies correlates of unprotected anal sex within this group. Sexual risk-taking was high, with 55% of these men engaging in anal intercourse without a condom within a 90-day period. Correlates of unprotected anal sex varied somewhat when looking at unprotected anal sex with a primary partner only and with non-primary partners; substance use variables (number of drugs used, use of inhalant nitrites or stimulant drugs with sex, length of time since use of alcohol/drugs, loss of control problems associated with alcohol/drug use) appear to play more of a role in unprotected anal sex with non-primary partners. Overall, logistic regression analyses indicated that sexual risk was greater for those who were more sexually active, enjoyed unprotected anal sex with withdrawal prior to ejaculation, did not approve of sex outside of a love relationship, and identified themselves as more risky. In addition, those who reported more social problems due to substance use had fewer expectations that substance use increased risk, had been HIV-tested, and used reappraisal/problem-solving coping strategies showed greater risk with a primary partner only. Sexual risk with non-primary partners was greater for those who used more drugs, reported more difficulty avoiding high-risk sex when aroused and were HIV+. The paper discusses the implications of these findings for the design of sexual risk-reduction interventions.

HIGH RISK SEXUAL BEHAVIOR AND ALCOHOL CONSUMPTION AMONG BAR-GOING GAY MEN, MELISSA J. PERRY, LAURA J. SOLOMON, RICHARD A. WINETT, JEFFREY A. KELLY, ROGER A. ROFFMAN, LAURIE L. DESIDERATO, SETH C. KALICHMAN, KATHLEEN J. KIKKEMA, ANN D. NORMAN, BRIAN SHORT, L. YVONNE STEVENSON, AIDS 1994, VOL 8, P1321-1324.

Objectives: To determine whether alcohol use prior to sexual behavior influenced the occurrence of unprotected anal intercourse among bar-going gay men.

Methods: Anonymous AIDS behavioral risk surveys were administered to men entering gay bars in 16 cities on three nights in February 1993 in six states in the United States.

Results: Of the 1519 men who completed the survey, 85% were current alcohol drinkers. Men who had unprotected anal intercourse after consuming alcohol drank more and reported more incidents of unprotected anal intercourse than men who had unprotected anal intercourse but not after drinking. Overall, unprotected anal intercourse occurred less frequently after alcohol consumption than without prior consumption.

Conclusions: This study found that heavy alcohol use and frequent high-risk sexual behavior occurred among the same individuals. However, we found no evidence for a causal link between alcohol use and unprotected sexual behavior in this sample of bar-going gay men.

LEVELS OF HIV TESTING AND LOW VALIDITY OF SELF-REPORTED TEST RESULTS AMONG ALCOHOLICS AND DRUG USERS, CHRISTINA P. LINDAN, ANDREW L. AVINS, WILLIAM J. WOODS, ESTHER S. HUDES, WAYNE CLARK, STEPHEN B. HULLEY, AIDS, 1994, VOL 8(11), P1149-1155.

Objectives: To evaluate HIV testing behavior, validity of self-reported serostatus, and intention to test among alcoholics and drug users entering treatment.

Design: Longitudinal cohort study.

Methods: A total of 952 clients voluntarily entering three outpatient and two inpatient public alcohol treatment centers in San Francisco were enrolled. Seventy-six per cent were men, 50% black, 81% had used both alcohol and drugs during the last year, 43% had injected drugs and 9% of the men were homosexual. Subjects completed an interviewer-administered questionnaire and blindly-linked HIV-antibody test at entry and after 1 year (81% follow-up).

Results: Fifty-seven per cent of subjects reported that they had previously sought HIV testing. Factors associated with HIV testing included homosexual contact, injecting drug use, having a partner who had been tested, and using condoms. Hispanics were the least likely of all ethnic groups to report testing. Of 60 subjects with HIV antibodies, 47 (78%) said they had already been tested; however, 19 (40%) inaccurately reported that their serostatus was negative and another four (9%) had not collected their test results. Blacks were much more likely than other groups to misreport or be unaware of their HIV status. Only half of the 68% who said they planned to be tested during the following year did so. Five (42%) out of 12 HIV-positive individuals who were unaware of, or misreported their serostatus at baseline, and who sought another HIV test during the follow-up year continued to report themselves as uninfected.

