The popular website Myspace.com faces court action since May 3, 2013 in the Court of Quebec, District of Montreal, from the music label company Disques A Tempo, in the case number 500-32-138309-135 for offenses related to copyrights and related rights for a total sum of $ 7,000.00 plus court costs and interest.

In its petition, Disques A Tempo accuses Myspace.com of “violating all copyrights, moral rights, images, artist name and company name on a musical product distributed and used illegally.”

According to the petition registered this day, Myspace is broadcasting an entire musical CD “Ouvertures Royales” belonging exclusively to Disques A Tempo and is doing so without paying duties or any other financial compensation to the rightholder , musician and conductor Roger-Luc Chayer. The petition also describes the refusal from Myspace to remove the offending material despite numerous requests from the copyrights owner who produced the CD and marketed it as early as last September.

The Berne Convention, signed by Canada and the United States, allows an aggrieved party to file legal procedures required for copyright in his country of residence and in his city, even if the violation is in a foreign country and according to this convention, the offending party may not invoke the distance to evade its obligations.

If no agreement is reached in this case, the case will proceed in few months. Note that the President of Disques A Tempo, Roger-Luc Chayer, is renowned by obtaining a conviction in very severe terms against Quebecor in another case of copyright. The jurisprudence is referenced to UNESCO, the International UN agency for culture.

The Province

NBC

In a piece that appeared on the website’s student newspaper posted Friday, the Daily Reveille asked several players on the LSU football team how accepting they would be if there were an openly gay player on the roster.  The attitudes of most of the players when it came to that question can be summed up by the words of quarterback Stephen Rivers.

“If he can play for LSU, he will play for LSU,” the sophomore told the paper.

Notice we said “most,” though.  When asked about a gay man being a member of the Tigers, running back Alfred Blue, well, went here:

“Football is supposed to be this violent sport — this aggressive sport that grown men are supposed to play. Ain’t no little boys out here between them lines. So if you gay, we look at you as a sissy. You know? Like, how you going to say you can do what we do and you want a man?”

In response to the quotes, LSU has issued a statement on behalf of Blue in an attempt to cram the homophobic toothpaste back in the tube.

“I understand that my comments may have sounded insensitive to those who read the Reveille article on Friday,” the player’s statement began. “I in no way meant to belittle any person’s way of life and feel that everyone deserves a chance to become whatever they want to be.  One of my comments that was left out of Friday’s article shows this. I told the reporter that if any person can help to contribute to the team, then that is the bottom line.

“I apologize if anyone was hurt by my comments and also to everyone that I may have let down.”

While there appears to be some significant momentum toward a homosexual football player stepping out of the closet, Blue’s comments make it perfectly clear that such a development would be the first step of what will likely be a long road to acceptance inside the locker room.

Albawaba

The Lebanese mayor of Dekwaneh defended his actions in an interview Tuesday after he ordered Lebanese security forces to raid and shut down a gay-friendly nightclub in the Beiruti suburb town.

Several club-goers were arrested and forced to undress in the municipal headquarters, where they were then photographed naked.

“I saw 25 men outside, or what looked like boys and men. I went inside… I saw people kissing, touching each other, and a man wearing a skirt. These homosexual acts that are happening… are scandalous sexual acts,” Antoine Shakhtoura said.

Shakhtoura had ordered the nightclub Ghost to be shut down on charges of “promoting prostitution, drugs and homosexuality.”

The closure of the club occurred “without legal notice,” said the founder of Lebanese LGBTQ rights organization Helem, Charbel Maydaa, pointing out that the police already oppress gay and transgender people.

Those arrested included “people from the Syrian community and a Lebanese transsexual woman, who was harassed and forced to undress in the municipal headquarters,” said Maydaa.

“Of course we made them take off their clothes,” Shakhtoura said referring to the people they transferred to the municipality’s headquarters who were also photographed there.

“We saw a scandalous situation and we had to know what these people were. Is it a woman or a man? Turned out to be a half woman and half man. I do not accept this in Dekwaneh,” he insisted.

“We didn’t fight for and defend this land and our honor for some people… to practice these things in my neighborhood, Dekwaneh,” Shakhtoura added.

In response, one of Ghost’s managers said, “even if they are [gay], well, that is their personal freedom and we do not have any problem with it at all.”

The nightclub’s management condemned the municipality’s accusation, stressing to Al-Akhbar that the accusations against them were false and that the raid of the Lebanese forces had no prior warning.

Helem, which was founded in 2004, had been monitoring the nightclub as it was a regular target of police abuse.

In a statement the organization issued recently, they said, “witnesses confirmed that customers near the nightclub were frequently exposed to abuse because of their appearance. Some are transferred in car trunks to the municipality where they are physically and verbally abused.”

As reported in Al-Akhbar, the Dekwaneh area has joined other Lebanese regions in their heightened discrimination towards Syrians in the country. Syrian nightclub goers often risk violence should they violate the 7:00 pm curfew imposed on Syrian refugees in parts of Lebanon.

India Times

WASHINGTON: Researchers, including an Indian-origin scientist, have developed a revolutionary new technique to deliver and fully release an anti-HIV drug into the brain.

Scientists from Florida International University’s Herbert Wertheim College of Medicine devised a new nanotechnique that can deliver and release AZTTP into the brain.

Madhavan Nair and Sakhrat Khizroev of the HWCOM’s department of immunology , used magneto-electric nanoparticles (MENs) to cross the blood-brain barrier and send a significantly increased level of AZTTP — up to 97% more — to HIV-infected cells. The blood-brain barrier keeps most medicines from reaching the brain. Most antiretroviral therapies used to treat HIV are deposited in the liver, lungs and other organs before they reach the brain. “This allows HIV to lurk unchecked ,” said Nair.

This new method could help patients suffering from deseases such as Alzheimer’s , Parkinson’s and epilepsy.

Science Blog

More than 1 in 270 people in the US are living with HIV and every 9.5 minutes someone is else is infected. The economic cost estimates associated with HIV/AIDS exceed 36 billion dollars a year. The development of effective drug treatments have allowed people with HIV to live longer with federal health officials now predicting that by 2015 one-half of the population with HIV in the US will be older than 50.

Efavirenz (tradenames: Sustiva®, Stocrin®) is an antiretroviral (ARV) drug commonly used to treat HIV. Its popularity as a medication, alone or more commonly in combination with other HIV medications (tradename: Atripla®), is due to its superior effectiveness in suppressing replication of the virus that causes AIDS. Though highly effective, a standard dose of efavirenz is known to carry a risk of side effects that include adverse neuropsychiatric complications such as depression, anxiety, sleep disturbances, impaired concentration, aggressive behavior, night terrors, hallucinations, paranoia, psychosis and delusions. However the question remains as to why these side effects occur. Recent anecdotal reports of the recreational use of efavirenz provided some clues.

Dr. John A. Schetz at the University of North Texas Health Science Center in Fort Worth, Texas, utilizes a mechanistic approach to solving problems and answering questions of importance to society. As a neuropharmacologist working to discover and develop new drugs for the treatment of neurological and psychiatric disorders, his experience and intuition helped solve the mystery as to why efavirenz, when taken as prescribed, can cause adverse psychiatric events, as well as why there are reports of efavirenz being diverted for recreational use. The later practice could encourage the emergence of ARV-resistant HIV strains by educating the HIV virus.

Dr. Schetz’s interest was sparked by a network news report covering the topic of ARV abuse in South Africa. The report described how pills used to treat HIV were being crushed and the powder smoked for its psychoactive effects. Though there were no scientific studies on the topic, Dr. Schetz was aware of studies describing neuropsychiatric side effects in HIV patients taking the medication as prescribed, as well as case reports of sudden onset adverse psychiatric events in patients with no history of mental illness. However, research study results suggested that the later patient population were genetically predisposed because they have less effective variants of the enzyme primarily responsible for metabolizing efavirenz, leading to much slower than expected breakdown of efavirenz, and consequently higher than expected levels of drug in the body. Dr. Schetz initiated his investigation with molecular profiling of the receptor pharmacology of efavirenz which lead to the pinpointing of interactions with multiple established sites of action for other known drugs of abuse. He and a number of his colleagues worked together to achieve a pre-clinical understanding of the psychoactivity induced by efavirenz that may help explain reports both of its adverse neuropsychiatric side effects in HIV patients and of its diversion for recreational use.

Dr. Schetz’s work is the first ever study of the mechanisms of efavirenz’s psychopharmacology and these new findings will help stimulate interest to support additional research related to the mechanism of ARV side effects and abuse potential. This would help translate the pre-clinical findings into preventative measures addressing HIV medication-induced adverse side effects in patients living with HIV. Additionally, preventative strategies would improve patient adherence and quality of life, reduce the potential risk for the emergence of HIV drug resistant strains, and could prevent diversion of HIV medication for illicit use.”

His findings will be presented April 21, 2012 during Experimental Biology 2013 in Boston, MA.

Wikipedia

Human immunodeficiency virus infection / acquired immunodeficiency syndrome (HIV/AIDS) is a disease of the human immune system caused by infection with human immunodeficiency virus (HIV).^[1] During the initial infection, a person may experience a brief period of influenza-like illness. This is typically followed by a prolonged period without symptoms. As the illness progresses, it interferes more and more with the immune system, making the person much more likely to get infections, including opportunistic infections and tumors that do not usually affect people who have working immune systems.

HIV is transmitted primarily via unprotected sexual intercourse (including anal and even oral sex), contaminated blood transfusions, hypodermic needles, and from mother to child during pregnancy, delivery, or breastfeeding.^[2] Some bodily fluids, such as saliva and tears, do not transmit HIV.^[3] Prevention of HIV infection, primarily through safe sex and needle-exchange programs, is a key strategy to control the spread of the disease. There is no cure or vaccine; however, antiretroviral treatment can slow the course of the disease and may lead to a near-normal life expectancy. While antiretroviral treatment reduces the risk of death and complications from the disease, these medications are expensive and may be associated with side effects.

Genetic research indicates that HIV originated in west-central Africa during the early twentieth century.^[4] AIDS was first recognized by the Centers for Disease Control and Prevention (CDC) in 1981 and its cause—HIV infection—was identified in the early part of the decade.^[5] Since its discovery, AIDS has caused nearly 30 million deaths (as of 2009).^[6] As of 2010, approximately 34 million people are living with HIV globally.^[7] AIDS is considered a pandemic—a disease outbreak which is present over a large area and is actively spreading.^[8]

HIV/AIDS has had a great impact on society, both as an illness and as a source of discrimination. The disease also has significant economic impacts. There are many misconceptions about HIV/AIDS such as the belief that it can be transmitted by casual non-sexual contact. The disease has also become subject to many controversies involving religion.

Signs and symptoms

There are three main stages of HIV infection: acute infection, clinical latency and AIDS.^[9][10]

Acute infection

Main symptoms of acute HIV infection

The initial period following the contraction of HIV is called acute HIV, primary HIV or acute retroviral syndrome.^[9][11] Many individuals develop an influenza-like illness or a mononucleosis-like illness 2–4 weeks post exposure while others have no significant symptoms.^[12][13] Symptoms occur in 40–90% of cases and most commonly include fever, large tender lymph nodes, throat inflammation, a rash, headache, and/or sores of the mouth and genitals.^[11][13] The rash, which occurs in 20–50% of cases, presents itself on the trunk and is maculopapular, classically.^[14] Some people also develop opportunistic infections at this stage.^[11] Gastrointestinal symptoms such as nausea, vomiting or diarrhea may occur, as may neurological symptoms of peripheral neuropathy or Guillain-Barre syndrome.^[13] The duration of the symptoms varies, but is usually one or two weeks.^[13]

Due to their nonspecific character, these symptoms are not often recognized as signs of HIV infection. Even cases that do get seen by a family doctor or a hospital are often misdiagnosed as one of the many common infectious diseases with overlapping symptoms. Thus, it is recommended that HIV be considered in patients presenting an unexplained fever who may have risk factors for the infection.^[13]

Clinical latency

The initial symptoms are followed by a stage called clinical latency, asymptomatic HIV, or chronic HIV.^[10] Without treatment, this second stage of the natural history of HIV infection can last from about three years^[15] to over 20 years^[16] (on average, about eight years).^[17] While typically there are few or no symptoms at first, near the end of this stage many people experience fever, weight loss, gastrointestinal problems and muscle pains.^[10] Between 50 and 70% of people also develop persistent generalized lymphadenopathy, characterized by unexplained, non-painful enlargement of more than one group of lymph nodes (other than in the groin) for over three to six months.^[9]

Although most HIV-1 infected individuals have a detectable viral load and in the absence of treatment will eventually progress to AIDS, a small proportion (about 5%) retain high levels of CD4⁺ T cells (T helper cells) without antiretroviral therapy for more than 5 years.^[13][18] These individuals are classified as HIV controllers or long-term nonprogressors (LTNP).^[18] Another group is those who also maintain a low or undetectable viral load without anti-retroviral treatment who are known as “elite controllers” or “elite suppressors”. They represent approximately 1 in 300 infected persons.^[19]

Acquired immunodeficiency syndrome

Main symptoms of AIDS.

