Parallel Processing of Steady-State Analysis for a Power Electronic System by PVM3 - Kato, T.; Minato, H. (IEEJ Transactions on Industry Applications, 1999)
It is important to get a steady-state operation of a power electronic circuit for its design. The shooting method, which is one of steady-state analysis methods, solves a boundary value condition which equates initial values to final values after one-period transient. This paper proposes how to process the analysis in parallel by using a Parallel Virtual Machine (PVM3) system. Especially the multiple shooting method(MSM) which divides the shooting time into subsections is suitable because it can parallel numerical processes for the divided shooting times by using multiple CPU units indepandently. This parallel method is applied to converter examples which are processed by PVM3. The computed results are investigated for their convergence and CPU times to check their parallel effects. According to the MSM algorithm, CPU times are reduced almost to 1/5 by using 5 computer units from a PVM3 system example. © 1999, The Institute of Electrical Engineers of Japan. All rights reserved.

Attitudes of patients before and after transplantation towards various allografts - Schlitt, H.J.; Brunkhorst, R.; Schmidt, H.H.J.; Nashan, B.; Haverich, A.; Raab, R. (Transplantation, 1999)
Background. The presence of an allogeneic graft inside the body may have psychological impact on transplant patients. It was the aim of this study to evaluate the attitude of patients before and after different types of organ transplantation towards organ allografts. Methods. A total of 1,049 patients (722 patients after and 327 patients on the waiting list for either kidney, liver, heart, or lung transplantation) under care of a single transplant center were studied using a questionnaire with blinded analysis of the data. Mental condition of the patients, their attitude towards the allograft and its donor, emotional stress caused by a graft, and correlation of the attitudes with clinical and demographic parameters were analyzed. Results. The self-reported mental condition of the patients was markedly and consistently better after organ transplantation; 27% of patients before and 60% after transplantation were in good mental condition. Sixty-two percent of transplant patients considered the graft as their own organ, 37% regarded it as a foreign organ now belonging to their body, and 1% considered it as a foreign body; among waiting list patients, 40%, 55%, and 5% assumed they would perceive their graft accordingly. The graft caused considerable emotional stress for 2% of transplant patients, whereas for 70% it did not cause any stress; the latter was assumed by 47% of patients before transplantation. Eleven percent of transplant patients frequently think about the origin of their graft, and 30% would like to have information about their donor. Knowledge about different religion, opposite sex, homosexuality, suicidal death, and age above 65 years of their donor would be of moderate or major concern for 0%, 3%, 21%, 24%, and 38% of the patients, respectively. Conclusions. The comprehensive survey shows that transplant patients incorporate their graft well into their body image. Emotional stress caused by the graft is very low and is generally less than assumed before transplantation. Knowledge about certain characteristics of the donor may cause increased concerns in some patients.

Developing quality measures for adolescent care: Validity of adolescents' self-reported receipt of preventive services - Klein, J.D.; Graff, C.A.; Santelli, J.S.; Hedberg, V.A.; Allan, M.J.; Elster, A.B. (Health Services Research, 1999)
Objective. To demonstrate the feasibility of directly surveying adolescents about the content of preventive health services they have received and to assess the validity of adolescent self-reported recall. Data Sources/Setting. Audiotaped encounters, telephone interviews, and chart reviews with 14-21 year olds being seen for preventive care visits at 15 pediatric and family medicine private practices, teaching hospital clinics, and health centers. Design. 537 adolescents presenting for well visits were approached, 400 (75 percent) consented, 374 (94 percent) were audiotaped, and 354 (89 percent) completed telephone interviews either two to four weeks or five to seven months after their visits. Audiotapes were coded for screening and counseling across 34 preventive service content areas. Intraobserver reliability (Cohen's kappa) ranged from 0.45 for talking about peers to 0.94 for discussing tobacco. The sensitivity and specificity of the adolescent self-reports were assessed using the audiotape coding as the gold standard. Results. Almost all adolescents surveyed (94 percent) remembered having had a preventive care visit, 93 percent identified the site of care, and most (84 percent) identified the clinician they had seen. There was wide variation in the prevalence of screening, based on the tape coding. Adolescent self- report was moderately or highly sensitive and specific at two weeks and six months for 24 of 34 screening and counseling items, including having discussed: weight, diet, body image, exercise, seatbelts, bike helmet use, cigarettes/smoking, smokeless tobacco, alcohol, drugs, steroids, sex, sexual orientation, birth control, condoms, HIV, STDs, school, family, future plans, emotions, suicidality, and abuse. Self-report was least accurate for blood pressure/cholesterol screening, immunizations, or for having discussed fighting, violence, weapon carrying, sleep, dental care, friends, or over- the-counter drug use. Conclusion. Adolescents' self-report of the care they have received is a valid method of determining the content of preventive health service delivery. Although recall of screening and counseling is more accurate within two to four weeks after preventive care visits, adolescents can report accurately on the care they had received five to seven months after the preventive health care visits occurred.
Keywords: Adolescents; Quality measurement; Self-report; Validity

Hope and resilience in suicide ideation and behavior of gay and bisexual men following notification of HIV infection - Siegel, K.; Meyer, I.H. (AIDS Education and Prevention, 1999)
Upon being notified that they are positive for HIV, people often experience terror and confusion. At the beginning stages of coping with HIV diagnosis, suicide ideation and behavior may arise as the infected person begins to envision frightening images of a future life with AIDS. We examined the narratives of gay men who contemplated or attempted suicide soon after they had learned of their HIV infection. We found that suicidal ideation and attempt often provoked a process of coping with HIV disease, leading to a redefinition of the meaning of HIV, enhancing one's sense of control over life, and promoting a renewed effort at self-help and help seeking, a new commitment to life, and a reappraisal of personal goals. We recommend that clinicians and HIV counselors be cognizant of these positive symbolic functions of suicidality in coping with HIV infection. Allowing people who were recently diagnosed with HIV to discuss suicidality may allow them to move toward acceptance and commitment to life.

Depression, hopelessness, suicidality, and related factors in sexual minority and heterosexual adolescents - Safren, S.A.; Heimberg, R.G. (Journal of Consulting and Clinical Psychology, 1999)
In the present study, the researchers examined factors related to depression, hopelessness, and suicidality in gay, lesbian, and bisexual adolescents, compared with demographically similar heterosexual adolescents. Sexual minority adolescents reported greater depression, hopelessness, and past and present suicidality than did heterosexual adolescents. However, when controlling for other psychosocial predictors of present distress, significant differences between the 2 samples disappeared. For past suicidality scores, the effects of sexual orientation were reduced, but still significant, when accounting for the other predictor variables. These results suggest that environmental factors associated with sexual orientation, which can be targeted and changed through prevention and intervention efforts, play a major role in predicting distress in this population.

Sexual orientation and risk of suicide attempts among a representative sample of youth - Garofalo, R.; Wolf, R.C.; Wissow, L.S.; Woods, E.R.; Goodman, E. (Archives of Pediatrics and Adolescent Medicine, 1999)
Objective: To examine whether sexual orientation is an independent risk factor for reported suicide attempts. Design: Data were from the Massachusetts 1995 Centers for Disease Control and Prevention Youth Risk Behavior Survey, which included a question on sexual orientation. Ten drug use, 5 sexual behavior, and 5 violence/victimization variables chosen a priori were assessed as possible mediating variables. Hierarchical logistic regression models determined independent predictors of suicide attempts. Selling: Public high schools in Massachusetts. Participants: Representative, population-based sample of high school students. Three thousand three hundred sixty-five (81%) of 4167 responded to both the suicide attempt and sexual orientation questions. Main Outcome Measure: Self-reported suicide attempt in the past year. Results: One hundred twenty-nine students (3.8%) selfidentified as gay, lesbian, bisexual, or not sure of their sexual orientation (GLBN). Gender, age, race/ethnicity, sexual orientation, and all 20 health-risk behaviors were associated with suicide attempt (P<.001). Gay, lesbian, bisexual, or not sure youth were 3.41 times more likely to report a suicide attempt. Based on hierarchical logistic regression, female gender (odds ratio [OR], 4.43; 95% confidence interval [CI], 3.30-5.93), GLBN orientation (OR, 2.28; 95% CI, 1.39-3.37), Hispanic ethnicity (OR, 2.21; 95% CI, 1.44-3.99), higher levels of violence/victimization (OR, 2.06; 95% CI, 1.80-2.36), and more drug use (OR, 1.31; 95% CI, 1.22-1.41) were independent predictors of suicide attempt (P<.001). Genderspecific analyses for predicting suicide attempts revealed that among males the OR for GLBN orientation increased (OR, 3.74; 95% CI, 1.92-7.28), while among females GLBN orientation was not a significant predictor of suicide. Conclusions: Gay, lesbian, bisexual, or not sure youth report a significantly increased frequency of suicide attempts. Sexual orientation has an independent association with suicide attempts for males, while for females the association of sexual orientation with suicidality may be mediated by drug use and violence/victimization behaviors.

Gay, lesbian, and bisexual youth risks for emotional, physical, and social problems: Results from a community-based survey - Lock, J.; Steiner, H. (Journal of the American Academy of Child and Adolescent Psychiatry, 1999)
Objective: Health problems of gay, lesbian, and bisexual (GLB) youth are reported as differing from those of heterosexual youth. Increased depression, suicide, substance use, homelessness, and school dropout have been reported. Most studies of GLB youth use clinical or convenience samples. The authors conducted a community school-based health survey that included an opportunity to serf-identify as GLB. Method: An anonymous self-report health care questionnaire was used during a community-based survey in 2 high schools in an upper middle class district. Results: Significantly increased health risks for self-identified GLB youth were found in mental health, sexual risk- taking, and general health risks compared with self-identified heterosexuals, but not in health domains associated with substance abuse, homelessness, or truancy. Conclusions: Self-identified GLB youth in community settings are at greater risk for mental health, sexual risk-taking, and poorer general health maintenance than their heterosexual peers.
Keywords: Adolescents; Bisexual; Community sample; Homosexual

Gay, lesbian, and bisexual youth: Understanding diversity and promoting tolerance in schools - Nichols, S.L. (Elementary School Journal, 1999)
Societal messages about normative culture permeate the lives of adolescents. Schools, as reflections of societal cultures, weave these messages throughout the informal curriculum by way of discipline, rules, and formal curricula. Many school climates foster norms, values, and belief systems that communicate rejection and intolerance to some students. In particular, gay, lesbian, and bisexual adolescents are a hidden minority in schools who are forced to negotiate homosexual identity development within typically homophobic climates. In this article I argue that schools are obligated to address the unique needs of homosexual youth because this population is at increased risk for committing suicide, physical and verbal abuse from peers, truancy, dropping out of school, and lowered self-esteem than their heterosexual counterparts. I propose that schools develop a diversity room and staff it with a diversity room specialist not only to meet the unique needs of homosexual adolescents but also to encourage a safe, accepting climate for all students.

Links between child abuse, suicide and sexual orientation - Garcia, I.; Adams, J.; Friedman, L.; East, P. (Journal of Investigative Medicine, 1999)
Pupose: Sexual orientation and identity are central issues in the development of young people. The impact which childhood abuse can have on sexuel orientation, early sexual practices, and long term emotional stability are areas of increasing interest. The purpose of this study was to address the complex relationships among these factors, specifically assessing the relationship between childhood abuse and sexual orientation, as well as the incidence of suicidal ideations and attempts amongst gay, bisexual, and heterosexual young people. Finally, the impact that childhood sexual abuse can have on same-sex experimentation in heterosexual adolescents was investigated. Methods: Anonymous questionnaires were distributed at a local university and a local junior college, along with addressed and stamped envelopes, in order to collect data from 18-30 year old college students. Chi-square analysis was used to test for differences between indivuals with differing sexual orientations with respect to suicide, abuse, and sexual histories. Results: Of the 155 returned questionnaires, 138 respondents met the age criterion and identified their sexual orientation so that they could be separated and compared in data analysis. Gay/bisexual individuals (n=31) showed a statistically significant increase in suicidal ideations (OR=2.88, p=0.01) compared to heterosexuals (n=107). Gay/bisexual individuals also showed an increase in suicide attempts (OR=2.09), physical abuse by a family member (OR=2.07), sexual abuse, either by unwanted sexual touch (OR= 1.93) or forced sexual act (OR= 1.27). Those who identified themselves as gay or bisexual were also more likely to be told they were ugly (OR=2.31), worthless (OR=1.46), and that they were not wanted (OR=1.09). However, these results did not achieve statistical significance. Finally, heterosexuals who were sexually abused were 3.33 times more likely to have a same-gender sexual experience than those who were not sexually abused, although this result did not reach statistical significance. Conclusions: The increased incidence of physical, sexual, and emotional abuse in gay and bisexual individuals is difficult to explain, but the implications are clear, especially in light of the higher incidence of suicide attempts and suicidal ideations among gays and bisexuals. It is imperative for families, friends, and health care providers to create an environment in which gay and bisexual youth can feel comfortable sharing their concerns about their sexual identity and about past abusive experiences in order to minimize the sense of isolation that many gay and bisexual youth feel as they develop towards adulthood.

Charges dropped in sex sting; protecting yourself online. - James, J.S. (AIDS treatment news, 1999)
Charges have been dropped against a reporter who was arrested in Sacramento in an online sex-sting operation. Bruce Mirken, who covers gay youth at risk, had arranged to meet a police officer posing as a 13-year-old boy during online conversations. Charges of attempted sex with a minor were dropped as no attempted touching or evidence of preparation for a sexual encounter had occurred. The arrest raises the concern that adults, looking to support gay and lesbian teens who need help, will become increasingly nervous about any relationship with gay youth, adding to the youths' isolation and increasing the likelihood of suicide. Advice is provided on computer file deletion and Internet privacy. In addition, the author provides his contact information, asking readers to submit further advice concerning online privacy.

Domestic violence and sexual abuse in women physicians: Associated medical, psychiatric and professional difficulties - Doyle, J.P.; Frank, E.; Saltzman, L.E.; McMahon, P.M.; Fielding, B.D. (Journal of Women's Health and Gender-Based Medicine, 1999)
Physicians have been called on to identify victims of domestic violence (DV) and sexual abuse (SA). Few data exist, however, on the prevalence of DV and SA in physicians themselves or on the personal or professional sequelae of such experiences. We determined the reported lifetime prevalence of DV and SA among women physicians and the personal characteristics, health-related factors, and work-related factors associated with these forms of abuse. We used data from the Women Physicians' Health Study, a large (n = 4501 respondents), nationally distributed questionnaire study that included questions on DV and SA histories, personal characteristics, and psychiatric, medical, and work-related histories. We compared the characteristics of women physicians with and without histories of DV or SA. The logistic models indicate that women physicians reporting DV histories (3.7% of the population) were significantly (p < 0.05) less likely to be single and significantly more likely to report depression histories, suicide attempts, substance abuse, current or past cigarette smoking, severe daily stress at home, chronic fatigue syndrome, and DV experienced by their mothers. Women physicians reporting SA histories (4.7% of the population) were significantly more likely to be younger than 60 years, identify themselves as homosexual or bisexual, to have specialized in psychiatry, obstetrics and gynecology, or emergency medicine, and to report histories of depression, suicide attempts, eating disorders, and fair or poor perceived health status. Although the reported lifetime prevalence of DV and SA among women physicians is below other reported figures, such experiences are associated with medical and psychiatric difficulties that could negatively affect them personally and professionally.

Difficulties inherent in certifying people with gender dysphoria - Feinberg, M. (Aviation Space and Environmental Medicine, 1999)
This is a first report of the aeromedical implications of an airman undergoing gender transformation. It is clear that during the period of instituting high-dose hormones to undergo sexual transformation appropriate observation periods should be implemented due to the strong effects of these drugs on the psyche.
Keywords: Aeromedical certification; Gender dysphoria

Male gender identity and sexual behaviour - Chused, J.F. (International Journal of Psycho-Analysis, 1999)
One consequence of a heightened interest in intersubjectivity in the current psychoanalytic literature has been a relative neglect of the examination of unconscious fantasies. Presenting material from the analysis of three males, each of whom, in childhood and/or adolescence, hid his penis between his legs and looked at himself in a mirror naked, the author demonstrates the importance of attending to both unconscious fantasies and their manifestations within the interactive field of analysis. The first patient is a young child with a gender identity disorder, whose wish to be like his mother was a response to the emotional loss of her during early childhood. The second patient is an adolescent, whose behaviour in front of a mirror was a manifestation of his desire to possess his mother and be her, to humiliate and sadistically control her, and at the same time, to experience the masochistic sexual gratification of being a seemingly helpless victim. The third patient, a 48-year-old male, came to analysis filled with suicidal impulses and self-hatred related to homosexual impulses. His repeated examination of himself in a mirror, with penis hidden, reflected severe castration anxiety, related to an ambivalent relationship with an angry mother and a longing for attention from an unavailable father. The article closes with a description of the similarities and differences in the dynamics of these three males as well as a discussion of the meaning of similar behaviour in other males seen in consultation.

Gender differences in health and risk behaviors among bisexual and homosexual adolescents - Saewyc, E.M.; Bearinger, L.H.; Heinz, P.A.; Blum, R.W.; Resnick, M.D. (Journal of Adolescent Health, 1998)
Objective: This study explored gender differences in the health and risk behaviors of 394 self-identified bisexual and homosexual adolescents who participated in an anonymous, school-based survey. Methods: Respondents included 182 girls and 212 boys; girls were significantly younger than boys (p < 0.001), so respondents were further grouped as younger (≤14 years) and older (≤15 years) for analysis. Chi-square was used to test for gender differences in health perceptions and risk behaviors. Items included general health perceptions and health care access, body image and disordered eating behaviors, sexual behaviors, alcohol use, and emotional health measures including mood, life satisfaction, and suicidal ideation and attempts. Results: Both younger and older girls were significantly more likely than their male age mates to report a history of sexual abuse, dissatisfaction with weight, a negative body image, more frequent dieting, and an earlier age at onset of sexual intercourse. Both younger and older boys were significantly more likely than girls to have a positive body image, to rate themselves as healthier than peers, to report no regular source of health care, to be sexually experienced, and to drink alcohol more often and in greater quantity; a significantly greater proportion of older boys than older girls reported alcohol use before school (19.0% vs. 3.9%; p < 0.05). No significant gender differences were found for measures of emotional health, including suicidal ideation and attempts; however, nearly 1 of 3 older boys and girls reported at least one suicide attempt. Conclusions: Gender is a substantive source of variation in health and risk behaviors among bisexual and homosexual adolescents. Health care providers should incorporate gender- specific approaches to health promotion and risk reduction with young people who self-identify as gay, lesbian, or bisexual.
Keywords: Adolescents; Bisexual; Gender differences; Health behavior; Homosexual; Risk behavior; Sexual orientation

The University of Minnesota Youth and AIDS Projects' Adolescent Early Intervention Program: A model to link HIV-seropositive youth with care - Remafedi, G. (Journal of Adolescent Health, 1998)
The survival of human immunodeficiency virus (HIV)-positive adolescents may be abbreviated by delays in health care delivery. Methods of linking youth with services have not been well studied. With support from the Special Projects of National Significance Program, the Youth and Acquired Immunodeficiency Syndrome (AIDS) Projects' (YAP) Adolescent Early Intervention Program offers early intervention health care services to all affected youth in Minnesota, a state with mandatory reporting of HIV/AIDS cases. The conceptual framework is a novel application of traditional public health disease surveillance strategies to link HIV-positive adolescents with health care services. The target population is composed of all 13-22-year- old HIV-positive persons reported to the Minnesota Department of Health (MDH). MDH staff locate and contact HIV-positive youth, conduct structured interviews regarding health status and needs, and facilitate enrollment at YAP. Sixteen male and 20 female participants (mean age 21 years; 56% people of color; 32% gay or bisexual) reported serious health risks, including inconsistent condom use (83%), poverty (78%), high school dropout (56%), unemployment (50%), illegal conduct (50%), medical debt (42%), unstable living situations (33%), running away (33%), substance abuse (33%) and attempted suicide (28%). More than one third reported each of six HIV- related symptoms. Seventy-five percent of participants sought advocacy/case coordination; 56%, clinical trials of experimental therapies; and 50%, vocational training and access to entitlement/eligibility programs. Linking HIV-positive youth to care is a valuable extension of the work of disease intervention specialists in states with similar reporting systems.
Keywords: Acquired immunodeficiency syndrome; Adolescence; Health care services; Human immunodeficiency virus; Special Projects of National Significance Program; Youth

HIV infection and suicide risk: An epidemiological inquiry among male homosexuals in Switzerland - Cochand, P.; Bovet, P. (Social Psychiatry and Psychiatric Epidemiology, 1998)
Conflicting results have been published about suicidality among HIV+ subjects; part of the alleged increased risk may be linked to premorbid risk factors such as drug addiction and homosexuality. In order to cope with these confounding factors, we assessed the degree of suicidal ideation in a sample of Swiss male homo- and bisexuals, comparing HIV- and HIV+ subjects. A total of 164 subjects returned a self-administered, home-completed questionnaire, which had been circulated among homosexuals in the French speaking part of Switzerland. Suicidal ideation was assessed through Poldinger's scale. Serostatus was known for 149 subjects, among whom 65 were HIV+. A high rate of suicide attempts was found among homosexuals, both HIV- and HIV+. Scores on Poldinger's scale are significantly, though moderately, higher among HIV+ subjects, and this finding seems to be a direct consequence of HIV infection.

The association between health risk behaviors and sexual orientation among a school-based sample of adolescents - Garofalo, R.; Wolf, R.C.; Kessel, S.; Palfrey, J.; DuRant, R.H. (Pediatrics, 1998)
Objective. This study is one of the first to examine the association between sexual orientation and health risk behaviors among a representative, school-based sample of adolescents. Design. This study was conducted on an anonymous, representative sample of 4159 9th- to 12th-grade students in public high schools from Massachusetts' expanded Centers for Disease Control and Prevention 1995 Youth Risk Behavior Survey. Sexual orientation was determined by the following question: 'Which of the following best describes you?' A total of 104 students self-identified as gay, lesbian, or bisexual (GLB), representing 2.5% of the overall population. Of GLB youth, 66.7% were male and 70% were white (not Hispanic). Health risk and problem behaviors were analyzed comparing GLB youth and their peers. Those variables found to be significantly associated with GLB youth were then analyzed by multiple logistic regression models. Results. GLB youth were more likely than their peers to have been victimized and threatened and to have been engaged in a variety of risk behaviors including suicidal ideation and attempts, multiple substance use, and sexual risk behaviors. Four separate logistic regression models were constructed. Model I, Onset of Behaviors Before Age 13, showed use of cocaine before age 13 years as strongly associated with GLB orientation (odds ratio [OR]: 6.10; 95% confidence interval [CI] = 2.45- 15.20). Early initiation of sexual intercourse (2.15; 10.6-4.38), marijuana use (1.98; 1.04-4.09), and alcohol use (1.82; 1.03-3.23) also was associated with GLB orientation. Model II, Lifetime Frequencies of Behaviors, showed that frequency of crack cocaine use (1.38; 1.06-1.79), inhalant use (1.30; 1.05-1.61), and number of sexual partners (1.27; 1.06-1.43) was associated with GLB orientation. Model III, Frequency of Recent Behaviors, showed smokeless tobacco use in the past 30 days (1.38; 1.20-1.59) and number of sexual partners in the previous 3 months (1.47; 1.31-1.65) were associated with GLB orientation. Model IV, Frequency of Behaviors at School, showed having one's property stolen or deliberately damaged (1,23; 1.08-1.40) and using marijuana (1.29; 1.05-1.59) and smokeless tobacco (1.53; 1.30-1.81) were associated with GLB orientation. Overall, GLB respondents engaged disproportionately in multiple risk behaviors, reporting an increased mean number of risk behaviors (mean = 6.81 ± 4.49) compared with the overall student population (mean = 3.45 ± 3.15). Conclusion. GLB youth who self- identify during high school report disproportionate risk for a variety of health risk and problem behaviors, including suicide, victimization, sexual risk behaviors, and multiple substance use. In addition, these youth are more likely to report engaging in multiple risk behaviors and initiating risk behaviors at an earlier age than are their peers. These findings suggest that educational efforts, prevention programs, and health services must be designed to address the unique needs of GLB youth.
Keywords: Risk behaviors; Sexual orientation; Suicide; Victimization

Long-term trends in self-reported HIV risk behavior: Injection drug users in Los Angeles, 1987 through 1995 - Longshore, D.; Annon, J.; Anglin, M.D. (Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 1998)
This article reviews trends in self-reported HIV risk behaviors across serial samples of injection drug-using (IDU) arrestees interviewed in Los Angeles. Between 1987 and 1995, a gradual decrease occurred in the percentage who share needles. However, measured over a past-year recall period, the prevalence of needle sharing remained high until 1994 to 1995, when it abruptly declined. Needle sharing with strangers and needle sharing at shooting galleries declined gradually throughout the study period. Among IDUs who shared needles, bleach use increased rapidly until 1991 but leveled off thereafter. No change occurred in number of sex partners, but condom use gradually increased among IDUs with 2 or more partners. Concurrent change in local needle exchange policy and practice may explain the abrupt decline in past-year needle sharing. New strategies may be needed to promote further increases in bleach use and condom use. Trends are reviewed in self-reported HIV risk behaviors across serial samples of 2156 arrested IV drug users (IVDUs) interviewed in Los Angeles, California. All IVDUs reported past-year injection drug use between 1987 and 1995. Over the period 1987-95, a gradual decrease occurred in the percentage who share injection equipment. However, measured over a past-year recall period, the prevalence of needle sharing at shooting galleries remained high until 1994/95, when it abruptly declined. Needle sharing with strangers and at shooting galleries declined gradually throughout the study period. Among IVDUs who shared needles, bleach use increased rapidly until 1991, then leveled off thereafter. No change occurred in the number of sex partners, but condom use gradually increased among IVDUs with 2 or more partners. Concurrent change in local needle exchange policy and practice may explain the abrupt decline in past-year needle sharing. New strategies may be needed to promote further increases in bleach and condom use.
Keywords: HIV risk; Injection drug users

Informal caregivers and the intention to hasten AIDS-related death - Cooke, M.; Gourlay, L.; Collette, L.; Boccellari, A.; Chesney, M.A.; Folkman, S. (Archives of Internal Medicine, 1998)
Objectives: To determine the extent to which homosexual men dying of the acquired immunodeficiency syndrome (AIDS) receive medication intended to hasten death. To assess the impact on caregivers of administering medications intended to hasten death. Methods: In a prospective study of caregiving partners of men with AIDS (n=140), characteristics of the ill partner, the caregiver, and the relationship were assessed at baseline and 1 month before the ill partner's death. Three months after the death, caregivers were asked if they had increased their partner's narcotic and/or sedative-hypnotic medication dose and if so, what had been the objective of the increase, and their comfort with their medication decisions. Results: Of 140 ill partners who died of AIDS, 17 (12.1%) received an increase in the use of medications immediately before death intended to hasten death. Diagnoses and care needs of ill partners who received increases in the use of medications to hasten death did not differ from those of ill partners receiving medication for symptoms. Fourteen increases (10%) in use of medications were administered by caregivers. These caregivers did not differ from those administering medication for symptom control in level of distress, caregiving burden, relationship characteristics, or comfort with the medication decision, but they reported more social support and positive meaning in caregiving. Conclusion: The decision to hasten death is not a rare event in this group of men. There is no evidence that it is the result of caregiver distress, poor relationship quality, or intolerable caregiving burden; and it does not cause excessive discomfort in the surviving partner. This study, although small, has implications for the policy debate on assisted suicide.