Conclusions: A large proportion of clients attending public alcohol treatment centers report having been HIV tested, much greater than that observed in other populations. However, misreporting of HIV test results was very common among seropositive subjects. Alcohol and drug treatment programs for this high-risk population should include interventions to optimize use of HIV testing for prevention and treatment, and improve understanding of test results.

ADDICTION AND RECOVER IN GAY AND ESBIAN PERSONS, ROBERT J. KUS, 1995, ALSO PUBLISHED AS JOURNAL OF GAY AND LESBIAN SOCIAL SERVICES, 1995, VOL 2(1), JAMES J. KELLY & RAYMOND M. BERGER, EDITORS. INCLUDES:

CHEMICAL DEPENDENCE AND HIV INFECTION, MELVIN I. POHL, P15-28.

In the United States, AIDS has affected gay men more than any social group. There are special relationships between drug dependence and HIV infections/AIDS. Any discussion of the special needs of chemically dependent gay and lesbian persons must include the special problems clinicians need to be aware of when caring for the HIV-positive patient. This article explores HIV disease including its causes, development, transmission, treatments, and effects.

LESBIAN ALCOHOL AND MARIJUANA USE: CORRELATES OF HIV RISK BEHAVIORS AND ABUSIVE RELATIONSHIPS, SUSANNA M. PERRY, JOURNAL OF PSYCHOACTIVE DRUGS, 1995, VOL 27(4) P413-419.

One hundred fifty-two self-identified lesbian and bisexual women participated in an exploratory study of lesbian health and high-risk sexual behaviors. These women were primarily White, middle class, and college educated. The relationship of alcohol and marijuana use to high-risk sexual behaviors and involvement in past or current abusive experiences was investigated. Having been involved in coercive sexual activities was related to some high-risk sexual activities and alcohol and marijuana use. The women in this sample were engaging in high-risk sexual activities, perhaps because of a lack of HIV-risk perception among lesbians in general, and in this sample in particular. These results demonstate the need for HIV and safer-sex education even among highly educated women and awareness of the interrelationship between drug use and unsafe sexual activities.

ALCOHOL AND DRUG USE IN HETEROSEXUAL AND HOMOSEXUAL PROSTITUTION, AND ITS RELATION TO PROTECTION BEHAVIOUR, R. DE GRAAF, I. VANWESENBEECK, G. VAN ZESSEN, C.J. STRAVER, J.H. VISSER, AIDS CARE, 1995, VOL 7(1), P35-47.

To assess the prevalence and effects of alcohol and drug use in heterosexual and homosexual commercial contacts, and the relationship between their use and unsafe sexual behaviour, 127 female prostitutes, 27 male prostitutes, 91 clients of female prostitutes and 24 clients of male prostitutes were interviewed face-to-face with the help of a semi-structured questionnaire. The respondents were living or working in different parts of The Netherlands. Alcohol and drug use was found to be relatively common among prostitutes. This was also so for the use of alcohol by clients, though to a lesser extent. Prostitutes' consumption varied widely according to the type of prostitution they were employed in. Those meeting their clients in clubs or bars reported the highest consumption of alcohol; hard drugs were used predominantly by street prostitutes. It appears that the main effects of alcohol and drug use are on how the individual experiences working as, or calling on, a prostitute, the social interaction between the two parties, and the sexual contact itself. The common assumption that drinking alcohol has negative effects on condom use was not borne out; though female prostitutes working under the influence of drugs were significantly more likely to report unsafe sex. The degree to which commercial partners were judged to be under the influence of alcohol or drugs was not found to bear upon the frequency of respondents' condom use. For those prostitutes who use hard drugs, this use plays an important role in their engaging in unsafe sexual activities. Prevention activities should focus especially on this group, and should take into account the role of such drug use.

ALCOHOL-RELATED RISK FACTORS ASSOCIATED WITH HIV INFECTION AMONG PATIENTS ENTERING ALCOHOLISM TREATMENT: IMPLICATIONS FOR PREVENTION, JOSEPH A. BOSCARINO, ANDREW L. AVINS, WILLIAM J. WOODS, CHRISTINA P. LINDAN, ESTHER S. HUDES, WAYNE CLARK, JOURNAL OF STUDIES ON ALCOHOL, 1995, VOL 56(6), P642-653.