Acquired immunodeficiency syndrome (AIDS) is defined in terms of either a CD4⁺ T cell count below 200 cells per µL or the occurrence of specific diseases in association with an HIV infection.^[13] In the absence of specific treatment, around half of people infected with HIV develop AIDS within ten years.^[13] The most common initial conditions that alert to the presence of AIDS are pneumocystis pneumonia (40%), cachexia in the form of HIV wasting syndrome (20%) and esophageal candidiasis.^[13] Other common signs include recurring respiratory tract infections.^[13]

Opportunistic infections may be caused by bacteria, viruses, fungi and parasites that are normally controlled by the immune system.^[20] Which infections occur partly depends on what organisms are common in the person’s environment.^[13] These infections may affect nearly every organ system.^[21]

People with AIDS have an increased risk of developing various viral induced cancers including: Kaposi’s sarcoma, Burkitt’s lymphoma, primary central nervous system lymphoma, and cervical cancer.^[14] Kaposi’s sarcoma is the most common cancer occurring in 10 to 20% of people with HIV.^[22] The second most common cancer is lymphoma which is the cause of death of nearly 16% of people with AIDS and is the initial sign of AIDS in 3 to 4%.^[22] Both these cancers are associated with human herpesvirus 8.^[22] Cervical cancer occurs more frequently in those with AIDS due to its association with human papillomavirus (HPV).^[22]

Additionally, people with AIDS frequently have systemic symptoms such as prolonged fevers, sweats (particularly at night), swollen lymph nodes, chills, weakness, and weight loss.^[23] Diarrhea is another common symptom present in about 90% of people with AIDS.^[24]

Transmission

HIV is transmitted by three main routes: sexual contact, exposure to infected body fluids or tissues, and from mother to child during pregnancy, delivery, or breastfeeding (known as vertical transmission).^[2] There is no risk of acquiring HIV if exposed to feces, nasal secretions, saliva, sputum, sweat, tears, urine, or vomit unless these are contaminated with blood.^[27] It is possible to be co-infected by more than one strain of HIV—a condition known as HIV superinfection.^[32]

Sexual

The most frequent mode of transmission of HIV is through sexual contact with an infected person.^[2] The majority of all transmissions occur through heterosexual contacts (i.e. sexual contacts between people of the opposite sex);^[2] however, the pattern of transmission varies significantly among countries. In the United States, as of 2009, most sexual transmission occurred in men who had sex with men,^[2] with this population accounting for 64% of all new cases.^[33]

As regards unprotected heterosexual contacts, estimates of the risk of HIV transmission per sexual act appear to be four to ten times higher in low-income countries than in high-income countries.^[34] In low-income countries, the risk of female-to-male transmission is estimated as 0.38% per act, and of male-to-female transmission as 0.30% per act; the equivalent estimates for high-income countries are 0.04% per act for female-to-male transmission, and 0.08% per act for male-to-female transmission.^[34] The risk of transmission from anal intercourse is especially high, estimated as 1.4–1.7% per act in both heterosexual and homosexual contacts.^[34][35] While the risk of transmission from oral sex is relatively low, it is still present.^[36] The risk from receiving oral sex has been described as “nearly nil”^[37] however a few cases have been reported.^[38] The per-act risk is estimated at 0–0.04% for receptive oral intercourse.^[39] In settings involving prostitution in low income countries, risk of female-to-male transmission has been estimated as 2.4% per act and male-to-female transmission as 0.05% per act.^[34]

Risk of transmission increases in the presence of many sexually transmitted infections^[40] and genital ulcers.^[34] Genital ulcers appear to increase the risk approximately fivefold.^[34] Other sexually transmitted infections, such as gonorrhea, chlamydia, trichomoniasis, and bacterial vaginosis, are associated with somewhat smaller increases in risk of transmission.^[39]

The viral load of an infected person is an important risk factor in both sexual and mother-to-child transmission.^[41] During the first 2.5 months of an HIV infection a person’s infectiousness is twelve times higher due to this high viral load.^[39] If the person is in the late stages of infection, rates of transmission are approximately eightfold greater.^[34]

Rough sex can be a factor associated with an increased risk of transmission.^[42] Sexual assault is also believed to carry an increased risk of HIV transmission as condoms are rarely worn, physical trauma to the vagina or rectum is likely, and there may be a greater risk of concurrent sexually transmitted infections.^[43]

Body fluids

CDC poster from 1989 highlighting the threat of AIDS associated with drug use

The second most frequent mode of HIV transmission is via blood and blood products.^[2] Blood-borne transmission can be through needle-sharing during intravenous drug use, needle stick injury, transfusion of contaminated blood or blood product, or medical injections with unsterilised equipment. The risk from sharing a needle during drug injection is between 0.63 and 2.4% per act, with an average of 0.8%.^[44] The risk of acquiring HIV from a needle stick from an HIV-infected person is estimated as 0.3% (about 1 in 333) per act and the risk following mucus membrane exposure to infected blood as 0.09% (about 1 in 1000) per act.^[27] In the United States intravenous drug users made up 12% of all new cases of HIV in 2009,^[33] and in some areas more than 80% of people who inject drugs are HIV positive.^[2]

HIV is transmitted in About 93% of blood transfusions involving infected blood .^[44] In developed countries the risk of acquiring HIV from a blood transfusion is extremely low (less than one in half a million) where improved donor selection and HIV screening is performed;^[2] for example, in the UK the risk is reported at one in five million.^[45] In low income countries, only half of transfusions may be appropriately screened (as of 2008),^[46] and it is estimated that up to 15% of HIV infections in these areas come from transfusion of infected blood and blood products, representing between 5% and 10% of global infections.^[2][47]

Unsafe medical injections play a significant role in HIV spread in sub-Saharan Africa. In 2007, between 12 and 17% of infections in this region were attributed to medical syringe use.^[48] The World Health Organisation estimates the risk of transmission as a result of a medical injection in Africa at 1.2%.^[48] Significant risks are also associated with invasive procedures, assisted delivery, and dental care in this area of the world.^[48]

People giving or receiving tattoos, piercings, and scarification are theoretically at risk of infection but no confirmed cases have been documented.^[49] It is not possible for mosquitoes or other insects to transmit HIV.^[50]

Mother-to-child

HIV can be transmitted from mother to child during pregnancy, during delivery, or through breast milk.^[51][52] This is the third most common way in which HIV is transmitted globally.^[2] In the absence of treatment, the risk of transmission before or during birth is around 20% and in those who also breastfeed 35%.^[51] As of 2008, vertical transmission accounted for about 90% of cases of HIV in children.^[51] With appropriate treatment the risk of mother-to-child infection can be reduced to about 1%.^[51] Preventive treatment involves the mother taking antiretroviral during pregnancy and delivery, an elective caesarean section, avoiding breastfeeding, and administering antiretroviral drugs to the newborn.^[53] Many of these measures are however not available in the developing world.^[53] If blood contaminates food during pre-chewing it may pose a risk of transmission.^[49]

Virology

A diagram showing the structure of HIV virus

HIV is the cause of the spectrum of disease known as HIV/AIDS. HIV is a retrovirus that primarily infects components of the human immune system such as CD4⁺ T cells, macrophages and dendritic cells. It directly and indirectly destroys CD4⁺ T cells.^[54]

HIV is a member of the genus Lentivirus,^[55] part of the family of Retroviridae.^[56] Lentiviruses share many morphological and biological characteristics. Many species of mammals are infected by lentiviruses, which are characteristically responsible for long-duration illnesses with a long incubation period.^[57] Lentiviruses are transmitted as single-stranded, positive-sense, enveloped RNA viruses. Upon entry into the target cell, the viral RNA genome is converted (reverse transcribed) into double-stranded DNA by a virally encoded reverse transcriptase that is transported along with the viral genome in the virus particle. The resulting viral DNA is then imported into the cell nucleus and integrated into the cellular DNA by a virally encoded integrase and host co-factors.^[58] Once integrated, the virus may become latent, allowing the virus and its host cell to avoid detection by the immune system.^[59] Alternatively, the virus may be transcribed, producing new RNA genomes and viral proteins that are packaged and released from the cell as new virus particles that begin the replication cycle anew.^[60]

Two types of HIV have been characterized: HIV-1 and HIV-2. HIV-1 is the virus that was originally discovered (and initially referred to also as LAV or HTLV-III). It is more virulent, more infective,^[61] and is the cause of the majority of HIV infections globally. The lower infectivity of HIV-2 as compared with HIV-1 implies that fewer people exposed to HIV-2 will be infected per exposure. Because of its relatively poor capacity for transmission, HIV-2 is largely confined to West Africa.^[62]

Pathophysiology

Scanning electron micrograph of HIV-1, colored green, budding from a cultured lymphocyte.

After the virus enters the body there is a period of rapid viral replication, leading to an abundance of virus in the peripheral blood. During primary infection, the level of HIV may reach several million virus particles per milliliter of blood.^[63] This response is accompanied by a marked drop in the number of circulating CD4⁺ T cells. The acute viremia is almost invariably associated with activation of CD8⁺ T cells, which kill HIV-infected cells, and subsequently with antibody production, or seroconversion. The CD8⁺ T cell response is thought to be important in controlling virus levels, which peak and then decline, as the CD4⁺ T cell counts recover. A good CD8⁺ T cell response has been linked to slower disease progression and a better prognosis, though it does not eliminate the virus.^[64]

The pathophysiology of AIDS is complex.^[65] Ultimately, HIV causes AIDS by depleting CD4⁺ T cells. This weakens the immune system and allows opportunistic infections. T cells are essential to the immune response and without them, the body cannot fight infections or kill cancerous cells. The mechanism of CD4⁺ T cell depletion differs in the acute and chronic phases.^[66] During the acute phase, HIV-induced cell lysis and killing of infected cells by cytotoxic T cells accounts for CD4⁺ T cell depletion, although apoptosis may also be a factor. During the chronic phase, the consequences of generalized immune activation coupled with the gradual loss of the ability of the immune system to generate new T cells appear to account for the slow decline in CD4⁺ T cell numbers.^[67]

Although the symptoms of immune deficiency characteristic of AIDS do not appear for years after a person is infected, the bulk of CD4⁺ T cell loss occurs during the first weeks of infection, especially in the intestinal mucosa, which harbors the majority of the lymphocytes found in the body.^[68] The reason for the preferential loss of mucosal CD4⁺ T cells is that the majority of mucosal CD4⁺ T cells express the CCR5 protein which HIV uses as a co-receptor to gain access to the cells, whereas only a small fraction of CD4⁺ T cells in the bloodstream do so.^[69]

HIV seeks out and destroys CCR5 expressing CD4⁺ T cells during acute infection.^[70] A vigorous immune response eventually controls the infection and initiates the clinically latent phase. CD4⁺ T cells in mucosal tissues remain particularly affected.^[70] Continuous HIV replication causes a state of generalized immune activation persisting throughout the chronic phase.^[71] Immune activation, which is reflected by the increased activation state of immune cells and release of pro-inflammatory cytokines, results from the activity of several HIV gene products and the immune response to ongoing HIV replication. It is also linked to the breakdown of the immune surveillance system of the gastrointestinal mucosal barrier caused by the depletion of mucosal CD4⁺ T cells during the acute phase of disease.^[72]

Diagnosis

A generalized graph of the relationship between HIV copies (viral load) and CD4⁺ T cell counts over the average course of untreated HIV infection.                      CD4⁺ T Lymphocyte count (cells/mm³)                      HIV RNA copies per mL of plasma

HIV/AIDS is diagnosed via laboratory testing and then staged based on the presence of certain signs or symptoms.^[11] HIV testing is recommended for all those at high risk, which includes anyone diagnosed with a sexually transmitted illness.^[14] In many areas of the world a third of HIV carriers only discover they are infected at an advanced stage of the disease when AIDS or severe immunodeficiency has become apparent.^[14]

HIV testing

Most people infected with HIV develop specific antibodies (i.e. seroconvert) within three to twelve weeks of the initial infection.^[13] Diagnosis of primary HIV before seroconversion is done by measuring HIV-RNA or p24 antigen.^[13] Positive results obtained by antibody or PCR testing are confirmed either by a different antibody or by PCR.^[11]

Antibody tests in children younger than 18 months are typically inaccurate due to the continued presence of maternal antibodies.^[73] Thus HIV infection can only be diagnosed by PCR testing for HIV RNA or DNA, or via testing for the p24 antigen.^[11] Much of the world lacks access to reliable PCR testing and many places simply wait until either symptoms develop or the child is old enough for accurate antibody testing.^[73] In sub-Saharan Africa as of 2007–2009 between 30 and 70% of the population was aware of their HIV status.^[74] In 2009, between 3.6 and 42% of men and women in Sub-Saharan countries were tested^[74] which represented a significant increase compared to previous years.^[74]

Classifications of HIV infection

Two main clinical staging systems are used to classify HIV and HIV-related disease for surveillance purposes: the WHO disease staging system for HIV infection and disease,^[11] and the CDC classification system for HIV infection.^[75] The CDC‘s classification system is more frequently adopted in developed countries. Since the WHO‘s staging system does not require laboratory tests, it is suited to the resource-restricted conditions encountered in developing countries, where it can also be used to help guide clinical management. Despite their differences, the two systems allow comparison for statistical purposes.^[9][11][75]

The World Health Organization first proposed a definition for AIDS in 1986.^[11] Since then, the WHO classification has been updated and expanded several times, with the most recent version being published in 2007.^[11] The WHO system uses the following categories:

• Primary HIV infection: May be either asymptomatic or associated with acute retroviral syndrome.^[11]
• Stage I: HIV infection is asymptomatic with a CD4⁺ T cell count (also known as CD4 count) greater than 500/uL.^[11] May include generalized lymph node enlargement.^[11]
• Stage II: Mild symptoms which may include minor mucocutaneous manifestations and recurrent upper respiratory tract infections. A CD4 count of less than 500/uL.^[11]
• Stage III: Advanced symptoms which may include unexplained chronic diarrhea for longer than a month, severe bacterial infections including tuberculosis of the lung, and a CD4 count of less than 350/uL.^[11]
• Stage IV or AIDS: severe symptoms which include toxoplasmosis of the brain, candidiasis of the esophagus, trachea, bronchi or lungs and Kaposi’s sarcoma. A CD4 count of less than 200/uL.^[11]

The United States Center for Disease Control and Prevention also created a classification system for HIV, and updated it in 2008.^[75] This system classifies HIV infections based on CD4 count and clinical symptoms,^[75] and describes the infection in three stages:

• Stage 1: CD4 count ≥ 500 cells/µl and no AIDS defining conditions
• Stage 2: CD4 count 200 to 500 cells/µl and no AIDS defining conditions
• Stage 3: CD4 count ≤ 200 cells/µl or AIDS defining conditions
• Unknown: if insufficient information is available to make any of the above classifications

For surveillance purposes, the AIDS diagnosis still stands even if, after treatment, the CD4⁺ T cell count rises to above 200 per µL of blood or other AIDS-defining illnesses are cured.^[9]

Prevention

AIDS Clinic, McLeod Ganj, Himachal Pradesh, India, 2010

Sexual contact

Consistent condom use reduces the risk of HIV transmission by approximately 80% over the long term.^[76] When condoms are used consistently by a couple in which one person is infected, the rate of HIV infection is less than 1% per year.^[77] There is some evidence to suggest that female condoms may provide an equivalent level of protection.^[78] Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor) immediately before sex seems to reduce infection rates by approximately 40% among African women.^[79] By contrast, use of the spermicide nonoxynol-9 may increase the risk of transmission due to its tendency to cause vaginal and rectal irritation.^[80] Circumcision in Sub-Saharan Africa “reduces the acquisition of HIV by heterosexual men by between 38% and 66% over 24 months”.^[81] Based on these studies, the World Health Organization and UNAIDS both recommended male circumcision as a method of preventing female-to-male HIV transmission in 2007.^[82] Whether it protects against male-to-female transmission is disputed^[83][84] and whether it is of benefit in developed countries and among men who have sex with men is undetermined.^[85][86][87] Some experts fear that a lower perception of vulnerability among circumcised men may cause more sexual risk-taking behavior, thus negating its preventive effects.^[88]

Programs encouraging sexual abstinence do not appear to affect subsequent HIV risk.^[89] Evidence for a benefit from peer education is equally poor.^[90] Comprehensive sexual education provided at school may decrease high risk behavior.^[91] A substantial minority of young people continues to engage in high-risk practices despite knowing about HIV/AIDS, underestimating their own risk of becoming infected with HIV.^[92] It is not known whether treating other sexually transmitted infections is effective in preventing HIV.^[40]

Pre-exposure

Treating people with HIV whose CD4 count ≥ 350cells/µL with antiretrovirals protects 96% of their partners from infection.^[93] This is about a 10 to 20 fold reduction in transmission risk.^[94] Pre-exposure prophylaxis with a daily dose of the medications tenofovir, with or without emtricitabine, is effective in a number of groups including men who have sex with men, couples where one is HIV positive, and young heterosexuals in Africa.^[79]

Universal precautions within the health care environment are believed to be effective in decreasing the risk of HIV.^[95] Intravenous drug use is an important risk factor and harm reduction strategies such as needle-exchange programmes and opioid substitution therapy appear effective in decreasing this risk.^[96][97]

Post-exposure

A course of antiretrovirals administered within 48 to 72 hours after exposure to HIV positive blood or genital secretions is referred to as post-exposure prophylaxis.^[98] The use of the single agent zidovudine reduces the risk of subsequent HIV infection fivefold following a needle stick injury.^[98] Treatment is recommended after sexual assault when the perpetrator is known to be HIV positive but is controversial when their HIV status is unknown.^[99] Current treatment regimes typically use lopinavir/ritonavir and lamivudine/zidovudine or emtricitabine/tenofovir and may decrease the risk further.^[98] The duration of treatment is usually four weeks^[100] and is frequently associated with adverse effects (with zidovudine in about 70% of cases, including nausea in 24%, fatigue in 22%, emotional distress in 13%, and headaches in 9%).^[27]

Mother-to-child

Programs to prevent the vertical transmission of HIV (from mothers to children) can reduce rates of transmission by 92–99%.^[51][96] This primarily involves the use of a combination of antiviral medications during pregnancy and after birth in the infant and potentially includes bottle feeding rather than breastfeeding.^[51][101] If replacement feeding is acceptable, feasible, affordable, sustainable, and safe, mothers should avoid breastfeeding their infants; however exclusive breastfeeding is recommended during the first months of life if this is not the case.^[102] If exclusive breastfeeding is carried out, the provision of extended antiretroviral prophylaxis to the infant decreases the risk of transmission.^[103]

Vaccination

As of 2012 there is no effective vaccine for HIV or AIDS.^[104] A single trial of the vaccine RV 144 published in 2009 found a partial reduction in the risk of transmission of roughly 30%, stimulating some hope in the research community of developing a truly effective vaccine.^[105] Further trials of the RV 144 vaccine are ongoing.^[106][107]

Management

There is currently no cure or effective HIV vaccine. Treatment consists of high active antiretroviral therapy (HAART) which slows progression of the disease^[108] and as of 2010 more than 6.6 million people were taking them in low and middle income countries.^[7] Treatment also includes preventive and active treatment of opportunistic infections.