Antecedents and consequences of victimization of lesbian, gay, and bisexual young people: A structural model comparing rural university and urban samples - Waldo, C.R.; Hesson-McInnis, M.S.; D'Augelli, A.R. (American Journal of Community Psychology, 1998)
Research indicates that antigay victimization is widespread and that lesbian, gay, and bisexual young people may be very vulnerable to such victimization. The current study builds upon previous work by Hershberger and D'Augelli (1995), who studied the consequences of sexual orientation-based victimization in 194 urban lesbian, gay, and bisexual youths. Using structural equation modeling, the present study models both antecedents and consequences (including psychological distress, self-esteem, and suicidality) of victimization via a secondary analysis of their data set. In addition, a second sample of 54 lesbian, gay, and bisexual youths from a rural university setting was examined to cross-validate and generalize the relationships found in urban settings. Results indicated that a revised model of victimization exhibited sufficient fit to the urban sample data and provided preliminary support for the generalizability of the model beyond the initial sample. Additional similarities were found between the urban and rural university community samples, including a high prevalence of reported suicide attempts: 42% of the urban sample and 32% of the rural university sample had attempted suicide at least once. Results indicated that victimization based on sexual orientation has similar correlates for young people in different community settings.
Keywords: Bisexual; Gay; Lesbian; Structural equation modeling; Victimization; Youths

The relationship between suicide risk and sexual orientation: Results of a population-based study - Remafedi, G.; French, S.; Story, M.; Resnick, M.D.; Blum, R. (American Journal of Public Health, 1998)
Objectives. This study examined the relationship between sexual orientation and suicide risk in a population-based sample of adolescents. Methods. Participants were selected from a cross-sectional, statewide survey of junior and senior public high school students. All males (n = 212) and females (n = 182) who described themselves as bisexual/homosexual were compared with 336 gender-matched heterosexual respondents on three outcome measures: suicidal ideation, intent, and self-reported attempts. Logistic regression analyses were used to examine the association between sexual orientation and outcome measures with adjustment for demographic characteristics. Results. Suicide attempts were reported by 28.1% of bisexual/homosexual males, 20.5% of bisexual/homosexual females, 14.5% of heterosexual females, and 4.2% of heterosexual males. For males, but not females, bisexual/homosexual orientation was associated with suicidal intent (odds ratio [OR] = 3.61; 95% confidence interval [CI] = 1.40, 9.36) and attempts (OR = 7.10; 95% CI = 3.05, 16.53). Conclusions: There is evidence of a strong association between suicide risk and bisexuality or homosexuality in males.

Reasons for living in homosexual and heterosexual young adults - Hirsch, J.K.; Ellis, J.B. (Archives of Suicide Research, 1998)
For researchers, suicide is a major concern in young adults. The additional stressors that may be present for gay or lesbian individuals may promote less adaptive characteristics than in heterosexual individuals. Gay and lesbian and heterosexual subjects completed the Reasons for Living Inventory (RFL) to determine levels of adaptive characteristics that may prevent suicidal behaviors. Results indicated that gay men and lesbian women endorsed less reasons for living than did heterosexual individuals. This reduced level of coping skills may be a result of increased responsibilities, demands, and stressors associated with choosing a homosexual lifestyle.
Keywords: Homosexual; Reasons for living; Suicide; Young adults

Health and development of gay and lesbian youths: Implications for HIV/AIDS - Perrin, E.C.; Sack, S. (AIDS Patient Care and STDs, 1998)
Health and behavioral issues of gay and lesbian adolescents have recently become a focus of research and interest. A well conceived framework within which to consider thoughtfully the uniqueness of problems faced by homosexual youths and the role of health-care providers is needed. The prevalence, sociocultural history, and theories of origin of the homosexual orientation (biologic, psychoanalytic, and social processes) as well as general issues in adolescent development (biologic, cognitive, and emotional) all contribute to the development of a comprehensive perspective through which better health care and education can be provided. Responsible sexual behavior, depression, and suicide are health-care issues that physicians must be sensitive to and address openly. Up to 50% of gay youths have 'seriously contemplated,' suicide and 25% are estimated to have attempted suicide, according to the literature. In one study, up to 38% of pediatricians were uncomfortable in caring for homosexual adolescents within their practice. Practical suggestions include reviewing the language in office information forms and brochures providing appropriate literature that demonstrates acceptance of homosexual and bisexual orientations, and avoiding heterosexist bias in questions inquiring about sexuality. Physicians have an opportunity to modify the health and psychosocial risks faced by gay and lesbian youths by restructuring professional settings and accepting broader responsibilities for raising community awareness.

Reasons for living in homosexual and heterosexual young adults - Hirsch, J.K.; Ellis, J.B. (Archives of Suicide Research, 1998)
For researchers, suicide is a major concern in young adults. The additional stressors that may be present for gay or lesbian individuals may promote less adaptive characteristics than in heterosexual individuals. Gay and lesbian and heterosexual subjects completed the Reasons for Living Inventory (RFL) to determine levels of adaptive characteristics that may prevent suicidal behaviors. Results indicated that gay men and lesbian women endorsed less reasons for living than did heterosexual individuals. This reduced level of coping skills may be a result of increased responsibilities, demands, and stressors associated with choosing a homosexual lifestyle. © 1998 Kluwer Academic Publishers. All rights reserved.
Keywords: Homosexual; Reasons for living; Suicide; Young adults

Developmental and adjustment issues of gay, lesbian, and bisexual adolescents: A review of the empirical literature - Morris, T.L. (Clinical Child and Family Psychology Review, 1998)
Various studies have reported adjustment problems experienced by gay, lesbian, and bisexual (GLB) adolescents. A primary purpose of this paper is to critically review this literature. Difficulties that have been studied include past suicide attempts, substance use and abuse, conduct problems, and academic concerns. For example, a considerable number of GLB youth report a history of suicide attempts, with prevalence rates ranging from 11 to 42%. However, among other methodological concerns, studies in this area have not used a comparison sample of heterosexual youths. Characteristics of development particular to GLB adolescents are described, the empirical research on adjustment issues is reviewed, and potential risk and protective factors for GLB youths are discussed. © 1998 Plenum Publishing Corporation.
Keywords: Adjustment issues; Bisexual adolescents; Developmental issues; Gay adolescents; Lesbian adolescents

Prevalence of suicide attempts and suicidal ideation among lesbian and gay youth - Saulnier, C.F. (Journal of Gay and Lesbian Social Services, 1998)
Researchers argue that a disproportionate number of lesbian and gay adolescents attempt suicide. The problem demands careful attention from social work. Most, perhaps all, social workers serve lesbian and gay clients. Some are aware of it. Yet all too often social workers assume that the sexual orientation of the adolescents with whom they work does not vary. When that assumption is made, social workers may be missing a key opportunity to understand and intervene with and on behalf of gay and lesbian teens. This paper begins by defining several pertinent terms. Next, it examines findings concerning prevalence and risk factors for suicidality in lesbian and gay youth, and provides information on recognizing lesbian and gay adolescents. The paper ends with an overview of areas in which social workers need to intervene. © 1998 by The Haworth Press, Inc. All rights reserved.

I will survive: Lesbian, gay, and bisexual youths’ experience of high school - Jordan, K.M.; Vaughan, J.S.; Woodworth, K.J. (Journal of Gay and Lesbian Social Services, 1998)
Much has been written about gay, lesbian, and bisexual students’ negative experience, such as harassment and hate crimes, in high school. This study was undertaken to further explore these issues, as well as to elucidate the positive coping skills, traits, and experiences of the students. Thirty-four current high school students completed a questionnaire containing both original items and previously-developed scales. The majority of the students (73.5%) reported receiving support regarding sexual orientation issues from someone at school, and 41.2% reported that information regarding gay, lesbian, and bisexual issues was available from school staff. However, 35.3% reported a previous suicide attempt, a figure consistent with previous literature. Additional positive and negative high school experiences, as well as their interrelationships, are discussed. © 1998 by The Haworth Press, Inc. All rights reserved.

Development and health care needs of lesbians - Lehmann, J.B.; Lehmann, C.U.; Kelly, P.J. (Journal of Women's Health, 1998)
Lesbians have complained about the lack of awareness and sensitivity of their health care providers, resulting in unnecessary examinations and inappropriate focus on reproductive issues. This study attempted to identify psychosocial and health care needs of lesbians, to assess relationships with primary care providers and disclosure of sexual orientation, and to describe the chronologic features of a sexual identity and lifestyle. An anonymous, self-administered, written questionnaire was distributed through a campus lesbian organization. Fifty-three women (median age 23 years) completed the questionnaire. Whereas 60% had disclosed their sexual orientation to their parents, only 31% had 'come out' to their health care provider. Of participants who had disclosed their sexual preference to a provider, 27% reported a negative effect on their health care, 57% of participants who never had penile intercourse had annual Papanicolaou smears, and 16% felt pressured in the past to accept birth control from a physician. Lesbian sexuality was associated with several risk factors, such as childhood abuse (20%), alcohol or drug problems (39%), suicide attempts (27%), depression (49%), and physical or verbal abuse at school (34%). Average age of awareness of sexual orientation was 15 years, and average age of first homosexual activity was 17 years. Lesbians are at risk for depression, substance abuse, and suicide attempts. Although most would like to confide in their physician, few do because of fears of negative reactions. Communication must be improved to better address their specific health care needs.

Perceptions of life and death among suicidal gay adolescents - Ben-Ari, A.T.; Gil, S. (Omega, 1998)
Suicide rates among homosexuals are higher than those among heterosexuals. This article suggests that gay youth who attempt suicide represent a special case in which the meanings associated with life and death are worth exploration. In light of the phenomenological paradigm, we are interested in how sixteen gay men who attempted suicide perceived life and death before the actual suicide attempt and how these perceptions are linked to the attempt. Orbach's model specifies four categories of attitudes toward life and death: attraction and aversion to life and attraction and aversion to death. Only three categories of Orbach's model emerged from the interview data. "Attraction to life" was missing and the analysis attempts to account for this gap. © 1998, Baywood Publishing Co., Inc.

Suicide and homosexual youth. (The Harvard mental health letter / from Harvard Medical School, 1998)

Homosexual homicides - Gojanovic, M.D. (Journal of Clinical Forensic Medicine, 1998)
This report describes four cases of male homosexual homicide committed in Split County, Croatia, in 1991 and 1995. The homosexual orientation of the victims was determined by police investigation. Three middle-aged to elderly person were killed by an unknown offender or offenders, in very similar ways within a few months of end other in 1991. The bodies were found in their houses with multiple blunt force injuries to the head. One victim also had marks of manual strangulation, and was choked with a handkerchief which had been put in his mouth. The last victim was a 45-year-old man, found in the bathroom with 33 stab wounds, mostly in the neck and back, and with two shots in the head from an underwater gun. He was killed by two adolescent males at the beginning of sexual intercourse. The presented cases show a high level of violence with multiple injuries may be associated with male homosexual homicide.

HIV positive tests at Coronial Services in Victoria 1989-1996: Lessons for HIV surveillance - Thompson, S.C.; Manjikian, A.; Ambrose, A.; Ireland, L.A.; Stevenson, E.M. (Australian and New Zealand Journal of Public Health, 1998)
Results of routine testing at other sites can supplement surveillance of the HIV epidemic in Australia which is largely based upon voluntary testing. Since 1989, systematic onsite HIV testing has been undertaken on all bodies taken to the Victorian Institute of Forensic Medicine (VIFM). Information was collected on all cases of HIV infection detected at VIFM between 1989 and 1996, and matched to surveillance databases. In 8 years, 75 people were diagnosed with HIV; all except one were male. The age range was 14-70 years, mean 37.4 years. The major causes of death were suicide 35%, AIDS 27%, drug toxicity 16%, natural causes 12% and injury 7%. The major exposure categories were male homosexual 51%, male bisexual 11%, homosexual/bisexual IDU 16%, IDU other 8%, and haemophiliac 7%. For only two was exposure information unavailable. Seropositivity for anti-HCV and HBsAg was 37% and 11% respectively. The deceased was recorded as having HIV/AIDS on the police report in 73% of cases, and at least 90% of subjects had been diagnosed with HIV prior to their death. The study suggests there is relatively little undiagnosed HIV infection in Victoria, that HIV infection has not moved outside traditional risk groups, and that many tests for HIV are undertaken using false namecodes. Many patients could not be matched on the HIV/AIDS databases, identifying a problem with HIV surveillance systems in Victoria, and the need to capture all information on HIV positives detected at VIFM.

Suicidal ideation, suicide attempts, and HIV infection - Kelly, B.; Raphael, B.; Judd, F.; Perdices, M.; Kernutt, G.; Burnett, P.; Dunne, M.; Burrows, G. (Psychosomatics, 1998)
A cross-sectional study was performed to investigate the prevalence and predictors of suicidal ideation and past suicide attempt in an Australian sample of human imumunodeficiency virus (HIV)-positive and HIV-negative homosexual and bisexual men. Sixty-five HIV-negative and 164 HIV-positive men participated. A suicidal ideation score was derived from using five items selected from the Beck Depression Inventory and the General Health Questionnaire (28-item version). Lifetime and current prevalence rates of psychiatric disorder were evaluated with the Diagnostic Interview Schedule Version-III-R. The HIV-positive (Centers for Disease Control and Prevention [CDC] Stage IV) men (n = 85) had significantly higher total suicidal ideation scores than the asymptomatic HIV-positive men (CDC Stage II/III) (n = 79) and the HIV-negative men. High rates of past suicide attempt were detected in the HIV-negative (29%) and HIV-positive men (21%). Factors associated with suicidal ideation included being HIV positive, the presence of current psychiatric disorder, higher neuroticism scores, external locus of control, and current unemployment. In the HIV-positive group analyzed separately, higher suicidal ideation was discriminated by the adjustment to HIV diagnosis (greater hopelessness and lower fighting spirit), disease factors (greater number of current acquired immunodeficiency syndrome [AIDS]-related conditions), and background variables (neuroticism). Significant predictors of a past attempted suicide were a positive lifetime history of psychiatric disorder (particularly depression diagnoses), a life-time history of injection drug use, and a family history of suicide attempts. The findings indicate increased levels of suicidal ideation in symptomatic HIV-positive men and high-light the role that multiple psychosocial factors associated with suicidal ideation and attempted suicide play in this population.

Assisted suicide. (AIDS policy & law, 1998)
A protege of Dr. Jack Kevorkian assisted in the suicide of a transsexual with AIDS in January. The patient suffered from a number of AIDS-related symptoms and died from intravenous poisoning. Dr. Kevorkian was not directly involved, although he did consult with the doctor who performed the assisted suicide.

Correlates of same-sex sexual behavior in a random sample of Massachusetts high school students - Faulkner, A.H.; Cranston, K. (American Journal of Public Health, 1998)
Objectives. This study documented risk behaviors among homosexually and bisexually experienced adolescents. Methods. Data were obtained from a random sample of high school students in Massachusetts. Violence, substance use, and suicide behaviors were compared between students with same-sex experience and those reporting only heterosexual contact. Differences in prevalence and standard errors of the differences were calculated. Results. Students reporting same-sex contact were more likely to report fighting and victimization, frequent use of alcohol, other drug use, and recent suicidal behaviors. Conclusions. Students with same-sex experience may be at elevated risk of injury, disease, and death resulting from violence, substance abuse, and suicidal behaviors.

A primer on homophobia for the child and adolescent psychiatrist - Lock, J.; Kleis, B.N. (Journal of the American Academy of Child and Adolescent Psychiatry, 1998)

Psychological adjustment and suicidal ideation in patients with AIDS - Gil, F.; Passik, S.; Rosenfeld, B.; Breitbart, W. (AIDS Patient Care and STDs, 1998)
This article assesses the psychosocial adjustment to illness and examines the relationship between adjustment and psychosocial and medical variables in 91 ambulatory HIV-infected patients. The 91 subjects were receiving ambulatory medical care in hospitals (Memorial Hospital, New York Hospital, and St. Vincent's Hospital) and in private medical consult (Gay Men's Health Crisis) in New York. The majority (74.5%) of subjects had AIDS. The sample was composed principally of white Roman Catholic homosexual men living alone. However, 49.5% were black or hispanic, 31.9% had intravenous drug use as their HIV risk behavior, 54.9% had past psychiatric history (including illegal drug use), and 22% had previous suicide attempts. Self- report measures of psychological adjustment (Psychological Adjustment to Illness Scale), mood (Brief Symptom Inventory), physical (PHYS) and psychological (PSYCH) symptoms from the Memorial Symptom Assessment Scale- Short Form (MSAS-SF), social support (Social Support Questionnaire-Short Report), suicidal ideation (Scale for Suicide Ideation Self-Report), and measures of disease status (Karnofsky Performance Rating Scale, HIV CDC Classification, and Absolute CD4+ Lymphocyte Count) were used in the study. The average age of subjects was 40 years (SD = 6.80). Fifty-two (63.4%) subjects acknowledged some indication of suicidal ideation. Variables that correlated with poor medical adjustment (health-care posture) were current suicide ideation (0.32, p = 0.003), number of psychological symptoms (0.45, p = 0.0001), physical symptoms (0.31, p = 0.006), social support (-0.24, p = 0.03), and satisfaction with the social support received (-0.36, p = 0.001). Poor sexual adjustment was related to current suicide ideation (0.39, p = 0.0004), number of psychological symptoms (0.40, p = 0.0003), satisfaction with the social support received (-0.28, p = 0.01), and number of physical symptoms (0.35, p = 0.002). In patients with a diagnosis of AIDS, the number of psychological symptoms (Beta = 0.29, R2 = 0.07, p - 0.02) and the satisfaction with the social support received (Beta = -0.38, R2 = 0.14, p - 0.003) were clear predictors of poor medical adjustment (health-care posture). Likewise, the predictors of poor sexual adjustment were psychological symptoms (Beta = 0.33, R2 = 0.10, p = 0.003) and suicidal ideation (Beta = 0.40, R2 = 0.10, p = 0.002). The results suggest that suicide ideation is associated with poor adjustment, rather than serving as an adaptive function, as has been suggested by others.

A process model for assessing adolescent risk for suicide - Stoelb, M.; Chiriboga, J. (Journal of Adolescence, 1998)
As the incidence of adolescent suicide within our society continues to rise, it becomes increasingly important for the mental health professional to be able to accurately assess suicide risk in adolescents who seek help. This process model discusses primary risk factors (previous attempt, affective disorders, and hopelessness), secondary risk factors (substance abuse and personality or behavioral disorders), situational risk factors (family functioning, suicide exposure, social support, life stressors, and homosexuality), and their combined implications and significance in determining an adolescent's level or risk for suicide. Use of both empirical data and clinical intuition are integrated to form a working client model that is continuously reassessed in four stages, guiding the mental health professional through a comprehensive assessment process.

Victimization, use of violence, and drug use at school among male adolescents who engage in same-sex sexual behavior - DuRant, R.H.; Krowchuk, D.P.; Sinal, S.H. (Journal of Pediatrics, 1998)
Objective: To examine the relationship between the number of male sexual partners of adolescent males and the frequency of victimization at school, missed school because of fear, used drugs at school, and engagement of fighting and weapon carrying both in and out of school. Study design: Sexually active male adolescents (NT = 3886) in 8th through 12th grades were administered the 1995 Vermont Youth Risk Behavior Survey. Results: A total of 8.7% of male adolescents reported one or more male sexual partners. Alcohol, marijuana, and smokeless tobacco use at school, not attending school because of fear, having been threatened or injured with a weapon at school, and weapon carrying at school accounted for 15.8% of the variation in the number of male sexual partners (p < 0.0001). Suicide attempts, school absence because of fear, cigarette smoking, alcohol use, and smokeless tobacco use at school, frequency of fighting requiring medical treatment, carrying a weapon, and carrying a weapon at school accounted for 17.2% out of 100% of the variation in the number of male sexual partners (p ≤ 0.00001). Conclusion: The number of male sexual partners reported by sexually active male adolescents correlated with a higher frequency of victimization, use of violence, and drug use at school. Frequency of suicide attempts and fighting outside of school were also correlated with the number of same-sex sexual partners.

Dilemma. James' right to information. (Accident and emergency nursing, 1998)

Psychiatric evaluation of a 'monk' requesting castration: A patient's fable, with morals - Roberts, L.W.; Hollifield, M.; McCarty, T. (American Journal of Psychiatry, 1998)

Lesbians and mental health: Preliminary results from the Chicago women's health survey - Hughes, T.L. (Journal of the Gay and Lesbian Medical Association, 1997)
Despite heightened awareness of and interest in the health status of lesbians over the past two decades, many gaps in knowledge remain. Much of the research has been conducted with small, homogeneous samples and few studies have included comparison groups of heterosexual women. This paper presents descriptive, preliminary data on several indicators of mental health from 284 lesbians and a comparison group of 134 heterosexual women. These findings are then discussed in relation to published data from other relevant studies. Results related to depression, suicidal thoughts and attempts, and use of therapy or counseling are generally consistent with those reported in other research on lesbians' health. Rates of childhood sexual abuse and partner abuse, however, are higher, and rates of alcohol use and substance abuse are lower, than most reports of these problems in the literature. © 1997 Gay and Lesbian Medical Association.
Keywords: Counseling; Depression; Lesbians; Mental health; Substance abuse

African-American suicide: A cultural paradox - Gibbs, J.T. (Suicide and Life-Threatening Behavior, 1997)
African-American suicide rates have traditionally been lower than White rates despite a legacy of racial discrimination, persistent poverty, social isolation, and lack of community resources. This paper focuses on four issues: (1) patterns and trends of Black suicide across the lifespan; (2) risk and protective factors in subgroups of Blacks; (3) the influence of cultural factors on suicide patterns of Blacks; and (4) implications of these patterns for prevention and early intervention of suicidal behavior among African Americans. Risk factors for Black suicide include: male sex, early adulthood, substance abuse, psychiatric disorders, family or interpersonal conflict, antisocial behavior, and homosexuality. Protective factors that mitigate the risks of suicide include religiosity, older age, southern residence, and social support. Implications for preventive policies and programs are discussed to counter the recent trend of rising suicide rates among adolescents and very elderly Blacks.