Objective: Reports suggest that alcoholics may be at risk for HIV infection. In this article we examine several alcohol-related risk factors for HIV infection among patients entering alcoholism treatment in an AIDS epicenter. Our objective was to identify key factors for HIV prevention and screening among populations receiving treatment for alcohol abuse or alcohol dependence. Method: Clients (N = 921) entering five alcoholism treatment centers in the San Francisco Bay area underwent an interview and blind serotesting for HIV antibodies (76% were male, 16% men who had sex with men, 50% black, 10% Latinos and 6.5% were HIV seropositive). Logistic regression was used to predict HIV serostatus from five possible alcohol-associated risk factors, controlling for demographics and traditional HIV risk factors. These were alcohol impairment, attitudes about socializing in bars, increased sexual risk expectancies when drinking, enhanced sexual expectancies when drinking and decreased nervousness when drinking. Male and female heterosexuals and men with a history of homosexuality were analyzed separately. Results: Among male and female heterosexuals, HIV infection was positively associated with higher alcohol impairment (OR = 2.69,p = .031) and negatively associated with higher sexual risk expectancies when drinking (OR = 0.24,p = .075). Among men who had sex with men, HIV infection was positively associated with higher bar socializating orientations (OR = 10.06,p = .004). Infection was also negatively associated with higher alcohol impairment (OR = 0.26,p = 0.24) for these men. Conclusions: Since these associations were independent of demographics and traditional HIV risk factors, our research suggests it may be important to also focus HIV screening and prevention on alcohol-related risk factors in AIDS epicenters. For heterosexual alcoholics, the focus should be on those with higher alcohol dependence. For male alcoholics who had sex with men, the focus should be on those who primarily socialize in bars. Further research is needed to determine why higher sexual risk perceptions when drinking were associted with lower rates of HIV infection for both groups, since this discovery may have important prevention implications. The negative association between infection and alcohol impairment among homoseuxal men also warrants further investigation.

REMISSION OF SUBSTANCE USE DISORDERS: GAY MEN IN THE FIRST DECADE OF AIDS, ROBERT H. REMIEN, RAYMOND GOETZ, JUDITH G. RABKIN, JANET B.W. WILLIAMS, MITCHELL BRADBURY, ANKE A EHRHARDT, JACK M. GORMAN, JOURNAL OF STUDIES ON ALCOHOL, 1995, VOL 56(2), P226-232.

Objective: Participants in a 5-year prospective study of HIV-seropositive and seronegative gay men demonstrated a significant decline in the rate (from lifetime to current) of alcohol and other DSM-III-R psychoactive substance use disorders. The goal of the current study was to identify factors associated with the cessation of problematic substance use, to observe rates of relapse over 4 years, and to describe factors associated with relapse and no relapse. Method: A volunteer community sample of self-identified gay men (N = 56) were administered a semi-structured interview and several self-report measures by trained mental health clinicians, twice annually over a 5-year period. Results: Retrospective and prospective data revealed a significant decline in substance use and problems associated with use in the decade of the 1980s. This change occurred, for the most part, without formal treatment. Numberous motivating factors were associated with this change, which included a fear of AIDS, a change in attitudes in the gay community, changes in other risk-taking behaviors and concerns about self-image. A variety of informal methods were employed. Most notable was "avoiding situations associated with substance use." Conclusions: Changes in substance abuse/dependence occurred in the context of health conerncs, caring for oneself and "cleaning up one's act." Having a concern about "self-image," avoiding situations associated with drug use and not using "drug substitution" as a method of quitting were important factors for maintaining successful change.

CONDOM USE AMONG GAY/BISEXUAL MALE SUBSTANCE ABUSERS USING THE TIMELINE FOLLOW-BACK METHOD, G. MICHAEL CROSBY, RON D. STALL, JAY P. PAUL, DONALD C. BARRETT, LORRAINE T. MIDANIK, ADDICTIVE BEHAVIORS, 1996, VOL 21(2) P249-257.