Antiviral therapy

Abacavir – a nucleoside analog reverse transcriptase inhibitor (NARTI or NRTI)

Current HAART options are combinations (or “cocktails”) consisting of at least three medications belonging to at least two types, or “classes,” of antiretroviral agents.^[109] Initially treatment is typically a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analogue reverse transcriptase inhibitors (NRTIs).^[109] Typical NRTIs include: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC).^[109] Combinations of agents which include a protease inhibitors (PI) are used if the above regime loses effectiveness.^[109]

When to start antiretroviral therapy is subject to debate.^[14][110] The World Health Organization, European guidelines and the United States recommends antiretrovirals in all adolescents, adults and pregnant women with a CD4 count less than 350/uL or those with symptoms regardless of CD4 count.^[14][109] This is supported by the fact that beginning treatment at this level reduces the risk of death.^[111] The United States in addition recommends them for all HIV-infected people regardless of CD4 count or symptoms; however it makes this recommendation with less confidence for those with higher counts.^[112] While the WHO also recommends treatment in those who are co-infected with tuberculosis and those with chronic active hepatitis B.^[109] Once treatment is begun it is recommended that it is continued without breaks or “holidays”.^[14] Many people are diagnosed only after treatment ideally should have begun.^[14] The desired outcome of treatment is a long term plasma HIV-RNA count below 50 copies/mL.^[14] Levels to determine if treatment is effective are initially recommended after four weeks and once levels fall below 50 copies/mL checks every three to six months are typically adequate.^[14] Inadequate control is deemed to be greater than 400 copies/mL.^[14] Based on these criteria treatment is effective in more than 95% of people during the first year.^[14]

Benefits of treatment include a decreased risk of progression to AIDS and a decreased risk of death.^[113] In the developing world treatment also improves physical and mental health.^[114] With treatment there is a 70% reduced risk of acquiring tuberculosis.^[109] Additional benefits include a decreased risk of transmission of the disease to sexual partners and a decrease in mother-to-child transmission.^[109] The effectiveness of treatment depends to a large part on compliance.^[14] Reasons for non-adherence include poor access to medical care,^[115] inadequate social supports, mental illness and drug abuse.^[116] The complexity of treatment regimens (due to pill numbers and dosing frequency) and adverse effects may reduce adherence.^[117] Even though cost is an important issue with some medications,^[118] 47% of those who needed them were taking them in low and middle income countries as of 2010^[7] and the rate of adherence is similar in low-income and high-income countries.^[119]

Specific adverse events are related to the agent taken.^[120] Some relatively common ones include: lipodystrophy syndrome, dyslipidemia, and diabetes mellitus especially with protease inhibitors.^[9] Other common symptoms include diarrhea,^[120][121] and an increased risk of cardiovascular disease.^[122] Newer recommended treatments are associated with fewer adverse effects.^[14] Certain medications may be associated with birth defects and therefore may be unsuitable for women hoping to have children.^[14]

Treatment recommendations for children are slightly different from those for adults. In the developing world, as of 2010, 23% of children who were in need of treatment had access.^[123] Both the World Health Organization and the United States recommend treatment for all children less than twelve months of age.^[124][125] The United States recommends in those between one year and five years of age treatment in those with HIV RNA counts of greater than 100,000 copies/mL, and in those more than five years treatments when CD4 counts are less than 500/ul.^[124]

Opportunistic infections

Measures to prevent opportunistic infections are effective in many people with HIV/AIDS. In addition to improving current disease, treatment with antiretrovirals reduces the risk of developing additional opportunistic infections.^[120] Vaccination against hepatitis A and B is advised for all people at risk of HIV before they become infected; however it may also be given after infection.^[126] Trimethoprim/sulfamethoxazole prophylaxis between four and six weeks of age and ceasing breastfeeding in infants born to HIV positive mothers is recommended in resource limited settings.^[123] It is also recommended to prevent PCP when a person’s CD4 count is below 200 cells/uL and in those who have or have previously had PCP.^[127] People with substantial immunosuppression are also advised to receive prophylactic therapy for toxoplasmosis and Cryptococcus meningitis.^[128] Appropriate preventive measures have reduced the rate of these infections by 50% between 1992 and 1997.^[129]

Alternative medicine

In the US, approximately 60% of people with HIV use various forms of complementary or alternative medicine,^[130] even though the effectiveness of most of these therapies has not been established.^[131] With respect to dietary advice and AIDS some evidence has shown a benefit from micronutrient supplements.^[132] Evidence for supplementation with selenium is mixed with some tentative evidence of benefit.^[133] There is some evidence that vitamin A supplementation in children reduces mortality and improves growth.^[132] In Africa in nutritionally compromised pregnant and lactating women a multivitamin supplementation has improved outcomes for both mothers and children.^[132] Dietary intake of micronutrients at RDA levels by HIV-infected adults is recommended by the World Health Organization.^[134][135] The WHO further states that several studies indicate that supplementation of vitamin A, zinc, and iron can produce adverse effects in HIV positive adults.^[135] There is not enough evidence to support the use of herbal medicines.^[136]

Prognosis

Disability-adjusted life yearfor HIV and AIDS per 100,000 inhabitants as of 2004.

no data   ≤ 10   10–25   25–50   50–100   100–500   500–1000

1000–2500   2500–5000   5000–7500   7500-10000   10000-50000   ≥ 50000

HIV/AIDS has become a chronic rather than an acutely fatal disease in many areas of the world.^[137] Prognosis varies between people, and both the CD4 count and viral load are useful for predicted outcomes.^[13] Without treatment, average survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype.^[138] After the diagnosis of AIDS, if treatment is not available, survival ranges between 6 and 19 months.^[139][140] HAART and appropriate prevention of opportunistic infections reduces the death rate by 80%, and raises the life expectancy for a newly diagnosed young adult to 20–50 years.^{[137][141][142]} This is between two thirds^[141] and nearly that of the general population.^[14][143] If treatment is started late in the infection, prognosis is not as good:^[14] for example, if treatment is begun following the diagnosis of AIDS, life expectancy is ~10–40 years.^[14][137] Half of infants born with HIV die before two years of age without treatment.^[123]

The primary causes of death from HIV/AIDS are opportunistic infections and cancer, both of which are frequently the result of the progressive failure of the immune system.^[129][144] Risk of cancer appears to increase once the CD4 count is below 500/μL.^[14] The rate of clinical disease progression varies widely between individuals and has been shown to be affected by a number of factors such as a person’s susceptibility and immune function;^[145] their access to health care, the presence of co-infections;^[139][146] and the particular strain (or strains) of the virus involved.^[147][148]

Tuberculosis co-infection is one of the leading causes of sickness and death in those with HIV/AIDS being present in a third of all HIV infected people and causing 25% of HIV related deaths.^[149] HIV is also one of the most important risk factors for tuberculosis.^[150] Hepatitis C is another very common co-infection where each disease increases the progression of the other.^[151] The two most common cancers associated with HIV/AIDS are Kaposi’s sarcoma and AIDS-related non-Hodgkin’s lymphoma.^[144]

Even with anti-retroviral treatment, over the long term HIV-infected people may experience neurocognitive disorders,^[152] osteoporosis,^[153] neuropathy,^[154] cancers,^[155][156] nephropathy,^[157] and cardiovascular disease.^[121] It is not clear whether these conditions result from the HIV infection itself or are adverse effects of treatment.

Epidemiology

Estimated prevalence of HIV among young adults (15–49) per country as of 2011.^[158]

HIV/AIDS is a global pandemic.^[159] As of 2010, approximately 34 million people have HIV worldwide.^[7] Of these approximately 16.8 million are women and 3.4 million are less than 15 years old.^[7] It resulted in about 1.8 million deaths in 2010, down from a peak of 2.2 million in 2005.^[7]

Sub-Saharan Africa is the region most affected. In 2010, an estimated 68% (22.9 million) of all HIV cases and 66% of all deaths (1.2 million) occurred in this region.^[160] This means that about 5% of the adult population is infected^[161] and it is believed to be the cause of 10% of all deaths in children.^[162] Here in contrast to other regions women compose nearly 60% of cases.^[160] South Africa has the largest population of people with HIV of any country in the world at 5.9 million.^[160] Life expectancy has fallen in the worst-affected countries due to HIV/AIDS; for example, in 2006 it was estimated that it had dropped from 65 to 35 years in Botswana.^[8]

South & South East Asia is the second most affected; in 2010 this region contained an estimated 4 million cases or 12% of all people living with HIV resulting in approximately 250,000 deaths.^[161] Approximately 2.4 million of these cases are in India.^[160]

In 2008 in the United States approximately 1.2 million people were living with HIV, resulting in about 17,500 deaths. The Centre for Disease Control and Prevention estimated that in 2008 20% of infected Americans were unaware of their infection.^[163] In the United Kingdom as of 2009 there where approximately 86,500 cases which resulted in 516 deaths.^[164] In Canada as of 2008 there were about 65,000 cases causing 53 deaths.^[165] Between the first recognition of AIDS in 1981 and 2009 it has led to nearly 30 million deaths.^[6] Prevalence is lowest in Middle East and North Africa at 0.1% or less, East Asia at 0.1% and Western and Central Europe at 0.2%.^[161]

History

Discovery

The Morbidity and Mortality Weekly Report reported in 1981 on what was later to be called “AIDS”.

AIDS was first clinically observed in 1981 in the United States.^[22] The initial cases were a cluster of injecting drug users and homosexual men with no known cause of impaired immunity who showed symptoms of Pneumocystis carinii pneumonia (PCP), a rare opportunistic infection that was known to occur in people with very compromised immune systems.^[166] Soon thereafter, an unexpected number of gay men developed a previously rare skin cancer called Kaposi’s sarcoma (KS).^[167][168] Many more cases of PCP and KS emerged, alerting U.S. Centers for Disease Control and Prevention (CDC) and a CDC task force was formed to monitor the outbreak.^[169]

Robert Gallo, co-discoverer of HIV in the early eighties among (from left to right) Sandra Eva, Sandra Colombini, and Ersell Richardson.

In the early days, the CDC did not have an official name for the disease, often referring to it by way of the diseases that were associated with it, for example, lymphadenopathy, the disease after which the discoverers of HIV originally named the virus.^[170][171] They also used Kaposi’s Sarcoma and Opportunistic Infections, the name by which a task force had been set up in 1981.^[172] At one point, the CDC coined the phrase “the 4H disease”, since the syndrome seemed to affect Haitians, homosexuals, hemophiliacs, and heroin users.^[173] In the general press, the term “GRID”, which stood for gay-related immune deficiency, had been coined.^[174] However, after determining that AIDS was not isolated to the gay community,^[172] it was realized that the term GRID was misleading and the term AIDS was introduced at a meeting in July 1982.^[175] By September 1982 the CDC started referring to the disease as AIDS.^[176]

In 1983, two separate research groups led by Robert Gallo and Luc Montagnier independently declared that a novel retrovirus may have been infecting AIDS patients, and published their findings in the same issue of the journal Science.^[177][178] Gallo claimed that a virus his group had isolated from an AIDS patient was strikingly similar in shape to other human T-lymphotropic viruses (HTLVs) his group had been the first to isolate. Gallo’s group called their newly isolated virus HTLV-III. At the same time, Montagnier’s group isolated a virus from a patient presenting with swelling of the lymph nodes of the neck and physical weakness, two characteristic symptoms of AIDS. Contradicting the report from Gallo’s group, Montagnier and his colleagues showed that core proteins of this virus were immunologically different from those of HTLV-I. Montagnier’s group named their isolated virus lymphadenopathy-associated virus (LAV).^[169] As these two viruses turned out to be the same, in 1986, LAV and HTLV-III were renamed HIV.^[179]

Origins

Both HIV-1 and HIV-2 are believed to have originated in non-human primates in West-central Africa and were transferred to humans in the early 20th century.^[4] HIV-1 appears to have originated in southern Cameroon through the evolution of SIV(cpz), a simian immunodeficiency virus (SIV) that infects wild chimpanzees (HIV-1 descends from the SIVcpz endemic in the chimpanzee subspecies Pan troglodytes troglodytes).^[180][181] The closest relative of HIV-2 is SIV(smm), a virus of the sooty mangabey (Cercocebus atys atys), an Old World monkey living in coastal West Africa (from southern Senegal to western Côte d’Ivoire).^[62] New World monkeys such as the owl monkey are resistant to HIV-1 infection, possibly because of a genomic fusion of two viral resistance genes.^[182] HIV-1 is thought to have jumped the species barrier on at least three separate occasions, giving rise to the three groups of the virus, M, N, and O.^[183]

There is evidence that humans who participate in bushmeat activities, either as hunters or as bushmeat vendors, commonly acquire SIV.^[184] However, SIV is a weak virus which is typically suppressed by the human immune system within weeks of infection. It is thought that several transmissions of the virus from individual to individual in quick succession are necessary to allow it enough time to mutate into HIV.^[185] Furthermore, due to its relatively low person-to-person transmission rate, SIV can only spread throughout the population in the presence of one or more high-risk transmission channels, which are thought to have been absent in Africa before the 20th century.