Comorbidity of gender dysphoria and other major psychiatric diagnoses - Cole, C.M.; O'Boyle, M.; Emory, L.E.; Meyer III, W.J. (Archives of Sexual Behavior, 1997)
Previous studies suggest that many transsexuals evidence an Axis I diagnosis according to the DSM-IV classification (e.g., psychoses, major affective disorder). The current study examined retrospectively the comorbidity between gender dysphoria and major psychopathology, evaluating the charts of 435 gender dysphoric individuals (318 male and 117 female). All had undergone an extensive evaluation, addressing such areas as hormonal/surgical treatment, and histories of substance abuse, mental illness, genital mutilation, and suicide attempts. In addition, a subgroup of 137 individuals completed the MMPI. Findings revealed over two thirds were undergoing hormone reassignment, suggesting a commitment to the real-life cross-gender process. One quarter had had problems with substance abuse prior to entering treatment, but less than 10% evidenced problems associated with mental illness, genital mutilation, or suicide attempts. Those completing the MMPI (93 female and 44 male) demonstrated profiles that were notably free of psychopathology (e.g., Axis I or Axis II criteria). The one scale where significant differences were observed was the Mf scale, and this held true only for the male-to-female group. Psychological profiles as measured by the MMPI were more 'normal' in the desired sex than the anatomic sex. Results support the view that transsexualism is usually an isolated diagnosis and not part of any general psychopathological disorder.
Keywords: comorbidity of psychiatric disorders; gender dysphoria; MMPI; transsexualism

Physician-assisted suicide and patients with human immunodeficiency virus disease - Slome, L.R.; Mitchell, T.F.; Charlebois, E.; Benevedes, J.M.; Abrams, D.I. (New England Journal of Medicine, 1997)
Background: Data are limited on the attitudes and practices of physicians regarding assisting the suicide of patients with human immunodeficiency virus (HIV) disease. Methods: Between November 1994 and January 1995, we used an anonymous, self-administered questionnaire to survey all 228 physicians in the Community Consortium, an association of providers of health care to patients infected with HIV in the San Francisco Bay area. The responses were compared with those in a 1990 survey of consortium physicians. Physician assisted suicide was defined as 'a physician providing a sufficient dose of narcotics to enable a patient to kill himself.' Respondents were to 'assume that the patient is a mentally competent, severely ill individual facing imminent death.' Results: One hundred eighteen of the questionnaires were evaluated. Respondents reported a mean of 7.9 'direct' and 13.7 'indirect' requests from patients for assistance. In responses based on a case vignette, 48 percent of the physicians said they would be likely or very likely to grant the request of a patient with the acquired immunodeficiency syndrome (AIDS) for assistance in a suicide, as compared with 28 percent of the respondents in 1990. Asked to estimate the number of times they had granted the request of a patient with AIDS for assistance in committing suicide, 53 percent said they had done so at least once (mean number of times, 4.2; median, 1.0; range, 0 to 100). In a multivariate analysis, factors positively associated with a physician's having, in fact, assisted a suicide were having had a higher number of patients with AIDS who had died; having received a higher number of indirect requests from patients for assistance; having a stated gay, lesbian, or bisexual orientation him- or herself; and having a higher 'intention to assist' score (as calculated from the physician's responses to the case vignette). Conclusions: Within a group of physicians caring for patients with HIV disease, the acceptance of assisted suicide increased between 1990 and 1995. A majority of respondents in 1995 said they had granted a request for assisted suicide from a patient with AIDS at least once.

Psychosocial issues in primary care of lesbian, gay, bisexual, and transgender youth - Kreiss, J.L.; Patterson, D.L. (Journal of Pediatric Health Care, 1997)
Lesbian, gay, bisexual, and transgender youth are risk for a multituted of physical, emotional, and social health problems. During the past decade it has been well documented that these youth have higher-than-average rates of depression, suicide attempts, substance abuse, sexually transmitted diseases, school failure, family rejection, and homelessness. The focus of this article is to outline skills and strategies that can assist the health practitioner in creating an optimal health care experience for sexual minority youth. Models of individuals and family adaptation, a clinical path, and a referral list are presented. Current health care delivery sites are examined, and recommendations are given for improvement of both practitioner skills and health care programs targeting these youth.

Growing up with a “spoiled identity”: Lesbian, gay and bisexual youth at risk - Grossman, A.H. (Journal of Gay and Lesbian Social Services, 1997)
Being a lesbian, gay or bisexual youth means having the stigma of homosexuality or bisexuality. A stigma is anything that discredits an individual and leads to one being assigned a “spoiled identity.” With reference to lesbian, gay and bisexual youth, the stigma is considered a blemish on one’s character that often leads to stereotyping and stigmatisation. This homophobia puts many lesbian, gay and bisexual youth at risk for suicide, chemical abuse, dropping out of school, verbal and physical abuse, homelessness, prostitution, HIV infection, and psychosocial developmental delays. Approaches and strategies for working with lesbian, gay and bisexual youth are suggested and trends and issues about homosexuality in the United States, with a potential impact on lesbian, gay and bisexual youth, are discussed. © 1997 by The Haworth Press, Inc. All rights reserved.

Predictors of suicide attempts among gay, lesbian, and bisexual youth - Hershberger, S.L.; Pilkington, N.W.; D'Augelli, A.R. (Journal of Adolescent Research, 1997)
This research identified predictors of past suicide attempts in 194 lesbian, gay, and bisexual youth, 15 through 21 years of age, who attended social and recreational groups in urban community settings. In comparison to youth who made no suicide attempts, attempters reported that they had disclosed more completely their sexual orientation to others, had lost more friends because of their disclosures, and had experienced more victimization due to their sexual orientation. Suicide attempters had lower self-esteem and acknowledged more mental health problems. The loss of friends due to youth's sexual orientation, and current suicidal ideation were among the strongest predictors of suicide attempts. Youth who reported early awareness of their sexual orientation, disclosure to family and friends, peer rejection, and victimization based on their sexual orientation may be at risk for mental health problems.

Gay, lesbian, and bisexual adolescents: Providing esteem-enhancing care to a battered population - Nelson, J.A. (Nurse Practitioner, 1997)
Suicide, HIV Infection, violent victimization, homelessness, and substance use are known to affect gay (gay males, lesbians, and bisexual persons of both genders) youths at disproportionately high rates. This article explores the difficulties gay youths experience In this society specific to their sexual orientation. These difficulties become Internalized by many gay youths, leading to high rates of preventable morbidities and mortalities. Stages of the “coming out” process for gay persons are reviewed within the framework of child and adolescent development. Barriers within the health care system, as well as within other social systems, specific to gay youths are examined. Such barriers include language use by the provider, sexual and social history questions asked by the provider, environmental images in the health care setting, and the responses of the provider to the adolescent. Strategies such as the use of gender-neutral wording, homosexual inclusive questioning In history taking, and the use of inclusive environmental clues to allow gay adolescents to feel safe and accepted are discussed. Health care providers are encouraged to employ such strategies to help reduce these barriers within various health care settings. © Williams and Wilkins 1997. All Rights Reserved.

Suicidal behaviors in homosexual and bisexual males. - Bagley, C.; Tremblay, P. (Crisis, 1997)
A stratified random sample of 750 males in Calgary, Canada, aged 18-27 years, were given questions on sexual activity and orientation. Mental health questions included a measure of suicidality and of acts of deliberate self-harm. A computerized response format, which has been established as a good method for eliciting sensitive personal data, ensured anonymity. Almost 13% of the males were classified as homosexual or bisexual on the basis of being currently homosexually active or by self-identification. Significantly higher rates of previous suicidal ideas and actions were reported by homosexually oriented males than by heterosexual males. Homosexually oriented males accounted for 62.5% of suicide attempters. These findings, which indicate that homosexual and bisexual males are 13.9 times more at risk for a serious suicide attempt, are consonant with previous findings. The predominant reason for the suicidality of these young males may be linked to the process of "coming out," especially for those who currently have high levels of depression. These results underscore the need for qualified services rarely available to homosexually oriented youth.

Working toward recovery with the lesbian patient. - Lynch, M.A. (The American journal of nursing, 1997)

National Lesbian Health Care Survey: Implications for Mental Health Care - Bradford, J.; Caitlin, R.; Rothblum, E.D. (Journal of Lesbian Studies, 1997)
This article presents demographic, lifestyle, and mental health information about 1,925 lesbians from all 50 states who participated as respondents in the National Lesbian Health Care Survey (1984–1985), the most comprehensive study on U.S. lesbians to date. Over half the sample had had thoughts about suicide at some time, and 18% had attempted suicide. Thirty-seven percent had been physically abused as a child or adult, 32% had been raped or sexually attacked, and 19% had been involved in incestuous relationships while growing up. Almost one third used tobacco on a daily basis, and about 30% drank alcohol more than once a week, 6% daily. About three fourths had received counseling at some time, and half had done so for reasons of sadness and depression. Lesbians in the survey also were socially connected and had a variety of social supports, mostly within the lesbian community. However, few had come out to all family members and coworkers. Level of openness about lesbianism was associated with less fear of exposure and with more choices about mental health counseling. © 1988, The Haworth Press. All rights reserved.

The gay adolescent: Stressors, adaptations, and psychosocial interventions - Radkowsky, M.; Siegel, L.J. (Clinical Psychology Review, 1997)
Social stigmatization hinders the ability of gay adolescents to achieve the tasks of adolescence. Because their sexual identity is denigrated by society, these youth have difficulty forming a positive identity and establishing healthy peer and intimate relationships. Family relations are often painful, and gay adolescents are susceptible to loneliness, isolation, depression, and suicide. Validation of these adolescents' affectional and erotic feelings helps to normalize their adolescence, as does providing' them with a peer group of other gay youth.

Death by homicide in Special Hospitals - Gordon, H.; Oyebode, O.; Minne, C. (Journal of Forensic Psychiatry, 1997)
Homicide by psychiatric inpatients is rare. This paper outlines initially a review of the literature on patients who have killed fellow patients or staff whilst admitted to psychiatric hospitals. It then describes cases of such homicide by patients in Special Hospitals. Various factors which may be associated with such homicides are then discussed. These include the relationship of homicide to suicide, risk of homosexual interaction and associations between psychopathic disorder, homicide and escape. After a homicide has occurred a range of options may then occur according to clinical and administrative factors.
Keywords: Homicide; Special Hospitals

Lesbian Uses of and satisfaction with mental health services: Results from Boston Lesbian Health Project - Sorensen, L.; Roberts, S.J. (Journal of Homosexuality, 1997)
In response to the dearth of specific information about lesbians' health status and practices in the health literature, a national study utilizing a self-administered questionnaire was conducted in 1987 by four associates of the Fenway Community Health Center in Boston to access data in these areas. The questionnaire solicited information about demographics, health practices, stress in personal and work lives, mental and physical health problems, sexual practices, family history of health related problems, and genetic attributes hypothesized to be related to 'gayness.' Questionnaires from 1,633 lesbian women provided the database for the study. This paper discusses the portion of the survey that dealt with mental health services and life experiences. Past studies that investigated mental health needs of lesbians focused on the quality of treatment by mental health providers, rates of suicide attempts, and alcoholism. This paper compares these past findings with the responses of the lesbians in this national, community-based study. Findings indicate that although a significant number of the lesbian women in this sample had been in therapy, they sought out therapy as a coping strategy to deal with similar issues as other women, i.e., depression and relationships. Suicide attempts decreased considerably after adolescence and 'coming out.' Rates of alcohol use and abuse, although difficult to compare with other studies, were higher than other women but similar to other studies investigating a community sample of lesbians. Even with a high family history of alcoholism, less than 5 percent reported having sought out therapy to deal with any issues of alcohol or drug use.

Suicidal ideation, bereavement, HIV serostatus and psychosocial variables in partners of men with AIDS - Rosengard, C.; Folkman, S. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 1997)
This prospective 2-year study examines suicidal ideation in 86 HIV-positive and 167 HIV-negative caregiving partners of men with AIDS. One hundred and fifty-six of the caregivers became bereaved during the course of the study. The study focuses on the relationship between suicidal ideation and bereavement status (bereaved vs non-bereaved), HIV serostatus (HIV-positive vs HIV-negative), and psycho-social factors (caregiving burdens, social support, coping, and optimism). Bereavement was related to suicidal ideation, but HIV serostatus was not. High suicidal ideators were characterized by feeling burdened by caregiving, perceiving low levels of social support and subjective social integration, and the use of behavioural escape-avoidance coping. Those who reported never having suicidal ideation were characterized by higher levels of optimism. Clinical implications are discussed.

D.C. hospital must pay $400,000 for forced test and denial of care. (AIDS policy & law, 1997)
A gay man who was tested for HIV without consent will be compensated upwards of $400,000 by Howard University Hospital in Washington, DC. The patient, John Doe, had taken an overdose of aspirin in a suicide attempt. He was stabilized, however, due to a policy that was in effect at the time, he was refused admittance to the psychiatric ward prior to a determination that he was free of infectious disease. John Doe filed a complaint with the DC Commission on Human Rights one year after hospital discharge, alleging that Howard University Hospital violated the District Human Rights Act. The statute bars discrimination on the basis of sexual orientation. The Commission found that the hospital failed to show necessity for excluding Doe from the psychiatric ward and awarded Doe $8,920 for lost income. Doe lost his job when his employer discovered that his test result was positive. In January 1993, Doe persuaded the DC Court of Appeals to reverse the Commission's decision regarding the statute of limitations on claim filing and failing to award Doe damages for discrimination. The court remanded the case but the Commission took no action for three years. The attorney's for Doe's estate filed a mandamus action to compel a decision. In April 1997, the Commission ordered Howard University to pay Doe for emotional distress as well as attorney and litigation fees.

Autopsy findings on patients with AIDS in Taiwan. - Hsiao, C.H.; Huang, S.H.; Huang, S.F.; Song, C.L.; Su, I.J.; Chuang, C.Y.; Yao, Y.T.; Lin, C.T.; Hsu, H.C. (Zhonghua Minguo wei sheng wu ji mian yi xue za zhi = Chinese journal of microbiology and immunology, 1997)
At National Taiwan University Hospital, from 1986 to 1996, autopsies were performed on 16 patients with acquired immunodeficiency syndrome. There were 15 men and 1 woman. Fourteen of these male patients had contracted the disease as a result of sexual practice, among which 9 were homosexual, 1 was bisexual and 4 were heterosexual. One of the patients had become infected by sharing a syringe during intravenous drug use. The female was a sex worker. Among these patients, only 2 had been tested for HIV before developing AIDS. On autopsy, lymphoid depletion and thymus atrophy were found in all patients. Testicular atrophy was noted in all the male patients. Three patients died of malignant lymphoma. Twelve patients died of opportunistic infections and 1 committed suicide. The initial opportunistic infection was usually oral candidiasis. Pneumocystis carinii pneumonia (PCP) was the most common opportunistic infection developed in the early stage while cytomegalovirus (CMV) infection was the most common one found in the late stage. Mycobacterium infection had developed in 8 patients. Six patients had disseminated Kaposi's sarcoma (KS) and 4 of them were homosexual. In 4 patients, biopsy specimens were proved to have KS associated viral (HHV-8) genome. Malignant lymphoma was found in 4 cases, all were of high grade B cell type. Epstein-Barr virus (EBV) encoding small RNA (EBER1) was demonstrated in all the lymphomas. In conclusion, (1) the prevalence of tuberculosis (38%) in patients with AIDS in Taiwan is high; (2) the most common opportunistic infections in this series are candidiasis, PCP and CMV infections; (3) the incidence of AIDS related non-Hodgkin's lymphoma in Taiwan has increased since 1995.

Indirect minority influence: Evidence for leniency in source evaluation and counterargumentation - Alvaro, E.M.; Crano, W.D. (Journal of Personality and Social Psychology, 1997)
In-group minorities instigate indirect change because of their distinctiveness, the unexpectedness of their position, and their common identity with their targets. Preliminary study (N = 408) uncovered links among a set of attitudes and revealed participants were unaware of the relationship between some attitudes despite significant correlation and proximity in multidimensional space. Study 1 (N = 222) advocated a ban of homosexual soldiers attributed to majority, in-group, or out-group minority sources. No direct influence was evident. When credited to an in-group minority, the message influenced attitudes toward gun control, which were linked to the focal beliefs. Relative to other sources, the in-group minority was more positively evaluated, and its message less strongly counterargued (both p < .05). Study 2 (N = 78) reversed direct and indirect attitude objects and replicated these results. Study 3 (N = 66) examined majority influence and revealed direct, but not indirect, majority influence when participants' membership group was threatened. Copyright 1997 by the American Psychological Association, Inc.

Genes and human behavior: the emerging paradigm. - Drew, A.P. (Zygon, 1997)
The physical properties of human beings and other organisms as well as their social behavioral traits are manifestations of both genetic inheritance and environment. Recent behavioral research has indicated that certain characteristics or behaviors--such as schizophrenia, divorce, and homosexuality--are highly heritable and are not governed exclusively by social environment. A balanced view of human behavior includes the effects of social learning as well as of genetically determined behavior. A new paradigm promotes enhanced understanding and acceptance of human diversity, be it cultural, racial, or sexual, and has the potential to unite scientists and theologians by creating common grounds of understanding.

The association of weapon carrying and fighting on school property and other health risk and problem behaviors among high school students - DuRant, R.H.; Kahn, J.; Beckford, P.H.; Woods, E.R. (Archives of Pediatrics and Adolescent Medicine, 1997)
Objective: To examine the association between weapon carrying on school property and engaging in health risk and problem behaviors such as fighting and substance use on school property, fear of attending school, and victimization at school. Designs: A complex 2-stage probability survey (Massachusetts Youth Risk Behavior Survey). Setting: High schools in Massachusetts. Participants: Three thousand fifty-four high school students. Main Outcome Measures: Number of days a weapon was carried on school property during the 30 days prior to the survey. Results: The prevalence of self- reported weapon carrying on school property was 15% among male students and 5% among female students (P< .001). Weapon carrying on school property was significantly (P<.001) associated with frequency of physical fights on school property (r=0.26), being a victim of threat or injury with a weapon on school property (r=0.27), being a victim of stolen or damaged goods on school property (r=0.14), not attending school owing to fear (r= 0.15), and substance use while at school, including smoking cigarettes (r=0.20), using chewing tobacco (r=0.18), smoking marijuana (r=0.24), and using alcohol (r=0.29). The association between weapon carrying and alcohol use in school was higher among students who were afraid to come to school (r= 0.49) than among students who were not afraid (r= 0.28). Students who had engaged in same-sex sexual activity (P<.001) or had been offered, given, or said illicit drugs at school (P<.001) were more likely to carry a weapon at school. Multiple regression analysis showed that male sex and the frequencies of physical fighting, being a victim of a threat or injury, drinking alcohol, smoking cigarettes, and being offered or said an illicit drug while on school property accounted for 21% of the variance in weapon carrying in school. When weapon carrying was dichotomized and analyzed with logistic regression, a model containing age, male sex, lower academic achievement, days not attending school owing to fear, times threatened or injured with a weapon at school, frequency of fighting at school, cigarette smoking, alcohol use, and being offered or said illicit drugs on school property correctly classified 91.83% of the students who did or did not carry weapons. Conclusions: Weapon carrying at school was more strongly associated more with use of violence and the use of substances at school than with previous victimization and fear of attending school. However, there is a subgroup of students that seems to have been victimized at school, is afraid to come to school, is using alcohol at school, and is carrying weapons at school.

Lesbian Youth Support Information Service (LYSIS): Developing a distance support agency for young lesbians - Bridget, J.; Lucille, S. (Journal of Community and Applied Social Psychology, 1996)
The Lesbian Youth Support Information Service (LYSIS) was established in 1991 as a result of research conducted into the needs and experiences of young lesbians. This research found that young lesbians are vulnerable to mental health problems, including depression, attempted suicide, self-harming behaviours and alcohol misuse, as well as isolation and social rejection. There were also strong indications that young lesbians are most vulnerable when they are coming to terms with their sexual orientation. LYSIS offers support to young lesbians in four main ways: correspondence counselling; telephone counselling; peer support; and information. LYSIS is part of an umbrella organization, the Lesbian Information Service (LIS), which provides indirect support for young lesbians including publishing, education and training, projects and campaigning.
Keywords: Counselling; Information; Lesbian; Mental health; Peer support; Support; Young women

Death waits for no man, but OIs do. - Vazquez, E. (Positively aware : the monthly journal of the Test Positive Aware Network, 1996)
Opportunistic infections (OIs) continue to be a leading cause of death in persons with AIDS, and have been found to be more prevalent in some populations than others. Researchers investigated which OIs occured most among three categories of HIV transmission: homosexual and bisexual men, intravenous drug users, and female partners. Death from cytomegalovirus (CMV), toxoplasmosis, and Kaposi's sarcoma occurs in homosexual and bisexual groups. Women have a much higher risk of bacterial pneumonia and bacterial sepsis. Injection drug users suffer greater risks of bacterial pneumonia and non-HIV related causes such as liver damage, heart attack, suicide and drug overdose. Female drug users had the poorest prognosis of any group studied, due to lower income and educational levels, and less healthy lifestyles.

Sex, death, and the courts: Compassion in Dying v. State of Washington; Quill v. Vacco; Romer v. Evans. - Dworkin, R. (The New York review of books, 1996)

Issues and implications in the counseling of survivors of multiple aids-related loss - Nord, D. (Death Studies, 1996)
Survivors of multiple AIDS-related loss face a unique phenomenon for which existing theories and diagnostic criteria regarding grief and trauma are inadequate. Unresolved grief and complicated bereavement are normal responses to multiple loss. This distinctive experience and the resulting symptoms have implications for counselors. Suggestions are offered for counselors to help clients process the aggregate and individual losses arising from this experience. AIDS provides a rare opportunity to analyze concurrent traumatization and complicated bereavement occurring on an ongoing basis. This analysis and its implications may therefore be useful in the future in regard to tragedies that share these characteristics. © 1996 Taylor & Francis Group, LLC.

Erratum to: Breaking Through the Wall of Silence: Gay, Lesbian, and Bisexual Issues for Middle Level Educators (Middle School Journal, (1996), 10.1080/00940771.1996.11461661) (Middle School Journal, 1996)
Erratum: On pages 39 and 40 of the Bailey & Phariss article appearing in theJanuary 1996 issue of MSJ is a misstatement regarding adolescent suicide. The correct statement should read: "it was estimated that gay and lesbian youth are two to three times more likely to attempt suicide than their heterosexual peers". © Copyright 1996 NMSA.

Euthanasia and physician-assisted suicide in homosexual men with AIDS - Bindels, P.J.E.; Krol, A.; Van Ameijden, E.; Mulder-Folkerts, D.K.F.; Van Den Hoek, J.A.R.; Van Griensven, G.P.J.; Coutinho, R.A. (Lancet, 1996)
Background: In the Netherlands a nationwide study has shown that, in 38% of deaths, there have been medical decisions concerning the end of life (MDEL); 2.1% of all deaths were brought about by euthanasia or physician-assisted suicide (PAS). We investigated the incidence of MDEL in homosexual men with AIDS, suspecting that it might be higher, and studied the effect of euthanasia/PAS on survival time. Methods: The patients were 131 male homosexual participants in a cohort study in Amsterdam, diagnosed between 1985 and 1992 as having AIDS; all had died before Jan 1, 1995. Clinical and laboratory data and information on mode of death were obtained from their physicians and by review of hospital records. Those who died by euthanasia/PAS or in whom there had been other MDEL were then compared with those who died naturally. Findings: 29 men (22%) had died by euthanasia/PAS and in 17 (13%) another MDEL had been made; thus, more than one-third of these men had made medical decisions concerning the end of life. The greatest difference between the groups was in age at time of diagnosis - 72% aged 40 or more in the euthanasia/PAS group compared with 38% in the natural death group. The likelihood (relative risk) of euthanasia/PAS increased with duration of survival after AIDS diagnosis. Comparison of the groups in terms of three laboratory markers (CD4+ and CD8+ cells and phytohaemagglutinin responses) in the two years before death, and estimates of these markers at the time of death, did not indicate any substantial shortening of life by euthanasia/PAS; in the judgment of the physicians, most of these patients would have died naturally within one month. Interpretation: A possible reason for the high incidence of MDEL in this cohort was a good knowledge of the characteristics of AIDS acquired through long-term awareness of HIV infection. The higher rate of euthanasia in those with long survival from AIDS diagnosis could reflect either additional suffering or the greater opportunity to discuss this option with friends and physicians. Our findings indicate that euthanasia and other MDEL did little to shorten life; rather, they were an extreme form of palliation, applied in the terminal phase of a lethal disease.

Primary care of lesbian and gay patients: Educating ourselves and our students - Harrison, A.E. (Family Medicine, 1996)
Although a significant proportion of the population is gay or lesbian, physicians receive little formal training about homosexuality, and the unique health care needs of these patients are often ignored. Gay men and women may have higher rates of depression, suicide, alcoholism, certain cancers, and cardiovascular disease than their heterosexual counterparts. In addition, they are at risk of being victims of violence because of their sexual orientation. Due to fear of stigmatization by the medical community, the most significant health risk for lesbians, gays, and bisexuals may be that they avoid routine health care. Gay youth are particularly vulnerable to internal and external pressures, resulting in higher rates of substance abuse, suicide, and homelessness. Older gay men and women, who generally view themselves positively, may be troubled by declining health and loneliness. Physicians can improve the health care of gay and bisexual men and women and their families by maintaining a non-homophobic attitude toward these patients, distinguishing sexual behavior from sexual identity, communicating with gender-neutral terms, and maintaining awareness of how their own attitudes affect clinical judgment. Medical educators should avoid making assumptions about the sexuality of their residents and students. Institutions need to realize that the presence of supportive heterosexual and openly gay faculty will help create an environment that fosters learning for all students. Scant research exists about the best ways to teach about the special challenges gay men and lesbians face. However, the majority of surveyed medical students prefer that issues regarding gays and lesbians be integrated throughout the entire medical school curriculum.

Witness's AIDS diagnosis seen as probative to alibi. (AIDS policy & law, 1996)
A Virginia Beach Circuit Court jury found Kevin W. Kirk guilty on two counts of robbing a convenience store and three counts of possessing a firearm. During the cross examination, Kirk's alibi witness and gay lover disclosed that he has AIDS. On appeal, Kirk argued that the trial judge erred in letting jurors hear testimony related to homosexuality and AIDS because the statements were irrelevant and prejudicial. The Virginia Court of Appeals rejected Kirk's appeal and his argument that he be tried separately for each charge.