Sexual risk for HIV transmission under the influence of alcohol and/or other drugs is not simply a cause-effect relationship; not everyone who drinks or uses other drugs has unprotected sex. The purpose of this study is to explore differences between substance using gay/bisexual men who use condoms during anal sex from those who do not. These differences are identified by comparing men whose anal sex while under the influence of alcohol and/or drugs is consistently protected to men whose anal sex while under the influence of alcohol/or drugs is consistently unprotected. Gay/bisexual men entering substance abuse treatment at a gay-identified agency in San Francisco were recruited to complete surveys and to be interviewed about sexual behavior, substance use, and related variables using an extended version of the Timeline Follow-back (TL). The TL procedure uses a blank calendar form and a series of questions to cue recall of drinking, drug use, and anal intercourse on each of the 30 days prior to the last date of alcohol and/or drug use. Men whose anal sex while under the influence of alcohol and/or drugs is consistently unprotected were significantly more likely to report having less than a college education (p = .04), more likely to have an income of less than $20,000 (p = .01), more likely to use amyl nitrite (p = .01) and cocaine (p = 0.2) and more likely to report a higher frequency of anal sex (p = .007). In addition, they were less likely to approve of sex without love (p = .003), less likely to perceive that safer sex is the community norm (p = .001), and less likely to have encouragement from friends to practice safer sex (p = .001). However, HIV status did not differentiate between the two groups. These two groups provide clear and interesting contrasts in terms of behavior, thus comparisons of the factors influencing sexual safety in these subgroups may enhance our understanding of risk taking. A better understanding of possible mediating variables can be important both in guiding future research in this area and in formulating intervention strategies to target gay men who drink or use drugs in combination with sexual activity.

ADOLECENTS

HOMOPHOBIA: A COFACTOR OF HIV DISEASE IN GAY AND LESBIAN YOUTH, A.H. GROSSMAN, JOURNAL ASSOC. NURSES AIDS CARE, 1994, VOL 5(1), P39-43.

Whether they 'come out' or hide their sexual orientation, most gay and lesbian youth experience the effects of prejudice and stigmatization emanating from society's homophobia. Having to cope with a disparaging and oppressive society creates unique stresses and developmental variations in identity development that are cofactors for HIV infection and disease. These cofactors include cognitive, emotional, and social isolation; feelings of alienation and despair; suicidal ideation; alcohol and other substance abuse; and furtive sexual contacts. Nurses and other providers need to be informed about these cofactors so they may provide meaningful HIV/AIDS prevention education to gay and lesbian youth.

HIV RISK IN GAY AND LESBIAN ADOLESCENTS, WILLIAM B. PEDERSON, HELPING GAY AND LESBIAN YOUTH: NEW POLICIES, NEW PROGRAMS, NEW PRACTICE, ED. T. DECRESCENZO (also published as Journal of Gay & Lesbian Social Services, 1994, Vol 1(3/4), P131-147.

Adolescents, regardless of sexual orientation, are at increased risk for HIV infection. Although the number of infected adolescents remains small, the number of adolescent AIDS cases is approximately doubling each year. This suggests that the rate of HIV infection among adolescents is expanding in a similar fashion to that seen among gay men in the early years of the epidemic. The purpose of this paper is to provide a framework for understanding the problems of HIV infection as it relates to the gay and lesbian adolescent. This framework is grounded in developmental theory, though key social, political, economic, and policy factors which are believed to contribute to the infection of HIV among gay and lesbian adolescents will also be presented. It will be argued that social practitioners who are working in the HIV and AIDS arena would do well to reexamine the paradigm which governs existing practice methodology.

ATTITUDES

STUDENTS' KNOWLEDGE OF AIDS AND THEIR ATTITUDES TOWARD GAY MEN AND LESBIAN WOMEN, INGRID GRIEGER, JOSEPH G. PONTEROTTO, JOURNAL OF COLLEGE STUDENT DEVELOPMENT, SEP 1988, VOL 29(5), P415-422.

In this the authors study assessed students' knowledge of AIDS-specific facts, their attitudes towards people with AIDS, and their general attitudes towards gay men and lesbian women.

ATTITUDES TOWARDS HOMOSEXUALITY IN AMERICAN HEALTH CARE LITERATURE 1983-1987, SANDRA L. SCHWANBERG, JOURNAL OF HOMOSEXUALITY, 1990, VOL 19(3), P117-136.

