Validity of the Quality of Well-Being Scale for persons with human immunodeficiency virus infection. HNRC Group. HIV Neurobehavioral Research Center.

To evaluate the validity of the Quality of Well-Being Scale (QWB) for studies of patients with human immunodeficiency virus (HIV) disease, 514 men were studied who were divided among four categories: Centers for Disease Control and Prevention (CDC) Group A (N = 272), CDC-B (N = 81), CDC-C (N = 47), and uninfected male controls (N = 114). The QWB and a variety of medical, neuropsychological, and biochemical measures were administered to all participants. When QWB scores were broken down by HIV group, the CDC-C group was significantly lower (.614) than the CDC-B (.679), CDC-A (.754), or control group (.801). The difference between Groups CDC-C and CDC-A was about .14 units of well-being, which suggests that individuals lose 1/7 equivalents of 1 well year of life for each year they are in Group CDC-C in comparison to the asymptomatic group (Group CDC-A). In comparison to the controls, this would equal a 1-year of life loss for each seven infected individuals. The QWB was shown to be significantly associated with CD4+ lymphocytes (p < .001), clinician ratings of neuropsychological impairment (p < .04), neurologists ratings of dysfunction (p < .001), and all subscales of the Profile of Mood States. Baseline QWB scores were significant prospective predictors of death over a median follow-up time of 30 months. Multivariate models demonstrated high covariation between predictors of QWB. It was concluded that the QWB is a significant correlate of biological, neuropsychological, neurological, psychiatric, and mortality outcomes for male HIV-infected patients.

Is gender dysphoria dysphoric? Elevated depression and anxiety in gender dysphoric and nondysphoric homosexual and bisexual men in an HIV sample. HNRC Group.

Few if any studies before the AIDS epidemic suggested that male homosexuals may on average have higher levels of depression than male heterosexuals. However, several samples of homosexual and bisexual men in HIV studies suggest that depression and anxiety are high in these populations, and that this psychiatric morbidity began before the AIDS epidemic. We tested the hypothesis that high childhood gender nonconformity (CGN) is associated with depression and anxiety, and so might account for differences in these variables among samples of homosexuals. A total of 254 homosexual or bisexual male subjects were assessed for depression, anxiety, and associated symptoms using various self-report and interview measures, as well as for CGN (using the Freund Feminine Gender Identity scale, FGI). For comparison purposes only, we also evaluated the subjects for the DSM-III diagnosis of Ego-Dystonic Homosexuality. Highly gender nonconforming men (high FGI scores) were more likely to have current symptoms of anxiety and depression by self-report, and to have had a lifetime history of depression by clinical interview. This association was more often due to FGI items dealing with childhood than adulthood. When the FGI was broken into subscales by a prior factor analysis, stepwise regression suggested that the subscale measuring core gender identity nonconformity (so-called "gender dysphoria") was more reliably associated with depression and anxiety than were the factors measuring nonconformity in the areas of masculine and feminine gender roles, or genitoerotic (sexual) roles. This subscale was also the only FGI measure correlating with Ego-Dystonic Homosexuality. AIDS (CDC stage and HIV serostatus) and age did not account for these findings. We conclude that the often-reported higher levels of depression, anxiety, and associated symptoms among homosexual and bisexual men in AIDS studies are more common in the subgroup of such men who are gender dysphoric. Theoretical and clinical implications of these data are discussed.

Biological research on sexual orientation: a critique of the critics.

Evolutionary biologists are tired of being accused of being too biologically deterministic, by critics who have little understanding of what biological or evolutionary theories actually imply. Misunderstandings came about because social-science disciplines often do not share evolutionary biology's tendency to build into their models multiple "normal" paths of development. Sociobiologists first explained homosexuality adaptively because they first try to explain everything adaptively. Most nonbiologists are unaware of this very strong evolutionary tradition. It is now fashionable to discount scientific objectivity, but there are many examples of where such an attack is unwarranted. Kinsey produced a nontypological theory of sexual orientation in spite of his history as a taxonomist. Sociobiologists produced a nonpathological explanation of nonreproductive homosexuality in spite of the centrality of reproductive success in their models. In judging whether a discipline is particularly likely to be misused in social debates, one must perform the appropriate intellectual "controls". One must examine appropriate uses as well as misuses, and one must examine other disciplines to see whether there are differences in the relative likelihood of abuse. Indeed, many social-science theories have been even more clearly abused than biological ones.