Attitudes towards gays and lesbians serving in the military - Harris, M.B.; Vanderhoof, J. (Journal of Gay and Lesbian Social Services, 1996)
The purpose of the resent study was to identify correlates of attitudes towards permitting gays and lesbians to serve in the military. Two studies were conducted, one with 210 adults enrolled in classes at a university and one with 31 high school students, most of whom were enrolled in ROTC classes. Although the high school students were more conservative, both samples revealed the high school students were more conservative, both samples revealed the same general pattern of findings. Support for having gays and lesbians serve in the military was closely related to endorsement of arguments in favor of their service, and both samples revealed the same general pattern of findings. Support for having gays and lesbians serve in the military was closely related to endorsement of arguments in favor of their service, and both variables were related to a complex of other conservative values as well as to personal acquaintance with gays and lesbians and to factual knowledge about homosexuality. People with less conservative views on a number of issues, who knew more gay and lesbian individuals, who knew more about homosexuality, who did not belong to a traditional religion, who did not own guns, and who were female were more likely to agree that gays and guns, ands who were female were more likely to agree that gays and lesbian should be permitted to service in the military. The results imply that increasing knowledge and personal familiarity might lead to greater acceptance of military service for gay and lesbians. Ways in which social service providers can use these findings to improve service to gay and lesbian client are discussed. © 1996 by The Haworth Press, Inc. All rights reserved.

Issues in the treatment of lesbian women and gay men with chronic mental illness - Hellman, R.E. (Psychiatric Services, 1996)
A growing theoretical and practical body of knowledge recognizes the common clinical concerns of chronic psychiatric patients who are homosexual and promotes their affirmative inclusion in psychiatric programs for other persons with chronic mental illness. This paper provides a clinical context for understanding essential issues in the inpatient and outpatient treatment of chronic psychiatric patients who are gay men or lesbian women. Such patients are largely an ignored or invisible subgroup in long-term psychiatric programs and in the gay and lesbian community. They are dependent on therapeutic communities, residences, and families that are heterosexually acculturated and often unaware of their needs. Most have experienced antihomosexual prejudice and the stigmatizing effects of mental illness. Affirmative models of treatment can be adapted to this population but must be modified to accommodate their psychiatric deficits. Increased efforts to destigmatize both mental illness and homosexuality are needed.

The school psychologist's role in suicide prevention - Sandoval, J.; Brock, S.E. (School Psychology Quarterly, 1996)
Youth suicide is a leading cause of death among adolescents and represents a major health problem for this population. The school psychologist's involvement in this health issue spans primary, secondary, and tertiary prevention and working with the aftermath of a suicide or suicide attempt. Primary prevention activities involve supporting and delivering curricula educating youth about suicide in general and promoting social problem solving in the school milieu. Other primary prevention activities include: Screening all students for suicidal ideation, creating networks of peer helpers, working to reduce the availability of suicidal means (e.g. gun control), training school personnel to identify and refer potentially suicidal individuals, and establishing interdisciplinary crisis response teams. Secondary prevention involves working with individuals and groups at risk for engaging in suicidal behavior. Special education, alternative education students, gay and lesbian youth, certain ethnic minority youth, and individuals with psychopathology need to receive differential services and attention. Tertiary prevention requires swift treatment and referral. Services delivered following a suicide are termed "postvention." Suicide survivors obviously must receive services as part of tertiary prevention, but school psychologists must be prepared to advise school personnel on such issues as memorializing a death, communicating information, and squelching rumors.

Erratum: Sexual orientation in adolescents who commit suicide (Suicide and Life-threatening Behavior (1995) 26:2 (218)) - Shaffer, D.; Gould, M.; Fisher, P.; Trautman, P.; Moreau, D.; Kleinman, M.; Flory, M. (Suicide and Life-Threatening Behavior, 1996)

The agony of Pyotr Ilyich Tchaikovsky - Vogelaar, P.W. (Medical Problems of Performing Artists, 1996)
This article intends to establish that the likely cause of death of Pyotr Ilyich Tchaikovsky at the age of 53 was enforced suicide. His homosexuality is examined in light of recent medical research, which appears to indicate that sexual orientation is biologically determined. His psychological profile is also analyzed, highlighting the period around his marriage at the age of 37, and the period shortly before his death. In addition, Tchaikovsky's emotional states during the composition of his Manfred Symphony and of the Sixth Symphony (Pathetique) are discussed.

New South Wales Council for Civil Liberties - Kirby, M. (Australian Journal of Forensic Sciences, 1996)

Longitudinal change in youth suicide mortality in Okinawa after World War II: A comparative study with mainland Japan - Kageyama, T.; Naka, K. (Psychiatry and Clinical Neurosciences, 1996)
Okinawa prefecture has a unique socio-cultural status in Japan including the experience of having been occupied by the USA from the end of World War II to 1972. In this study, the longitudinal change in youth suicide mortality for those aged 10-29 years in Okinawa (1960-90) was compared with that for the same sex-age groups in mainland Japan (1950-90). In contrast with mainland Japan, no dramatic change in the youth suicide mortality was observed in Okinawa in the 1960s. The rise and fall of teenage suicide mortality in Okinawa during the 1970-80s might be associated with 'reversion anxiety', rather than with the traumatic experience of World War II itself. This seems to be inconsistent with previous speculation regarding the change in youth suicide mortality in mainland Japan. The suicide mortality for men aged 20-29 in Okinawa was significantly higher than that for the same sex age group in mainland Japan through the observed period. The possible effects of the USA occupation, economic anomie or migration on the suicide in Okinawa should be further examined.
Keywords: Okinawa; social anxiety; traumatic experience; World War II; youth suicide mortality

AIDS, euthanasia and nursing. - Ogden, R. (Nursing standard (Royal College of Nursing (Great Britain) : 1987), 1996)
Requests for euthanasia can pose a dilemma for nurses. Some of the arguments for and against euthanasia are presented here together with a summary of a study into the phenomenon of 'underground' euthanasia. These are considered in relation to the law and nursing ethics.

Methemoglobinemia secondary to cleaning solution ingestion - Freeman, L.; Wolford, R.W. (Journal of Emergency Medicine, 1996)
Methemoglobinemia is a rare cause of cyanosis in pediatric patients. A 16-month-old male presented to the Emergency Department cyanotic and short of breath after ingestion of a hair-care-equipment cleaning solution. After calling the salon and consulting Polsindex, the substance was found to be Mar-V-cide, containing 20% Hyamine 3500, 50% cationic detergents, 20% isopropyl alcohol, and 1% sodium nitrite, which caused the methemoglobinemia in this case. Initial pulse oximetry on room air was 72% and improved minimally with supplemental oxygen. The patient's methemoglobin level was 63%. Methylene blue was administered (2 mg/kg intravenously), and the patient rapidly improved. Nitrates occur in high concentrations in some fond and water. Infants are particularly susceptible to chronic nitrate-induced methemoglobinemia because of their low stomach acid production, large numbers of nitrite-reducing bacteria, and the relatively easy oxidation of fetal hemoglobin. Acute nitrite toxicity results from industrial exposure, accidental ingestion (e.g., abuse of organic nitrites as an aphrodisiac, especially in the male homosexual population), and suicidal ingestion. Methemoglobinemia may occur in a number of drug or chemical ingestions, but a comprehensive review of the literature failed to identify a similar reported case.
Keywords: ingestion; methemoglobinemia; pediatric; poisoning

An equal struggle (psychodynamic assessment following repeated episodes of deliberate self harm) - Jones, A. (Journal of Psychiatric and Mental Health Nursing, 1996)
Psychodynamic psychotherapy is a complex method of enabling a person to engage with life difficulties. This narrative paper investigates the value of psychodynamic psychotherapy within the framework of the 'Health of the Nation' document (Department of Health 1992). The paper explores an encounter with a young gay man who was admitted to the medical unit following an episode of deliberate self harm, in response to profound and the-matic relationship difficulties. The writer (a liaison mental health nurse, working in a general hospital setting) examines the complexities of the transference, countertransference relationship. A case is made for the facilitation of choice as a primary goal of therapy. It is suggested that the inauguration of transference resolution is determined through an equi-table relationship, in which therapist and client are engaged equally in the struggle toward understanding. The paper concludes with the suggestion that psychotherapy is an appropriate and effective method for dealing with relational conflict. However, personal, temporal and social resources may not provide the client with what is, in Kleinian terms, a necessary holding environment. The assessment process nevertheless can provide important learning and enable significant changes to be made in supportive networks. © 1996 Blackwell Science Ltd.
Keywords: Assessment; Clinical supervision; Health of the nation; Psychotherapy; Suicide

A simulation model of the dynamics of HIV transmission in intravenous drug users - Atkinson, J. (Computers and Biomedical Research, 1996)
The complex dynamics of HIV transmission and subsequent progression to AIDS make the use of traditional mathematical modeling techniques problematic. In a previous paper for this journal, Leslie and Brunham established the utility of a nonmathematical simulation language in modeling HIV transfer under conditions similar to those found among homosexual males. This study considers the application of such an approach in modeling HIV spread among intravenous drug users (IDUs) injecting within a 'shooting gallery,' a location providing a common needle supply to a large number of users. Modeling HIV transmission in this population involves not only consideration of heterogeneity in partnership selection, but also of the fact that spread of the virus is not directly from person to person, but via injection equipment. The General Purpose Simulation System was used to create a hypothetical cohort of IDUs, drawing from a common needle supply. Following introduction of an index case, the HIV infection rate in this cohort was followed over 5 simulated years. The model was then used to consider the effects of systematic variation in the frequency of injection and needle-cleaning behavior.

Biological rhythms in the human life cycle and their relationship to functional changes in the suprachiasmatic nucleus - Swaab, D.F.; Van Someren, E.J.W.; Zhou, J.N.; Hofman, M.A. (Progress in Brain Research, 1996)
Biological rhythms play a prominent role in the human life cycle. The endogenous rhythms are entrained by the environment and have an astronomical counterpart which is obvious for daily, monthly, and yearly rhythms, and may possibly also be present in weekly rhythms. Circadian rhythms are present in, e.g. testosterone levels, spontaneous birth, strokes, and death from cardiovascular causes. Circaseptan rhythms are present in, e.g. spontaneous birth, 17-ketosteroid levels, myocardial infarctions, and strokes. The relationship of these rhythms with the suprachiasmatic nucleus (SCN) has not yet been established. Circatrigintan rhythms, such as the menstrual cycle, have so far not been associated with the SCN. Circannual rhythms are present in, e.g. mood, suicides, reproduction, birth weight, sleep and season of birth of psychiatric patients. The human SCN shows strong circadian and circannual fluctuations in the number of neurons expressing vasopressin. The vasopressin and VIP cell population of the SCN develop late, i.e. for a major part postnatally. After the age of 50 the amplitudes of circadian and circannual fluctuations of the vasopressin cell numbers are reduced whereas the number of vasopressin expressing neurons decreases after the age of 80 and do so even more and earlier in Alzheimer's disease. Sex differences are present in the shape of the vasopressin subnucleus of the SCN and in the vasoactive intestinal polypeptide (VIP) cell number. The sex differences in the SCN, the doubling of the number of vasopressin neurons in the SCN of homosexual men, and a variety of animal experimental observations indicate that the SCN is involved in sexual behavior and reproduction. The exact role of the SCN in these processes is subject to current research.

Evaluation of statewide education program for school clinic staff - Wells, D.B.; Teagle, S.E.; Brinsfield, C.; Cleveland, E.R.; Hardin, B.H.; Peterson, M.S.; Portilla, M.G.; Pumphrey, C.L.; Smith, P.D.; West, B. (Journal of Investigative Medicine, 1996)
In an effort to improve access to health care among adolescents, the AR Dept. of Health (ADH) operates 22 school-based clinics statewide. School-based clinic staff, however, lack training in comprehensive adolescent health care. To address this need, the adolescent health divisions of ADH and AR Children's Hosp. (ACH) developed a 3-day fellowship program (grant MCJ05SH01, DHS). The training consisted of rotations through the comprehensive adolescent clinic at ACH, lectures, and individual case conferences. Each participant was instructed on how to take a comprehensive adolescent case history and were required to complete one before exiting the program. To evaluate the program, 1 pre- and 2 post- tests (after 3 days, and 4 mos. post) were conducted. We evaluated clinic staffs' comfort levels, using a 5-point scale ( 1=extremely uncomfortable; 5=extremely comfortable), in discussing 22 health-related topics with adolescents. The sample included 35 subjects, the majority of whom were female (97%) and Caucasian (57%). Most of the participants were RNs, LPNs, health educators, or social workers, ranging in age from 20 - 40 yrs. The average yrs. of experience working with adolescents was 6 yrs (SD=6.62). Preliminary analysis of the pre- and first post-test indicated that, overall, participants reported greater comfort discussing sexuality issues, including family planning (34.5%), STDs (31%), and high risk behaviors (24.1%). Participants reported they were "extremely uncomfortable" discussing abortion (10.3%), sports-related injuries (7.1%), and homosexuality (3.7%). Participants reported they were "very uncomfortable" discussing rape (28.6%), psychosomatic complaints (27.6%), family conflict (20.7%), and suicide (17.9%). By the end of the 3 days, participants reported an increase in their comfort levels discussing 95% of the 22 health topics. They reported the largest decline in discomfort levels discussing psychosomatic complaints (73.1% decline), suicide (37.9%), and family conflict (28.5%). The final report will include data from the second post-test to examine longer-term change. Preliminary results indicate the need for future school health staff training efforts that focus on issues participants are "uncomfortable" discussing with adolescents.

Adult male survivors of childhood sexual abuse: Prevalence, sexual abuse characteristics, and long-term effects - Dhaliwal, G.K.; Gauzas, L.; Antonowicz, D.H.; Ross, R.R. (Clinical Psychology Review, 1996)
Despite the plethora of research literature on female victims of childhood sexual abuse, it is only recently that male victims have received some attention. The present paper critically reviews the literature on men who had been sexually abused in childhood. It examines the issues of prevalence, nature of the abuse, and the long-term effects of childhood sexual abuse. Where provided, comparisons between men and women who had been sexually abused as children are included. This review identifies several gaps in the literature that warrant measures to be taken in order to enhance our understanding of male sexual abuse. The tentative conclusion at this juncture is that a significant number of men has been sexually abused in childhood, and that very little empirically-sound research has been undertaken to better the present situation of such individuals.

The health status of adolesents in Canada - Tonkin, R.S.; Frappier, J.-Y.; Goldberg, E.; Westwood, M. (International Pediatrics, 1995)
Adolescents in Canada share similar developmental challenges and health concerns to those experienced elsewhere. However, there are differences in how these issues manifest themselves, and in the way that adolescent health services are funded and delivered. This article describes these differences from both a historical and an international perspective. Canada's youth are healthy and have ready access to prepaid hospital and medical care. Primary care services are largely provided by family physicians while there is a network of specialists and tertiary care hospitals. In some provinces, adolescents can access a range of community-based services such as community health centers, family planning and/or sexually transmitted disease clinics, and mental health units. The main health concerns of adolescents in Canada include: mental health problems, issues related to sexual health, alcohol and substance misuse, and injuries. Issues such as teen pregnancy, multiple drug use, physical and sexual abuse, and suicide are more common in marginalized adolescents (aboriginals, gay and lesbian, disabled or chronically ill) in Canada than in the general adolescent population.

Chapter 1: Aids and homophobia/heterosexism - Appleby, G.A. (Journal of Gay and Lesbian Social Services, 1995)
Homophobia and heterosexism are complementary social processes that shaped the social construction and the public health response to AIDS. Both concepts view gay and lesbian oppression from different vantage points. Homophobia is a weapon of sexism and is manifested in fear and hatred. Heterosexism is an ideological system that denigrates non-heterosexual behavior. Both processes are well served by the social institutions of family, religion, law, and the ideologies of sexuality and gender. The consequences have been societal and personal: inadequate HIV medical and social services; lack of a national AIDS policy; widespread discrimination and prejudice against gay men, lesbians, and persons living with AIDS; stress, violence, and suicide; substance abuse; and HIV risk behavior and relapse. Mental health and social services, social supports, education and prevention programs, community development, and social action to broaden civil rights and to challenge institutional oppression are required to counter the ravages of hate and discrimination. © 1995 Taylor & Francis Group, LLC.

Homosexuality, type 1: An Xq28 phenomenon - Turner, W.J. (Archives of Sexual Behavior, 1995)
Despite the absence of phenotypic manifestations in alternating generations characteristic of X-linked disorders, a thesis is presented that a major type of Kinsey grades 5 and 6 male homosexuality is determined by a gene in the Xq28 region. A total of 133 families in 78 kinships of male and female homosexual probands, in addition to 116 families (including those of 40 famous homosexuals) from the literature, revealed an unbalanced secondary sex ratio in the maternal generation of male, but not of female, homosexuals. On the maternal side, in this study, the ratio of all uncles to all aunts of 90 males homosexuals was 132/209, χ2 = 8.52, p = 0.004. On the maternal side for the total of all sources, the ratio of uncles to aunts of male homosexuals was 241/367, χ2 = 13.20; p < 0.0001. The male/female ratio of the total number of maternal sibships bearing homosexuals (310/628: 0.491) was a measure of fetal wastage of the mothers' male sibs: 49%. This ratio was very close to that of the total number of children born to fathers affected with any one of nine Xq28-linked male semilethal conditions (255/508: ratio 0.556); for the difference between the two populations χ2 = 0.859, p = 0.354. The male/female ratio of the total number of children born to female carriers of any one of these same conditions (1,232/1,062: ratio 1.16), χ2 = 13.8 p ≤0.0001, is close to that of the total number of children in homosexual sibships: 511/413, χ2 = 10.4, p = 0.005. Between the number of children born to Xq28 mothers and to those born of mothers of homosexuals χ2 = 0.581, p = 0.446. One may readily surmise that the maternal influence so often related to homosexuality may lie in the mother being a genetic carrier, with traits thereto associated. In this study, 65% of the mothers of homosexuals had no or only one live-born brother. Additional support for a genetic hypothesis is found in the occurrence of multiple instances-almost exclusively among maternal relatives-of infertility, spontaneous abortions, miscarriages, stillbirths, remaining single past age 30, and suicide. Of 109 male and 43 female homosexual index cases in the present series there were 6 instances of brother/sister homosexual sibships. Instances of homosexual parent-to-homosexual child transmission occurred as follows: one father-to-son; one father-to-daughter; one bisexual father-son; one father/mother-to-2 sons; one of mother-to-son, and one of father-to-son and father-to-bisexual daughter. There were 16 instances of presumptive transmissions from heterosexual father-to-homosexual son and 5 of heterosexual father-to-homosexual daughter. A hypothesis is proposed: Homosexuality is due to a gene at Xq28 characterized by (i) elongated cytosine-containing trinucleotide repeats upstream to translation of a gene, (ii) elongated CpG islands upstream of the trinucleotides, and (iii) cytosine methylation of CpG islands and of the cytosine-containing trinucleotides. © 1995 Plenum Publishing Corporation.
Keywords: genetic; homosexuality; methylation; nucleotide repeats; pseudoautosomal; sex ratio; Xq28

The Impact of Victimization on the Mental Health and Suicidality of Lesbian, Gay, and Bisexual Youths - Hershberger, S.L.; D'Augelli, A.R. (Developmental Psychology, 1995)
Lesbian, gay, and bisexual youths 15 to 21 years old were studied to determine the impact of verbal abuse, threat of attacks, and assault on their mental health, including suicide. Family support and self-acceptance were hypothesized to act as mediators of the victimization and mental health-suicide relation. Structural equation modeling revealed that in addition to a direct effect of victimization on mental health, family support and self-acceptance in concert mediated the victimization and mental health relation. Victimization was not directly related to suicide. Victimization interacted with family support to influence mental health, but only for low levels of victimization. © 1995 American Psychological Association.

Suicide and Sexual Orientation: A Critical Summary of Recent Research and Directions for Future Research - Muehrer, P. (Suicide and Life‐Threatening Behavior, 1995)
Research on the hypothesized relationship between sexual orientation and suicide is limited both in quantity and quality. National or statewide data on the frequency and causes of completed suicide in gay and lesbian people in the general population, including youth, do not exist. Similarly, national or statewide data on the frequency of suicide attempts among the general population or among gay and lesbian people, including youth, do not exist. Methodological limitations in the small research literature include a lack of consensus on definitions for key terms such as suicide attempt and sexual orientation, uncertain reliability and validity of measures for these terms, nonrepresentative samples, and a lack of appropriate nongay and/or nonclinical control groups for making accurate comparisons. These numerous methodological limitations prevent accurate conclusions about the role sexual orientation might play in suicidal behavior; the limitations also suggest opportunities for future research. Furthermore, recent evaluations of some school suicide‐awareness programs suggest that these programs are ineffective and may actually have unintended negative effects. The premature dissemination of unproven programs is unwarranted. 1995 The American Association for Suicidology

Sexual Orientation in Adolescents Who Commit Suicide - Shaffer, D.; Hicks, R.H.; Parides, M.; Gould, M. (Suicide and Life‐Threatening Behavior, 1995)
It has been suggested that there is a strong relationship between suicidal behavior and homosexuality in adolescence. It has been further suggested that it is due to the stigmatization and feelings of isolation that are experienced by many gay adolescents. Much of the literature that has given support to these hypotheses has been conducted on uncontrolled nonrepresentative samples and its generalizability is open to question. An opportunity to examine the relationship in an unselected sample arose in a case control, psychological autopsy study of 120 of 170 consecutive suicides under age 20 and 147 community age, sex, and ethnic matched controls living in the Greater New York City area. Homosexuality was defined as having had homosexual experiences or having declared a homosexual orientation. Three teenagers and no controls met these criteria. The difference was not significant. The circumstances of death were examined and are described. In no instance did suicide directly follow an episode of stigmatization. All three suicides had evidence of significant psychiatric disorder before death. In spite of opportunities for biased reporting, it is concluded that this study finds no evidence that suicide is a common characteristic of gay youth, or that when suicide does occur among gay teenagers, that it is a direct consequence of stigmatization or lack of support. 1995 The American Association for Suicidology

Introduction to Supplemental Issue: Research Issues in Suicide and Sexual Orientation - Mościcki, E.K.; Muehrer, P.; Potter, L.B. (Suicide and Life‐Threatening Behavior, 1995)

Report on lesbian health - Denenberg, R. (Women's Health Issues, 1995)

Recommendations for a Research Agenda in Suicide and Sexual Orientation: Working Groups, Workshop on Suicide and Sexual Orientation (Suicide and Life‐Threatening Behavior, 1995)

The science and politics of gay teen suicide - Richardson, J. (Harvard Review of Psychiatry, 1995)

Reproductive status, family interactions, and suicidal ideation: Surveys of the general public and high-risk groups - de Catanzaro, D. (Ethology and Sociobiology, 1995)
Evolutionary modeling predicts an erosion of self-preservative genetic expression in the conjunction of low reproductive potential and burdensomeness toward kin. Although culture and pathology clearly bear on human suicide, some of its emotional concomitants could reflect such evolution. A survey probing reproductive behavior, quality of family contacts, and suicidal ideation was administered to samples of the general public of Ontario and high-suicide-risk groups, including elderly, psychiatric, criminal psychiatric, and homosexual individuals. Within each sample, variance in suicidal ideation related to reproductive and family-social variables. Social isolation and perceived burdensomeness toward family were especially correlated with suicidal ideation. © 1995.

Family treatment: The sibling bond and other relationship issues:handbook of developmental family psychology and psychopathology - Mancoske, R.J.; Wadsworth, C.M.; Dugas, D.S.; Hasney, J.A. (Social Work (United States), 1995)
Using data from Louisiana vital statistics records, the authors found an increased suicide risk for people with AIDS. Between 1987 and 1991 the suicide rate for people with AIDS (175 per 10, 000) was 134.6 times that of the general population (1.3 per 10, 000). The suicide rate of people with AIDS in the metropolitan New Orleans area (126 per 10, 000) was half that of the state’s nonmetropolitan areas (249 per 10, 000). This article explores the implications of this astounding suicide rate for social work practice. © 1995 by the National Association of Social Workers, Inc.
Keywords: Gay men; HIV/AIDS; Rural areas; Stressors; Suicide rate

Diane Arbus’s grostesque ‘human comedy’ - McPherson, H. (History of Photography, 1995)
In the spate of publications that has appeared since Diane Arbus’s death in 1971. numerous critics have commented upon her freakish subject matter and sought to explicate or neutralize her often disturbing photographs. Moreover, in Arbus’s case, her short, intense life and suicide have been fashioned into a potent legend that has tended to obscure rather than illuminate her photographic oeuvre. All too frequently, the work has been ‘explained’ by constructing Arbus herself as a freak and tragic genius who paid for her art with her life. Viewed from this perspective the ‘weirdness’ of her photographic subjects, including transvestites, midgets, dwarfs and nudists, is perceived as somehow selfreflexive, while her suicide seemingly attests to her sincerity and compassion. This dubious psycho-biographic take, however, in no way accounts for the extraordinary power and popular appeal of Arbus’s photographs, which have been reproduced widely and exhibited all over the world. © 1995 Taylor & Francis Ltd.

