Factors associated with homophobia in medical students from eleven Peruvian universities. / Factores asociados a la homofobia en estudiantes de Medicina de once universidades peruanas.

BACKGROUND: The consequences of homophobia can affect the integrity, mental and physical health of homosexual individuals in society. There are few studies in Peru that have evaluated homophobia in the medical student population. OBJECTIVE: To establish the social, educational and cultural factors associated with homophobia among Peruvian medical students. METHODS: A cross-sectional analytical study was conducted in 12 medicine schools in Peru. Homophobia was defined according to a validated test, which was associated with other variables. Statistical associations were identified. RESULTS: The lowest percentages of homophobic students (15-20%) were found in the four universities in Lima, while universities in the interior of the country had the highest percentages (22-62%). Performing a multivariate analysis, we found that the frequency of homophobia was lower for the following variables: the female gender (PRa=0.74; 95% CI, 0.61-0.92; p=0.005), studying at a university in Lima (PRa=0.57; 95% CI, 0.43-0.75; p<0.001), professing the Catholic religion (PRa=0.53; 95% CI, 0.37-0.76; p<0.001), knowing a homosexual (PRa=0.73; 95% CI, 0.60-0.90; p=0.003) and having treated a homosexual patient (PRa=0.76; 95% CI, 0.59-0.98; p=0.036). In contrast, the frequency of homophobia increased in male chauvinists (PRa=1.37; 95% CI, 1.09-1.72; p=0.007), adjusted by four variables. CONCLUSIONS: Homophobia was less common in women, in those who study in the capital, those who profess Catholicism and those who know/have treated a homosexual. In contrast, male chauvinists were more homophobic.

Late Presentation and Missed Opportunities for HIV Diagnosis in Guatemala.

Early HIV diagnosis remains a challenge in many regions with delayed diagnosis resulting in increased morbidity and mortality. We conducted a retrospective cohort study of people living with HIV receiving outpatient care at a large tertiary referral center in Guatemala to describe the proportion of late presenters (LP) and missed opportunities for HIV diagnosis. Of 3686 patients, 2990 (81.1%) were LP who were more likely to be male (60.2% vs. 48.0%, p < 0.0001), heterosexual (88.0% vs. 78.0%, p < 0.0001) and rural dwellers (43.7% vs. 33.8%. p < 0.0001). The proportions of patients who presented late or with AIDS at diagnosis decreased over time. Only 665 patients (18.2%) sought care in the 2 years prior to HIV diagnosis. This study, the first of its kind in Central America to focus on late presenters and missed opportunities for HIV diagnosis, demonstrates extremely high rates of LP in Guatemala. Although in recent years rates of LP have improved somewhat, the need for screening outside of traditional healthcare settings is apparent.

Health Insurance Coverage among Puerto Rican Adults in Same-Sex Relationships.

OBJECTIVE: The primary objectives of this study were to measure and compare health insurance coverage between nonelderly Puerto Rican adults in cohabiting same-sex relationships and their counterparts in cohabiting different-sex relationships. METHODS: This study used data from the 2008-2014 Puerto Rican Community Survey on nonelderly adults (18-64 years) in cohabiting same-sex (n=274) and different-sex (n=58,128) relationships. Multinomial logistic regression models estimated differences in primary source of health insurance while controlling for key demographic and socioeconomic characteristics. RESULTS: Compared with men in different-sex relationships, men in same-sex relationships were less likely to have employer-sponsored insurance (ESI). Women in same-sex relationships were less likely than others to have ESI, insurance purchased directly from an insurer, and public health insurance after controlling for socio-demographic factors. CONCLUSIONS: Employment-based discrimination and policy barriers may have prevented same-sex couples from enjoying the full benefits associated with marriage and cohabitation in Puerto Rico, including employer-sponsored health insurance.

[Suicide in lesbian, gay, bisexual and trans populations: systematic review of a decade of research (2004-2014)]. / Suicidio en poblaciones lesbiana, gay, bisexual y trans: revisión sistemática de una década de investigación (2004-2014).