Definition and measurement of sexual orientation.

Measurement and definition of sexual orientations have increasingly become a central focus in both research design and public policy debates. This paper reviews major methods, and their theoretical underpinnings, for the definition and measurement of sexual orientation, highlighting their limitations and pitfalls, both practical and conceptual. The increasing politicization of this area is discussed and cautioned against. Recommendations, both general and geared toward measurement concerns with adolescent populations, are made. A specific measurement strategy, which can be utilized at a number of different levels, is detailed.

Personality and lipid level differences associated with homosexual and bisexual identity in men.

Self-identified homosexual (n = 30), bisexual (n = 29), and heterosexual (n = 31) men were compared on measures of gender-typical behavior, sex role, ego strength, and lipid levels. Homosexual men differed significantly from the heterosexual men on the gender-typical behavior and feminine sex-role measure (both in adulthood and in childhood), and several trends and significant differences were found on the biochemical measures of lipid levels (especially when 7 obese men were removed from the analyses). As a rule, the bisexual men were different from the heterosexual men on the above measures, but were indistinguishable from the homosexual men. Bisexuals differed from both of the other two groups, however, by scoring lower on the ego strength scale and by reporting themselves to be more often troubled, lonely, and depressed. We caution that the lipid analyses were made on single blood samples and require an extended replication; however, we report the data because of their possible theoretical interest and because they replicate work of 20 years ago.

Psychopathology and social functioning in men prenatally exposed to diethylstilbestrol (DES).

Previous research has suggested increased psychopathology in prenatally diethylstilbestrol (DES)-exposed persons. The current study compares the psychiatric histories and social functioning of 27 men with a history of high-dose prenatal DES exposure and their unexposed brothers. We expected DES subjects to show greater lifetime psychopathology and poorer social functioning than controls. Both groups showed high rates of lifetime depression, lifetime alcoholism, and current psychiatric symptoms in excess of community norms. The only diagnosis on which DES subjects exceeded their unexposed brothers was Major Depressive Disorder (MDD). DES-exposed men had almost twice the prevalence of at least one episode of MDD and had significantly more recurrent episodes. The relatively small number of subjects with concomitant lack of statistical power may have contributed to the difficulty obtaining significant effects.

A factor analysis of the Klein sexual orientation grid in two disparate samples.

Many researchers interested in sexual orientation can be separated into two camps: The "lumpers," who try to reduce sexual classifications to as small a number of categories as possible, and the "splitters," who try to show differences among groups and individuals that make classification schemes increasingly difficult and/or intricate. We report factor analyses of the Klein Grid (a questionnaire with 21 sexual orientation items) to see how many factors emerge in two samples of strikingly different origins. In both samples, the first factor to emerge loaded substantially on all of the Klein Grid's 21 items. This factor accounted for a majority of the variance. In both samples, a second, correlated factor emerged which indexed a separation between most of the items and those having to do with social and/or emotional preferences. In both samples, a third correlated factor also emerged, but this factor differed between the two populations: one refined the social/emotional distinction and the other distinguished ideal behavior from past and current behavior. We conclude on the basis of our analysis that both the lumpers and the splitters are correct.

Effects of recalled childhood gender nonconformity on adult genitoerotic role and AIDS exposure. HNRC Group.

The connections between childhood gender nonconformity (assessed by the Freund Feminine Gender Identity Scale, or FGI) and adult genitoerotic role (assessed by a sex history) were examined. The core sample was a group of 106 men who had sex with other men before 1980 and who are currently enrolled in two longitudinal studies of AIDS. Although other workers have cautioned against assuming a priori that childhood gender role is inherently related to adult preferences for particular sexual acts, our data suggest that there is at least a statistical association between these two concepts. In particular, the FGI (and many of its factors and items) are significantly associated with preferences for receptive anal intercourse and, less clearly, with oral-anal contact--but not with oral-genital intercourse or insertive and intercourse. Suggestions for AIDS prevention and safe-sex awareness are made on the basis of these findings. The data also suggest that in sex research involving homosexual men, the correct genitoerotic role distinction is not insertive vs. receptive behaviors, or even insertive vs. receptive and intercourse, but receptive anal intercourse vs. all other behaviors.