Suicidal behaviour in HIV infection: A case-control study of deliberate self-harm in people with HIV infection - Catalan, J.; Sejjas, D.; Lief, T.; Pergami, A.; Burgess, A. (Archives of Suicide Research, 1995)
A group of 22 individuals with HIV infection who had made acts of self-harm were compared with a sex and age-matched control group of individuals without known HIV infection who had also being involved in acts of deliberate self-harm (DSH). Compared with all DSH individuals referred to the deliberate self-harm service during the same period, men were over-represented amongst HIV subjects. Compared with matched controls, HIV subjects were more likely to include gay/bisexual men, and not be employed. Individuals with HTV infection were more likely to be receiving outpatient psychiatric care at the time of DSH, and to have received it in the past. A diagnosis of depression was given more frequently to HTV subjects, while alcohol misuses was more often diagnosed in controls. Concerns about their physical health were prominent amongst HTV seropositives. Psychiatric follow-up was offered to HIV subjects more often than to controls. The results indicate that HTV disease is a potential contributing factor to deliberate self-harm, and highlight the need for efforts to identify individuals with HTV infection at risk of deliberate self-harm, ant to develop effective interventions to prevent suicidal behaviour in this group of individuals. © 1995 Kluwer Academic Publishers. Printed in the Netherlands.
Keywords: AIDS; Attempted suicide; Deliberate self-harm; HIV; Suicidal behaviour

Agenda Workshop on Research Issues in Suicide and Sexual Orientation (Suicide and Life‐Threatening Behavior, 1995)

Models of Development: Understanding Risk in Adolescence - Graber, J.A.; Brooks‐Gunn, J. (Suicide and Life‐Threatening Behavior, 1995)
In this paper, we review developmental models for understanding adolescence as they might be applied to emerging sexuality and the challenges and risks that may be associated with different sexual orientations and identities. Models have been identified as: cumulative events or simultaneous change, accentuation, or trajectory models. Inclusion of risk and protective factors and considering the extent of balance between these elements of an adolescent's life is also discussed in terms of predicting mental health outcomes. These models have been particularly useful in the study of the development of psychopathology and clearly relate to the broader issue of understanding suicide risk during adolescence. 1995 The American Association for Suicidology

Public policy or personal gain - The politics of medical representation - Nelson, B. (Australian and New Zealand Journal of Medicine, 1995)

AIDS and suicide - Kirchner, J.T. (Journal of Family Practice, 1995)
An association between suicide and the acquired immune deficiency syndrome (AIDS) has been noted in several epidemiologic studies. Numerous case reports also support the trend of an increased suicide risk in persons infected with human immunodeficiency virus (HIV) and persons with AIDS. A variety of medical, neurologic, and psychiatric factors may contribute to the death of an HIV patient. I present the case of a 27-year-old man who committed suicide approximately 2 years after he received a diagnosis of AIDS. He had no previous psychiatric history. It is imperative that physicians caring for such patients be aware of the various neurologic and psychiatric manifestations of HIV infection. If appropriate, an assessment of suicide risk should be included in the regular office visit.
Keywords: acquired immune deficiency syndrome; human immunodeficiency virus; psychotic disorders; Suicide

AIDS, euthanasia and grief. - van den Boom, F. (AIDS care, 1995)
Almost 50% of people with AIDS in the Netherlands make the necessary arrangements for a possible death by the administration of thanatic drugs. In approximately 50% of those who arranged for it, euthanasia is performed. Euthanasia is a well-considered decision. By means of euthanasia people with AIDS want to prevent unbearable suffering and a degrading existence. Those who have arranged for euthanasia were proven to have adapted to the disease better than those who had not. No relationship was found between ending life by means of euthanasia and complicated grief in survivors. However, if the euthanasia process itself was complicated, the risk of complicated grief increased.

AIDS and euthanasia - Green, G. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 1995)
This paper estimates the proportion of people with HIV who have considered asking assistance to end their lives and explores their motivations and plans of action to hasten death. 16/57 (28%) people with HIV have considered asking for assistance to hasten death, significantly more than seronegative controls (4/67) (3%) (p < 0.001). In follow-up interviews with seropositive respondents the figure increased to 19/57 (33%). The main motivations are fear of being dependent and losing dignity and control in the final stages of the disease. These results are discussed in the light of current legislation about euthanasia and recent evidence that about one-half of NHS doctors would be prepared to comply with requests for euthanasia were it legal to do so.

Incest and other intrafamilial sexual abuse. - Aw, S.C.; Kok, L.P. (Annals of the Academy of Medicine, Singapore, 1995)
This study describes eight female adolescents who were sexually abused in childhood. Four were victims of incest. The mean age of onset of sexual abuse was 9.8 years and except for one, all had multiple incidents. All were from the lower socioeconomic class. The majority had disorganised families. The reactions of the majority of the victims were fear, intense anger and self mutilation. All were separated from their families on disclosure of the abuse. A significant clinical sequela was that of suicidal tendency in all of them, six of whom attempted suicide repeatedly. Promiscuous behaviour at adolescence occurred in one victim of father-child incest. Lesbianism resulted in one other. None suffered from any formal psychiatric disorder.

Psychological needs and HIV/AIDS - Hedge, B.; Sherr, L. (Clinical Psychology & Psychotherapy, 1995)
Mental Health problems are associated with life‐threatening illnesses generally and Acquired Immune Deficiency Syndrome (AIDS) specifically. This report describes the range and extent of psychological problems and therapeutic input for all patients (n = 258) referred to an HIV clinical psychology service over a one‐year period at a teaching hospital in the area of highest HIV prevalence in the UK. The majority (79%) were HIV positive; of these 92% were gay males, 6.5% heterosexual women and 1.5% heterosexual men. The age range was 15 to 72 years. Referrals were received for patients at all stages of HIV disease and for partners and relatives who were HIV negative but affected by HIV infection in another. The highest rate of referral was for HIV positive patients who were asymptomatic and the greatest intensity of need was for those with AIDS. Suicide (ideation or behaviour) was an issue in referral for 43 patients. Assessment revealed the major problems to include anxiety (48%), relationship problems (31.7%), depression (26.5%), adjustment to HIV status (16.9%), bereavement (12%), employment (11%), sexual issues (10%), isolation and suicide (9% each). Psychological therapy for the majority took the form of short‐term or crisis intervention. Group intervention did not substitute for individual therapy. The needs of patients were examined. They ranged from general interventions addressing adjustment to infection with HIV or an AIDS diagnosis, to specific input for issues such as sexual difficulties or coping with physical illness and bereavement. The data are discussed in terms of the growing demand for psychological services. Copyright © 1995 John Wiley & Sons, Ltd.

Transsexualism, dissociation, and child abuse: An initial discussion based on nonclinical data - Devor, H. (Journal of Psychology and Human Sexuality, 1994)
Forty-five self-defined female-to-male transsexuals were interviewed as part of a wide ranging sociological field study about female-to-male transsexuals. The data in this study are unusual in that they were obtained outside of any clinical settings. Questions were asked about childhood experiences of physical, sexual and emotional abuse. Sixty percent reported one or more types of severe child abuse. In the course of discussing other issues, participants also reported having experienced many of the commonly cited initial and long-term effects of child abuse, including fear, anxiety and depression, eating disorders, substance abuse, excessive aggression, and suicide ideation and attempts. It was not possible to determine to what extent the sources of these complaints lay in child abuse, in gender dysphoria, in some combination of the two, or elsewhere. While no information was solicited about dissociative responses to child abuse, I have speculated, as have some of the participants themselves, that, in some cases, transsexualism may be an adaptive extreme dissociative survival response to severe child abuse. © 1994 by The Haworth Press, Inc. All rights reserved.

Homosexuality - Friedman, R.C.; Downey, J.I. (New England Journal of Medicine, 1994)

The impact of hate violence on victims: emotional and behavioral responses to attacks. - Barnes, A.; Ephross, P.H. (Social work, 1994)
Criminal acts stemming from prejudice based on race, religion, sexual orientation, or ethnicity--frequently referred to as "hate violence"--have increased during recent years. This study explored the nature of hate attacks and victims' responses to them. The sample consisted of 59 victims and included black, white, and Southeast Asian people. Data were obtained through focus group meetings, individual interviews, and questionnaires. More than half of the victims reported experiencing a series of attacks rather than a single attack. Anger, fear, and sadness were the emotional responses most frequently reported by victims. About one-third of the victims reported behavioral responses such as moving from the neighborhood or purchasing a gun. The responses of hate violence victims were similar to those of victims of other types of personal crime. Implications for social work intervention are discussed.

Effects of a multi-factor education program on the attitude of child and youth worker students toward gays and lesbians - Christensen, S.; Sorensen, L.M. (Child & Youth Care Forum, 1994)
Reports from gay and lesbian youth suggest that negative attitudes of caregivers impair their effectiveness. A program addressing attitudes, behavior and cognitions was designed to effect and maintain positive attitudes toward this client group. Thirty-five child and youth worker students participated in one of two 6-hour programs: one provided increased exposure to gay/lesbian lives; the other examined youth suicide. Change was assessed in two post-tests. Experimental subjects had significantly more positive scores on the affective and cognitive measures (F(1,26)=4.68, p<.05;F(1,26)=4.50, p<.05) but did not differ on the behavioral measure (F(1,29)=1.02, p=.32). Group means on all three measures did not differ significantly four weeks later. These results indicate negative attitudes can be moderated. Means of maintaining this positive change are suggested and implications for the education of service providers are discussed. © 1994 Human Sciences Press, Inc.

Risk factors for suicide among gay, lesbian, and bisexual youths - Proctor, C.D. (Social Work (United States), 1994)
The study described in this article explores risk factors for suicide among gay, lesbian, and bisexual youths. A convenience sample of 221 self-identified gay, lesbian, and bisexual youths who attended youth groups across the United States and Canada were given the Adolescent Health Questionnaire, which assessed family issues, the social environment, and self-perceptions. The youths’ scores were significantly associated with suicidal ideation and attempts. Implications for social services are discussed. © 1994 National Association of Social Workers, Inc.
Keywords: Adolescents; Bisexuals; Gay men; Lesbians; Suicide

Challenging heterosexism in college health service delivery - McKee, M.B.; Hayes, S.F.; Renee Axiotis, I. (Journal of the American College Health Association, 1994)
The empowerment and affirmation of lesbian, bisexual, and gay students is long overdue. This article explores how human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS), substance abuse, violence and hate-related crimes, suicide, and heterosexism all adversely affect the physical and emotional health of nonheterosexual college students. College health services must expand their current scope and practice and assume a leadership role in combating all forms of oppression by actively incorporating and addressing the unique health issues and needs of the lesbian, bisexual, and gay population. This article provides a brief overview of the relevant healthcare issues for lesbians, bisexuals, and gays; examples of heterosexism in college health services; and recommendations for institutional and personal and professional change. © 1994, Taylor & Francis Group, LLC.
Keywords: Bisexuality; College students; Heterosexism; Homophobia; Homosexuality; Lesbians; Sexual orientation

Verbal and Physical Abuse as Stressors in the Lives of Lesbian, Gay Male, and Bisexual Youths: Associations With School Problems, Running Away, Substance Abuse, Prostitution, and Suicide - Savin-Williams, R.C. (Journal of Consulting and Clinical Psychology, 1994)
A common theme identified in empirical studies and clinical reports of lesbian, gay male, and bisexual youths is the chronic stress that is created by the verbal and physical abuse they receive from peers and adults. This article reviews the verbal and physical abuse that threatens the well-being and physical survival of lesbian, gay male, and bisexual youths. This response to gay male, lesbian, and bisexual adolescents by significant others in their environment is often associated with several problematic outcomes, including school-related problems, running away from home, conflict with the law, substance abuse, prostitution, and suicide. Although the causal link between these stressors and outcomes has not been scientifically established, there is suggestive evidence that these outcomes are consequences of verbal and physical harassment.

Psychoanalysis as a lifeline: A clinical study of a transference perversion - Baker, R. (International Journal of Psycho-Analysis, 1994)
Case material from the analysis of a fetishistic cross-dresser is reported. The evolution of a transference perversion and treatment impasse, in the form of the recalcitrant symptom of anal flatulence, is described. The patient's contrasting needs to cling perversely and addictively to the analyst, on the one hand, and to provoke an acting out of the countertransference, on the other, are placed in the context of his dread of rejection and potentially suicidal reaction. The author argues in favour of offering psychoanalysis as a lifeline, but with the condition that the psychoanalytic setting and boundaries are maintained and that gratifications are denied. Limited but precise interpretive psychoanalytic work in the transference was maintained. The relatively good outcome is explained in terms of the provision of safety, survival of the analyst and avoidance of countertransference acting out, which, in the author's view, represents an implicit and mutative transference interpretation, the specific factor in bringing about psychic change. This enabled the patient to recognise and accept the analyst as a 'new' object and, as a consequence, to question and reject his idealisation of the anal universe that he inhabited.

Suicidal Behavior and Gay-Related Stress among Gay and Bisexual Male Adolescents - Rotheram-Borus, M.J.; Hunter, J.; Rosario, M. (Journal of Adolescent Research, 1994)
Adolescents are increasingly at risk for attempting suicide, particularly among those subgroups experiencing high stress. Typically, adolescentfemales are atfar greater risk (10.3% attempt suicide) as compared to males (6.2% attempt suicide). In contrast to rates among adolescents in community-based studies, attempted suicide was reported by 39% of a consecutive series of 138 self-identified gay and bisexual males, ages 14 through 19 years, presenting at a social service agency for lesbian and gay adolescents in New York City. More than one-half ofattempters had tried to kill themselves more than once, and suicide attempters were more likely to have dropped out of school, to be ejected from their homes, and to have friends or relatives who attempted suicide. Gay-related stressors were significantly more common among suicide attempters as compared to nonattempters, but general life stress was not higher Thesefindings imply that gay youths are at increased risk for attempting suicide. Clinicians and staff in community-based agencies need to enhance their awareness of the possibilities of suicide attempts among gay and bisexual male youths, increasing screening for risk and actively seeking to reduce gay-related stress. © 1994, Sage Publications. All rights reserved.

Using visual media to reduce homophobia: A classroom demonstration - Walters, A.S. (Journal of Sex Education and Therapy, 1994)
A classroom demonstration using visual media was designed as a means for decreasing homophobia. Slides and video scenarios showed that gay,/lesbian/bisexual characters are most often depicted as stereotyped, suicidal, or pathological. Homophobia and empathy for homosexuals were measured at the beginning and end of the term. Results showed a significant decrease in homophobia and a significant increase in empathy among students exposed to the demonstration. Analogous changes in attitudes toward homosexuals were not found among students not exposed to the demonstration. © 1994 Taylor & Francis Group, LLC.

Emotional, behavioral, and HIV risks associated with sexual abuse among adult homosexual and bisexual men - Bartholow, B.N.; Doll, L.S.; Joy, D.; Douglas Jr., J.M.; Bolan, G.; Harrison, J.S.; Moss, P.M.; McKirnan, D. (Child Abuse and Neglect, 1994)
From May 1989 through April 1990, 1,001 adult homosexual and bisexual men attending urban sexually transmitted disease clinics were interviewed regarding abusive sexual contacts during childhood and adolescence. Sexual abuse was found to be significantly associated with mental health counseling and hospitalization, psychoactive substance use, depression, suicidal thought or actions, social support, sexual identity development, HIV risk behavior including unprotected anal intercourse and injecting drug use, and risk of sexually transmitted diseases including HIV infection. Data suggest that sexual abuse may have a wide-ranging influence on the quality of life and health risk behavior of homosexual men. Increased awareness as to the potential outcomes of male sexual abuse is critically important to the design and implementation of medical and psychological services for sexually abused men. © 1994.
Keywords: Adult outcome; AIDS; HIV; Homosexuality; Males; Sexual abuse; Sexual identity

Sudden unexpected death in a male homosexual cohort - Ndimbie, O.K.; Perper, J.A.; Kingsley, L.; Harty, L.; Winkelstein, A. (American Journal of Forensic Medicine and Pathology, 1994)
There has been considerable debate as to the risk of suicide, accidents, and homicide in populations at high risk for HIV infection. The purpose of the present investigation was to determine the incidence of sudden and unexpected deaths in a well-defined cohort of homosexual and bisexual men prospectively studied since 1984. All subjects were enrolled in the Pitt Men's Study, the Pittsburgh, Pennsylvania, component of the Multicenter AIDS Cohort Study. Of this group, 861 were between the ages of 20 and 44, and 35% were seropositive for HIV. There were 70 deaths attributed to AIDS. Five additional deaths were classified as sudden and unexpected, an annual rate of 0.08% (80/100,000). Only one of these was classified by the coroner's office as a suicide; three were due to accidents, and one was a drug overdose of undetermined cause. Only two of the five unexpected deaths were HIV seropositive, and none had the diagnosis of AIDS. The sudden and unexpected death rate in this cohort did not significantly differ from the 0.07% (70/100,000) yearly incidence in the age- and race-matched male population. Thus, in this well-defined male gay cohort, there does not appear to be an increased risk of violent and drug-related deaths in persons at risk for, or with a diagnosis of, AIDS.

National Lesbian Health Care Survey: Implications for Mental Health Care - Bradford, J.; Ryan, C.; Rothblum, E.D. (Journal of Consulting and Clinical Psychology, 1994)
This article presents demographic, lifestyle, and mental health information about 1,925 lesbians from all 50 states who participated as respondents in the National Lesbian Health Care Survey (1984-1985), the most comprehensive study on U.S. lesbians to date. Over half the sample had had thoughts about suicide at some time, and 18% had attempted suicide. Thirty-seven percent had been physically abused as a child or adult, 32% had been raped or sexually attacked, and 19% had been involved in incestuous relationships while growing up. Almost one third used tobacco on a daily basis, and about 30% drank alcohol more than once a week, 6% daily. About three fourths had received counseling at some time, and half had done so for reasons of sadness and depression. Lesbians in the survey also were socially connected and had a variety of social supports, mostly within the lesbian community. However, few had come out to all family members and coworkers. Level of openness about lesbianism was associated with less fear of exposure and with more choices about mental health counseling.

Human immunodeficiency virus infection in Taiwan, 1984 to 1994. - Chen, M.Y.; Wang, G.R.; Chuang, C.Y.; Shih, Y.T. (Journal of the Formosan Medical Association = Taiwan yi zhi, 1994)
From 1984 to September 1994, a total of 9,099,734 serum samples from six population groups were tested for the antibody to human immunodeficiency virus type 1 (HIV). Mandatory testing was carried out for blood donors, military recruits, immigrants and prisoners; other population groups were tested anonymously with consent. A total of 695 samples were seropositive and, of these HIV carriers, 142 developed acquired immunodeficiency syndrome (AIDS). Although the prevalence of HIV infection and AIDS has remained low, there has been a rapid increase since 1991. Of the 142 AIDS cases, 68 were in homosexuals/bisexuals, 6 were in hemophiliacs, 7 were in prisoners/intravenous drug users, 49 were in heterosexuals and for 12 cases, the risk factors were unknown. Before 1987, 69 (90.8%) of the 76 HIV-infected persons were homosexuals or hemophiliacs. Thereafter, the risk groups diversified, with the main group shifting from hemophiliacs to intravenous drug users, and the number of heterosexuals surpassing that of homosexuals. Among the 142 cases of AIDS, 135 were males and only 7 were females. Despite the short period of follow-up, 114 have died (including 3 suicides).

Depressive distress among homosexually active African American men and women - Cochran, S.D.; Mays, V.M. (American Journal of Psychiatry, 1994)
Objective: Although early surveys of psychological adjustment among gay men and lesbians suggest only minor and not clinically relevant differences from heterosexual populations, concerns about psychiatric morbidity associated with HIV infection have renewed interest in the prevalence of psychological distress in this population, particularly among gay men. These later studies have focused primarily on white men. However, research indicates higher crude prevalence rates of psychological distress in community-drawn samples of African American subjects than in white subjects and also higher rates in women than in men. The authors examined rates of depressive distress and suicidal thoughts among homosexually active African American men and women who might be especially at risk for psychiatric morbidity due to multiple stigmatized social statuses. Method: Two nationally recruited groups of homosexually active African Americans (829 men and 603 women) completed self-administered questionnaires, including the Center for Epidemiologic Studies Depression Scale. Results: Homosexually active black women were as distressed as HIV-infected gay black men. Men with symptomatic HIV disease were significantly more distressed than men who were HIV infected but asymptomatic, HIV-antibody negative, or whose HIV status was unknown. Both men and women reported distress levels in excess of those previously reported in studies of blacks or primarily white gay men. Conclusions: Further research is needed to identify specific predictors of life stressors and lack of social support among homosexually active African Americans who appear to be at higher risk for depressive distress.

Vitality and growth in HIV-infected gay men - Schwartzberg, S.S. (Social Science and Medicine, 1994)
The emphasis in the psychosocial literature on Human Immunodeficiency Virus (HIV) has been placed, correctly, on the traumatic impact of AIDS in terms of mortality, bereavement, suicide, psychopathology, and coping with life amid enormous multiple stressors. However, an important aspect of the HIV epidemic has been paid only minimal attention: many HIV-positive gay men have experienced beneficial, or even life-transforming, aspects of their situation. Seven HIV-positive gay men are described here who have successfully integrated HIV into a framework of world- and self-beliefs that allows for coherence, stability, emotional vitality, and positive self-regard. Eight general characteristics of these men are presented. These men represent a subgroup from a sample of 19 subjects in a qualitative clinical interview study exploring how HIV-positive gay men ascribe meaning to AIDS and their own HIV infection [1]. © 1994.
Keywords: AIDS; HIV; meaning; resilience

Going early, going late: The rationality of decisions about suicide in aids - Battin, M.P. (Journal of Medicine and Philosophy (United Kingdom), 1994)
Where assistance in suicide is readily available to those dying of AIDS, as in the west coast gay communities of the United States and in the Netherlands, we must examine the different roles of physicians and friends (including lovers, spouses, family members, religious advisors, members of support groups, and intimate others) in helping a person with AIDS decide about and carry out suicide. This paper makes a central assumption: That where assistance in suicide is available, it is the moral obligation of others to protect and enhance as much as possible the rationality ofthat choice. Four components are identified in a rational choice about suicide in AIDS-whetherit is a choice for or against suicide. Phrased as questions a person with AIDS might ask him-or herself, they are:(1)“Is suicide an option I want to consider?”(2)“Shall hold out for the chance of a cure?”(3)“How shall I time my suicide?”(4)“What weight shall I give to the welfare and interests of others?” Although physicians often make assertions relevant to (1), they are appropriately involved only in (3);and although friends or intimate partners often provide the patient with anecdotal information relevant to (3), they should be involved primarily in (1). In short, both physicians and friendsoftenintervene in the wrong parts of choices made by a person with AIDS about suicide. © 1994 by The Society for Health and Human Values.
Keywords: AIDS; Assisted suicide; Euthanasia; Rationality; Role of friends and physicians; Timing

Gender issues in the treatment of suicidal individuals - Canetto, S.S. (Death Studies, 1994)
Historically, the literature on the treatment of suicidal behavior has not given explicit consideration to gender issues. There are, however, several important reasons for considering the influence of gender in the treatment of suicidal individuals. First, women’s patterns of suicidal behavior are different from those of men. Second, reasons for suicidal behavior are often assumed to vary by gender. Third, gender has been recognized as having an impact on the dynamics of psychotherapy. This article focuses on gender dynamics relevant to psychotherapy with suicidal adults. Specifically, it reviews the literature on the relationships between gender and (a) the epidemiology of suicidal ideation and behaviors, (b) the reasons for suicidal behavior, and (c) the initiation and goals of psychological treatment for the suicidal individual. © 1994 Taylor & Francis Group, LLC.

HIV seroconversion in intravenous drug users in San Francisco, 1985-1990 - Moss, A.R.; Vranizan, K.; Gorter, R.; Bacchetti, P.; Watters, J.; Osmond, D. (AIDS, 1994)
Objective: To examine the HIV seroconversion rate, risk factors for seroconversion, and changes in risk behavior over time in intravenous drug users (IVDU) in San Francisco, 1985-1990. Design: Observational study. Setting: All methadone maintenance and 21-day methadone detoxification programs in San Francisco. Participants: A total of 2351 heterosexual IVDU, of whom 681 were seronegative at first visit and seen at least twice ('repeaters'). Main outcome measures: HIV seroconversion rates, risk factors for seroconversion, and changes in behavior. Results: The HIV seroconversion rate in repeaters was 1.9% per person-year (ppy) of follow-up [2.1% in women versus 1.7% in men (not significant); 4% in African Americans versus 1% in whites (P = 0.006); 3.9% ppy in the first third of the study, 1.2% in the second (P = 0.007), and 1.9% in the last (not significant)]. Risk factors for seroconversion were five or more sexual partners per year [hazard ratio (HR) = 2.6; P = 0.02], use of shooting gallery ever (HR = 2.9; P = 0.02), and less than 1 year (lifetime) in methadone maintenance (HR = 2.7; P = 0.02). Self-reported intravenous cocaine use fell from 33 to 15% over 5 years, shooting gallery use fell from 19 to 6%, and the proportion with five or more sexual partners fell from 25 to 10%. Bleach use rose to 75% of needle-sharers. Conclusions: The 1985-1990 HIV seroconversion rate in IVDU (1.9% ppy) was comparable to that in San Francisco cohorts of homosexual men (1.4% ppy). A decline in HIV seroconversion coincided with changes in risk behavior. Stable attendance of methadone maintenance was highly protective: the seroconversion rate in subjects with 1 year or more in methadone was 12% ppy.
Keywords: HIV; Intravenous drug users; Methadone; Risk factors; Seroconversion

Music and melancholia - Wintersgill, P. (Journal of the Royal Society of Medicine, 1994)
This is a brief look at the psychiatric ailments of some of the great composers: two of whom committed suicide; four suffered from severe depression, three had other assorted ailments; and three were suffering from manic depressive illnesses. Their mood swings are compared with their periods of intense composition. For some composers it seems that they are most productive immediately after a phase of depression.
Keywords: Composers; Depression; Psychiatric ailments

A new perspective on the Oedipal complex: A voice therapy session - Firestone, R.W. (Psychotherapy, 1994)
This article reports the case of a young man who experienced suicidal impulses in competitive situations involving both relationship and career issues. The clinical data illustrate the concept of 'identification with the aggressor' in relation to a father's angry, rivalrous feelings toward his son. The author discusses dynamics operating in families where immature or insecure parents compete with and show resentment toward the child of the same sex and direct overt or covert aggression toward him/her. Later, the internalized aggression emerges as a negative thought process when the individual strives to achieve personal or vocational goals. An exploration of the theoretical implications of the case contributes to an understanding of unresolved Oedipal issues that can affect young people at risk for suicide, particularly high-achieving adolescents who seemingly have everything to live for.