Specific proposed high-risk transmission channels, allowing the virus to adapt to humans and spread throughout the society, depend on the proposed timing of the animal-to-human crossing. Genetic studies of the virus suggest that the most recent common ancestor of the HIV-1 M group dates back to circa 1910.^[186] Proponents of this dating link the HIV epidemic with the emergence of colonialism and growth of large colonial African cities, leading to social changes, including a higher degree of sexual promiscuity, the spread of prostitution, and the accompanying high frequency of genital ulcer diseases (such as syphilis) in nascent colonial cities.^[187] While transmission rates of HIV during vaginal intercourse are low under regular circumstances, they are increased many fold if one of the partners suffers from a sexually transmitted infection causing genital ulcers. Early 1900s colonial cities were notable due to their high prevalence of prostitution and genital ulcers, to the degree that, as of 1928, as many as 45% of female residents of eastern Kinshasa were thought to have been prostitutes, and, as of 1933, around 15% of all residents of the same city had syphilis.^[187]

An alternative view holds that unsafe medical practices in Africa after World War II, such as unsterile reuse of single use syringes during mass vaccination, antibiotic and anti-malaria treatment campaigns, were the initial vector that allowed the virus to adapt to humans and spread.^{[185][188][189]}

The earliest well documented case of HIV in a human dates back to 1959 in the Congo.^[190] The virus may have been present in the United States as early as 1966,^[191] but the vast majority of infections occurring outside sub-Saharan Africa (including the U.S.) can be traced back to a single unknown individual who became infected with HIV in Haiti and then brought the infection to the United States some time around 1969.^[192] The epidemic then rapidly spread among high-risk groups (initially, sexually promiscuous men who have sex with men). By 1978, the prevalence of HIV-1 among gay male residents of New York and San Francisco was estimated at 5%, suggesting that several thousand individuals in the country had been infected.^[192]

Society and culture

Stigma

Ryan White became a poster child for HIV after being expelled from school because he was infected.

AIDS stigma exists around the world in a variety of ways, including ostracism, rejection, discrimination and avoidance of HIV infected people; compulsory HIV testing without prior consent or protection of confidentiality; violence against HIV infected individuals or people who are perceived to be infected with HIV; and the quarantine of HIV infected individuals.^[193] Stigma-related violence or the fear of violence prevents many people from seeking HIV testing, returning for their results, or securing treatment, possibly turning what could be a manageable chronic illness into a death sentence and perpetuating the spread of HIV.^[194]

AIDS stigma has been further divided into the following three categories:

• Instrumental AIDS stigma—a reflection of the fear and apprehension that are likely to be associated with any deadly and transmissible illness.^[195]
• Symbolic AIDS stigma—the use of HIV/AIDS to express attitudes toward the social groups or lifestyles perceived to be associated with the disease.^[195]
• Courtesy AIDS stigma—stigmatization of people connected to the issue of HIV/AIDS or HIV-positive people.^[196]

Often, AIDS stigma is expressed in conjunction with one or more other stigmas, particularly those associated with homosexuality, bisexuality, promiscuity, prostitution, and intravenous drug use.^[197]

In many developed countries, there is an association between AIDS and homosexuality or bisexuality, and this association is correlated with higher levels of sexual prejudice such as anti-homosexual/bisexual attitudes.^[198] There is also a perceived association between AIDS and all male-male sexual behavior, including sex between uninfected men.^[195] However, the dominant mode of spread worldwide for HIV remains heterosexual transmission.^[199]

Economic impact

Changes in life expectancy in some hard-hit African countries.                      Botswana                     Zimbabwe                     Kenya                     South Africa                     Uganda

HIV/AIDS affects the economics of both individuals and countries.^[162] The gross domestic product of the most affected countries has decreased due to the lack of human capital.^[162][200] Without proper nutrition, health care and medicine, large numbers of people die from AIDS-related complications. They will not only be unable to work, but will also require significant medical care. It is estimated that as of 2007 there were 12 million AIDS orphans.^[162] Many are cared for by elderly grandparents.^[201]

By affecting mainly young adults, AIDS reduces the taxable population, in turn reducing the resources available for public expenditures such as education and health services not related to AIDS resulting in increasing pressure for the state’s finances and slower growth of the economy. This causes a slower growth of the tax base, an effect that is reinforced if there are growing expenditures on treating the sick, training (to replace sick workers), sick pay and caring for AIDS orphans. This is especially true if the sharp increase in adult mortality shifts the responsibility and blame from the family to the government in caring for these orphans.^[201]

At the household level, AIDS causes both loss of income and increased spending on healthcare. A study in Côte d’Ivoire showed that households with an HIV/AIDS patient, spent twice as much on medical expenses as other households. This additional expenditure also leaves less income to spend on education and other personal or family investment.^[202]

Religion and AIDS

The topic of religion and AIDS has become highly controversial in the past twenty years, primarily because some religious authorities have publicly declared their opposition to the use of condoms.^[203][204] The religious approach to prevent the spread of AIDS according to a report by American health expert Matthew Hanley titled The Catholic Church and the Global Aids Crisis argues that cultural changes are needed including a re-emphasis on fidelity within marriage and sexual abstinence outside of it.^[204]

Some religious organisations have claimed that prayer can cure HIV/AIDS. In 2011, the BBC reported that some churches in London were claiming that prayer would cure AIDS, and the Hackney-based Centre for the Study of Sexual Health and HIV reported that several people stopped taking their medication, sometimes on the direct advice of their pastor, leading to a number of deaths.^[205] The Synagogue Church Of All Nations advertise an “anointing water” to promote God’s healing, although the group deny advising people to stop taking medication.^[205]

Media portrayal

One of the first high-profile cases of AIDS was the American Rock Hudson, a gay actor who had been married and divorced earlier in life, who died on 2 October 1985 having announced that he was suffering from the virus on 25 July that year. He had been diagnosed during 1984.^[206] A notable British casualty of AIDS that year was Nicholas Eden, a gay politician and son of the late prime minister Anthony Eden.^[207] On November 24, 1991, the virus claimed the life of British rock star Freddie Mercury, lead singer of the band Queen, who died from an AIDS related illness having only revealed the diagnosis on the previous day.^[208] However he had been diagnosed as HIV positive during 1987.^[209] One of the first high-profile heterosexual cases of the virus was Arthur Ashe, the American tennis player. He was diagnosed as HIV positive on 31 August 1988, having contracted the virus from blood transfusions during heart surgery earlier in the 1980s. Further tests within 24 hours of the initial diagnosis revealed that Ashe had AIDS, but he did not tell the public about his diagnosis until April 1992.^[210] He died, aged 49, as a result on 6 February 1993.^[211]

Therese Frare’s photograph of gay activist David Kirby, as he lay dying from AIDS while surrounded by family, was taken in April 1990. LIFE magazine said the photo became the one image “most powerfully identified with the HIV/AIDS epidemic.” The photo was displayed in LIFE magazine, was the winner of the World Press Photo, and acquired worldwide notoriety after being used in a United Colors of Benetton advertising campaign in 1992.^[212] In 1996, Johnson Aziga a Ugandan-born immigrant Canadian was diagnosed as a HIV-positive, but then he had unprotected sex with 11 women without telling them he has HIV. Since 2003, seven of them were infected with HIV, and two of them died of complications of AIDS.^[213][214] At last Aziga was convicted of first-degree murder and be liable to a life sentence.^[215]

Denial, conspiracies, and misconceptions

A small group of individuals continue to dispute the connection between HIV and AIDS,^[216] the existence of HIV itself, or the validity of HIV testing and treatment methods.^[217][218] These claims, known as AIDS denialism, have been examined and rejected by the scientific community.^[219] However, they have had a significant political impact, particularly in South Africa, where the government’s official embrace of AIDS denialism (1999–2005) was responsible for its ineffective response to that country’s AIDS epidemic, and has been blamed for hundreds of thousands of avoidable deaths and HIV infections.^{[220][221][222]} Operation INFEKTION was a worldwide Soviet active measures operation to spread information that the United States had created HIV/AIDS. Surveys show that a significant number of people believed – and continue to believe – in such claims.^[223]

There are many misconceptions about HIV and AIDS. Three of the most common are that AIDS can spread through casual contact, that sexual intercourse with a virgin will cure AIDS, and that HIV can infect only homosexual men and drug users. Other misconceptions are that any act of anal intercourse between two uninfected gay men can lead to HIV infection, and that open discussion of homosexuality and HIV in schools will lead to increased rates of homosexuality and AIDS.^[224][225]

Research

HIV/AIDS research includes all medical research which attempts to prevent, treat, or cure HIV/AIDS along with fundamental research about the nature of HIV as an infectious agent and AIDS as the disease caused by HIV.

HIV/AIDS research includes following the usual advice given by doctors in responding to HIV. The most universally recommended method for the prevention of HIV/AIDS is to avoid blood-to-blood contact between people and to otherwise practice safe sex. The most recommended method for treating HIV is for HIV-positive people to receive attention from a doctor who would coordinate the patient’s management of HIV/AIDS. There is no cure for HIV/AIDS.

Many governments and research institutions participate in HIV/AIDS research. This research includes behavioral health interventions such as sex education, and drug development, such as research into microbicides for sexually transmitted diseases, HIV vaccines, and antiretroviral drugs. Other medical research areas include the topics of pre-exposure prophylaxis, post-exposure prophylaxis, and Circumcision and HIV.

Notes

References

• Mandell, Gerald L.; Bennett, John E.; Dolin, Raphael, eds. (2010). Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases (7th ed.). Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 978-0-443-06839-3.
• Joint United Nations Programme on HIV/AIDS (UNAIDS) (2011). Global HIV/AIDS Response, Epidemic update and health sector progress towards universal access. Joint United Nations Programme on HIV/AIDS.

Xtra.ca

A publicly-funded Islamic school in Edmonton has come under fire after a video emerged of a Muslim leader comparing homosexuality to diabetes, cancer and AIDS in a lunch-hour talk to students.

Last fall Mustafa Khattab, the former imam at the Al Rashid Mosque in Edmonton, delivered a talk on the etiquette of interacting with people of the opposite sex to a group of students in the break room at the Edmonton Islamic Academy. Towards the end of his talk, someone asked Khattab about an Islamic perspective on homosexuality. Khattab, who was invited to give the talk, described homosexuality as “abnormal” and affirmed that it is not allowed by Islam.

“So for me somebody who is homosexual is like somebody who has diabetes, or cancer, or AIDS,” he said. “He has a special case and this person needs a special treatment. Can I talk to them? Why not? Just like I talk to everybody, okay. Personally I don’t like to be associated with them.”

He then shared a story about how he once moved his chair away from a gay man who was talking to him about discrimination and demonstrated his point by moving around a table. Khattab further claimed that homosexuality is “against everything” including nature and recounted that in his 20 to 25 years of farming he never came across gay ducks or goats.

“So for me somebody who is homosexual is like somebody who has diabetes, or cancer, or AIDS,” Mustafa Khattab told students last fall. “Personally I don’t like to be associated with them.”

(mustafakhattab.weebly.com)

“The best thing I like about the West is freedom and the worst thing about the West is too much freedom,” he said. “Sure, you’re allowed to do whatever you want but don’t go to the extreme. Don’t go overboard.”

In an email statement, Khattab, who has since left his position at the mosque and now works as an assistant lecturer in Islamic studies at Al-Azhar University in Cairo, Egypt according to his website, says it would be “unfortunate” to characterize him or Edmonton’s Islamic Academy as homophobic.

“We have to agree that this is a very controversial topic in almost all faiths and it’s hard sometimes to express your views on issues like this in a diplomatic way,” he writes. “Since I was talking to a group of high school students about a sensitive issue like this, I tried to make a point in a funny way, rather than being blunt. I agree I might have been unlucky in my choice of words, but I believe the comment was taken out of context and misrepresented. Whoever reported the comment failed to mention what I said about gays and lesbians being our brothers and sisters in humanity and they shouldn’t be discriminated against — even if we might disagree with what they do.”

Kim Capstick, the spokesperson for Alberta Education Minister Jeff Johnson, feels that Khattab’s comments do not reflect the spirit of Alberta’s Human Rights Act or the Charter which prohibit discrimination on the basis of sexual orientation.

“It is very clear in our expectations at all schools — whether they are private, public, Catholic, francophone, or home education — must respect diversity within this province,” she says. “That’s one of the things that makes Alberta great. We have amazing diversity. We need to make sure all kids, regardless of background, race, sexuality, colour, that all kids feel safe at school.”

Capstick says the ministry became aware of the situation on April 12 when it read an editorial on the Sun News Network website. She notes that Johnson was “incredibly concerned” with the story after it came to his attention and asked ministry officials to visit the school to confirm that Khattab was not a teacher and that the school did not condone his comments.

The school’s principal, Jawdah Jorf, refused to answer Xtra’s questions about which policies the Edmonton Islamic Academy has in place to support queer students.

“We already gave our stand and views to the media,” Jorf told Xtra by email. “We are not accepting any media interviews anymore as our comments were clear through the Edmonton Journal and the CTV news.”

In her interview with the Journal she disavowed Khattab’s comments and affirmed that they are his personal opinions and do not reflect the school’s view.

“I don’t understand how homosexuality is related to cancer or diabetes,” Jorf told the Journal. “You can’t compare these things. I don’t see how anyone can agree with a statement of that kind.”

Capstick says that Alberta’s new Education Act, which was passed last year and will come into effect in 2015, strives to ensure that students feel safe at school.

“We simply won’t tolerate any acts of hatred like that which would make kids not feel safe at school,” she says. “We just passed a new Education Act late last year and a big part of that legislation was ensuring that kids feel safe at school and that school was safe for all kids, regardless of which school they attend.”

Though the new Act addresses bullying among staff and students, it does not specifically mention any one group, including queer students.

“[Bullying is] wrong in all forms for all people,” Capstick says. “We didn’t want to inadvertently leave a group out.”

Liberal MLA and education critic Kent Hehr says this story is a “textbook example” of why public funding of private schools should be questioned. He believes that it’s not the proper role of government to fund private schools.

“Alberta funds private schools at a higher rate than any province,” he tells Xtra. “Remember in the Constitution Act the government has to provide education to the public, separate, and francophone schools, and after that it’s a political choice. In my view it’s bad public policy it doesn’t lead to better outcomes for your society.”

Kris Wells, a researcher at the University of Alberta’s Institute for Sexual Minority Studies and Services, says there is no reason why sexual orientation and gender identity can’t be addressed in age-appropriate ways in any faith community.

“What the school needs to do, if they have those kind of invited lecturers, is to ensure that there is someone who could can talk openly about the reality of sexual and gender minorities in Canada to counterbalance those hateful comments that were shared,” he says. “This way we can use this horrible incident and frame it as an opportunity to openly and professionally talk about these issues within that particular school community.

“We need to be talking about all these issues in our faith communities somehow,” he continues. “The presumption that LGBT youth don’t exist within faith-based schools is ludicrous and laughable and we continue to ignore that reality at our own peril and it’s our youth who suffer. They suffer through enforced silence, through bullying, and in tragic cases they take their own life.”