UNLABELLED: Lesbian, gay, bisexual and trans (LGBT) populations have a high prevalence of suicide behaviors. AIM: To review the literature on suicide among LGBT populations. MATERIAL AND METHODS: A systematic review of the scientific literature published between 2004 and 2014 on suicidality among LGBT people was conducted. Forty-five articles were selected for a thematic analysis. RESULTS: The research on suicide among LGBT people has increased during the last decade. The vast majority of studies have been conducted in the U.S. and other English speaking countries. At the same time, in a great part, these studies have been published in journals specializing in mental health and public health of sexual minorities. In general, they provide a significant foundation on protective and risk factors for suicide as well as their epidemiology. CONCLUSIONS: The focus of research on suicide among LGBT populations is mainly exploratory. More attention on these at-risk groups is required from the suicide research community in order to provide useful evidence for prevention and development of focalized and effective interventions.

Suicidio en poblaciones lesbiana, gay, bisexual y trans: revisión sistemática de una década de investigación (2004-2014) / Suicide in lesbian, gay, bisexual and trans populations: systematic review of a decade of research (2004-2014)

Lesbian, gay, bisexual and trans (LGBT) populations have a high prevalence of suicide behaviors. Aim: To review the literature on suicide among LGBT populations. Material and Methods: A systematic review of the scientific literature published between 2004 and 2014 on suicidality among LGBT people was conducted. Forty-five articles were selected for a thematic analysis. Results: The research on suicide among LGBT people has increased during the last decade. The vast majority of studies have been conducted in the U.S. and other English speaking countries. At the same time, in a great part, these studies have been published in journals specializing in mental health and public health of sexual minorities. In general, they provide a significant foundation on protective and risk factors for suicide as well as their epidemiology. Conclusions: The focus of research on suicide among LGBT populations is mainly exploratory. More attention on these at-risk groups is required from the suicide research community in order to provide useful evidence for prevention and development of focalized and effective interventions.

HIV Prevalence and Awareness of Positive Serostatus Among Men Who Have Sex With Men and Transgender Women in Bogotá, Colombia.

OBJECTIVES: We estimated HIV prevalence among men who have sex with men (MSM) and transgender women in Bogotá, Colombia, and explored differences between HIV-positive individuals who are aware and unaware of their serostatus. METHODS: In this cross-sectional 2011 study, we used respondent-driven sampling (RDS) to recruit 1000 MSM and transgender women, who completed a computerized questionnaire and received an HIV test. RESULTS: The RDS-adjusted prevalence was 12.1% (95% confidence interval [CI] = 8.7, 15.8), comparable to a previous RDS-derived estimate. Among HIV-positive participants, 39.7% (95% CI = 25.0, 54.8) were aware of their serostatus and 60.3% (95% CI = 45.2, 75.5) were unaware before this study. HIV-positive-unaware individuals were more likely to report inadequate insurance coverage, exchange sex (i.e., sexual intercourse in exchange for money, goods, or services), and substance use than other participants. HIV-positive-aware participants were least likely to have had condomless anal intercourse in the previous 3 months. Regardless of awareness, HIV-positive participants reported more violence and forced relocation experiences than HIV-negative participants. CONCLUSIONS: There is an urgent need to increase HIV detection among MSM and transgender women in Bogotá. HIV-positive-unaware group characteristics suggest an important role for structural, social, and individual interventions.

Con un pie en dos islas: cultural bridges that inform sexual and reproductive health in the Dominican Republic and New York.

Immigrants from the Dominican Republic have grown in number and currently make up a substantial portion of New York City's population. In order to better understand the cultural context of Dominican women's sexual and reproductive health attitudes and practices, focus groups were conducted with Dominican women living in New York City as well as with women living in the Dominican Republic. Analysis found that women in the USA had more economic independence and a greater sense of freedom in regards to sexuality than women in the Dominican Republic. However, those in New York City also hoped to maintain their cultural identity in many ways. Women associated the prevalence of gender-based violence with male unemployment and alcohol abuse. Women in both locales reported limited condom use and saw contraception as a woman's responsibility. Many barriers to using the healthcare system were identified and, in many cases, there exists a preference for herbal treatments and folk remedies. This study provided many important insights that have the potential to increase the quality of sexual and reproductive health care for Dominican women.

Encuesta LGBT: Sexualidad y derechos. Participantes de la marcha de la ciudadanía LGBT, Bogotá 2007 / LGBT Survey: Sexuality and rights. Participants of the march of LGBT citizens, Bogota 2007

Aparte de revelar aspectos poco conocidos del perfil social y político de las(os) participantes de las marchas del orgullo y, por extensión, de la población LGBT de las grandes ciudades latinoamericanas, el interés principal de esta investigación es mapear los patrones de violencia y discriminación a los que están sujetos los(as) gays, lesbianas, travestis, transexuales y bisexuales...