Stressful life events: Moderators of the relationships of gender and gender roles to self-reported depression and suicidality among college students - Waelde, L.C.; Silvern, L.; Hodges, W.F. (Sex Roles, 1994)
The present study examined whether relationships of self-reported depression and suicidality to gender roles or gender are moderated by the type of stressful life events that individuals experience. The focus was on events in stereotypic male (achievement) versus female (interpersonal) domains. This study of 290 women and 247 men undergraduates employed the Beck Depression Inventory (BDI), the Personal Attributes Questionnaire and a measure of recent negative life events. In the presence of high achievement stress, high masculinity was related to low suicidality for men. In the presence of high interpersonal stress, high femininity was related to low self-reported depression for women. These findings were interpreted as consistent with the androgyny model of adjustment. However, independent of gender roles, high interpersonal stress was related to high self-reported depression more strongly among women than among men. Suicidality was related to interpersonal events for women and achievement events for men. These findings were interpreted as consistent with the self-schema model of depression. © 1994 Plenum Publishing Corporation.

Safety profile of didanosine among patients with advanced HIV disease who are intolerant to or deteriorate despite zidovudine therapy: Results of the canadian open ddI treatment program - Montaner, J.S.G.; Rachlis, A.; Beaulieu, R.; Gill, J.; Schlech, W.; Phillips, P.; Auclair, C.; Boulerice, F.; Schindzielorz, A.; Smaldone, L.; Wainberg, M.; Singer, J.; et al. (Journal of Acquired Immune Deficiency Syndromes, 1994)
The aim of this study was to ascertain the safety profile of didanosine (Videx; ddI) within the Canadian Open Treatment Program. Symptomatic HIV+ subjects with AIDS or ARC or CD4 <200/mm3 were eligible to receive didanosine if they were either (a) intolerant to zidovudine (Retrovir, ZDV) or (b) deteriorating despite ZDV therapy. The dose of didanosine (powder formulation) was based on body weight as follows: 3=75 kg, 375 mg b.i.d.; 50-74 kg, 250 mg b.i.d.; 35-49 kg, 167 mg b.i.d. Participants were monitored with physical examinations and prespecified laboratory studies by their treating physicians on a monthly basis. Follow-up data were collected in a central database through five regional coorClinators. A total of 168 physicians across Canada participated in the program, and 825 subjects who started didanosine after July 1, 1990, were included in the analysis. Of these, 97% were male, 88% homosexual, and 59% had a prior diagnosis of AIDS. Reasons for enrolling was ZDV intolerance in 39%, failure in 25%, both in 32%, and other in 4%. Data were prospectively collected until July 31, 1991. Total follow-up was 3,440 patient-months and median follow-up was 4.3 months. A total of 78 deaths were reported, 44 of which occurred within a month after the last dose of didanosine. Causes of death included AIDS-related unspecified causes (13 patients), MAC (11), wasting (7), AIDS-related CNS involvement other than OI’s (7), Kaposi’s sarcoma (7), Pneumocystis carinii pneumonia (6), sudden death, including suicides and accidents (6), lymphoma (5), toxoplasmosis (4), crypto-coccosis (4), cytomegalovirus (3), unspecified causes (2), tuberculosis (1), PML (1), and disseminated histoplasmosis (1). Didanosine was discontinued in 140 (17%) subjects during the study period due to adverse events. The most common severe adverse events were diarrhea (16 patients), nausea and vomiting (11), peripheral neuropathy (7), and pancreatitis (6). We conclude that didanosine has a favorable safety profile, even among individuals with advanced HIV disease who have failed or are no longer tolerant of ZDV therapy. © 1994 Raven Press Ltd., New York.
Keywords: ARC; Didanosine; HIV; Safety; Therapy; Zidovudine

A controlled comparison of HIV and general medical referrals to a liaison psychiatry service - Ellis, D.; Collis, I.; King, M. (AIDS Care, 1994)
A retrospective case-control study was performed to compare the patterns of psychiatric illness and treatment in 70 patients referred to the psychiatric liaison service from the HIV/AIDS team in a London teaching hospital with 70 age- and sex-matched controls referred for psychiatric assessment from general medical and surgical wards or out-patient clinics. Organic, mood, adjustment and personality disorders were the most common primary diagnoses. The rate of referral in the HIV group was five times that in the control group. The prevalence of each group of diagnoses was not significantly different between the HIV and control groups, except in the case of alcohol dependence (15/70 (control) v. 3/70 (HIV), p = 0.005). Forty-four per cent of the HIV group and 30% of the control group fulfilled DSM-III-R criteria for a secondary diagnosis of non-alcohol psychoactive substance abuse. A diagnosis of borderline personality disorder was made more often in the HIV group. The high frequency of psychoactive substance abuse in both the HIV and control groups has important implications for the provision of psychiatric services. © 1994 Taylor … Francis Group, LLC. All rights reserved.

Seroprevalence of and risk factors for HIV-1 infection in injection drug users in Montreal and Toronto: A collaborative study - Lamothe, F.; Bruneau, J.; Coates, R.; Rankin, J.G.; Soto, J.; Arshinoff, R.; Brabant, M.; Vincelette, J.; Fauvel, M. (CMAJ, 1993)
Objective: To determine the prevalence of antibodies to HIV-1 and risk factors for HIV-1 infection among injection drug users. Design: Questionnaire survey. A venous blood sample was taken for HIV-1 antibody testing. Setting: Montreal and Toronto. Participants: A total of 810 subjects who had used injection drugs in the previous 6 months recruited mainly from treatment centres and from the street in Montreal (425 subjects) and from treatment centres in Toronto (385 subjects) between September 1988 and September 1990. The overall participation rate was 82%. Outcome measures: HIV-1 seropositivity, sociodemographic and behavioural risk factors for HIV-1 infection. Results: The overall seroprevalence rate of HIV-1 infection was 4.8% (95% confidence limits [CL] 3.5 and 6.5). In Montreal the rate was 8.2% (95% CL 6.0 and 11.2), and in Toronto 1.0% (95% CL 0.4 and 2.6) (p < 0.001). Seropositive subjects were significantly older (p = 0.041) and were more likely to have a history of imprisonment (p = 0.006) than seronegative subjects. In univariate analysis seropositivity was associated with the following behaviours: more frequent cocaine use (p < 0.001), injecting drugs in 'shooting galleries' (p = 0.002), sharing equipment with a person known to be HIV-1 seropositive (p = 0.006), 'booting' fresh blood (p = 0.004), homosexual or bisexual orientation (p = 0.006), engaging in prostitution (p < 0.001) and, for men, number of male sexual partners in the previous 6 months (p = 0.007). In multivariate analysis the determinants of HIV-1 seropositivity were Montreal as the city of recruitment (odds ratio [OR] 6.7, 95% CL 2.32 and 19.42), engaging in prostitution (OR 2.13, 95% CL 1.01 and 4.75), a history of imprisonment (OR 3.51, 95% CL 1.33 and 9.29) and sharing equipment with a person known to be HIV-1 seropositive (OR 4.43, 95% CL 1.43 and 13.74). Conclusions: Our findings show that HIV-1 is circulating among injection drug users in Montreal and Toronto and that both drug use and sexual behaviours are implicated in the transmission of infection in the populations studied. Adapted preventive programs should be developed to prevent further spread of HIV-1 infection in this population.

Suicidality in AIDS long-term survivors: What is the evidence? - Rabkin, J.G.; Remien, R.; Katoff, L.; Williams, J.B.W. (AIDS Care, 1993)
This study was designed to investigate suicidal ideation and attempts, thoughts about living and dying, and the maintenance, diminution and loss of hope in a sample of long-term AIDS survivors. The study sample consisted of 53 gay men enrolled as clients at Gay Mens Health Crisis in New York City who had had an AIDS-defining opportunistic infection at least 3 years prior to study entry. Despite the experience of protracted biological stress associated with life-threatening illness and the psychological stress of living with AIDS, we found low rates of current syndromal mood disorders (6%) or psychiatric distress. While thoughts about death and wishes to die were reported by a significant portion of men, they were context-specific, occurring almost exclusively during serious illness, often accompanied by severe pain or at times of bereavement. Only two men had made a suicide attempt after being diagnosed with AIDS and both had a history of prior (pre-AIDS) suicide attempts. While anger was a prominent affect, hopelessness was not. Overall, we found a high level of positive psychological health independent of HIV illness stage or degree of illness-induced physical limitation.This study was designed to investigate suicidal ideation and attempts, thoughts about living and dying, and the maintenance, diminution and loss of hope in a sample of long-term AIDS survivors. The study sample consisted of gay men enrolled as clients at Gay Mens Health Crisis in New York City who had an AIDS-defining opportunistic infection at least three years prior to study entry. Our inquiry was motivated by clinical impressions and suggestive empirical data that a diagnosis of AIDS confers upon people an inflated risk of suicide (e.g. Frierson and Lippmann, 1988; Kizer et al., 1988; Marzuk et al, 1988; Plott et al., 1989). Since other investigators have failed to find increased suicide risk among people with AIDS (e.g. O'Dowd and McKegney, 1990; McKegney & O'Dowd, 1992), or men with asymptomatic HIV infection or ARC (Chuang et al., 1989), or after HIV testing (Perry etaL, 1990), this remains an open question. At least five risk factors may be salient as predictors of suicidal ideation, attempts and completed acts among gay men with AIDS. First, there is the increased probability of a prior attempt associated with sexual identity conflicts reported in samples of gay adolescents and adults (Rotheram-Borus et al, submitted; Schneider et al, 1989). Past suicide attempts. © 1993, Taylor & Francis Group, LLC. All rights reserved.

Suicide and HIV disease - Pugh, K.; Catalan, J.; O'Donnell, I. (AIDS Care, 1993)
It has been suggested that HIV infection is associated zuith an increased risk of suicidal behaviour. This paper reviews the literature on suicide in patients with HIV disease and discusses methodological problems encountered in studying the incidence of suicide in this population. A snowballing method was used to identify cases of suicide in patients who were receiving treatment for HIV disease in a central London health district. The possible under detection of suicides among AIDS patients is considered. The six case reports are described to illustrate the clinical and psychosocial characteristics of suicides, and they are discussed in relation to other findings on suicide in patients with HIV disease and other physical illnesses. © 1993, Taylor & Francis Group, LLC. All rights reserved.

Lesbian, gay, and bisexual youth in community settings: Personal challenges and mental health problems - D'Augelli, A.R.; Hershberger, S.L. (American Journal of Community Psychology, 1993)
Studied 194 lesbian, gay, and bisexual youth aged 21 and younger who attended programs in 14 community centers to determine the personal challenges they face due to their sexual orientation and their responses to these stresses. First awareness of sexual orientation typically occurred at age 10, but disclosure to another person did not occur until about age 16. There was much variability in sexual behavior, and many youths reported both same-sex and opposite-sex sexual experiences. Although most had told at least one family member about their sexual orientation, there remained much concern about family reactions. Suicide attempts were acknowledged by 42% of the sample. Attempters significantly differed from nonattempters on several milestones of sexual orientation development, social aspects of sexual orientation, parents' knowledge of sexual orientation, and mental health problems. © 1993 Plenum Publishing Corporation.
Keywords: lesbian, gay, bisexual, youth; sexual orientation; suicide

Le dernier des procédés révolutionnaires: La fabrication et l’expertise de la poudre ronde (1795-1830) - Bret, P. (Annals of Science, 1993)
During the French Revolution, political and military circumstances, combined with lack of success with chlorate powder, led the government to favour rationalization of manufacturing processes in an attempt to increase the range of guns. In 1796, ‘poudre ronde’, invented by J. P. Champy (1744-1816), Lavoisier’s successor as head of the administration of powders and saltpetres, seemed to be nearly the ideal gunpowder. For a reduced price, it produced sufficient power, with maximum security in manufacture and use. Despite the approval of the scientific and military experts, however, production was stopped through politico-bureaucratic obstruction. At the end of the Empire, J. S. Champy (1778-1845) perfected his father’s process to create the first mechanized production system, the introduction of which brought about the modification of the work processes and the design of gunpowder factories created during the Restoration. Paradoxically, the success of this system led to its failure after a decade of production that always remained experimental. ‘Poudre ronde’ called in question metallurgical techniques by blowing up the canons. The hitherto unpublished first expert report on this process, of 1813, provides the opportunity to follow through the development of a manufacturing process that foreshadows the mechanization of the gunpowder industry in the nineteenth century, while remaining quite clearly the product of year II of the Revolution. The opportunity is also provided to enquire into the criteria and quality of expert opinion at the time when chemical analysis of gunpowder was beginning under Proust, Gay-Lussac and Brianchon. © Taylor & Francis Group, LLC.

Preventing mental health problems among lesbian and gay college students - D'Augelli, A.R. (The Journal of Primary Prevention, 1993)
Young adults who self-identify as lesbian, gay, or bisexual experience major stresses in managing their sexual orientation. They are at risk for serious mental health problems, including suicide and depression. The mental health concerns of lesbian and gay male college students are reviewed. These problems result from the difficulties involved in developing a lesbian or gay personal identity, and are exacerbated by widespread negative attitudes, harassment, and violence directed toward lesbians and gay men on college campuses. Several systemic preventive interventions are recommended to decrease mental health problems in this population. © 1993 Human Sciences Press, Inc.
Keywords: homophobia; homosexuality; youth

Social work with gay and lesbian adolescents - Morrow, D.F. (Social Work (United States), 1993)
Gay and lesbian adolescents are a socially oppressed group discriminated against by a heterosexist and homophobic society. Because of the negative stigma society places on lesbian and gay adolescents, they face numerous difficulties that require social support and intervention. Issues pertinent to social work with lesbian and gay adolescents are examined in the context of three main social institutions: the family, the social culture, and the educational setting. Suggestions are made for improving intervention with this population, including increasing personal awareness of one's own homophobia and heterosexist bias in working with client groups; educating oneself and client groups about homosexuality; establishing positive social support programs to serve lesbian and gay adolescents; advocating for sanctions to end gay and lesbian harassment in the educational system; supporting the hiring of openly gay and lesbian teachers to serve as positive role models; and advocating for the inclusion of sexual orientation information in school sex education curricula. © 1993 by the National Association of Social Workers, Inc.
Keywords: Adolescents; Gay men; Lesbians

Gay and lesbian youth: Contributing factors to serious attempts or considerations of suicide - Hammelman, T.L. (Journal of Gay and Lesbian Psychotherapy, 1993)
This is a study of gay and lesbian youths’ tendencies for suicide and the extent to which these tendencies are influenced by sexual orientation, violence, age, substance abuse, physical or emotional abuse, family rejection, or gender. Based on a sample of 48 respondents, nearly one-half seriously considered suicide while one- third actually attempted suicide. Close to three-quarters of this population cited sexual orientation as some or most of the reason for their suicide consideration or attempt with the majority revealing that they had done so at age 17 or before. Fifty percent or more of those who (1) had a substance abuse problem, (2) were physically or emotionally abused, or (3) experienced family rejection, reported that sexual orientation was the main reason for these problems. These results are clinically significant for therapists who work with this population. The mere existence of suicide considerations or attempts because of sexual orientation calls for a proactive stance which includes conducting a thorough psycho-social assessment, performing crisis intervention and assisting youth to increase their coping mechanisms. © 1993 Taylor & Francis Group, LLC.

A Visitation of Difference - McRuer, R. (Journal of Homosexuality, 1993)
This essay is a consideration of the position of "region" in queer theory, particularly black queer theory. Although only minimal analysis has been directed at black gay cultural production, most attention given to black gay cultural production has focused predominantly on urban areas/communities re-presented in films such as "Tongues United" and "Paris is Burning." This paper employs Randall Kenan's novel "A Visitation of Spirits," which focusses on a black gay youth growing up in the rural African-American community of Tims Creek, North Carolina, to consider what cultural work is done when queer desire turns up in such an apparently unlikely and inhospitable place. Examining how region plays a role in the construction of centers and margins, this article argues against always shuffling queer desire "safely" off to the big city, and considers what transformative cultural work can be done on the "margins" of the queer world. © 1993 by The Haworth Press, Inc. All rights reserved.

Intentional Self-Infection with HIV by Long-Term Partners of HIV-Positive Homosexual Men: Four Case Reports - Morgan, M.; Jones, J. (AIDS Patient Care, 1993)

Hide and Seek: The Search for a Lesbian Theatre Aesthetic - Rapi, N. (New Theatre Quarterly, 1993)
Is there a specific lesbian theatre aesthetic? If so, is butch and femme at the heart of it? Or androgyny? Or the freedom-confinement dynamic? Or, on another level, distancing role from essential being’, and woman’ and man’ as social constructs from male and female as biological entities? By focusing on a number of lesbian texts, including her own work, Nina Rapi explores both the theory and practice of an emerging aesthetic that reveals the performance of being’, seeking to shift the axis of categorization’, and so to create a new and exciting theatre language. Nina Rapi is a playwright and translator whose theatre work includes Ithaka (Riverside Studios, June 1989; Link Theatre, staged readings, April 1992; published in Seven Plays by Women, 1991), Critical Moments, a trilogy of shorts (Soho Poly Theatre, June 1990), Johnny Is Dead (First One Person Play Festival, Etcetera Theatre, March 1991), Dreamhouse (Oval House and Chat's Palace, April-May 1991), Dance of Guns (touring production, including King's Head and Jackson's Lane Theatres, April-May 1992), and Dangerous Oasis (Finborough, March 1993). © 1993, Cambridge University Press. All rights reserved.

Recommendations for the Inclusion of Training about Persons with HIV Disease in Counseling Psychology Graduate Programs - Werth, J.L., Jr. (The Counseling Psychologist, 1993)
Historically, exposing future mental health professionals to diversity has primarily meant preparation for different racial and ethnic groups. Recently, however, thanks in large measure to the efforts of counseling psychologists, there has been an increasing interest in acknowledging the special needs of other underrepresented groups, such as the elderly, gay men and lesbians, and persons with disabilities. This article presents a rationale for including training about persons infected with the human immunodeficiency virus (HIV) in psychology graduate programs. Some of the reasons why students need training about HIV include the prevalence of the disease, ethical obligations, and competency considerations. A specific way to introduce students to the many issues related to HIV disease is to include persons with HIV disease in courses on providing services for diverse populations. Specific information that should be covered includes the epidemiology of HIV disease, confidentiality concerns, the issue of rational suicide, the students ’personal prejudices, HIV disease basic, HIV-related semantics, neurological conditions, and psychosocial factors and stressors. © 1993, Sage Publications. All rights reserved.

AIDS in the Republic of China, 1992 - Chuang, C.-Y.; Chang, P.-Y.; Lin, K.-C. (Clinical Infectious Diseases, 1993)
From May 1985 to December 1992, a total of 5, 931, 032 serum samples from eight population groups were tested for antibody to human immunodeficiency virus type 1 (HIV). Mandatory testing is carried out for blood donors, military recruits, immigrants, and prisoners. The other population groups were tested anonymously with consent. A total of 407 samples were seropositive. Of those HIV carriers, 63 developed AIDS: 37 were homosexuals, 6 were hemophiliacs, 1 was an intravenous drug user, 15 were heterosexuals, and 4 had no known risk factors. Although the prevalence of HIV infection and AIDS in Taiwan has remained low, the increase since 1988 has been rapid. Before 1987, all of the 48 persons with HIV infection were homosexuals or hemophiliacs. Thereafter, the risk groups diversified, with the main group shifting from homosexuals to heterosexuals and the number of intravenous drug users surpassing the number of hemophiliacs. Among the 63 patients with AIDS, 59 were male and only 4 were female; 53 have died (3 committed suicide). © 1993 by The University of Chicago.

Death and AIDS: A review of the medico-legal literature - Huber, J.T. (Death Studies, 1993)
As there is still neither a known cure for the acquired immunodeficiency syndrome (AIDS) nor any vaccine to prevent infection with the human immunodeficiency virus (HIV), an AIDS diagnosis continues to denote a death sentence. One might think that approaching dying, death, and bereavement in the AIDS pandemic would be the same as with other terminal illnesses. However, that is not the case. No other single disease in the history of the American legal system has generated more litigation than this disease. This article examines some of the medico-legal issues associated with AIDS-related death such as estate planning, discrimination, insurance, long-term care, the right to die, and suicide as detailed in medical and legal discourse. © 1993 Taylor & Francis Group, LLC.

Suicide Among AIDS Patients - Copeland, A.R. (Medicine, Science and the Law, 1993)
I studied 25 cases of suicide in people diagnosed as having the acquired immunodeficiency syndrome (AIDS) or who thought that they had that disorder, during 1985–1989. Case reports are presented. A discussion ensues concerning the occurrence of this phenomenon and the medical examiner's role in AIDS' public health situation in general. © 1993, The British Academy of Forensic Sciences. All rights reserved.

“Gotcha covered”: Puzzling out the mysteries of health insurance benefits coverage - Bruder, P. (Hospital Topics, 1993)

Youth Alienation as an Emerging Pediatric Health Care Issue: Update - Farrow, J.A. (American Journal of Diseases of Children, 1993)

Legal trends in bioethics. - Onel, S.; Fry-Revere, S. (The Journal of clinical ethics, 1992)

The other "Irish question". - Browne, H. (WorldAIDS, 1992)
The influence of the Roman Catholic Church on Irish society makes it difficult for sex and health educators and HIV/AIDS prevention efforts. Divorce, abortion, consensual sex between consenting adult men, and contraception for those under 18 years is banned in Ireland. Public opinions and recent court decisions do appear to bring a measure of hope for more lenient attitudes. The trends vary from the recent Supreme Court case of the 14-year old rape victim being permitted an abortion because she was suicidal to a radio talk show host, Father Michael Cleary who suspected she was "set-up" to test the ban on abortion. Father Cleary also outraged health educators by stating inaccurately that condoms did not prevent AIDS. It is estimated that 500 Irish women have abortions each year in Britain; there have been 262 reported AIDS cases and estimates of up to 10,000 HIV infected out of a population of 3.5 million. An AIDS education campaign was mounted in 1987, but in the 37-minute Department of Health video only 1 minute was devoted to condoms and no sex was promoted as the only safe sex. Access is limited to consenting pharmacies and clinics for people 18 years of older; rural chemists may exercise discretion and refuse sales. In 1991, the government proposed lowering the age to 17 years for condom availability and assigning the regional health boards, the responsibility of determining who sells contraceptives. A university lecturer reported that inaction on this bill was close to "criminal inactivity." Challenges in February 1991 were made by the Irish Family Planning Association (IFPA) in setting up a condom sales kiosk in Dublin. The IFPA was fined, but opinion polls indicated that 57% supported condom availability for 16 year olds. On Valentines Day in 1992, condom vending machines, which are illegal, were installed in pubs and nightclubs, police action has been cautious. A new health minister is concerned about AIDS prevention and the republic's first woman President holds liberal views on sexual matters. The European Court of Human Rights supported an Irish senators appeal on the legality of homosexuality. A Gay Pride float won the best new entry award in the St. Patrick's Day parade in Cork.

Creating a Safer School Environment for Lesbian and Gay Students - Treadway, L.; Yoakam, J. (Journal of School Health, 1992)
ABSTRACT: 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 safer 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 referrals can help lesbian and gay young people. 1992 American School Health Association

Erotomania in an adolescent: clinical and theoretical considerations - Urbach, J.R.; Khalily, C.; Mitchell, P.P. (Journal of Adolescence, 1992)
Erotomania is a relatively rare delusional syndrome, typically seen in heterosexual women of middle-age or beyond. This is the first reported occurrence in an adolescent, and one of very few involving homosexual orientation. A detailed case report is discussed in the context of adolescent developmental phenomena, including "crushes", identity formation, and the resolution of sexual orientation. The presentation of erotomania as alleged sexual abuse, and a possible etiologic role for childhood sexual trauma, are considered. © 1992.

Suicide related to human immunodeficiency virus infection in Stockholm - Rajs, J.; Fugelstad, A. (Acta Psychiatrica Scandinavica, 1992)
During a 5‐year period (July 1, 1985 to June 30, 1990), a systematic investigation of medicolegal autopsy cases with regard to the occurrence of human immunodeficiency virus (HIV) infection was carried out at the Department of Forensic Medicine in Stockholm, Sweden. Cases where a positive result was obtained from enzyme‐linked immunosorbent assay and Western blotting were counted as HIV‐positive (85 instances among 16,938 deaths, or 0.50%). Of these deaths, 21 (25%) were suicides. The number and proportion of suicides among HIV‐positive homo‐ and bisexual males increased during the study period but remained unchanged for infected intravenous drug addicts. This increase of suicides among homo‐ and bisexual males could be related to the duration of the infection and to the manifestation of acquired immunodeficiency syndrome (AIDS) symptoms. Only 1 of the 21 suicides occurred in a hospital; 17 were committed in the homes of the deceased and 3 outdoors. Medicinal drug overdosage was the dominant choice of suicide method. Six of 12 homo‐ and bisexual males who committed suicide were of non‐Swedish origin, i.e. immigrants, likely to have a less stable social network and thereby probably receiving less psychosocial support than the native population. Copyright © 1992, Wiley Blackwell. All rights reserved
Keywords: cause of death; HIV infection; medicolegal autopsy; suicide

Rational Suicide and AIDS: Considerations for the Psychotherapist - Werth, J.L., Jr. (The Counseling Psychologist, 1992)
One of the issues arising out of the increasing incidence of acquired immunodeficiency syndrome (AIDS) is whether or not suicide may be considered to be a rational choice for a person with AIDS. In an effort to address this dilemma, this article begins by reviewing the literature pertaining to suicide and persons with terminal illnesses. Then, after recounting the suicide rate for persons with AIDS, it explores some of the physical and psychosocial factors that may be a part of a decision by a person with AIDS to commit suicide. Siegels criteria for a rational suicide are applied to the case of a person with AIDS. In addition, the role of the psychotherapist in the decision-making process is critically examined, as are some arguments against allowing suicide. Finally, suggestions for future directions by counseling psychologists are offered. © 1992, Sage Publications. All rights reserved.