Homosexuality is romantic attraction, sexual attraction, or sexual activity between members of the same sex or gender. As an orientation, homosexuality refers to “an enduring pattern of or disposition to experience sexual, affectionate, or romantic attractions” primarily or exclusively to people of the same sex. “It also refers to an individual’s sense of personal and social identity based on those attractions, behaviors expressing them, and membership in a community of others who share them.”^[1][2]

Homosexuality is one of the three main categories of sexual orientation, along with bisexuality and heterosexuality, within the heterosexual–homosexual continuum (with asexuality sometimes considered a fourth). Scientific and medical understanding is that sexual orientation is not a choice, but rather a complex interplay of biological and environmental factors,^[1][3] especially with regard to early uterine environment.^[4] While there are those who still hold the view that homosexual activity is “unnatural” or “dysfunctional”,^[5][6] research has shown that homosexuality is an example of a normal and natural variation in human sexuality and is not in and of itself a source of negative psychological effects.^[1][7] Prejudice and discrimination against homosexual and bisexual people (homophobia) have, however, been shown to cause significant psychological harm, and are especially damaging to children who are homosexual or bisexual.^[7][8]

The most common terms for homosexual people are lesbian for females and gay for males, though gay is also used to refer generally to both homosexual males and females. The number of people who identify as gay or lesbian and the proportion of people who have same-sex sexual experiences are difficult for researchers to estimate reliably for a variety of reasons, including many gay people not openly identifying as such due to homophobia and heterosexist discrimination.^[9] Homosexual behavior has also been documented and is observed in many non-human animal species.^{[10][11][12][13][14]}

Many gay and lesbian people are in committed same-sex relationships, though only recently have census forms and political conditions facilitated their visibility and enumeration.^{[15][16][17][18][19][20][21][22][23][24]} These relationships are equivalent to heterosexual relationships in essential psychological respects.^[2] Homosexual relationships and acts have been admired, as well as condemned, throughout recorded history, depending on the form they took and the culture in which they occurred.^[25] Since the end of the 19th century, there has been a global movement towards increased visibility, recognition, and legal rights for homosexual people, including the rights to marriage and civil unions, adoption and parenting, employment, military service, equal access to health care, and the introduction of anti-bullying legislation to protect gay minors.

Etymology

Zephyrus and Hyacinthus
Attic red-figure cup from Tarquinia, 480 BC (Boston Museum of Fine Arts)

The word homosexual is a Greek and Latin hybrid, with the first element derived from Greek ὁμός homos, ‘same’ (not related to the Latin homo, ‘man’, as in Homo sapiens), thus connoting sexual acts and affections between members of the same sex, including lesbianism.^[26][27] The first known appearance of homosexual in print is found in an 1869 German pamphlet by the Austrian-born novelist Karl-Maria Kertbeny, published anonymously,^[28] arguing against a Prussian anti-sodomy law.^[28][29] In 1879, Gustav Jäger used Kertbeny’s terms in his book, Discovery of the Soul (1880).^[30] In 1886, Richard von Krafft-Ebing used the terms homosexual and heterosexual in his book Psychopathia Sexualis, probably borrowing them from Jäger. Krafft-Ebing’s book was so popular among both layman and doctors that the terms “heterosexual” and “homosexual” became the most widely accepted terms for sexual orientation.^[31][32] As such, the current use of the term has its roots in the broader 19th-century tradition of personality taxonomy.

Many modern style guides in the U.S. recommend against using homosexual as a noun, instead using gay man or lesbian.^[33] Similarly, some recommend completely avoiding usage of homosexual as it has a negative, clinical history and because the word only refers to one’s sexual behavior (as opposed to romantic feelings) and thus it has a negative connotation.^[33] Gay and lesbian are the most common alternatives. The first letters are frequently combined to create the initialism LGBT (sometimes written as GLBT), in which B and T refer to bisexual and transgender people.

Although early writers also used the adjective homosexual to refer to any single-sex context (such as an all-girls school), today the term is used exclusively in reference to sexual attraction, activity, and orientation. The term homosocial is now used to describe single-sex contexts that are not specifically sexual. There is also a word referring to same-sex love, homophilia.

Some synonyms for same-sex attraction or sexual activity include men who have sex with men or MSM (used in the medical community when specifically discussing sexual activity) and homoerotic (referring to works of art).^[34][35] Pejorative terms in English include queer, faggot, fairy, poof, and homo.^{[36][37][38][39]} Beginning in the 1990s, some of these have been reclaimed as positive words by gay men and lesbians, as in the usage of queer studies, queer theory, and even the popular American television program Queer Eye for the Straight Guy.^[40] The word homo occurs in many other languages without the pejorative connotations it has in English.^[41] As with ethnic slurs and racial slurs, however, the misuse of these terms can still be highly offensive; the range of acceptable use depends on the context and speaker.^[42] Conversely, gay, a word originally embraced by homosexual men and women as a positive, affirmative term (as in gay liberation and gay rights),^[43] has come into widespread pejorative use among young people.^[44]

History

Societal attitudes towards same-sex relationships have varied over time and place, from expecting all males to engage in same-sex relationships, to casual integration, through acceptance, to seeing the practice as a minor sin, repressing it through law enforcement and judicial mechanisms, and to proscribing it under penalty of death.

In a detailed compilation of historical and ethnographic materials of Preindustrial Cultures, “strong disapproval of homosexuality was reported for 41% of 42 cultures; it was accepted or ignored by 21%, and 12% reported no such concept. Of 70 ethnographies, 59% reported homosexuality absent or rare in frequency and 41% reported it present or not uncommon.”^[45]

In cultures influenced by Abrahamic religions, the law and the church established sodomy as a transgression against divine law or a crime against nature. The condemnation of anal sex between males, however, predates Christian belief. It was frequent in ancient Greece; “unnatural” can be traced back to Plato.^[46]

Many historical figures, including Socrates, Lord Byron, Edward II, and Hadrian,^[47] have had terms such as gay or bisexual applied to them; some scholars, such as Michel Foucault, have regarded this as risking the anachronistic introduction of a contemporary construction of sexuality foreign to their times,^[48] though others challenge this.^[49]

Regarding homosexuality nature and historic expression there are two seemingly opposite positions. These are represented by a constructionist and an essentialist approach. In general Social constructionism considers that there are “social constructions” resulting from the many characteristics of a particular social group, and not from some essential nature of the individual self. On the other hand Essentialists defend the existence of real essences that define the individual’s expressions, and social learned aspects are only secondary. David M. Halperin devotes a chapter:Homosexuality: a cultural construct of his work One Hundred Years of Homosexuality to this subject.^[50] He says that the essentialism applied to sexual categories means that the terms like “gay” or “straight” refer to culturally not modifiable, essentially personal traits. On the contrary, Constructionists mean that these terms are the names of social processes. Halperin leans towards this last position, as he considers that sexuality, including homosexuality, has been expressed in essentially different ways in different historic societies, as it is in present day ones. He, nevertheless, cites Esteven Epstein ^[51] that compares the controversy between essentialists and constructionists to the general nature versus nurture debate. As one of the main representatives of essentialists he cites John Boswell, and Michel Foucault as a prominent constructionist.^[52]

Gay generally refers to male homosexuality, but may be used in a broader sense to refer to all LGBT people. In the context of sexuality, lesbian refers only to female homosexuality. The word “lesbian” is derived from the name of the Greek island Lesbos, where the poet Sappho wrote largely about her emotional relationships with young women.^[53][54]

Africa

Though often ignored or suppressed by European explorers and colonialists, homosexual expression in native Africa was also present and took a variety of forms. Anthropologists Stephen Murray and Will Roscoe reported that women in Lesotho engaged in socially sanctioned “long term, erotic relationships” called motsoalle.^[55] E. E. Evans-Pritchard also recorded that male Azande warriors in the northern Congo routinely took on young male lovers between the ages of twelve and twenty, who helped with household tasks and participated in intercrural sex with their older husbands. The practice had died out by the early 20th century, after Europeans had gained control of African countries, but was recounted to Evans-Pritchard by the elders to whom he spoke.^[56]

The first record of possible homosexual couple in history is commonly regarded as Khnumhotep and Niankhkhnum, an Egyptian male couple, who lived around 2400 BCE. The pair are portrayed in a nose-kissing position, the most intimate pose in Egyptian art, surrounded by what appear to be their heirs.

Americas

Dance to the Berdache
Sac and Fox Nation ceremonial dance to celebrate the two-spirit person. George Catlin (1796–1872); Smithsonian Institution, Washington, DC

Among indigenous peoples of the Americas prior to European colonization, a common form of same-sex sexuality centered around the figure of the Two-Spirit individual. Typically this individual was recognized early in life, given a choice by the parents to follow the path and, if the child accepted the role, raised in the appropriate manner, learning the customs of the gender it had chosen. Two-Spirit individuals were commonly shamans and were revered as having powers beyond those of ordinary shamans. Their sexual life was with the ordinary tribe members of the same sex.

Homosexual and transgender individuals were also common among other pre-conquest civilizations in Latin America, such as the Aztecs, Mayans, Quechuas, Moches, Zapotecs, and the Tupinambá of Brazil.^[57][58]

A woman spying on a pair of male lovers. China, Qing Dynasty.

The Spanish conquerors were horrified to discover sodomy openly practiced among native peoples, and attempted to crush it out by subjecting the berdaches (as the Spanish called them) under their rule to severe penalties, including public execution, burning and being torn to pieces by dogs.^[59]

East Asia

In East Asia, same-sex love has been referred to since the earliest recorded history.

Homosexuality in China, known as the passions of the cut peach and various other euphemisms has been recorded since approximately 600 BCE. Homosexuality was mentioned in many famous works of Chinese literature. The instances of same-sex affection and sexual interactions described in the classical novel Dream of the Red Chamber seem as familiar to observers in the present as do equivalent stories of romances between heterosexual people during the same period. Confucianism, being primarily a social and political philosophy, focused little on sexuality, whether homosexual or heterosexual. Opposition to homosexuality in China originates in the medieval Tang Dynasty (618-907), attributed to the rising influence of Christian and Islamic values,^[60] but did not become fully established until the Westernization efforts of the late Qing Dynasty and the Republic of China.^[61]

Homosexuality in Japan, variously known as shudo or nanshoku has been documented for over one thousand years and was an integral part of Buddhist monastic life and the samurai tradition. This same-sex love culture gave rise to strong traditions of painting and literature documenting and celebrating such relationships.

Similarly, in Thailand, Kathoey, or “ladyboys”, have been a feature of Thai society for many centuries, and Thai kings had male as well as female lovers^{[citation needed]}. While Kathoey may encompass simple effeminacy or transvestism, it most commonly is treated in Thai culture as a third gender. They are generally accepted by society^{[citation needed]}, and Thailand has never had legal prohibitions against homosexuality or homosexual behavior.

South Asia

Gay sex in threesome with one woman and two men. Miniature from an Urdu text, Mughal India.

The Laws of Manu, the foundational work of Hindu law, mentions a “third sex”, members of which may engage in nontraditional gender expression and homosexual activities.^[62] The Hijra are a caste of third-gender, or transgender group who live a feminine role. Hijra may be born male or intersex, and some may have been born female.

Throughout Hindu and Vedic texts there are many descriptions of saints, demigods, and even the Supreme Lord transcending gender norms and manifesting multiple combinations of sex and gender.^[63] There are several instances in ancient Indian epic poetry of same sex depictions and unions by gods and goddesses. There are several stories of depicting love between same sexes especially among kings and queens. Kama Sutra, the ancient Indian treatise on love talks about feelings for same sexes. Transsexuals are also venerated e.g. Lord Vishnu as Mohini and Lord Shiva as Ardhanarishvara (which means half woman).^[64]

Europe

The earliest Western documents (in the form of literary works, art objects, and mythographic materials) concerning same-sex relationships are derived from ancient Greece.

In regard of male homosexuality such documents depict a world in which relationships with women and relationships with youths were the essential foundation of a normal man’s love life. Same-sex relationships were a social institution variously constructed over time and from one city to another. The formal practice, an erotic yet often restrained relationship between a free adult male and a free adolescent, was valued for its pedagogic benefits and as a means of population control, though occasionally blamed for causing disorder. Plato praised its benefits in his early writings^[65] but in his late works proposed its prohibition.^[66] In the Symposium (182B-D), Plato equates acceptance of homosexuality with democracy, and its suppression with despotism, saying that homosexuality “is shameful to barbarians because of their despotic governments, just as philosophy and athletics are, since it is apparently not in best interests of such rulers to have great ideas engendered in their subjects, or powerful friendships or physical unions, all of which love is particularly apt to produce”.^[67] Aristotle, in the Politics, dismissed Plato’s ideas about abolishing homosexuality (2.4); he explains that barbarians like the Celts accorded it a special honor (2.6.6), while the Cretans used it to regulate the population (2.7.5).^[67]

Female youths are depicted surrounding Sappho in this painting of Lafond “Sappho sings for Homer”, 1824.

Little is known of female homosexuality in antiquity. Sappho, born on the island of Lesbos, was included by later Greeks in the canonical list of nine lyric poets. The adjectives deriving from her name and place of birth (Sapphic and Lesbian) came to be applied to female homosexuality beginning in the 19th century.^[68][69] Sappho’s poetry centers on passion and love for various personages and both genders. The narrators of many of her poems speak of infatuations and love (sometimes requited, sometimes not) for various females, but descriptions of physical acts between women are few and subject to debate.^[70][71]

Sappho reading to her companions on an Attic vase of c. 435 BC.

In Ancient Rome the young male body remained a focus of male sexual attention, but relationships were between older free men and slaves or freed youths who took the receptive role in sex. All the emperors with the exception of Claudius took male lovers. The Hellenophile emperor Hadrian is renowned for his relationship with Antinous, but the Christian emperor Theodosius I decreed a law on August 6, 390, condemning passive males to be burned at the stake. Justinian, towards the end of his reign, expanded the proscription to the active partner as well (in 558), warning that such conduct can lead to the destruction of cities through the “wrath of God”. Notwithstanding these regulations, taxes on brothels of boys available for homosexual sex continued to be collected until the end of the reign of Anastasius I in 518.

During the Renaissance, wealthy cities in northern Italy — Florence and Venice in particular — were renowned for their widespread practice of same-sex love, engaged in by a considerable part of the male population and constructed along the classical pattern of Greece and Rome.^[72][73] But even as many of the male population were engaging in same-sex relationships, the authorities, under the aegis of the Officers of the Night court, were prosecuting, fining, and imprisoning a good portion of that population. From the second half of the 13th century, death was the punishment for male homosexuality in most of Europe.^[74] The eclipse of this period of relative artistic and erotic freedom was precipitated by the rise to power of the moralizing monk Girolamo Savonarola. In northern Europe the artistic discourse on sodomy was turned against its proponents by artists such as Rembrandt, who in his Rape of Ganymede no longer depicted Ganymede as a willing youth, but as a squalling baby attacked by a rapacious bird of prey.

The relationships of socially prominent figures, such as King James I and the Duke of Buckingham, served to highlight the issue, including in anonymously authored street pamphlets: “The world is chang’d I know not how, For men Kiss Men, not Women now;…Of J. the First and Buckingham: He, true it is, his Wives Embraces fled, To slabber his lov’d Ganimede” (Mundus Foppensis, or The Fop Display’d, 1691).

Love Letters Between a Certain Late Nobleman and the Famous Mr. Wilson was published in 1723 in England and was presumed by some modern scholars to be a novel. The 1749 edition of John Cleland‘s popular novel Fanny Hill includes a homosexual scene, but this was removed in its 1750 edition. Also in 1749, the earliest extended and serious defense of homosexuality in English, Ancient and Modern Pederasty Investigated and Exemplified, written by Thomas Cannon, was published, but was suppressed almost immediately. It includes the passage, “Unnatural Desire is a Contradiction in Terms; downright Nonsense. Desire is an amatory Impulse of the inmost human Parts.”^[75] Around 1785 Jeremy Bentham wrote another defense, but this was not published until 1978.^[76] Executions for sodomy continued in the Netherlands until 1803, and in England until 1835.