Sexual solicitation of Latino male day laborers by other men / Solicitación sexual de hombres jornaleros latinos por otros hombres

OBJECTIVE: To examine the likelihood of Latino day laborers being solicited for sex by other men. MATERIAL AND METHODS: 450 Latino day laborers were recruited in Los Angeles, California, from July to September 2005. Logistic regression analysis was used to determine which day laborers were more likely to be solicited and subsequently to have sex. RESULTS: Thirty-eight percent reported being solicited for sex by another man while seeking work. Those solicited were more likely to live longer in the US, be more educated and screen positive for drug dependence. Of those solicited, 9.4 percent had sex with their solicitors. Those screening positive for drug dependence were more likely to have sex. Most of the day laborers who had anal sex with their solicitors did not always use condoms. CONCLUSIONS: HIV prevention efforts should target drug dependent day laborers, who may place themselves at risk for HIV through sex with male solicitors.

OBJETIVO: Examinar hasta qué punto los jornaleros latinos son solicitados por otros hombres para tener relaciones sexuales. MATERIAL Y MÉTODOS: Cuatrocientos cincuenta jornaleros latinos fueron reclutados en Los Ángeles, California, de julio a septiembre de 2005. Un análisis de regresión logística fue utilizado para determinar cuáles jornaleros tenían más probabilidades de que fueran solicitados y, subsecuentemente, de que tuvieran sexo. RESULTADOS: Treinta y ocho por ciento reportaron que fueron solicitados para sexo por otros hombres mientras buscaban trabajo. Estos hombres que fueron solicitados tenían más probabilidades de haber vivido más tiempo en los Estados Unidos, tener más educación formal y dar resultados positivos en dependencia de drogas. De los solicitados, 9.4 por ciento tuvieron sexo con los solicitadores. Aquellos que dieron resultados positivos para dependencia de drogas tenían más probabilidades de tener sexo. La mayoría de los jornaleros que tuvieron sexo anal con los solicitadores no siempre usaron condón. CONCLUSIONES: Esfuerzos de prevención del VIH deben dirigirse a jornaleros dependientes de drogas quienes pueden estar exponiéndose al riesgo de contraer VIH al tener sexo con solicitadores masculinos.

Sexual solicitation of Latino male day laborers by other men.

OBJECTIVE: To examine the likelihood of Latino day laborers being solicited for sex by other men. MATERIAL AND METHODS: 450 Latino day laborers were recruited in Los Angeles, California, from July to September 2005. Logistic regression analysis was used to determine which day laborers were more likely to be solicited and subsequently to have sex. RESULTS: Thirty-eight percent reported being solicited for sex by another man while seeking work. Those solicited were more likely to live longer in the US, be more educated and screen positive for drug dependence. Of those solicited, 9.4% had sex with their solicitors. Those screening positive for drug dependence were more likely to have sex. Most of the day laborers who had anal sex with their solicitors did not always use condoms. CONCLUSIONS: HIV prevention efforts should target drug dependent day laborers, who may place themselves at risk for HIV through sex with male solicitors.

Do specialized services exist for LGBT individuals seeking treatment for substance misuse? A study of available treatment programs.

Substance abuse research has demonstrated that client sexual orientation influences treatment outcomes. Consequently, many substance user treatment programs offer services for lesbian, gay, bisexual, and transgender (LGBT) individuals. In a recent search of SAMHSA treatment listings, 11.8% (N=911) of substance user treatment programs (including residential, outpatient, and partial hospitalization) in the United States and Puerto Rico indicated that they offer specialized services for LGBT clients. However, a telephone survey we conducted in 2003-2004 revealed that 70.8% of these "LGBT" programs were no different from services offered to the general population, and only 7.4% could identify a service specifically tailored to the needs of LGBT clients. Implications for LGBT individuals seeking services are discussed, the study's limitations are noted, and future research directions are identified.

Safety, efficacy and pharmacokinetics of ritonavir 400mg/saquinavir 400mg twice daily plus rifampicin combined therapy in HIV patients with tuberculosis.