Six strains of human immunodeficiency virus type 1 isolated in Japan and their molecular phylogeny - Shimizu, N.; Takeuchi, Y.; Naruse, T.; Inagaki, M.; Moriyama, E.; Gojobori, T.; Hoshino, H. (Journal of Molecular Evolution, 1992)
Five strains of human immunodeficiency virus type 1 (HIV-1) were isolated from five Japanese hemophilia patients. Two isolates, HIV1[GUN-1] and HIV-1[GUN-2], were from brother patients with hemophilia B and the other three isolates, HIV-I[GUN-3], HIV-1[GUN-4], and HIV1[GUN-5], were from hemophilia A patients. Another HIV-1 strain, HIV-1[GUN-6], was isolated from a Canadian male homosexual with AIDS. The restriction endonuclease cleavage maps of the proviral genomes of these six HIV-1 strains revealed that they were apparently different from each other. The phylogenetic trees constructed using restriction maps and nucleotide sequences were quite similar, indicating that phylogenetic analyses of Japanese HIV-1 isolates can be done using restriction maps of the proviruses. Phylogenetic analyses showed that they were more closely related to HIV-1s which had been reported to be isolated from homosexual patients in the United States than those isolated from African patients. In particular, GUN-1 and GUN-2 isolates were on the branch of a San Francisco isolate, ARV2, while GUN-5 and GUN-6 isolates were on the branch of HTLV-IIIB-related isolates. © 1992, Springer-Verlag New York Inc. All rights reserved.
Keywords: AIDS; HIV-1 isolate; Japanese hemophiliac; Phylogenetic tree; Restriction map

Risk of deliberate self‐harm and factors associated with suicidal behaviour among asymptomatic individuals with human immunodeficiency virus infection - Gala, C.; Pergami, A.; Catalan, J.; Riccio, M.; Durbano, F.; Musicco, M.; Baldeweg, T.; Invernizzi, G. (Acta Psychiatrica Scandinavica, 1992)
The study was aimed at evaluating the risk of deliberate self‐harm (DSH) and factors associated with suicidal behaviour in 213 asymptomatic individuals with human immunodeficiency virus (HIV) infection in 3 transmission categories (68 gay men, 123 intravenous drug users and 22 heterosexuals). The results showed that 12 HIV‐seropositive (HIV +) subjects were involved in DSH after the notification of a positive HIV test result, of which 8 occurred within 6 months and 4 between 6 months and 3 years. HIV + subjects with a past psychiatric history showed a 7.7‐fold increase in the relative risk of DSH, and HIV + subjects with a history of DSH showed a 5‐fold increase in the relative risk of DSH compared with HIV + individuals without a past psychiatric history and a history of DSH. Professionals involved in the care of HIV + individuals need to be aware of this risk, especially in the first few months after notification of HIV status and also at later stages of acquired immunodeficiency syndrome. Copyright © 1992, Wiley Blackwell. All rights reserved
Keywords: AIDS; deliberate self‐harm; drug abuse; HIV; homosexuality; suicidal risk

Physicians’ attitudes toward assisted suicide in aids - Slome, L.; Moulton, J.; Huffine, C.; Gorter, R.; Abrams, D. (Journal of Acquired Immune Deficiency Syndromes, 1992)
We investigated factors influencing attitudes and practices among San Francisco physicians toward physician-assisted suicide in the context of AIDS. To explore this topic a questionnaire was developed for use in comparing two physician groups. This self-administered instrument was completed by 69 physician members of the San Francisco County Community Consortium (CCC), a community-based clinical research organization whose members care for persons with human immunodeficiency virus (HIV) disease. A comparison group consisted of 86 randomly sampled San Francisco physicians recruited from the California Medical Association mailing list. Anonymity of respondents was maintained. Chi-squares and t-tests were conducted to compare physician groups with regard to demographics and experiences with AIDS. Factor analytic techniques and correlational analyses were used to identify attitudinal and behavioral predictors of willingness to assist in a patient suicide. Twenty-three percent of the total sample would be likely to grant the patient's initial request for assistance in committing suicide. When faced with an adamant request, CCC members would be more likely to assist than comparison group physicians. Ethical beliefs were the strongest predictor of physicians' intention to assist. Identification with the AIDS patient also had significant predictive value. © 1992 Raven Press, New York.
Keywords: Assisted suicide; Euthanasia; Medical ethics

Early brain changes in HIV infection: Neuropathoiogical study of 11 HIV seropositive, non-aids cases - Gray, F.; Lescs, M.-C.; Keohane, C.; Paraire, F.; Marc, B.; Durigon, M.; Gherardi, R. (Journal of Neuropathology and Experimental Neurology, 1992)
We examined 11 brains of human immunodeficiency virus (HIV) seropositive cases who died from unnatural causes (10 intravenous drug abusers who died from heroin overdose and 1 homosexual dead from a gunshot injury); 10 brains of HIV seronegative heroin addicts who died from overdose and 1 seronegative drug abuser who died from gunshot injury served as controls. Complete postmortem examination did not show evidence of acquired immune deficiency syndrome (AIDS) or AIDS related complex. Terminal changes including nerve cell ischemia, edema and diffuse vascular congestion were observed in all cases. Perivascular pigment deposition with macrophages was a constant finding in drug addicts and was probably related to chronic intravenous injection. In contrast, cerebral vasculitis was significantly more frequent and marked in HIV seropositive cases and was often associated with lymphocytic meningitis. Granular ependymitis, myelin pallor with reactive astrocytosis and microglial proliferation were also more frequent and more severe in HIV seropositive cases. Immunocytochemistry was negative for HIV antigens. Our study further supports the view that early central nervous system changes occur in HIV infection. © 1992 by the American Association of Neuropathologists.
Keywords: Acquired immune deficiency syndrome; Central nervous system; Heroin addiction; Human immunodeficiency virus; Overdose; Vasculitis

The influence of mental health problems on aids-related risk behaviors in young adults - Stiffman, A.R.; Dore, P.; Earls, F.; Cunningham, R. (Journal of Nervous and Mental Disease, 1992)
This paper explores how symptoms of mental health problems influence acquired immune deficiency syndrome-related risk behaviors, and how changes in those symptoms relate to risk behaviors engaged in by young adults. Repeated interviews with 602 youths since 1984 provide a history of change in behaviors. Mental health symptoms during adolescence (alcohol/drug [r =.28]; conduct disorder [r =.27]; depression [r =.16]; suicide [r =.14]; anxiety [r =.16]; and posttraumatic stress [r =.09]) are associated with higher numbers of risk behaviors (specifically, prostitution, use of intravenous drugs, and choice of a high-risk sex partner) during young adulthood. Changes in mental health symptoms between adolescence and young adulthood are related to the number of risk behaviors engaged in by young adulthood (total number of symptoms [B =.10], alcohol/drug abuse or dependence [B =.34], depression [B =.20], suicidality [B =.35], anxiety [B =.13], and posttraumatic stress [B =.14]). Changes in symptoms of mental health problems are associated specifically with those risk behaviors that are initiated primarily in young adulthood: Intravenous drug use, prostitution, and choice of risky partners. The findings show that prevention and treatment of mental health problems are important components of preventive interventions for human immunodeficiency virus infection in high-risk teens and young adults. © 1992 by The Williams & Wilkins.

The Sexual Abuse of Male Children and Adolescents: A Review of Current Research - Watkins, B.; Bentovim, A. (Journal of Child Psychology and Psychiatry, 1992)
Keywords: boys; Childhood sexual abuse; perpetrators

Surveillance of human immunodeficiency virus (HIV) antibodies in medicolegal autopsies in Finland - Monitoring early changes in HIV- seropositivity among risk groups and average population - Karhunen, P.J.; Brummer-Korvenkontio, H.; Laaksonen, H.; Kantanen, M.-L.; Arstila, P.; Leinikki, P. (Journal of Forensic Sciences, 1992)
In order to cooperate with voluntary screening programs aimed at the surveillance of the HIV epidemic in Finland, we have studied medicolegal autopsies for HIV antibodies since 1986 using an enzyme immunoassay on postmortem sera. The investigation covered 47.4% and 39.2%, respectively, of all deaths under the age of 65 years in the metropolitan areas of Helsinki and Turku-two cities on the densely populated southern coast of Finland from which most HIV infections have thus far been detected. Nine HIV-positive cases (0.12%) were detected among the 7305 medicolegal autopsies tested in 1986 to 1990. This figure is higher than the prevalence of 0.01 to 0.03% in voluntary screening programs for the general population would suggest. Seven of our cases had previously tested positive, and two were previously unknown cases, indicating that people at high risk are clustered in the medicolegal autopsy series. Of the six cases in an early stage of infection, three committed suicide suggesting the importance of HIV-screening in suicide cases in tracing symptomless HIV carriers. Five of the cases were detected in 1990, a year when the number of new HIV infections had more than doubled compared to the previous two years. This suggests that testing of medicolegal autopsies as surrogate tests for the population gives useful information even in low-prevalence areas like Finland. Such testing has none of the ethical problems of many other back-up surveys, and may be particularly sensitive to early changes in epidemiology.
Keywords: AIDS; autopsy; epidemiology; HIV; homosexuality; narcotics addicts; pathology and biology

HIV-related risk behaviors among cocaine users - Khalsa, H.K.; Kowalewski, M.R.; Anglin, M.D.; Wang, J. (AIDS Education and Prevention, 1992)
Risk behaviors related to human immunodeficiency virus (HIV) infection and transmission were studied in a sample of 167 male cocaine users admitted during a 5-month period to an inpatient drug treatment program. Data obtained included drug history and related behaviors, sexual behaviors, knowledge, and attitudes regarding HIV infection and AIDS. Approximately 20% of the sample had used IV drugs in the year prior to the interview and 94% of these reported sharing needles; 20% of the IV drug users (IVDUs) reported always using bleach to clean needles. With regard to sexual practices, 7% of the total sample reported sex with other males in the year prior to the interview; 86% of the total sample reported having sex with females and 80% of these noted they never or rarely used condoms during vaginal sex. Respondents generally did not believe they themselves were at high risk for HIV infection, yet they continued to engage in acknowledged high-risk behaviors. These findings suggest that IVDUs and non-IV cocaine users are likely to contribute to the spread of HIV in several populations. 167 cocaine-dependent male admissions to an inpatient alcohol and drug treatment program at West Los Angeles Veterans Administration Medical Center in 1988-89 were studied to identify determinants of HIV infection and issues relevant in planning risk-reduction behavior. Criteria for cocaine drug dependent diagnosis was based on the staff physician's determination according to the DSM-III-R. 18% were at least 29 years old, 51% were 30-39 years, 26% were 40-49 years, and 5% were 50 years. 53% were black, 32% white, 7% Hispanic,and 8% other. 38% were unemployed, 33% had full-time employment, and 10% worked part-time. 19% received welfare or disability or had irregular jobs. 16% were homeless at the time of the interview. 76% had a high school education or higher. 57% had an income US $15,000/year. 42% were separated or divorced. 88% had been in jail for at least 1 day. The average score on the knowledge of AIDS 6-point scale was 4.45 with iv drug users (IVDUs) having the highest scores. 25% had been tested previously for HIV infection. 10.6% of the 47 tested were seropositive. Most had prior other drug and alcohol use. 74% perceived themselves to be cocaine dependent. 20% (32) had used iv drugs within 6 months of the interview of which 88% were iv cocaine users (IVCUs). Most heavy IVCUs concentrated use within 1-3 months. 50% reported iv heroin use. IVCU drug use was between 1-10 times a month. Source of needle acquisition is provided. 21% used a needle only once. 46% reused needles 2-6 times, and 33% 10 times. 94% (31) reported sharing needles with 1 other person and 55% in group situations of whom 26% were strangers. 10% in group situations shared in shooting galleries and 13% with strangers. Only 5 of the 33 IVDUs reported using effective needle cleaning methods. 85% had sex with female partners and 7% had male sex partners. 71 % of heterosexuals and 75% of homosexuals had 1-5 partners. 3% (5) of the total sample of 67 had male IVDU sex partners. 21% had sex with female IVDUs. 60% of those having sex with IVDUs had 1-5 partners. 16.2% reported participating in anal sex with 5 partners. 91.7% did use condoms regularly. 50% reported being high during sex. 11% reported being paid for sex. 17% recognized being at greater risk and 41% thought their risk was lower. 72% reported behavior changes to reduce the risk of HIV infection. Subjects report fewer sexual contacts than previous studies. More pay for sex with crack. Female use patterns are different. IVDUs and non-IVCUs are likely to contribute to the spread of HIV in several populations.

A review of the long-term effects of child sexual abuse - Beitchman, J.H.; Zucker, K.J.; Hood, J.E.; DaCosta, G.A.; Akman, D.; Cassavia, E. (Child Abuse and Neglect, 1992)
The existing literature on the long-term sequelae of child sexual abuse is reviewed. The evidence suggests that sexual abuse is an important problem with serious long-term sequelae; but the specific effects of sexual abuse, independent of force, threat of force, or such family variables as parental psychopathology, are still to be clarified. Adult women with a history of childhood sexual abuse show greater evidence of sexual disturbance or dysfunction, homosexual experiences in adolescence or adulthood, depression, and are more likely than nonabused women to be revictimized. Anxiety, fear, and suicidal ideas and behavior have also been associated with a history of childhood sexual abuse but force and threat of force may be a necessary concomitant. As yet, there is insufficient evidence to confirm a relation between a history of childhood sexual abuse and a postsexual abuse syndrome and multiple or borderline personality disorder. Male victims of child sexual abuse show disturbed adult sexual functioning. The relation between age of onset of abuse and outcome is still equivocal. Greater long-term harm is associated with abuse involving a father or stepfather and abuse involving penetration. Longer duration is associated with greater impact, and the use of force or threat of force is associated with greater harm. © 1992.
Keywords: Long-term effects; Sexual abuse in childhood

A question of mercy. - Selzer, R. (The New York times magazine, 1991)

Switzerland's videotex computer sex education programme. - Barbey, M.A. (Planned parenthood in Europe = Planning familial en Europe, 1991)
Switzerland's videotex computer sex education program in French is a telematic service set up in youth centers, schools and post offices, or for a monthly home rental charge of 9 swiss francs. German and Italian versions will be available by the end of 1991. CIAO receives 100 calls a month, or 20,000 screen page consultations. Anonymity is assured for caller and specialist through identification by pseudonym. This article discusses the experience of 2 trained specialists, a social worker and a sex education teacher, who answer questions. 70% of callers are boys, perhaps due to greater familiarity with computers, and to public location and freer attitude talking about sex in a group. Girls may use family planning centers for their questions. The typical boys 13-15 years questions concern anatomy and the size of the penis, breast stimulation, masturbation. Guilt and fear of consequences are communicated. Adolescents tend to focus on relationships, with shyness a typical pattern. There is expressed concern for whether it's OK to sexually explore certain sex zones, and what tells me she's happy. Communication between partners about sex is the difficulty and specialists emphasize asking the girl herself how she feels. With increasing age, the focus is very specific; i.e., premature ejaculation, STD's, homosexuality, but also with concern for knowledge about normal love-making and worry about not wanting it enough. In general, questions tend to be bound by traditional roles and questions on contraception are rare. Condom questions are usually related to AIDs. Questions express self-doubt and honesty, which sometimes focuses on the tragedy of sexual abuse, rape, AIDS, and suicide. Specialists find the work rewarding and helpful in sex education discussions in the classroom; great respect for young people is generated.

Mortality attributable to HIV infection/AIDS--United States, 1981-1990. (MMWR. Morbidity and mortality weekly report, 1991)
From 1981 through 1990, 100,777 deaths among persons with acquired immunodeficiency syndrome (AIDS) were reported to CDC by local, state, and territorial health departments; almost one third (31,196) of these deaths were reported during 1990. During the 1980s, AIDS emerged as a leading cause of death among young adults in the United States. By 1988, human immunodeficiency virus (HIV) infection/AIDS had become the third leading cause of death among men 25-44 years of age and, by 1989, was estimated to be second, surpassing heart disease, cancer, suicide, and homicide (Figure 1). In 1988, HIV infection/AIDS ranked eighth among causes of death among women 25-44 years of age (Figure 2); in 1991, based on current trends, HIV infection/AIDS is likely to rank among the five leading causes of death in this population (1).

Risk factors for attempted suicide in gay and bisexual youth - Remafedi, G.; Farrow, J.A.; Deisher, R.W. (Pediatrics, 1991)
Studies of human sexuality have noted high rates of suicidality among homosexual youth, but the problem has not been systematically examined. This work was undertaken to identify risk factors for suicide attempts among bisexual and homosexual male youth. Subjects were 137 gay and bisexual males, 14 through 21 years of age, from the upper Midwest and Pacific Northwest. Forty-one subjects (41/137) reported a suicide attempt; and almost half of them described multiple attempts. Twenty-one percent of all attempts resulted in medical or psychiatric admissions. Compared with nonattempters, attempters had more feminine gender roles and adopted a bisexual or homosexual identity at younger ages. Attempters were more likely than peers to report sexual abuse, drug abuse, and arrests for misconduct. The findings parallel previous studies' results and also introduce novel suicide risk factors related to gender nonconformity and sexual milestones.
Keywords: adolescence; gender role; homosexuality; sexual abuse; substance abuse; suicide

Gay and lesbian homeless/street youth: Special issues and concerns - Kruks, G. (Journal of Adolescent Health, 1991)
Data on homeless and runaway youth were collected through a consortium of agencies, including one that provides services to a high percentage of gay- lesbian-, and bisexual-identified youth. Gay and bisexual male youth appear to be at increased risk for both homelessness and suicide. Gay male street youth may have been forced out of their homes because of their sexual orientation, and are more likely to engage in survival sex (prostitution) than their nongay male counterparts. In one sample, 53% of gay-identified street youths had attempted suicide, compared with 32% of a cohort of street youths that included both gay and nongay youths. Prejudice, discrimination, and homophobia are still rampant in society today; these factors contribute to a multiplicity of problems that face the young person who is gay. © 1991 Society for Adolescent Medicine.
Keywords: Adolescence Gay youth Homeless youth Prostitution

AIDS‐Related Factors Predictive of Suicidal Ideation of Low and High Intent Among Gay and Bisexual Men - Schneider, S.G.; Taylor, S.E.; Kemeny, M.E.; Hammen, C. (Suicide and Life‐Threatening Behavior, 1991)
ABSTRACT: AIDS‐related stressors were studied in relationship to suicidal ideation and suicide intent among 778 gay and bisexual men (none with AIDS). Over the previous six months, 27% (n = 212) reported suicidal ideation. Subjects who reported suicidal ideation (compared to those who did not) were more likely to report recent (last 6 months) bereavement of partner, recent ARC diagnosis, and multiple close friends with ARC. Suicide ideators were divided by a median split on a self‐report scale of suicide intent into low (n = 105) and high (n = 107) intent suicide ideators. News of HIV seropositivity was specifically related to low intent suicidal ideation. High intent suicidal ideation was associated with having a partner with AIDS or ARC, or multiple close friends with AIDS, or having ARC. Generally speaking, while temporally discrete AIDS‐related events were associated the report of suicidal ideation, ongoing stressors which may more greatly challenge adaptational capacities were more associated with high intent suicidal ideation. 1991 The American Association for Suicidology

Factors Influencing Suicide Intent in Gay and Bisexual Sucide Ideators: Differing Models for Men With and Without Human Immunodeficiency Virus - Schneider, S.G.; Taylor, S.E.; Hammen, C.; Kemeny, M.E.; Dudley, J. (Journal of Personality and Social Psychology, 1991)
Of 778 gay and bisexual men (none with acquired immunodeficiency syndrome [AIDS]), 27% n = 212 reported suicidal ideation over the previous 6 months. Covariance structure models were used to explore predictors of suicide intent among n = 112 suicide ideators with n = 100 and without n = 112 human immunodeficiency virus (HIV). Current AIDS-related stressors (deaths and illnesses and perceived AIDS risk) and past levels of adaptive functioning (social isolation and depression) were significantly more powerful predictors of suicide intent among HIV-positive than among HIV-negative ideators. Biological AIDS risk predicted neither suicide intent, current distress, nor perceived AIDS risk. Pathways to suicide intent appear to be psychologically, rather than biologically, mediated. Among HIV-positive ideators, AIDS-related death and illness events predicted suicide intent but not current distress symptoms. Some suicidal ideation in response to AIDS-related events may be an effort to cope rather than a manifestation of psychological distress.

Risk factors for shooting gallery use and cessation among intravenous drug users - Celentano, D.D.; Vlahov, D.; Cohn, S.; Anthony, J.C.; Solomon, L.; Nelson, K.E. (American Journal of Public Health, 1991)
Background. Shooting galleries, locations where intravenous drug users (IVDUs) can rent or borrow needles and syringes, are a high-risk environment for HIV-1 transmission. This study investigates risk factors for lifetime attendance at shooting galleries and differentiates characteristics of those who continue to frequent shooting galleries and those who have stopped. Methods. We interviewed 2615 active IVDUs in Baltimore in 1988 and 1989 and determined patterns of IV drug use, sociodemographics, and HIV-1 serostatus as related to persistence vs cessation of shooting gallery use. Results. Over half (52%) of active IVDUs reported ever using a shooting gallery, with 33% reporting use within the prior 3 months. In multivariate analysis, lifetime shooting gallery use was associated with male gender, homosexuality/bisexuality, low socioeconomic status, Black race, and heavier drug involvement. Persistent shooting gallery users were more frequently male, homosexual/bisexual, homeless, less educated, and started IV drug use more recently compared with those who ceased going to shooting galleries. Conclusions. Shooting gallery attendance may be pragmatic from a sociological and economic perspective, but it carries with it a heightened risk of acquiring HIV-1 infection.

Free will versus determinism in bioethics: comparative philosophical and Jewish perspectives. - Steinberg, A. (Assia, Jewish medical ethics, 1991)

Lance: A gay recovering alcoholic misdiagnosed as HIV-positive - Kus, R.J.; Carpenter, M.A. (Archives of Psychiatric Nursing, 1991)
Lance is a 29-year-old gay alcoholic who was misdiagnosed as human immunodeficiency virus (HIV)-positive. In reaction to the diagnosis, Lance subsequently engaged in a series of destructive behaviors towards himself and others. When he was told that his diagnosis was in error, Lance was able to break out of his self-destructive cycle. This article explores the symbolic interactionist concepts of definition of the situation and of stigma and provides nursing implications for caring for people with HIV infection and the acquired immune deficiency syndrome. © 1991.

Human t cell lymphotropic virus types i and ii in intravenous drug users in san francisco: Risk factors associated with seropositivity - Feigal, E.; Murphy, E.; Vranizan, K.; Bacchetti, P.; Chaisson, R.; Drummond, J.E.; Blattner, W.; McGrath, M.; Greenspan, J.; Moss, A. (Journal of Infectious Diseases, 1991)
Serologic assays for human T cell lymphotropic virus types 1 and II (HTLVI/II) infection were done in 676 intravenous drug users (IVDUs) in San Francisco between 1985 and 1987: 150 in 1985,44 in 1986, and 482 in 1987. All sera were tested by Western blot, ELISA, and p24 RIA. A total of 111 participants were seropositive in a minimum of two assays. Duration of intravenous heroin use was strongly associated with the risk of HTLV I/II seropositivity:⪰ 21 years odds ratio, 6.1 (95% confidence interval [Cl], 2.2-17.5), compared with <10 years of heroin use. Additional independent risk factors included black or Hispanic race, female sex, and the use of drugs in a shooting gallery. Coinfection of HTLV I/II and human immunodeficiency virus was less frequent than expected by chance (P <.02). Longitudinal specimens were available in 154 participants. The age- and race-adjusted seroconversion rate was 3.4% (95% Cl, 1.3-8.9) per person per year. Of the 349 homosexual men tested, none were HTLV I/II-seropositive. © 1991 by The University of Chicago.

Christian psychiatry: The impact of evangelical belief on clinical practice - Galanter, M.; Larson, D.; Rubenstone, E. (American Journal of Psychiatry, 1991)
Objective: The authors surveyed psychiatrists in the Christian Psychiatry movement to assess the role of religious belief in their practices. Method: The psychiatrists were members of the Christian Medical and Dental Society; questionnaires were sent to 260, and usable responses were received from 193. The subjects were asked about demographic and practice variables, "born again" religious experiences, group cohesion, and beliefs about using the Bible and prayer in treatment. Results: The respondents were somewhat more religious than Americans overall, who are themselves more religious than most psychiatrists. Nearly all reported having been "born again," after which they generally experienced a decrease in emotional distress. There was a significant difference in the respondents' affiliative feelings toward psychiatrists in the Christian Psychiatry movement and other psychiatrists. For acute schizophrenic or manic episodes, the respondents considered psychotropic medication the most effective treatment, but they rated the Bible and prayer more highly for suicidal intent, grief reaction, sociopathy, and alcoholism. Whether or not a patient was "committed to Christian beliefs" made a significant difference in whether the respondents would recommend prayer to the patient as treatment. About one-half said they would discourage strongly religious patients from an abortion, homosexual acts, or premarital sex, and about one-third said they would discourage other patients from these activities. Conclusions: Many studies have suggested a need for more sensitivity to religious issues by psychiatrists, and this study provides systematic findings on one approach. It remains important to evaluate ways in which a religious perspective can be related to clinical practice and what benefits and problems may derive from such a relationship.