Between 1864 and 1880 Karl Heinrich Ulrichs published a series of twelve tracts, which he collectively titled Research on the Riddle of Man-Manly Love. In 1867, he became the first self-proclaimed homosexual person to speak out publicly in defense of homosexuality when he pleaded at the Congress of German Jurists in Munich for a resolution urging the repeal of anti-homosexual laws.^[9] Sexual Inversion by Havelock Ellis, published in 1896, challenged theories that homosexuality was abnormal, as well as stereotypes, and insisted on the ubiquity of homosexuality and its association with intellectual and artistic achievement.^[77] Although medical texts like these (written partly in Latin to obscure the sexual details) were not widely read by the general public, they did lead to the rise of Magnus Hirschfeld‘s Scientific-Humanitarian Committee, which campaigned from 1897 to 1933 against anti-sodomy laws in Germany, as well as a much more informal, unpublicized movement among British intellectuals and writers, led by such figures as Edward Carpenter and John Addington Symonds. Beginning in 1894 with Homogenic Love, Socialist activist and poet Edward Carpenter wrote a string of pro-homosexual articles and pamphlets, and “came out” in 1916 in his book My Days and Dreams. In 1900, Elisar von Kupffer published an anthology of homosexual literature from antiquity to his own time, Lieblingminne und Freundesliebe in der Weltliteratur.

Middle East

Dance of a bacchá (dancing boy)
Samarkand, (ca 1905–1915), photo Sergei Mikhailovich Prokudin-Gorskii. Library of Congress, Washington, DC.

In the ancient Assyrian society, homosexuality was present and common; it was also not prohibited. Instead, some ancient religious Assyrian texts contain prayers for divine blessings on homosexual relationships.^[78]Assyrian priests were often cross-dressing homosexual men.^[79]

Among some Middle Eastern Muslim cultures, egalitarian or age-structured homosexual practices were widespread and thinly veiled. The prevailing pattern of same-sex relationships in the temperate and sub-tropical zone stretching from Northern India to the Western Sahara is one in which the relationships were—and are—either gender-structured or age-structured or both. In recent years, egalitarian relationships modeled on the western pattern have become more frequent, though they remain rare. Same-sex intercourse officially carries the death penalty in several Muslim nations: Saudi Arabia, Iran, Mauritania, northern Nigeria, Sudan, and Yemen.^[80]

Israel is considered the most tolerant country in the Middle East and Asia to homosexuals,^[81] while the Israeli city Tel Aviv has been named “the gay capital of the Middle East,”^[82] and is considered one of the most gay friendly cities in the world.^[83] The annual Pride Parade in support of homosexuality takes place in Tel Aviv.^[84]

Some scholars argue that there are examples of homosexual love in ancient literature, like in the Mesopotamian Epic of Gilgamesh as well as in the Biblical story of David and Jonathan. In the Epic of Gilgamesh, the relationship between the main protagonist Gilgamesh and the character Enkidu has been seen by some to be homosexual in nature.^{[85][86][87][88]} Similarly, David’s love for Jonathan is “greater than the love of women.”^[89]

Ottoman illustration depicting a young man used for group sex (from Sawaqub al-Manaquib)

There are a handful of accounts by Arab travelers to Europe during the mid-1800s. Two of these travelers, Rifa’ah al-Tahtawi and Muhammad sl-Saffar, show their surprise that the French sometimes deliberately mis-translated love poetry about a young boy, instead referring to a young female, to maintain their social norms and morals.^[90]

In Persia, homosexuality and homoerotic expressions were tolerated in numerous public places, from monasteries and seminaries to taverns, military camps, bathhouses, and coffee houses. In the early Safavid era (1501–1723), male houses of prostitution (amrad khane) were legally recognized and paid taxes.

Today, governments in the Middle East often ignore, deny the existence of, or criminalize homosexuality. Homosexuality is illegal in almost all Muslim countries.^[91] Iranian President Mahmoud Ahmadinejad, during his 2007 speech at Columbia University, asserted that there were no gay people in Iran. However, the probable reason is that they keep their sexuality a secret for fear of government sanction or rejection by their families.^[92]

South Pacific

In many societies of Melanesia, especially in Papua New Guinea, same-sex relationships were an integral part of the culture until the middle of the last century. The Etoro and Marind-anim for example, even viewed heterosexuality as sinful and celebrated homosexuality instead. In many traditional Melanesian cultures a prepubertal boy would be paired with an older adolescent who would become his mentor and who would “inseminate” him (orally, anally, or topically, depending on the tribe) over a number of years in order for the younger to also reach puberty. Many Melanesian societies, however, have become hostile towards same-sex relationships since the introduction of Christianity by European missionaries.^[93]

Sexuality and identity

Kinsey scale

The Kinsey scale, also called the Heterosexual-Homosexual Rating Scale,^[94] attempts to describe a person’s sexual history or episodes of his or her sexual activity at a given time. It uses a scale from 0, meaning exclusively heterosexual, to 6, meaning exclusively homosexual. In both the Male and Female volumes of the Kinsey Reports, an additional grade, listed as “X”, was used for asexuality.^[95][96]

Orientation and behavior

The American Psychological Association, the American Psychiatric Association, and the National Association of Social Workers identify sexual orientation as “not merely a personal characteristic that can be defined in isolation. Rather, one’s sexual orientation defines the universe of persons with whom one is likely to find the satisfying and fulfilling relationships”:^[2]

Sexual orientation is commonly discussed as a characteristic of the individual, like biological sex, gender identity, or age. This perspective is incomplete because sexual orientation is always defined in relational terms and necessarily involves relationships with other individuals. Sexual acts and romantic attractions are categorized as homosexual or heterosexual according to the biological sex of the individuals involved in them, relative to each other. Indeed, it is by acting—or desiring to act—with another person that individuals express their heterosexuality, homosexuality, or bisexuality. This includes actions as simple as holding hands with or kissing another person. Thus, sexual orientation is integrally linked to the intimate personal relationships that human beings form with others to meet their deeply felt needs for love, attachment, and intimacy. In addition to sexual behavior, these bonds encompass nonsexual physical affection between partners, shared goals and values, mutual support, and ongoing commitment.^[2]

Coming out of the closet

“Coming out (of the closet)” is a phrase which refers to one’s disclosure of their sexual orientation or gender identity, and is described and experienced variously as a psychological process or journey.^[97] Generally, coming out is described in three phases. The first phase is the phase of “knowing oneself”, and the realization emerges that one is open to same-sex relations.^[98] This is often described as an internal coming out. The second phase involves one’s decision to come out to others, e.g. family, friends, or colleagues. The third phase more generally involves living openly as an LGBT person.^[99] In the United States today, people often come out during high school or college age. At this age, they may not trust or ask for help from others, especially when their orientation is not accepted in society. Sometimes their own families are not even informed.

According to Rosario, Schrimshaw, Hunter, Braun (2006), “the development of a lesbian, gay, or bisexual (LGB) sexual identity is a complex and often difficult process. Unlike members of other minority groups (e.g., ethnic and racial minorities), most LGB individuals are not raised in a community of similar others from whom they learn about their identity and who reinforce and support that identity. Rather, LGB individuals are often raised in communities that are either ignorant of or openly hostile toward homosexuality.”^[100]

Outing is the practice of publicly revealing the sexual orientation of a closeted person.^[101] Notable politicians, celebrities, military service people, and clergy members have been outed, with motives ranging from malice to political or moral beliefs. Many commentators oppose the practice altogether,^[102] while some encourage outing public figures who use their positions of influence to harm other gay people.^[103]

Gender identity

The earliest writers on a homosexual orientation usually understood it to be intrinsically linked to the subject’s own sex. For example, it was thought that a typical female-bodied person who is attracted to female-bodied persons would have masculine attributes, and vice versa.^[104] This understanding was shared by most of the significant theorists of homosexuality from the mid-19th century to early 20th century, such as Karl Heinrich Ulrichs, Richard von Krafft-Ebing, Magnus Hirschfeld, Havelock Ellis, Carl Jung and Sigmund Freud, as well as many gender variant homosexual people themselves. However, this understanding of homosexuality as sexual inversion was disputed at the time, and through the second half of the 20th century, gender identity came to be increasingly seen as a phenomenon distinct from sexual orientation.

Transgender and cisgender people may be attracted to men, women or both, although the prevalence of different sexual orientations is quite different in these two populations (see sexual orientation of transwomen). An individual homosexual, heterosexual or bisexual person may be masculine, feminine, or androgynous, and in addition, many members and supporters of lesbian and gay communities now see the “gender-conforming heterosexual” and the “gender-nonconforming homosexual” as negative stereotypes. However, studies by J. Michael Bailey and K.J. Zucker have found that a majority of gay men and lesbians report being gender-nonconforming during their childhood years.^[105] Richard C. Friedman, in Male Homosexuality published in 1990,^[106] writing from a psychoanalytic perspective, argues that sexual desire begins later than the writings of Sigmund Freud indicate, not in infancy but between the ages of 5 and 10 and is not focused on a parent figure but on peers. As a consequence, he reasons, homosexual men are not abnormal, never having been sexually attracted to their mothers anyway.^[107]

Same-sex relationships

Male homosexuality symbol

People with a homosexual orientation can express their sexuality in a variety of ways, and may or may not express it in their behaviors.^[1] Many have sexual relationships predominately with people of their own gender identity, though some have sexual relationships with those of the opposite gender, bisexual relationships, or none at all (celibate).^[1] The Kinsey scale attempts to describe a person’s sexual history or episodes of their sexual activity at a given time. It uses a scale from 0, meaning exclusively heterosexual, to 6, meaning exclusively homosexual. It is based on actual sexual behavior surveys. Research indicates that many lesbians and gay men want, and succeed in having, committed and durable relationships. For example, survey data indicate that between 40% and 60% of gay men and between 45% and 80% of lesbians are currently involved in a romantic relationship.^[108] Survey data also indicate that between 18% and 28% of gay couples and between 8% and 21% of lesbian couples in the U.S. have lived together ten or more years.^[108] Studies have found same-sex and opposite-sex couples to be equivalent to each other in measures of satisfaction and commitment in relationships, that age and gender are more reliable than sexual orientation as a predictor of satisfaction and commitment to a relationship, and that people who are heterosexual or homosexual share comparable expectations and ideals with regard to romantic relationships.^{[109][110][111]}

Demographics

Reliable data as to the size of the gay and lesbian population are of value in informing public policy.^[112] For example, demographics would help in calculating the costs and benefits of domestic partnership benefits, of the impact of legalizing gay adoption, and of the impact of the U.S. military’s Don’t Ask Don’t Tell policy.^[112] Further, knowledge of the size of the “gay and lesbian population holds promise for helping social scientists understand a wide array of important questions—questions about the general nature of labor market choices, accumulation of human capital, specialization within households, discrimination, and decisions about geographic location.”^[112]

Measuring the prevalence of homosexuality presents difficulties. It is necessary to consider the measuring criteria that is used, the cutoff point and the time span taken to define a sexual orientation.^[9] Many people, despite having same-sex attractions, may be reluctant to identify themselves as gay or bisexual. The research must measure some characteristic that may or may not be defining of sexual orientation. The number of people with same-sex desires may be larger than the number of people who act on those desires, which in turn may be larger than the number of people who self-identify as gay, lesbian, or bisexual.^[112]

In 1948 and 1953, Alfred Kinsey reported that nearly 46% of the male subjects had “reacted” sexually to persons of both sexes in the course of their adult lives, and 37% had had at least one homosexual experience.^[113][114] Kinsey’s methodology was criticized.^[115][116] A later study tried to eliminate the sample bias, but still reached similar conclusions.^[117] LeVay cites these Kinsey results as an example of the caution needed to interpret demographic studies, as they may give quite differing numbers depending on what criteria are used to conduct them, in spite of using sound scientific methods.^[9]

Estimates of the occurrence of same-sex behavior range from 2 to 10 percent of the population.^{[118][119][120][121][122][123][124]} A 1992 study reported that 6.1% of males in Britain have had a homosexual experience, while in France the number was reported at 4.1%.^[125] In New Zealand, a 2006 study suggested that 20% of the population anonymously reported some homosexual feelings with few of them identifying as homosexual. Percentage of persons identifying as homosexual was 2–3%.^[123] According to a 2008 poll, 13% of Britons have had some form of same-sex sexual contact while only 6% of Britons identify themselves as either homosexual or bisexual.^[126] Contrastingly, a survey by the UK Office for National Statistics (ONS) in 2010 found that 1.5% of Britons identified themselves as gay or bisexual, and the ONS suggests that this is in line with other surveys showing the number between 0.3% and 3%.^[114][127]

According to major studies, 2% to 10% of people have had some form of same-sex sexual contact within their lifetime.^{[118][119][120][121][122][128][129][130][131]} In a 2006 study, 20% of respondents anonymously reported some homosexual feelings, although only 2-3% identified themselves as homosexual.^[123]

In the United States, according to exit polling on 2008 Election Day for the 2008 presidential election, 4% of the national electorate self-identified as gay, lesbian, or bisexual, the same percentage as in 2004.^[132] According to the 2000 United States Census there were about 601,209 same-sex unmarried partner households.^[133] In the 2012 presidential election, 5% of the national electorate openly identified themselves as lesbian, gay, or bisexual.

Psychology

Psychology was one of the first disciplines to study a homosexual orientation as a discrete phenomenon. The first attempts to classify homosexuality as a disease were made by the fledgling European sexologist movement in the late 19th century. In 1886 noted sexologist Richard von Krafft-Ebing listed homosexuality along with 200 other case studies of deviant sexual practices in his definitive work, Psychopathia Sexualis. Krafft-Ebing proposed that homosexuality was caused by either “congenital [during birth] inversion” or an “acquired inversion”. In the last two decades of the 19th century, a different view began to predominate in medical and psychiatric circles, judging such behavior as indicative of a type of person with a defined and relatively stable sexual orientation. In the late 19th century and early 20th century, pathological models of homosexuality were standard.