The purpose of this paper was to content analyze a purposive sample of American health care literature from 1983-1987 to ascertain what impact if any, the AIDS epidemic has had on the images of gay men and lesbian women in health sciences literature. Empirical studies, letters to the editor, policy statements and opinion papers expressing attituds towards homosexuaity and psychosocial aspects of AIDS in nursing, general medicine, and psychiatric literature were content analyzed. Findings indicate that although positive, neutral and negative images were found in the 59 articles which were examined, the largest proportion (61%) were negative. This reflects a change in the literature from previously neutral positions. Implications for patient care and further research are addressed.

AIDS, HOMOSEXUALITY PUBLIC OPINION, AND CHANGING CORRELATES OVER TIME, RICHARD SELTZER, JOURNAL OF HOMOSEXUALITY, 1993, VOL 26(1), P85-97.

Comparing data from national Los Angeles Times surveys allows for an examination of changes in attitudes toward AIDS in 1985, when the crisis was first coming to public attention, and in 1987, when public opinion had a greater opportunity to stabilize. The primary predictors of public opinion did not change from 1985 to 1987, but there were somewhat less irrational attitudes among most segments of the population by 1987. However, among those who were conservative on the issue of homosexuality, personal concern for AIDS fell and support for repression grew.

THE EFFECTS OF A GAY/LESBIAN PANEL DISCUSSION ON COLLEGE STUDENT ATTITUDES TOWARD GAY MEN, LESBIANS, AND PERSONS WITH AIDS (PWAS), SHELLY GREEN, PAUL DIXON, VALERIE GOLD-NEIL, JOURNAL OF SEX EDUCATION AND THERAPY, 1993, VOL 19(1), P47-63.

This paper presents the results of a study examining the effectiveness of a gay/lesbian panel discussion conducted within a university-level human sexuality class. The panel was intended to alter the students' attitudes regarding gays, lesbians, and persons with AIDS (PWAS). A pretest-posttest design was used to assess students attitudes toward the target groups prior to and directly following the intervention. Results indicate that females reported significantly more positive attitudes than males overall, and that the panel was effective in altering the attitudes of females, while males showed no significant change from pretest to posttest. Supplemental analyses are presented, and implications for future research are discussed.

DISCRIMINATION

ANTI-GAY VIOLENCE AND VICTIMIZATION IN THE UNITED STATES, AN OVERVIEW, KEVIN T. BERRILL, JOURNAL OF INTERPERSONAL VIOLENCE, 5(3), 1990, P274-294.

This article provides a general description of the nature and scope of violence and harassment against lesbians and gy men in the United States. It summarizes the results of local, state, and national surveys, and discusses gender and racial/ethnic differences in types and incidence of victimizations. The article examines anti-gay violence and harassment in such contexts as the home, schools, college and university campuses, and prisons and jails. There is a discussion of the perpetrators of anti-gay violence and the growing role of organized hate groups in such attacks. The article also examines time trends in anti-gay violence and the possible relationship between such violence and increasing public awareness about AIDS. It concludes with a discussion of the limitations of existing data and the need for greater attention to the issue.

EDUCATION

JOURNAL OF HOMOSEXUALITY, 1992, VOL 22(3/4) INCLUDES:

HIV EDUCATION FOR GAY, LESBIAN, AND BISEXUAL YOUTH: PERSONAL RISK, PERSONAL POWER, AND THE COMMUNITY OF CONSCIENCE, KEVIN CRANSTON, P247-259.

Adolescent gay and bisexual males face a higher risk of infection with HIV than most other young people because of their behaviors and because HIV prevention programs have failed to address their unique concerns. Ironically, current efforts to heighten public awareness about the AIDS pandemic may be nullifying the potential for gay, lesbian, and bisexual young persons at high risk to form the support networks needed to modify their behavior. The personal and group empowerment of gay, lesbian, and bisexual young peole is a necessary prerequisite to their ability to make healthy behavioral choices aorund HIV and other health issues. This paper proposes a comprehensive health education model for HIV prevention for gay, lesbian, and bisexual adolescents. Current health education efforts would be augmented by broader self and group empowerment training that would develop self-esteem, social skills, support networks, and access to risk reduction materials. An integrated system of care involving school-based programs, multi-service youth agencies and self-help groups would be in a position to deliver appropriate educational, mental health, medical, and social support services. Such a system of care presents gay, lesbian, and bisexual youth with their best chance to reduce their risk of infection with HIV and develop into emotionally healthy individuals.