A review of the short-term effects of child sexual abuse - Beitchman, J.H.; Zucker, K.J.; Hood, J.E.; daCosta, G.A.; Akman, D. (Child Abuse and Neglect, 1991)
This is the first of a two-part report that critically evaluates empirical studies on the short- and long-term effects of child sexual abuse. With the exception of sexualized behavior, the majority of short-term effects noted in the literature are symptoms that characterize child clinical samples in general. Among adolescents, commonly reported sequelae include sexual dissatisfaction, promiscuity, homosexuality, and an increased risk for revictimization. Depression and suicidal ideation or behavior also appear to be more common among victims of sexual abuse compared to normal and psychiatric nonabused controls. Frequency and duration of abuse, abuse involving penetration, force, or violence, and a close relationship to the perpetrator appear to be the most harmful in terms of long-lasting effects on the child. The high prevalence of marital breakdown and psychopathology among parents of children who are sexually abused makes it difficult to determine the specific impact of sexual abuse over and above the effects of a disturbed home environment. Given the broad range of outcome among sexual abuse victims, as well as the methodological weaknesses present in many of the studies reviewed, it is not possible at this time to postulate the existence of a "post-sexual-abuse-syndrome" with a specific course or outcome. © 1991.
Keywords: Abuse-specific effects; Child sexual abuse; Short-term effects

Sexual confusion among certain college males. - Goff, J.L. (Adolescence, 1990)
In dealing with college age (18-22) males, clinical observations have shown a fairly common inability to successfully form intimate relationships with same-age females. This problem often appears to be due to an inability to bond and trust that is rooted in the formative years in the nuclear home. When this happens, the young male frequently develops a fear of being sexually abnormal, perhaps even homosexual. This manifests itself in shame, anxiety, depression, denial, reaction formation, performance anxiety, concern about being found out, isolation, substance abuse and, occasionally, acting out. Getting such persons to admit these fears is generally extremely difficult, requiring gentle and empathetic, but persistent, probing on the part of the therapist. Therapy consists of understanding and acceptance by the client that these fears are most often reactive, that they are commonly held, and that when they are seen in proper perspective, they often diminish. The present paper reviews some of the literature on sexual developmental issues of the adolescent male as a backdrop for this problem. The specific difficulties related to reactive homophobia are explored, and some therapeutic approaches suggested.

Depression among lesbians: An invisible and unresearched phenomenon - Rothblum, E.D. (Journal of Gay and Lesbian Psychotherapy, 1990)
Despite the research emphasis on depression among women, there has been virtually no focus on depression among lesbians. This article reviews evidence for factors that might place lesbians at increased risk for depression as well as factors that would protect lesbians from depression. Additionally, it discusses the research on suicide attempts, alcoholism, and physical and sexual abuse of lesbians, all disorders related to depression. Homophobia, the coming out process, and the lesbian community are presentee! as issues not faced by heterosexual women. Depression among lesbians who are non-white, not middle class, and not young adults is discussed. Finally, the article jpre- sents evidence for the role of therapists and self-help groups in affecting depression rates among lesbians. © 1990 Taylor & Francis Group, LLC.

Violence Against Lesbian and Gay Male Youths - Hunter, J. (Journal of Interpersonal Violence, 1990)
This article documents the incidence of violent assaults toward lesbian and gay male youths and those youths' suicidal behavior. Data were obtained by reviewing charts for the first 500 youths seeking services in 1988 at the Hetrick-Martin Institute, a community-based agency serving lesbian and gay male adolescents in New York City. The adolescents, who ranged in age from 14 to 21 years, were predominantly minority (35% Black, 46% Latino) and typically were referred by peers, media, schools, and emergency shelters. Of the youths, 41% in the sample reported having suffered violence from families, peers, or strangers; 46% of that violence was gay-related. These reports of violence occurred in conjunction with a high rate of suicide attempts: 41% of the girls and 34% of the boys who experienced violent assaults reported having attempted suicide. These alarming rates indicate the need for more systematic monitoring of violence toward and suicidal behavior among lesbian and gay male youths. © 1990, SAGE PUBLICATIONS. All rights reserved.

Psychopathologic features among drug addicts and homosexuals with HIV infection - Cazzullo, C.L.; Gala, C.; Martini, S.; Pergami, A.; Rossini, M.; Russo, R. (International Journal of Psychiatry in Medicine, 1990)
Personal and familial psychopathological histories and information about early losses were collected and the results of the locus of control test and tests for psychological responses were determined for a series of ninety-two HIV-infected subjects (58 drug addicts; 26 homosexuals; 8 heterosexuals, partners of drug addicts). A higher percentage of drug addicts reported past histories of attempted suicide than the homosexuals. Early loss events were more frequent for homosexuals than for drug addicts. There was a higher psychopathological risk for asymptomatic HIV seropositivity in homosexuals, drug addicts who had attempted suicide, subjects that acknowledged that they have serious illness and subjects with external coping mechanisms rather than internal.

Metamorphosis of an asian butterfly - Jewell, A. (Pacific Review, 1990)
These two critical and financial successes in London’s West End, with the common theme of Madame Butterfly, dem-onstrate and at times question some continuing western attitudes towards East Asia. Basically, boy (French diplomat/ American marine) meets girl (Chinese transvestite ‘actress’/ Vietnamese bargirl) in Asian city (Beijing/Saigon). They fall in love, part, and one of them commits suicide. © 1990 Oxford university press.

Reproduction and life strategies in the Paleozoic tabulate coral Paleofavosites capax (Billings) - LEE, D.‐J.; NOBLE, J.P.A. (Lethaia, 1990)
Asexual and sexual modes of colony formation in a tabulate coral Paleofavosites capax are recognized from the early Silurian Gun River Formation of Anticosti Island. Québee. Colonies produced by asexual fragmentation comprise monospecific ‘clumped populations’. They are characterized by circular and concave bases, and lack a protocorallite origin of colony growth. Sexually produced colonies, where in situ, are always dispersed and characterized by conical bases with a definite protocorallite point origin of colony growth. Asexual colony formation by fragmentation in P. capax appears to have been an adaptation to a habitat of muddy substrates. Sexual reproduction in this species probably played a minor role but was necessary for the maintenance of gene diversity and long‐distance dispersal. A comparison of corallite size distributions between populations demonstrates that intrapopulation variation in the ‘dispersed population’ and the conical colonies in ‘transported populations’ of P. capax is significantly larger than the variation in the ‘clumped populations’. It is suggested that this difference reflects the two modes of reproduction. The above observations are significant to systematic studies because they show that estimates of species morphologic parameters can he seriously biased even when based on a relatively large sample size from a well‐defined population if that population is largely a result of asexual colony formation. Copyright © 1990, Wiley Blackwell. All rights reserved

Psychological functioning in a cohort of gay men at risk for AIDS: A three-year descriptive study - Joseph, J.G.; Caumartin, S.M.; Tal, M.; Kirscht, J.P.; Kessler, R.C.; Ostrow, D.G.; Wortman, C.B. (Journal of Nervous and Mental Disease, 1990)
This study describes the mental health of a large cohort of gay men participating in the Chicago Multicenter AIDS Cohort Study/Coping and Change Study. Six biannual questionnaires were self-administered between 1984 and 1988. General mental health was determined by the Hopkins Symptom Checklist (HSCL). An abbreviated version of the Center for Epidemiologic Study Depression Scale (CESD-5) and an adapted Diagnostic Interview Schedule (DIS) question also measured depression. Suicidal ideation was assessed by one question in the HSCL. AIDS-specific distress was determined by three subscales specifically developed for this study. While mean HSCL and CESD-5 scores were stable during the observational period, AIDS-specific distress increased over time. The HSCL scores for the cohort were somewhat elevated above general population norms but considerably below psychiatric outpatient norms. Fewer than 12% of the men reported elevated HSCL or CESD-5 scores three or more times. A self-reported episode of depression of two weeks or more, measured by the DIS screening question, was experienced by 40.1% of the sample. Suicidal ideation was reported on three or more visits by 18.8% of the men. The younger members of this cohort exhibit greater general and AIDS-specific distress. Income was inversely associated with general distress. HIV-seropositive participants had generally higher AIDS-specific distress scores than those who were seronegative, but their scores were equivalent on the HSCL and CESD-5. © 1990 by William & Wilkins.

Followup observations of operated male-to-female transsexuals - Stein, M.; Tiefer, L.; Melman, A. (Journal of Urology, 1990)
We performed an in-depth interview to ascertain the psychosocial and functional status in 10 of 22 male-to-female transsexuals who underwent vaginoplasty from May 1985 to December 1988. Followup from 5 to 48 months was available for 14 patients. Our patients comprised a well educated, mostly employed, law abiding group with a low abiding group with a low incidence of drug use. Most patients were able to develop strong support systems and showed a marked decrease in suicidal tendencies postoperatively. Functionally, the majority of the patients were able to lubricate the neovagina and have painless intercourse with a potential for orgasm. The cosmetic result was judged to be good, with no patient reporting being discovered of having had a prior operation by the sexual partner. We experienced a 21% rate of vaginal stenosis with 40% of these patients fully functional after a corrective operation.

Needle Sharing among Male Prostitutes: Preliminary Findings of the Prospero Project - Waldorf, D.; Murphy, S.; Lauderback, D.; Reinarman, C.; Marotta, T. (Journal of Drug Issues, 1990)
To date there is only sketchy information about the needle-sharing practices of IV drug users. This article reviews the existing literature on needle-sharing practices and presents quantitative findings on IV drug use, needle-sharing practices and the utilization of shooting galleries of male sex workers. Self-reports of 178 street hustlers, male prostitutes who sell sexual favors in public places, indicate a high incidence of IV drug use, particularly methamphetamines, cocaine and heroin. They also report considerable syringe sharing, as well and needle sharing in social settings such as shooting galleries, bath houses and sex clubs. Pragmatic issues, such as availability of syringes and convenience, are said to be the principle reasons to share needles. Race and ethnicity were not important factors for this group. It would appear from this preliminary data that a sizeable percentage of street hustlers in San Francisco are at risk to contract the HIV virus because of their needle-sharing practices. © 1990, Florida State University College of Criminology and Criminal Justice. All rights reserved.

Search for early lesions following human immunodeficiency virus type 1 infection. A study of six individuals who died a violent death after seroconversion - Madea, B.; Roewer, H.J.; Krueger, G.R.F.; Ablashi, D.V.; Josephs, S.F. (Archives of Pathology and Laboratory Medicine, 1990)
Histologic studies supplemented by in situ hybridization for human immunodeficiency virus type 1 (HIV-1), Epstein-Barr virus, cytomegalovirus, and human herpesvirus type 6 were performed on tissues obtained from the autopsy of six patients who died either by homicide or suicide shortly after learning of their seroconversion. Except for mild nonspecific tissue reactions, no lesions were noted that would indicate HIV-1 infection. DNA from all viruses was detected in some lymphoid cells. The amount of DNA for Epstein-Barr virus, cytomegalovirus, and human herpesvirus type 6 corresponded to that observed for clinically occult latent infection. Lymphoid cells carrying HIV-1 DNA were even less frequent. Cells positive for HIV-1 were noted in the lamina propria of the large intestine in three male homosexuals and in one female prostitute. The cells were arranged similar to antigen-presenting cells. The present findings are consistent with current theories regarding the pathogenesis of HIV-1-associated disease.

Risk factors for human immunodeficiency virus infection among parenteral drug abusers in a low-prevalence area - Chandrasekar, P.H.; Molinari, J.A.; Kruse, J.A. (Southern Medical Journal, 1990)
Information is scant regarding epidemiologic risk factors for human immunodeficiency virus (HIV) infection among parenteral drug abusers (PDAs) residing in areas of low seroprevalence. A detailed interview and HIV serologic testing were conducted among PDAs hospitalized at Detroit Receiving Hospital for reasons unrelated to HIV infection. The study involved 22 seropositive (17 men, 5 women) and 52 seronegative (34 men, 18 women) drug abusers in Detroit, Michigan, an area of relatively low HIV prevalence. The interviews included inquiries regarding risk factors such as duration of drug abuse, visits to “shooting galleries,” use of “hit men,” needle sharing, sterile injection techniques, use of “street” antibiotics, promiscuity, visits to prostitutes, homosexuality, history of sexually transmitted diseases, and history of travel to areas of high HIV prevalence. A strong association was noted between the number of risk factors present and HIV seropositivity. The presence of any three or more risk factors was significantly associated (P <.05) with seropositivity. Awareness of epidemiologic risk factors for HIV infection among PDAs in a low-prevalence area is useful in identification of seropositive drug abusers and is crucial in designing educational interventional strategies to interrupt viral transmission. © 1990 Southern Medical Association.

HIV-infected IV drug users in methadone treatment: Outcome and psychological correlates - A preliminary report - Batki, S.L.; Sorensen, J.L.; Gibson, D.R.; Maude-Griffin, P. (NIDA Research Monograph Series, 1989)

AIDS: Ethical Implications for Psychological Intervention - Morrison, C.F. (Professional Psychology: Research and Practice, 1989)
Examines the ethical issues facing psychologists working with people who are infected with AIDS (acquired immune deficiency syndrome) and individuals in high-risk groups. Duty to treat is examined with a consideration of homophobia and biases about intravenous drug users. Confidentiality is discussed in the context of record keeping, in cases of conflict with duty to warn, and in cases of suicide. Psychologists are urged to consider possible ethical dilemmas before they arise, to ensure that the best decisions are made.

Psychological and social consequences of hiv exposure: Homosexuals in southern california - Kaisch, K.; Anton-Culver, H. (Psychology & Health, 1989)
The purpose of this study was to identify the psychological and social consequences experienced by apparently healthy homosexual men who learn that they have positive results on the HIV antibody test, but who have not yet developed AIDS or ARC. Employing a census survey of the male membership of three homophile organizations in a Southern California county (n = 1905), 30 HIV positives and 55 negatives completed a biographical questionnaire, the IPAT Anxiety Scale Questionnaire, the IPAT Depression Scale, and the Coping Strategies Inventory. Results indicate that HIV positives show considerable disorganization after hearing test results, have clinically high levels of anxiety (n = 10), and clinically high levels of depression (n = 14) when compared to the normative samples. Positives also reported pervasive changes in their sexual activity (n = 30), and experienced negative consequences in social (n = 15) and occupational functioning (n = 10). Twelve subjects reported suicidal ideation after they heard the results of their testing, with one subject reporting a suicide attempt. The methodological limitations of the study were examined, with an emphasis on the limitations of the survey method. Speculations to account for the reported behaviors were discussed. © 1989, Taylor & Francis Group, LLC. All rights reserved.
Keywords: anxiety; coping; depression; HIV antibody test; homosexual men; social and occupational effects

Cocaine Use and HIV Infection in Intravenous Drug Users in San Francisco - Chaisson, R.E.; Bacchetti, P.; Osmond, D.; Brodie, B.; Sande, M.A.; Moss, A.R. (JAMA: The Journal of the American Medical Association, 1989)
We assessed risk factors for human immunodeficiency virus (HIV) infection in 633 heterosexual intravenous drug users. The HIV seroprevalence was 26% in blacks, 10% in Hispanics, and 6% in whites. Intravenous cocaine use significantly increased the risk of HIV infection, with a seroprevalence of 35% in daily cocaine users (odds ratio, 6.4; 95% confidence interval, 3.0 to 13.3). Black subjects were more likely to use cocaine regularly. Drug use in shooting galleries and sharing of drug injection equipment were also associated with HIV infection and were more common in cocaine users. By multivariate analysis, black race, daily cocaine injection by blacks and Hispanics, all other cocaine injection, heavy use prior to entry into methadone treatment by blacks, and use of drugs in shooting galleries were independent predictors of HIV infection. Methadone therapy was associated with substantial reductions in heroin use and some reduction in cocaine use, but 24% of cocaine users receiving methadone began or increased cocaine injection after entry into treatment. © 1989, American Medical Association. All rights reserved.

Suicidal Behavior in Adolescent and Young Adult Gay Men - Schneider, S.G.; Farberow, N.L.; Kruks, G.N. (Suicide and Life‐Threatening Behavior, 1989)
ABSTRACT: The relationship of homosexuality to suicidal behavior was explored by questionnaire responses from 52 men in gay‐and‐lesbian college organizations and 56 men in gay rap groups. A family background of alcoholism and physical abuse, social supports perceived as rejecting of homosexuality, and no religious affiliation were associated with a history of suicidal ideation, reported by 55% of the participants. Racial/ethnic minorities tended to be overrepresented among suicidal as compared to nonsuicidal gay men. Suicide attempts, reported by 20% of the sample, were most often associated with intrapersonal distress, and occurred most often while individuals were “closeted” and/or in the context of recent rejection for being homosexual. Nearly all attempters were aware of their homosexual feelings, but had not yet established a “positive gay identity” at the time of their first suicide attempt. Suicidal behavior in gay youths may be the product both of familial factors that predispose youths to suicidal behavior, and of social and intrapersonal stressors involved in coming to terms with an emerging homosexual identity. 1989 The American Association for Suicidology

Gay, Lesbian, and Bisexual Adolescents: A Critical Challenge to Counselors - COLEMAN, E.; REMAFEDI, G. (Journal of Counseling & Development, 1989)
Meeting the health care needs of gay, lesbian, and bisexual teenagers has become a public health imperative, and mental health professionals should be prepared for the challenge. The stigma of homosexuality often gives rise to psychosocial problems for adolescents, who are in the process of sexual identity development. The stigma also may complicate delivery of appropriate, ethical, and sound mental health treatment. Suggestions are offered to support healthy development, to assist recovery from stigma, and to avert the disastrous consequences of suicide and AIDS. 1989 American Counseling Association

Providing sensitive health care to gay and lesbian youth - Sanford, N.D. (Nurse Practitioner, 1989)
While the years of adolescence are usually very difficult, for gay and lesbian youth they are tremendously traumatic. Gay and lesbian youth face many problems because of the homophobia in our culture; such a young person often hides his or her gay or lesbian identity, and health care professionals often deny its existence. Increased anxiety and fear cause gay and lesbian youth to be particularly vulnerable to the major problems of adolescence, such as drug and alcohol abuse, sexual acting-out, pregnancy, AIDS, homelessness and suicide. The etiology of homosexuality is still not understood, and a number of theories are discussed in this article. Troiden’s model of gay and lesbian identity development is presented, covering sensitization, identity confusion, assumption and commitment. A lack of appropriate role models has been a significant problem, although some change is occurring. Specific ways of helping these troubled adolescents are given, with a particular emphasis on education and providing methods of support. © Williams and Wilkins 1989. All Rights Reserved.

AIDS-related illness and AIDS risk in male homo/bisexual substance abusers: Case reports and clinical issues - Westermeyer, J.; Seppala, M.; Gasow, S.; Carlson, G. (American Journal of Drug and Alcohol Abuse, 1989)
Little has been written about the treatment of substance use disorders among seropositive HIV patients or high-risk seronegative substance abusers. Demographic and clinical characteristics, along with treatment issues, were examined based on experience with 18 patients in a substance abuse program in a university medical center (3 AID, 3 ARC, 9 seropositive only, and 3 seronegative high risk). Scores on a substance abuse rating scale were extremely high. Most of them abused three or more different substances, had used drugs parenterally, had more than 50 sex partners, and/or had received previous substance abuse treatment. Affective disorder, suicide attempt, and antisocial personality were frequent in this group. About half of the patients complied with treatment and showed improvement in their substance disorder. Several common themes in the management of these patients are described. © 1989 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.

Mortality and morbidity in transsexual patients with cross-gender hormone treatment - Asscheman, H.; Gooren, L.J.G.; Eklund, P.L.E. (Metabolism, 1989)
Sex steroid treatment is associated with side effects. The number of deaths and morbidity cases in 425 transsexual patients treated with cross-gender hormones were evaluated retrospectively and compared with the expected number in a similar reference group of the population. The number of deaths in male-to-female transsexuals was five times the number expected, due to increased numbers of suicide and death of unknown cause. Combined treatment with estrogen and cyproterone acetate in 303 male-to-female transsexuals was associated with a 45-fold increase of thromboembolic events, hyperprolactinemia (400-fold), depressive mood changes (15-fold), and transient elevation of liver enzymes. Androgen treatment in 122 female-to-male transsexuals was associated with weight increase >10% (17.2%) and acne (12.3%). In both groups persistent liver enzyme abnormalities could be attributed to other causes than sex steroids (hepatitis B and alcohol abuse). Much of the morbidity was minor and reversible with appropriate treatment or temporary discontinuation of hormone treatment. Thus, the dilemma of prescribing cross gender hormones in view of the needs of these patients is not resolved. Explanation of possible side effects and careful clinical judgment remain the cornerstone of the clinical decision to prescribe cross-gender hormones. Furthermore, follow up of this relatively young population to disclose long-term side effects and to elucidate the association of sex steroids with coronary heart disease, as well as efforts to reduce the risk of thromboembolic events, are required. © 1989.

Sodomy in Enlightenment Prussia - Steakley, J. (Journal of Homosexuality, 1989)

Sexual acting out and the desire for revenge. - Hull, J.W.; Lane, R.C.; Okie, J. (Psychoanalytic review, 1989)

Substance abuse and suicide. The San Diego study - Rich, C.L.; Fowler, R.C.; Young, D. (Annals of Clinical Psychiatry, 1989)
We investigated 283 suicides in San Diego between November 1981 and June 1983. The first 204 cases were collected consecutively. The next 79 were consecutive cases under age 30. The sample consisted, then, of three separate but overlapping consecutive series: 133 cases under age 30, 150 cases age 30 and over, and 204 cases of all ages. Overall, substance abuse/dependence was diagnosed in about two thirds of the cases, both over and under age 30. Depressive disorders were most commonly diagnosed in association with substance abuse (SA) in both age groups. Many other disorders also accompanied SA. There were significantly more diagnoses of ' drug' abuse among the younger cases than among the older suicides. The frequency of alcohol abuse was the same. There were no significant differences in the rates of SA between the men and women in the 204 consecutive cases. Of the 45 suicides with psychotic disorders in the consecutive series, more than half (62%) were also substance abusers. Of the 15 cases who had personality disorders, 14 also were substance abusers. Also, 12 of 13 gay males were known to be substance abusers. In all cases, the drugs most frequently abused were alcohol, sedatives, marijuana, and stimulants. Depressive symptoms were common in the cases with SA even if an affective disorder was not formally diagnosed. We conclude that SA is possibly fat more important as a primary etiology of suicides than was previously believed.

The role of culture and family in mental illness - Jaschke, V.; Doi, T. (Bulletin of the Menninger Clinic, 1989)

Mortality in psychiatric inpatients - Casadebaig, F.; Quemada, N. (Acta Psychiatrica Scandinavica, 1989)
ABSTRACT– The number of persons taken into psychiatric hospital care during 1982 in France was estimated using data on length of stay and analysing these by the person‐year method. The number of observed deaths was compared by sex and age group with the number of deaths expected if the mortality in the general French population in 1982 were applied to the numbers of inpatients of the same sex and age group. The result of this comparison was that the mortality in mentally ill inpatients was found to be 3 times higher than that in the general population. This higher rate is further accentuated in younger age groups, especially women. This excess mortality has been observed with respect to natural causes of death as well as to unnatural causes, i.e. injury and suicide. Deaths from diseases of the circulatory system are overrepresented. As is true in the general population, these diseases account for the greatest number of deaths. Excess mortality is also high from diseases of the respiratory system. There is a high excess mortality due to signs, symptoms and ill‐defined conditions, especially among women. Only in the case of neoplasms is there no excess mortality. Finally, excess mortality is found for deaths by injury and poisoning, especially for women, and suicides, particularly among men. Nevertheless, up to the age of 34, the female suicide rate is higher than that of men. Copyright © 1989, Wiley Blackwell. All rights reserved
Keywords: mortality; psychiatric inpatient

HIV-related deaths outside medical institutions in Stockholm - Rajs, J.; Karlsson, T.; Eklund, B.; Bergendahl, K. (Forensic Science International, 1989)
During a 3-year period (August 1st, 1985 to July 31st, 1988) a systematic investigation of medico-legal autopsy cases with regard to the presence of antibodies for HIV-virus was carried out at the Department of Forensic Medicine in Stockholm, Sweden. Prior to autopsy, blood samples were taken from femoral or subclavian veins and were investigated by use of ELISA-screening and Western blotting test. During the first year of study, HIV infection was demonstrated in 11 out of 3464 deaths (0.32%), during the second year in 29 out of 3483 deaths (0.83%), and during the last year in 13 out of 3107 deaths (0.42%). It was shown that 48 out of the total of 53 HIV positive cases were previously registered, but information about the infection was available to the autopsist in only 27 cases. Drug addicts dominated 41 of 53 cases. There were only eight homo- and bisexual males, two non drug addict Central Africans and two persons who received blood transfusions. Eight of the 53 persons died of natural causes whereas 45 deaths were due to violence and drugs. The causes of death of the HIV positive drug addicts were compared to the causes of death of the HIV negative addicts. The HIV positive drug addicts tended to die suddenly in connection with the intravenous administration of heroin and at lower blood concentrations of morphine more often than the HIV-negative addicts. No increase in the suicide frequency was noted in drug addicts in Stockholm during the studied period. © 1989.
Keywords: Causes of death; Drug addicts; HIV infection; Medico-legal autopsies