The American Psychological Association, the American Psychiatric Association, and the National Association of Social Workers state:

^[4] The longstanding consensus of research and clinical literature demonstrates that same-sex sexual and romantic attractions, feelings, and behaviors are normal and positive variations of human sexuality.^[135] There is now a large body of research evidence that indicates that being gay, lesbian or bisexual is compatible with normal mental health and social adjustment.^[4] The World Health Organization‘s ICD-9 (1977) listed homosexuality as a mental illness; it was removed from the ICD-10, endorsed by the Forty-third World Health Assembly on May 17, 1990.^{[136][137][138]} Like the DSM-II, the ICD-10 added ego-dystonic sexual orientation to the list, which refers to people who want to change their gender identities or sexual orientation because of a psychological or behavioral disorder (F66.1). The Chinese Society of Psychiatry removed homosexuality from its Chinese Classification of Mental Disorders in 2001 after five years of study by the association.^[139] According to the Royal College of Psychiatrists “This unfortunate history demonstrates how marginalisation of a group of people who have a particular personality feature (in this case homosexuality) can lead to harmful medical practice and a basis for discrimination in society.^[4] There is now a large body of research evidence that indicates that being gay, lesbian or bisexual is compatible with normal mental health and social adjustment. However, the experiences of discrimination in society and possible rejection by friends, families and others, such as employers, means that some LGB people experience a greater than expected prevalence of mental health difficulties and substance misuse problems. Although there have been claims by conservative political groups in the USA that this higher prevalence of mental health difficulties is confirmation that homosexuality is itself a mental disorder, there is no evidence whatever to substantiate such a claim.”^[140]

Most lesbian, gay, and bisexual people who seek psychotherapy do so for the same reasons as heterosexual people (stress, relationship difficulties, difficulty adjusting to social or work situations, etc.); their sexual orientation may be of primary, incidental, or no importance to their issues and treatment. Whatever the issue, there is a high risk for anti-gay bias in psychotherapy with lesbian, gay, and bisexual clients.^[141] Psychological research in this area has been relevant to counteracting prejudicial (“homophobic“) attitudes and actions, and to the LGBT rights movement generally.^[142]

The appropriate application of affirmative psychotherapy is based on the following scientific facts:^[135]

• Same-sex sexual attractions, behavior, and orientations per se are normal and positive variants of human sexuality; in other words, they are not indicators of mental or developmental disorders.
• Homosexuality and bisexuality are stigmatized, and this stigma can have a variety of negative consequences (e.g., Minority Stress) throughout the life span (D’Augelli & Patterson, 1995; DiPlacido, 1998; Herek & Garnets, 2007; Meyer, 1995, 2003).
• Same-sex sexual attractions and behavior can occur in the context of a variety of sexual orientations and sexual orientation identities (Diamond, 2006; Hoburg et al., 2004; Rust, 1996; Savin-Williams, 2005).
• Gay men, lesbians, and bisexual individuals can live satisfying lives as well as form stable, committed relationships and families that are equivalent to heterosexual relationships in essential respects (APA, 2005c; Kurdek, 2001, 2003, 2004; Peplau & Fingerhut, 2007).
• There are no empirical studies or peer-reviewed research that support theories attributing same-sex sexual orientation to family dysfunction or trauma (Bell et al., 1981; Bene, 1965; Freund & Blanchard, 1983; Freund & Pinkava, 1961; Hooker, 1969; McCord et al., 1962; D. K. Peters & Cantrell, 1991; Siegelman, 1974, 1981; Townes et al., 1976).

Cause

General

The causes of homosexuality, and more generically the causes of human sexual orientation, have been the subject of abundant scientific inquiry, and the activity has been developed mainly in the direction of biological and environmental factors. The biological factors that have been researched are genetic and hormonal, particularly during the fetal developmental period, that influence the resulting brain structure, and other characteristics such as handedness.^[3][4] There are a wide range of environmental factors (sociological, psychological, or early uterine environment), and various biological factors, that may influence sexual orientation; though many researchers believe that it is caused by a complex interplay between nature and nurture, they favor biological models for the cause.^[1][3]

The American Academy of Pediatrics stated in Pediatrics in 2004:

The American Psychological Association, American Psychiatric Association, and National Association of Social Workers stated in 2006:

The Royal College of Psychiatrists stated in 2007:

The American Psychological Association states “there are probably many reasons for a person’s sexual orientation and the reasons may be different for different people”, and says most people’s sexual orientation is determined at an early age.^[1] Research into how sexual orientation in males may be determined by genetic or other prenatal factors plays a role in political and social debates about homosexuality, and also raises concerns about genetic profiling and prenatal testing.^[145]

Professor Michael King states: “The conclusion reached by scientists who have investigated the origins and stability of sexual orientation is that it is a human characteristic that is formed early in life, and is resistant to change. Scientific evidence on the origins of homosexuality is considered relevant to theological and social debate because it undermines suggestions that sexual orientation is a choice.”^[146]

Innate bisexuality (or predisposition to bisexuality) is a term introduced by Sigmund Freud, based on work by his associate Wilhelm Fliess, that expounds that all humans are born bisexual but through psychological development—which includes both external and internal factors—become monosexual, while the bisexuality remains in a latent state.

Garcia-Falgueras and Swaab state in the abstract of their 2010 study, “The fetal brain develops during the intrauterine period in the male direction through a direct action of testosterone on the developing nerve cells, or in the female direction through the absence of this hormone surge. In this way, our gender identity (the conviction of belonging to the male or female gender) and sexual orientation are programmed or organized into our brain structures when we are still in the womb. There is no indication that social environment after birth has an effect on gender identity or sexual orientation.”^[147]

Evolutionary perspectives

The authors of a 2008 study stated “there is considerable evidence that human sexual orientation is genetically influenced, so it is not known how homosexuality, which tends to lower reproductive success, is maintained in the population at a relatively high frequency”. They hypothesized that “while genes predisposing to homosexuality reduce homosexuals’ reproductive success, they may confer some advantage in heterosexuals who carry them”. Their results suggested that “genes predisposing to homosexuality may confer a mating advantage in heterosexuals, which could help explain the evolution and maintenance of homosexuality in the population”.^[148] A 2009 study also suggested a significant increase in fecundity in the females related to the homosexual people from the maternal line (but not in those related from the paternal one).^[149]

A review paper by Bailey and Zuk looking into studies of same-sex sexual behaviour in animals challenges the view that such behaviour lowers reproductive success, citing several hypotheses about how same-sex sexual behavior might be adaptive; these hypotheses vary greatly among different species. Bailey and Zuk also suggest future research needs to look into evolutionary consequences of same-sex sexual behaviour, rather than only looking into origins of such behaviour.^[150]

Lesbian narratives and sexual orientation awareness

Lesbians often experience their sexuality differently from gay men, and have different understandings about etiology from those derived from studies focused mostly on men. For information specific to female homosexuality, see Lesbian.

In a U.S.-based 1970s mail survey by Shere Hite, lesbians self-reported their reasons for being lesbian. This is the only major piece of research into female sexuality that has looked at how women understand being homosexual since Kinsey in 1953. The research yielded information about women’s general understanding of lesbian relationships and their sexual orientation.

Women talked about social conditioning, which made it “almost impossible for me to have a truly healthy sexual relationship with a man”.^[151] Another woman stated that because of their conditioning “[w]omen are much more sensitive to other people’s needs”, and so “[s]ex is better with women physically and emotionally”, stating she preferred the symmetries of power and aesthetic between women.^[151] Some talked about preferring women, “[p]ersonally, I like girls better, they are more tender and loving”,^[151] and some went into how they found that emotional relationships with women were more satisfying than those with men, with women making more creative and versatile lovers. One woman reported it was easier for her “to give myself emotionally to a woman”.^[151] A woman who had been a lesbian for two years said she found that sexual relationships with women were more pleasurable on both psychological and physical levels than with men; this was “because the women I’ve had sex with have been my friends first, which was never the case with men. Being friends sets up a trust that I think is essential for satisfying physical intimacy. Relating to another woman physically seems to me like the most natural thing in the world. You’ve already got a head start on knowing how to give her pleasure. Gentleness seems to be the key, and is the main difference between relating to men and women.’”^[151] Women talked about women making better sexual partners and that was a dominant theme: “I find women better lovers; they know what a woman wants and most of all there is an emotional closeness that can never be matched with a man. More tenderness, more consideration and understanding of feelings, etc.”^[151] This was because men were perceived as unliberated “sexually or emotionally or any other way”, and lesbianism was perceived “as an alternative to abstinence” and to men generally.^[151] Men were perceived as usually juvenile, while a relationship with women was described as “more of a communion with self”.^[151] Sex as well as relationships with women were seen as a way of achieving independence from men; “[s]ex with a woman means independence from men.”^[151] Male sexual performance was another problem, “[t]wenty minutes for a man, at least an hour with a woman, usually more”,^[151] as well as attention to the sexual needs of women who themselves “seem to have a more sustained energy level after orgasm, and are more likely to know and do something about it if I’m not satisfied”.^[151] One understanding of the difference was that sex with women “is not an ‘exchange’ or a ‘trade’ or services”, and not focused on orgasm, with “more kissing and holding” and “more concern for my pleasure”, which was experienced as liberating. Sex with women was also seen as a political act; “I see lesbianism as putting all my energies (sexual, political social, etc.) into women. Sex is a form of comfort and to have sex indiscriminately with males is to give them comfort.”.^[151]

Hite is more concerned with what respondents say than quantifiable data. She found the two most significant differences between respondents’ experience with men and women were the focus on clitoral stimulation, and more emotional involvement and orgasmic responses.^[151] Since Hite carried out her study she has acknowledged that some women may have chosen the political identity of a lesbian. Julie Bindel, a UK journalist, reaffirmed that “political lesbianism continues to make intrinsic sense because it reinforces the idea that sexuality is a choice, and we are not destined to a particular fate because of our chromosomes.” as recently as 2009.^[152]

Sexual orientation change efforts

There are no studies of adequate scientific rigor to conclude whether recent sexual orientation change efforts do work to change a person’s sexual orientation. Those efforts have been controversial due to tensions between the values held by some faith-based organizations, on the one hand, and those held by LGBT rights organizations and professional and scientific organizations and other faith-based organizations, on the other. The longstanding consensus of the behavioral and social sciences and the health and mental health professions is that homosexuality per se is a normal and positive variation of human sexual orientation, and therefore not a mental disorder.^[8] The American Psychological Association says that “most people experience little or no sense of choice about their sexual orientation”.^[153] Some individuals and groups have promoted the idea of homosexuality as symptomatic of developmental defects or spiritual and moral failings and have argued that sexual orientation change efforts, including psychotherapy and religious efforts, could alter homosexual feelings and behaviors. Many of these individuals and groups appeared to be embedded within the larger context of conservative religious political movements that have supported the stigmatization of homosexuality on political or religious grounds.^[8]

No major mental health professional organization has sanctioned efforts to change sexual orientation and virtually all of them have adopted policy statements cautioning the profession and the public about treatments that purport to change sexual orientation. These include the American Psychiatric Association, American Psychological Association, American Counseling Association, National Association of Social Workers in the USA,^[154] the Royal College of Psychiatrists,^[155] and the Australian Psychological Society.^[156] The American Psychological Association and the Royal College of Psychiatrists expressed concerns that the positions espoused by NARTH are not supported by the science and create an environment in which prejudice and discrimination can flourish.^[155][157]

The American Psychological Association “encourages mental health professionals to avoid misrepresenting the efficacy of sexual orientation change efforts by promoting or promising change in sexual orientation when providing assistance to individuals distressed by their own or others’ sexual orientation and concludes that the benefits reported by participants in sexual orientation change efforts can be gained through approaches that do not attempt to change sexual orientation”.^[158]

Fluidity of orientation

The American Psychiatric Association (APA) has stated “some people believe that sexual orientation is innate and fixed; however, sexual orientation develops across a person’s lifetime”.^[159] A report from the Centre for Addiction and Mental Health states: “For some people, sexual orientation is continuous and fixed throughout their lives. For others, sexual orientation may be fluid and change over time”.^[160] One study has suggested “considerable fluidity in bisexual, unlabeled, and lesbian women’s attractions, behaviors, and identities”.^[161][162]

Gender and fluidity

In a 2004 study, the female subjects (both gay and straight women) became sexually aroused when they viewed heterosexual as well as lesbian erotic films. Among the male subjects, however, the straight men were turned on only by erotic films with women, the gay ones by those with men. The study’s senior researcher said that women’s sexual desire is less rigidly directed toward a particular sex, as compared with men’s, and it’s more changeable over time.^[163]

Parenting

Scientific research has been generally consistent in showing that lesbian and gay parents are as fit and capable as heterosexual parents, and their children are as psychologically healthy and well-adjusted as children reared by heterosexual parents.^{[164][165][166]} According to scientific literature reviews, there is no evidence to the contrary.^{[2][167][168][169][170]}

Health

Physical

The terms “Men who have sex with men” (MSM) and “women who have sex with women” (WSW) refer to people who engage in sexual activity with others of the same sex regardless of how they identify themselves—as many choose not to accept social identities as lesbian, gay and bisexual.^{[171][172][173][174][175]} These terms are often used in medical literature and social research to describe such groups for study, without needing to consider the issues of sexual self-identity. The terms are seen as problematic, however, because they “obscure social dimensions of sexuality; undermine the self-labeling of lesbian, gay, and bisexual people; and do not sufficiently describe variations in sexual behavior”.^[176] MSM and WSW are sexually active with each other for a variety of reasons with the main ones arguably sexual pleasure, intimacy and bonding. In contrast to its benefits, sexual behavior can be a disease vector. Safe sex is a relevant harm reduction philosophy.^[177] The United States currently prohibits men who have sex with men from donating blood “because they are, as a group, at increased risk for HIV, hepatitis B and certain other infections that can be transmitted by transfusion.”^[178] The UK^[179] and many European countries have the same prohibition.^[178]

Public health

These safer sex recommendations are agreed upon by public health officials for women who have sex with women to avoid sexually transmitted infections (STIs):

• Avoid contact with a partner’s menstrual blood and with any visible genital lesions.
• Cover sex toys that penetrate more than one person’s vagina or anus with a new condom for each person; consider using different toys for each person.
• Use a barrier (e.g., latex sheet, dental dam, cut-open condom, plastic wrap) during oral sex.
• Use latex or vinyl gloves and lubricant for any manual sex that might cause bleeding.^[180]

These safer sex recommendations are agreed upon by public health officials for men who have sex with men to avoid sexually transmitted infections:

• Avoid contact with a partner’s bodily fluids and with any visible genital lesions.
• Use condoms for anal and oral sex.
• Use a barrier (e.g., latex sheet, dental dam, cut-open condom) during anal–oral sex.
• Cover sex toys that penetrate more than one person with a new condom for each person; consider using different toys for each person and use latex or vinyl gloves and lubricant for any sex that might cause bleeding.^[181][182]

Mental

When it was first described in medical literature, homosexuality was often approached from a view that sought to find an inherent psychopathology as its root cause. Much literature on mental health and homosexual patients centered on their depression, substance abuse, and suicide. Although these issues exist among people who are non-heterosexual, discussion about their causes shifted after homosexuality was removed from the Diagnostic and Statistical Manual (DSM) in 1973. Instead, social ostracism, legal discrimination, internalization of negative stereotypes, and limited support structures indicate factors homosexual people face in Western societies that often adversely affect their mental health.^[183] Stigma, prejudice, and discrimination stemming from negative societal attitudes toward homosexuality lead to a higher prevalence of mental health disorders among lesbians, gay men, and bisexuals compared to their heterosexual peers.^[184] Evidence indicates that the liberalization of these attitudes over the past few decades is associated with a decrease in such mental health risks among younger LGBT people.^[185]

Gay and lesbian youth

Gay and lesbian youth bear an increased risk of suicide, substance abuse, school problems, and isolation because of a “hostile and condemning environment, verbal and physical abuse, rejection and isolation from family and peers”.^[186] Further, LGBT youths are more likely to report psychological and physical abuse by parents or caretakers, and more sexual abuse. Suggested reasons for this disparity are that (1) LGBT youths may be specifically targeted on the basis of their perceived sexual orientation or gender non-conforming appearance, and (2) that “risk factors associated with sexual minority status, including discrimination, invisibility, and rejection by family members…may lead to an increase in behaviors that are associated with risk for victimization, such as substance abuse, sex with multiple partners, or running away from home as a teenager.”^[187] A 2008 study showed a correlation between the degree of rejecting behavior by parents of LGB adolescents and negative health problems in the teenagers studied:

Higher rates of family rejection were significantly associated with poorer health outcomes. On the basis of odds ratios, lesbian, gay, and bisexual young adults who reported higher levels of family rejection during adolescence were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse compared with peers from families that reported no or low levels of family rejection.^[188]

Crisis centers in larger cities and information sites on the Internet have arisen to help youth and adults.^[189] The Trevor Helpline, a suicide prevention helpline for gay youth, was established following the 1998 airing on HBO of the Academy Award winning short film Trevor.