CREATING A SAFER SCHOOL ENVIRONMENT FOR LESBIAN AND GAY STUDENTS, L. TREADWAY, J. YOAKAM, JOURNAL OF SCHOOL HEALTH, 1992, VOL 62(7), P352-357.

Information obtained from clinical experiences of the University of Minnesota Youth and AIDS Project (YAP), a primary AIDS prevention program for gay and bisexual males ages 14-21, is described. More than 300 YAP clients have been interviewed regarding sexual behavior, suicide attempts, drug use, and experiences in disclosing their homosexuality to peers and parents during their high school years. The authors also have drawn from their experiences as support group leaders for gay, lesbian, and bisexual youth in high school and community settings. Constructive and destructive coping strategies employed by gay, lesbian, and bisexual students are described. Roles and responsibilities of school professionals to create a safter school environment also are presented. Key issues include how school professionals support or deny the existence of homosexuality in young people; how adults' biases against homosexuality, as well as institutionalized heterosexism, prevent lesbian and gay students from succeeding in school; how language, behaviors, and environmental cues contribute to school professionals' approachability; how children of lesbian and gay parents suffer when negative attitudes toward homosexuality are not challenged; and what resources and referals can help lesbian and gay young people.

ADOLESCENT READERS' RESPONSES TO THE BOOKLET ON SEX, SINI HANNONEN, M. HEALTH CARE AND PERTTI KEKKI, JOURNAL OF ADOLESCENT HEALTH, 1995, VOL 16(4), P328-333.

Purpose: To investigate the reception and the readers' reactions to a booklet about sex, which is mailed annually to all 16-year old Finnish adolescents.

Methods: Eight hundred youngsters were randomly selected to the study. A questionnaire was sent to them six weeks after the mailing of the booklet, the Sextiin. After three rounds, a response rate of 65% (N = 521) was achieved.

Results: The booklet reached 97% of the respondents, of whom 72% read all of it. The respondents' attitudes towards and reactions to the Sextiin were mainly positive. They reacted least positively to the articles on homosexuality and masturbation. Twelve percent of the respondents indicted that they opened the condom package that was attached to the Sextiin.

Conclusions: The study shows that the campaign reached its target group well. As the adolescents' reactions to the Sextiin proved to be mainly positive, a claim for further use of the mass media for educational purposes is justified.

EMPLOYMENT

WE'RE COUNTING ON EQUALITY, MONITORING EQUAL OPPORTUNITIES IN THE WORKPLACE IN RELATION TO SEX, RACE, DISABILITY, SEXUALITY, HIV/AIDS, AND AGE, MAREE GLADWIN, CITY CENTRE, 32-35 FEATHERSTONE ST, LONDON, EC1Y 8QX.

GAY

MEDICAL PROBLEMS OF THE HOMOSEXUAL ADOLESCENT, W.F. OWEN JR,

JOURNAL OF ADOLESCENT HEALTH CARE, 1985, JULY, VOL 6(4), P278-285.

Physicians treating adolescents should take a complete sexual history, including sexual orientation and practices, to determine whether their patients are homosexually active. Lesbians are at very low risk for sexually transmitted diseases, but they do have other health concerns. Four general groups of conditions may be encountered in homosexually active men: classical sexually transmitted diseases (gonorrhea, infections with Chlamydia trachomatis, syphilis, herpes simplex infections, genital warts, pubic lice, scabies); enteric diseases (infections with Shigella species, Campylobacter jejuni, Entamoeba histolytica, Giardia lamblia, hepatitis A, hepatitis B, hepatitis non-A, non-B, and cytomegalovirus); trauma (fecal incontinence, hemorrhoids, anal fissure, foreign bodies, rectosigmoid tears, allergic proctitis, penile edema, chemical sinusitis, inhaled nitrite burns, and sexual assault of the male patient); and the AIDS. Clinicians can assist homosexual teenagers by understanding their special health needs, by counseling them about safe sexual practices, and by accepting their relationshps nonjudmentally. (author).