Incidence of AIDS dementia in a two-year follow-up of AIDS and ARC patients on an initial phase II AZT placebo-controlled study: San Diego cohort.

In a prospective study to determine the incidence of clinical dementia in patients with AIDS and ARC, 29 men and 3 women, 19 with ARC and 13 with AIDS, were examined neurologically and neuropsychologically every 6 months for 2 years during a placebo-controlled zidovudine (AZT) licensing trial. Most received two MRI brain scans. Although no patient was clinically demented at baseline, 9 (28%) developed dementia during the 2 years. Progression to dementia was associated with neuropsychological deterioration and with worsening on MRI during a preceding 6-month period, but not with baseline treatment group assignment. The results suggest that patients at CDC Stage IV who do not receive antiretroviral treatment earlier in their illness may develop clinical dementia at an annual rate of about 14%.

The periodic table model of the gender transpositions: Part II. Limerent and lusty sexual attractions and the nature of bisexuality.

I propose a theory that puts the notion of two sexual attractions into a precise, testable form, and then I mesh it with the periodic table model of the gender transpositions described previously (Pillard & Weinrich, 1987). I define a limerent sexual attraction, active in eroticizing the physical and personality characteristics of a particular Limerent Object, and a lusty sexual attraction, active in producing erotic arousal when encountering a new Lusty Object. Three hypotheses then account for much of what we know about sexual orientation: (a) Limerence and lustiness are experienced by both men and women-but there is an average difference in the ease with which each can be elicited in a particular sex. Limerence is experienced by most women in our culture as an autonomously arising desire, whereas lustiness, when it occurs, is experienced mostly as a reaction to particular stimuli. Lustiness is experienced by most men in our culture as an autonomously arising desire, whereas limerence, when it occurs, is experienced mostly in reaction to particular stimuli. (b) In some people the limerent attraction can be indifferent (or nearly so) to the sex or gender of the Limerent Object. (c) The lusty attraction is rarely indifferent to the sex or gender of the Lusty Object. Individuals may vary in their readiness to respond to the two kinds of attraction. Some of this variability can be understood in the light of the periodic table model described previously, and some of it can be understood in the light of cultural conditioning and socialization. The result is a theory that deduces many of the major facts about sexual orientation from only a small number of hypotheses.

Evidence of familial nature of male homosexuality.

We recruited 51 predominantly homosexual and 50 predominantly heterosexual men as index subjects for a family study of sexual orientation. The sexual orientation of siblings (115 sisters and 123 brothers) was ascertained in two ways: via interview with the index subjects and via interview of and/or mailed questionnaire to the siblings themselves. Index subjects' knowledge of the sexual orientation of their siblings was, for the most part, quite accurate. Moreover, heterosexual index men had about as many homosexual brothers as would be predicted given national prevalence figures for homosexuality, but homosexual index men had about four times as many homosexual brothers, although in both cases most brothers were heterosexual. There was no significant difference between the index groups in number of homosexual sisters. We conclude that there is a significant familial component to male homosexuality.

Nonreproduction, homosexuality, transsexualism, and intelligence: I. A systematic literature search.

The relationship between various forms of nonreproduction (especially homosexuality) and intelligence (as measured by IQ and other tests) is investigated by a systematic review of the literature, selecting studies without regard to the direction of their findings. Most studies found the more homosexual subject groups' scores to be higher than those of the more heterosexual controls, and all exceptions to this trend are concentrated in one subgroup: prisoners. Moreover, the more representative the sample studied, and the less subject to challenge the methodology used, the clearer and more statistically significant was the superiority in intelligence of the more homosexual over the more heterosexual group.