OBJECTIVE: To assess the drug concentrations, efficacy and safety of concomitant use of rifampicin and regimens containing ritonavir/saquinavir (400mg/400mg twice daily) in tuberculosis-HIV treatment-naive patients. DESIGN AND METHODS: This was an open-label, non-randomised, multiple-dose study. On study day (D)1, tuberculosis treatment (rifampicin 600mg/isoniazid 400mg per day fasting plus pyrazinamide 2 g/day) was introduced in 30 patients. On D31, highly active antiretroviral therapy (HAART) consisting of two nucleoside analogues plus ritonavir/saquinavir 400mg/400mg twice daily was initiated (n = 20). The pharmacokinetics were assayed with a validated reversed-phase HPLC method before the introduction of HAART on D30 (for rifampicin), after 30 days of HAART at D60 (for rifampicin plus ritonavir/saquinavir), and at the end of the study (without rifampicin) on D210 (for ritonavir/saquinavir). Clinical evaluations were performed on a monthly basis. CD4 counts and viral load were collected on D30, D60 and D180. Genotyping test for HIV was collected at baseline and at D180. Primary endpoints were drug concentration and viral load at D180 (<80 copies/mL). Secondary endpoints were presence of grade 3 and serious adverse events, clinical improvement, CD4 count and genotypic resistance to ritonavir/saquinavir. RESULTS: Ten patients dropped out of the study during tuberculosis therapy alone. Mean (+/- SD) baseline CD4 count (on D30) was 151.89 (+/- 146.77) cells/mm(3) and viral load was 5.34 (+/- 0.4) log. During the antiretroviral therapy, 15 patients dropped out, 14 because of adverse events. One patient (of five) presented a viral load of <80 copies/mL at D180. All but one patient increased CD4 counts from baseline. No genotypic resistance was detected. Clinical improvement was evident in all five patients who tolerated the therapy. Serum concentrations of ritonavir/saquinavir and rifampicin remained within the therapeutic range. CONCLUSIONS: Therapeutic concentrations of the studied drugs and reduction of viral load were achieved; adverse events are the main limitation of use of a ritonavir/saquinavir regimen in treatment-naive patients, but its clinical benefits were evident.

Conceptualization and measurement of homosexuality in sex surveys: a critical review

O artigo traz uma revisão das principais pesquisas nacionais sobre sexualidade que apresentam perguntas sobre homossexualidade, com foco nas questões conceituais e metodológicas sobre as definições de sexo, os aspectos de medição da homossexualidade, as técnicas de amostragem e de entrevistas e o formato do questionário. As taxas de declaração sobre atração pelo mesmo sexo, comportamento, parceiros e identidade também são apresentadas e comparadas. O estudo da homossexualidade em inquéritos populacionais foi moldado com base em tradições de investigação e questões provenientes desde a sexologia até a epidemiologia do HIV/AIDS. O comportamento sexual é assunto central nas pesquisas sobre sexualidade desde Kinsey. Os temas sobre atração sexual, identidade e/ou orientação sexual surgem mais recentemente. São abordadas e discutidas as diferenças no tratamento de homens e mulheres na formulação e análise das pesquisas, assim como as taxas de respostas em diferentes pesquisas, em distintos países e momentos históricos. Ressaltamos a relevância de que sejam consideradas tanto mudanças metodológicas quanto sociais para interpretar as diferenças constatadas.

Conceptualization and measurement of homosexuality in sex surveys: a critical review.

This article reviews major national population sex surveys that have asked questions about homosexuality focusing on conceptual and methodological issues, including the definitions of sex, the measured aspects of homosexuality, sampling and interviewing technique, and questionnaire design. Reported rates of major measures of same-sex attraction, behavior, partners, and sexual identity from surveys are also presented and compared. The study of homosexuality in surveys has been shaped by the research traditions and questions ranging from sexology to the epidemiology of HIV/AIDS. Sexual behavior has been a central topic at least since Kinsey. Issues of sexual attraction and/or orientation and sexual identity have emerged more recently. Differences in the treatment of men and women in the design and analysis of surveys as well as in the reported rates in different surveys, in different countries and time periods are also presented and discussed. We point out the importance of the consideration of both methodological and social change issues in assessing such differences.

The epidemiology of genital infection with herpes simplex virus types 1 and 2 in genitourinary medicine attendees in inner London.