GAY YOUTH AND AIDS, DOUGLAS A. FELDMAN, JOURNAL OF HOMOSEXUALITY, VOL 17 (1/2) 1989.

Gay male teenagers face considerable adversity during their "coming out" process due to the AIDS epidemic. They must decide whether to be tested for HIV-1 infection, whether to postpone sexual activity, how to select a partner, and which kinds of sexual practices to engage in. Gay youth often make such decisions based upon misinformation and faulty premises. This paper reviews what is known about gay youth and AIDS, and assesses their possible risk for HIV-1 infection. It is recommended that school and community-based health education programs be developed to teach gay and bisexual youth about safe sex. Moreover, research is needed into sociocultural variations among gay youth in order to develop appropriate and effective intervention strategies for AIDS risk reduction in this diverse population.

HOMOSEXUAL RITUALS AND SAFER SEX, MICHAEL POLLAK, JOURNAL OF HOMOSEXUALITY, 1993, VOL 25(3), P307-317.

After discussing different forms of collective homosexual rituals, the article discusses the emergence of new ritualized forms of safer sex, such as Jack-Off Parties.

HOMOSEXUALS AND AIDS: A NEW APPROACH TO THE ILLNESS, CLAUDE VANDEVYER, JOURNAL OF HOMOSEXUALITY 1993, VOL 25(3), P319-327.

AIDS, historically connected with homosexuals, has provoked a number of social, psychological, and moral reactions within the homosexual community itself as well as elsewhere. Among questions raised, there are all those concerning the meaning and place of human sexuality. Between strict moral condemnation and publicity for "Safer Sex," there is room for a personal ethic, reflection, and a more responsible behavior.

THE EVOLUTION OF THE AIDS ILLNESS AND THE POLARISATION OF VALUES, LINDINALVA LAURINDO DA SILVA, JOURNAL OF HOMOSEXUALITY, 1993, VOL 25(3), P293-305.

This article is based on a study carried out in Sao Paolo, Brazil, from 1983 to 1986 among male homosexuals. It deals with the various practices and life-styles which constitute the homosexual world in Sao Paulo, and questions regarding AIDS. An analysis is made of the contrasting biographies of two patients suffering from the AIDS virus. The emphasis will be placed on the evolution of the illness and the changes in values that occur during this period. The ways in which the sexual life-style adopted prior to the illness influences the individual social course or mobility (i.e. trajectory of the inflicted person will also be illustrated.

HEALTH

FAILURE TO IDENTIFY VENEREAL DISEASE IN A LESBIAN POPULATION, P.

ROBERTSON, J. SCHACHTER, SEXUALLY TRANSMITTED DISEASES, 1981, APR-JUN, VOL 8(2), P75-76.

Venereal disease in the male homosexual population has been well studied, but little information is available about venereal disease in lesbians. A screening of 148 sexually active lesbians revealed no cases of syphilis, cervical gonorrhea, herpes simplex virus, or Chlamydia trachomatis infections. Cervical atypia, ranging from mild dysplasia to carcinoma in situ, was detected in four women (2.7%). This group of lesbians had a lognerr mean interval between routine Papanicolau smears (21 months) than did other women using the same clinic facility (8 months). Results indicate that routine screening for venereal disease may not be cost-effective in a lesbian population, but routine Papanicolau smears should be encouraged.

WORKING WITH GAY AND LESBIAN ADOLESCENTS, GARY REMAFEDI, ROBERT BLUM,

PEDIATRIC ANNALS 15:11, NOV 1986 P773-783.

Due to the epidemic of the acquired immuno-deficiency syndrome, adolescent homosexuality has become one of the most critical issues of pediatrics and adolescent health care in the 1980s. However, the

controversies surrounding the issue often discourage health professionals, educators, researchers, and the gay community alike from being involved in the care of young people struggling with the problems of sexual identity; the general lack of data regarding homosexual youths perpetuates the emotionalism of the subject. Our intent here is to provide practical information from the literature and from our own experience to pediatricians and other profesionals who are interested in working with young gays and lesbians.

NEW RESEARCH ISSUES IN LESBIAN HEALTH, NANCY SHAW, PAPER PRESENTED AT

THE "HOMOSEXUALITY, WHICH HOMOSEXUALITY" CONFERENCE HELD IN AMSTERDAM IN 1987.

THE NATIONAL LESBIAN HEALTH CARE SURVEY FINAL REPORT, JUDITH BRADFORD

AND CAITLIN RYAN, AVAILABLE FROM: NATIONAL LESBIAN & GAY HEALTH

FOUNDATION, P.O. BOX 65472, WASHINGTON D.C. 20035, USA $18 PLUS POSTAGE. EXTENDED REVIEW AVAILABLE FROM LESBIAN INFORMATION SERVICE.

IDENTITY

LESBIAN,GAY AND BISEXUAL IDENTITIES OVER THE LIFESPAN, PSYCHOLOGICAL PERSPECTIVES, ED ANTHONY R. D'AUGELLIE, CHARLOTTE J. PATTERSON, OXFORD UNIVERSITY PRESS, 1995, INCLUDES:

THE IMPACT OF THE HIV EPIDEMIC ON U.S. GAY MALE COMMUNITIES, JAY P. PAUL, ROBERT B. HAYS & THOMAS J. COATES, P347-397.

SEX

FEMINIST REVIEW, 34, SPRING 1990, INCLUDES:

MAPPING: LESBIANS, AIDS AND SEXUALITY, AN INTERVIEW WITH CINDY PATTON BY SUE O'SULLIVAN, P120-133.

SOCIAL SERVICES

LESBIAN AND GAY ISSUES: A RESOURCE MANUAL FOR SOCIAL WORKERS, H. HILDAGO, T.L. PETERSON AND N.J. WOODMAN, NATIONAL ASSOCIATION OF SOCIAL WORKERS, 1980. INCLUDES:

SEXUALLY TRANSMITTED DISEASES, PAUL A. PAROSKI, P68

PSYCHOSOCIAL ISSUES RELATED TO THE DIAGNOSIS OF AIDS, GARY G. TREESE, P73

SUICIDE

INCREASED RISK OF SUICIDE IN PERSONS WITH AIDS, PETER M. MARZUK, HELEN TIERNEY, KENNETH TARDIFF, ELLIOT M. GROSS, EDWARD B. MORGAN, MING-ANN HSU, J. JOHN MANN, JOURNAL OF AMERCIAN MEDICAL ASSOCIATION, 1988, VOL 259(9), P1333-1337.

The rate of suicide has been reported to be higher in persons with chronic and life-threatening illnesses (eg, cancer, Huntington's disease, and renal failure). We studied the rate of suicide in 1985 in New York City residents diagnosed with the acquired immunodeficiency syndrome (AIDS). There were 668 suicides in New York City residents in 1985, yielding a rate of 9.29 per 100,000 person-years. In men aged 20 to 59 years without a known diagnosis of AIDS, the rate was 18.75 per 100,000 person-years. There were 3828 individuals who lived with the diagnosis of AIDS for some part, or all, of 1985. There were 12 suicides in men aged 20 to 59 years from this group who lived 1763.25 person-years with a diagnosis of AIDS. This yields a suicide rate of 680.56 per 100,000 person-years. Thus, the relative risk of suicide in men with AIDS aged 20 to 59 years was 36.30 times (95% confidence limits, 20.45 to 64.42) that of men aged 20 to 59 years without this diagnosis, and 66.15 times (95% confidence limits, 37.38 to 117.06) that of the general population. We conclude that AIDS represents a significant risk factor for suicide.

THERAPY

THE COUNSELING PSYCHOLOGIST, 1991, VOL 19(2), INCLUDES:

AFFIRMATIVE PSYCHOTHERAY FOR GAY MEN, JOSEPH W. SHANNON, WILLIAM J. WOODS, P197-215.

This article explores unique issues that confront gay male clients. These issues include identity development and management, interpersonal issues, and special issues, such as the impact of aging, antigay violence, and acquired immune deficiency syndrome (AIDS). Diversity within the male gay community is also addressed throughout the article, and case examples are used to illustrate issues more fully. The article concludes with recommendations for treatment and research

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