OBJECTIVE: To characterise the epidemiological and clinical features of genital herpes and the diagnostic role of HSV-2 specific serology in an ethnically diverse cohort of genitourinary medicine (GUM) attendees in inner London. METHODS: Genital swabs (n = 186) were tested by real time polymerase chain reaction (PCR) and serum samples (n = 70) by HSV-2 specific enzyme linked immunoassay (ELISA). RESULTS: Among 186 patients (median age 29 years), 104/186 (56%) were male and 176/186 (95%) heterosexual; ethnicity was predominantly black Caribbean (76/186, 41%), white (65/186, 35%), or black-African (41/186, 22%). The most common lesion sites were penis (85/104 men, 82%) and vulva (63/82 women, 77%); 114/186 (61%) patients were diagnosed clinically with first episode disease. Women were more likely to present <5 days of onset (p = 0.008). Black Caribbean patients were more likely to present > or = 5 days (p = 0.04) and decline HIV testing (p = 0.03). By PCR, 108/186 (58%) swabs tested positive for HSV-1 (7/108, 6.5%) or HSV-2 (101/108, 93.5%). Independent predictors of a positive PCR were heterosexual group, <5 days of onset, and visible genital ulceration on examination. HSV-2 was associated with black Caribbean and black African ethnicity; HSV-1 with white ethnicity (p = 0.006). By HSV-2 specific serology, 16/42 (38%) first episodes caused by HSV-2 were recurrent infections, and 7/19 (37%) patients with recurrent genital disease but negative PCR had genital herpes. CONCLUSIONS: Epidemiological trends in genital HSV-1 and HSV-2 infection appear to vary between ethnic groups in the United Kingdom. HSV-2 specific serology improves diagnostic accuracy in GUM populations where most genital infections are caused by HSV-2.

Epidemiology of HIV among black and minority ethnic men who have sex with men in England and Wales.

OBJECTIVES: To examine the epidemiology of HIV among black and minority ethnic (BME) men who have sex with men (MSM) in England and Wales (E&W). METHODS: Ethnicity data from two national HIV/AIDS surveillance systems were reviewed (1997-2002 inclusive), providing information on new HIV diagnoses and those accessing NHS HIV treatment and care services. In addition, undiagnosed HIV prevalence among MSM attending 14 genitourinary medicine (GUM) clinics participating in the Unlinked Anonymous Prevalence Monitoring Programme and having routine syphilis serology was examined by world region of birth. RESULTS: Between 1997 and 2002, 1040 BME MSM were newly diagnosed with HIV in E&W, representing 12% of all new diagnoses reported among MSM. Of the 1040 BME MSM, 27% were black Caribbean, 12% black African, 10% black other, 8% Indian/Pakistani/Bangladeshi, and 44% other/mixed. Where reported (n = 395), 58% of BME MSM were probably infected in the United Kingdom. An estimated 7.4% (approximate 95% CI: 4.4% to 12.5%) of BME MSM aged 16-44 in E&W were living with diagnosed HIV in 2002 compared with 3.2% (approximate 95% CI: 2.6% to 3.9%) of white MSM (p<0.001). Of Caribbean born MSM attending GUM clinics between 1997 and 2002, the proportion with undiagnosed HIV infection was 15.8% (95% CI: 11.7% to 20.8%), while among MSM born in other regions it remained below 6.0%. CONCLUSIONS: Between 1997-2002, BME MSM accounted for just over one in 10 new HIV diagnoses among MSM in E & W; more than half probably acquired their infection in the United Kingdom. In 2002, the proportion of BME MSM living with diagnosed HIV in E&W was significantly higher than white MSM. Undiagnosed HIV prevalence in Caribbean born MSM was high. These data confirm the need to remain alert to the sexual health needs and evolving epidemiology of HIV among BME MSM in E&W.

[Human papillomavirus infection, a possible biological marker of sexual behavior among university students]. / La infección por el virus del papiloma humano, un posible marcador biológico de comportamiento sexual en estudiantes universitarios.

OBJECTIVE: To estimate the prevalence of Human papillomavirus (HPV) among university students and to use it as a biological marker to assess sexual behavior. MATERIAL AND METHODS: A cross-sectional study was carried out between 2000 and 2001 among 194 students at Universidad Autónoma del Estado de Morelos, Mexico. A data collection instrument was applied and genital samples were taken to detect oncogenic HPV DNA. Data were analyzed using the chi-squared test and odds ratios. RESULTS: Overall HPV prevalence was 14.4%. Women who had had two or more sexual partners during the previous year showed a greater risk of HPV infection (OR 6.0, 95% CI 1.7-21.1), as did women who had used oral contraceptives and spermicides at their latest intercourse (OR 3.0, 95% CI 1.0-8.7). Males who consumed cocaine were at a greater risk of HPV infection (OR 7.6, 95% CI 1.3-45.1). CONCLUSIONS: HPV prevalence is relatively high. HPV is a reliable biological marker of sexual behavior among females. A greater sample size may be needed to assess its reliability among men.