Law and politics

Legality

Homosexual acts legal   Same-sex marriage   Marriage recognized but not performed   Other type of partnership (or unregistered cohabitation)   Same-sex unions not recognized

Homosexual acts illegal   Not enforced   Heavy penalty   Up to life in prison   Death penalty

Rings indicate local or case-by-case application.

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• v
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Most nations do not prohibit consensual sex between unrelated persons above the local age of consent. Some jurisdictions further recognize identical rights, protections, and privileges for the family structures of same-sex couples, including marriage. Some nations mandate that all individuals restrict themselves to heterosexual relationships; that is, in some jurisdictions homosexual activity is illegal. Offenders can face the death penalty in some fundamentalist Muslim areas such as Iran and parts of Nigeria. There are, however, often significant differences between official policy and real-world enforcement. See Violence against LGBT people.

Although homosexual acts were decriminalized in some parts of the Western world, such as Poland in 1932, Denmark in 1933, Sweden in 1944, and the United Kingdom in 1967, it was not until the mid-1970s that the gay community first began to achieve limited civil rights in some developed countries. On July 2, 2009, homosexuality was decriminalized in India by a High Court ruling.^[190] A turning point was reached in 1973 when the American Psychiatric Association removed homosexuality from the Diagnostic and Statistical Manual of Mental Disorders, thus negating its previous definition of homosexuality as a clinical mental disorder. In 1977, Quebec became the first state-level jurisdiction in the world to prohibit discrimination on the grounds of sexual orientation. During the 1980s and 1990s, most developed countries enacted laws decriminalizing homosexual behavior and prohibiting discrimination against lesbian and gay people in employment, housing, and services. On the other hand, many countries today in the Middle East and Africa, as well as several countries in Asia, the Caribbean and the South Pacific, outlaw homosexuality. In six countries, homosexual behavior is punishable by life imprisonment; in ten others, it carries the death penalty.^[191]

Laws against sexual orientation discrimination

United States

• Employment discrimination refers to discriminatory employment practices such as bias in hiring, promotion, job assignment, termination, and compensation, and various types of harassment. In the United States there is “very little statutory, common law, and case law establishing employment discrimination based upon sexual orientation as a legal wrong.”^[192] Some exceptions and alternative legal strategies are available. President Bill Clinton‘s Executive Order 13087 (1998) prohibits discrimination based on sexual orientation in the competitive service of the federal civilian workforce,^[193] and federal non-civil service employees may have recourse under the Due Process Clause of the U.S. Constitution.^[194] Private sector workers may have a Title VII action under a quid pro quo sexual harassment theory,^[195] a “hostile work environment” theory,^[196] a sexual stereotyping theory,^[197] or others.^[192]
• Housing discrimination refers to discrimination against potential or current tenants by landlords. In the United States, there is no federal law against such discrimination on the basis of sexual orientation or gender identity, but at least thirteen states and many major cities have enacted laws prohibiting it.^[198]
• Hate crimes (also known as bias crimes) are crimes motivated by bias against an identifiable social group, usually groups defined by race (human classification), religion, sexual orientation, disability, ethnicity, nationality, age, gender, gender identity, or political affiliation. In the United States, 45 states and the District of Columbia have statutes criminalizing various types of bias-motivated violence or intimidation (the exceptions are AZ, GA, IN, SC, and WY). Each of these statutes covers bias on the basis of race, religion, and ethnicity; 32 of them cover sexual orientation, 28 cover gender, and 11 cover transgender/gender-identity.^[199] In October 2009, the Matthew Shepard and James Byrd, Jr. Hate Crimes Prevention Act, which “…gives the Justice Department the power to investigate and prosecute bias-motivated violence where the perpetrator has selected the victim because of the person’s actual or perceived race, color, religion, national origin, gender, sexual orientation, gender identity or disability”, was signed into law and makes hate crime based on sexual orientation, amongst other offenses, a federal crime in the United States.^[200]

European Union

In the European Union, discrimination of any type based on sexual orientation or gender identity is illegal under the Charter of Fundamental Rights of the European Union.^[201]

Political activism

Barbara Gittings picketing Independence Hall July 4, 1966. Photo taken by Kay Lahusen.

Since the 1960s, many LGBT people in the West, particularly those in major metropolitan areas, have developed a so-called gay culture. To many, gay culture is exemplified by the gay pride movement, with annual parades and displays of rainbow flags. Yet not all LGBT people choose to participate in “queer culture”, and many gay men and women specifically decline to do so. To some it seems to be a frivolous display, perpetuating gay stereotypes. To some others, the gay culture represents heterophobia and is scorned as widening the gulf between gay and non-gay people.

With the outbreak of AIDS in the early 1980s, many LGBT groups and individuals organized campaigns to promote efforts in AIDS education, prevention, research, patient support, and community outreach, as well as to demand government support for these programs.

The bewildering death toll wrought by the AIDS epidemic at first seemed to slow the progress of the gay rights movement, but in time it galvanized some parts of the LGBT community into community service and political action, and challenged the heterosexual community to respond compassionately. Major American motion pictures from this period that dramatized the response of individuals and communities to the AIDS crisis include An Early Frost (1985), Longtime Companion (1990), And the Band Played On (1993), Philadelphia (1993), and Common Threads: Stories from the Quilt (1989).

Publicly gay politicians have attained numerous government posts, even in countries that had sodomy laws in their recent past. Examples include Guido Westerwelle, Germany’s Vice-Chancellor; Peter Mandelson, a British Labour Party cabinet minister and Per-Kristian Foss, formerly Norwegian Minister of Finance.

LGBT movements are opposed by a variety of individuals and organizations. Some social conservatives believe that all sexual relationships with people other than an opposite-sex spouse undermine the traditional family^[202] and that children should be reared in homes with both a father and a mother.^[203][204] There is concern that gay rights may conflict with individuals’ freedom of speech,^{[205][206][207][208][209]} religious freedoms in the workplace,^[210][211] the ability to run churches,^[212] charitable organizations^[213][214] and other religious organizations^[215] in accordance with one’s religious views, and that the acceptance of homosexual relationships by religious organizations might be forced through threatening to remove the tax-exempt status of churches whose views do not align with those of the government.^{[216][217][218][219]}

Critics charge that political correctness has led to the association of sex between males and HIV being downplayed.^[220][221]

Military service

The US Army defines homosexual conduct as “a homosexual act, a statement by a soldier that demonstrates a propensity or intent to engage in homosexual acts, the solicitation of another to engage in homosexual act or acts, or a homosexual marriage or attempted marriage.”^[222]

Policies and attitudes toward gay and lesbian military personnel vary widely around the world. Some countries allow gay men, lesbians, and bisexual people to serve openly and have granted them the same rights and privileges as their heterosexual counterparts. Many countries neither ban nor support LGB service members. A few countries continue to ban homosexual personnel outright.

Most Western military forces have removed policies excluding sexual minority members. Of the 26 countries that participate militarily in NATO, more than 20 permit openly gay, lesbian and bisexual people to serve. Of the permanent members of the United Nations Security Council, three (United Kingdom, France and United States) do so. The other two generally do not: China bans gay and lesbian people outright, Russia excludes all gay and lesbian people during peacetime but allows some gay men to serve in wartime (see below). Israel is the only country in the Middle East region that allows openly LGB people to serve in the military.

While the question of homosexuality in the military has been highly politicized in the United States, it is not necessarily so in many countries. Generally speaking, sexuality in these cultures is considered a more personal aspect of one’s identity than it is in the United States.

According to American Psychological Association empirical evidence fails to show that sexual orientation is germane to any aspect of military effectiveness including unit cohesion, morale, recruitment and retention.^[223] Sexual orientation is irrelevant to task cohesion, the only type of cohesion that critically predicts the team’s military readiness and success.^[224]

On March 18, 2010, after U.S. President Obama announced that he wanted to put an end to the Don’t Ask, Don’t Tell policy, former U.S. general and high ranking NATO official John Sheehan blamed homosexuals serving in the Dutch military for the fall of Srebrenica to Serb militias in the Bosnian War fifteen years earlier, stating that homosexuals had weakened the Dutch UN battalion charged with protecting the enclave. In the U.S. Senate, Sheehan said that European countries had tried to “socialize” their armed forces by letting people serve in the army too easily, which according to him, left them weakened. He claimed that his opinion was shared by the leadership of the Dutch armed forces, mentioning the name “Hankman Berman”, most probably referring to the then chief of the Dutch defence staff, Henk van den Breemen.^[225] Dutch authorities dismissed Sheehan’s statements as “disgraceful” and “total nonsense”.^{[226][227][228][229][230]}

Society and sociology

Public opinion

2007 Pew Global Research Poll: Should homosexuality be accepted in society? Percentage of responders that answered accept:

  81% – 90%

  71% – 80%

  61% – 70%

  51% – 60%

  41% – 50%

  31% – 40%

  21% – 30%

  11% – 20%

  1% – 10%

  No data

Societal acceptance of non-heterosexual orientations such as homosexuality is lowest in Asian and African countries, and is highest in Europe, Australia, and the Americas. Western society has become increasingly accepting of homosexuality over the past few decades.

Relationships

In 2006, the American Psychological Association, American Psychiatric Association and National Association of Social Workers stated in an amicus brief presented to the Supreme Court of the State of California: “Gay men and lesbians form stable, committed relationships that are equivalent to heterosexual relationships in essential respects. The institution of marriage offers social, psychological, and health benefits that are denied to same-sex couples. By denying same-sex couples the right to marry, the state reinforces and perpetuates the stigma historically associated with homosexuality. Homosexuality remains stigmatized, and this stigma has negative consequences. California’s prohibition on marriage for same-sex couples reflects and reinforces this stigma”. They concluded: “There is no scientific basis for distinguishing between same-sex couples and heterosexual couples with respect to the legal rights, obligations, benefits, and burdens conferred by civil marriage.”^[2]

Religion

Though the relationship between homosexuality and religion can vary greatly across time and place, within and between different religions and sects, and regarding different forms of homosexuality and bisexuality, current authoritative bodies and doctrines of the world’s largest religions generally view homosexuality negatively. This can range from quietly discouraging homosexual activity, to explicitly forbidding same-sex sexual practices among adherents and actively opposing social acceptance of homosexuality. Some teach that homosexual orientation itself is sinful,^[231] others state that only the sexual act is a sin,^[232] others are completely accepting of gays and lesbians,^[233] while some encourage homosexuality.^[234] Some claim that homosexuality can be overcome through religious faith and practice. On the other hand, voices exist within many of these religions that view homosexuality more positively, and liberal religious denominations may bless same-sex marriages. Some view same-sex love and sexuality as sacred, and a mythology of same-sex love can be found around the world. Regardless of their position on homosexuality, many people of faith look to both sacred texts and tradition for guidance on this issue.

Discrimination

Gay bullying

Gay bullying can be the verbal or physical abuse against a person who is perceived by the aggressor to be lesbian, gay, bisexual or transgender, including persons who are actually heterosexual or of non-specific or unknown sexual orientation. In the US, teenage students heard anti-gay slurs such as “homo”, “faggot” and “sissy” about 26 times a day on average, or once every 14 minutes, according to a 1998 study by Mental Health America (formerly National Mental Health Association).^[235]

Heterosexism and homophobia

Protests in New York City against Uganda‘s Anti-Homosexuality Bill.

In many cultures, homosexual people are frequently subject to prejudice and discrimination. A 2011 Dutch study concluded that 49% of Holland’s youth and 58% of youth foreign to the country reject homosexuality.^[236] Similar to other minority groups they can also be subject to stereotyping. These attitudes tend to be due to forms of homophobia and heterosexism (negative attitudes, bias, and discrimination in favor of opposite-sex sexuality and relationships). Heterosexism can include the presumption that everyone is heterosexual or that opposite-sex attractions and relationships are the norm and therefore superior. Homophobia is a fear of, aversion to, or discrimination against homosexual people. It manifests in different forms, and a number of different types have been postulated, among which are internalized homophobia, social homophobia, emotional homophobia, rationalized homophobia, and others.^[237] Similar is lesbophobia (specifically targeting lesbians) and biphobia (against bisexual people). When such attitudes manifest as crimes they are often called hate crimes and gay bashing.

Negative stereotypes characterize LGB people as less romantically stable, more promiscuous and more likely to abuse children, but there is no scientific basis to such assertions. Gay men and lesbians form stable, committed relationships that are equivalent to heterosexual relationships in essential respects.^[2] Sexual orientation does not affect the likelihood that people will abuse children.^{[238][239][240]} Claims that there is scientific evidence to support an association between being gay and being a pedophile are based on misuses of those terms and misrepresentation of the actual evidence.^[239]

Violence against gays and lesbians

In the United States, the FBI reported that 15.6% of hate crimes reported to police in 2004 were based on perceived sexual orientation. Sixty-one percent of these attacks were against gay men.^[241] The 1998 murder of Matthew Shepard, a gay student, is a notorious such incident in the U.S.

Homosexual behavior in other animals

Roy and Silo, two New York Central Park Zoo male Chinstrap Penguins similar to those pictured, became internationally known when they coupled and later were given an egg that needed hatching and care, which they successfully did.^[242]

Homosexual, bisexual and transgender behaviors occur in a number of other animal species. Such behaviors include sex, courtship, affection, pair bonding, and parenting^[13] and are very widespread: a 1999 review by researcher Bruce Bagemihl shows that homosexual behavior has been observed in close to 1500 species, ranging from primates to gut worms, and is well documented for 500 of them.^[13][14] Animal sexual behaviour takes many different forms, even within the same species. The motivations for and implications of these behaviors have yet to be fully understood, since most species have yet to be fully studied.^[243] According to Bagemihl, “the animal kingdom [does] it with much greater sexual diversity—including homosexual, bisexual and nonreproductive sex—than the scientific community and society at large have previously been willing to accept.”^[244]

See also

• LGBT rights by country or territory
• LGBT rights at the United Nations
• Anti-LGBT rhetoric
• Biology and sexual orientation
• Fraternal birth order and male sexual orientation
• Gender identity disorder
• Hate speech
• List of nonfiction books about homosexuality
• List of gay, lesbian or bisexual people
• Non-westernized concepts of male sexuality
• Religion and sexuality
• Riddle homophobia scale
• Sexuality and gender identity-based cultures

Notes

References

External links

NBC

A deadly bacterial meningitis outbreak striking gay men in New York City is unlikely to abate any time soon, New York City health officials warn. The disease has sickened 22 and killed seven NYC men over the last two years.

After four cases of meningococcal disease among gay men were reported in Los Angeles county in recent months, there were concerns that the New York City outbreak had spread, but public health officials in Los Angeles and New York say the strains are not connected.

The New York City outbreak has been linked to parties, online websites or apps that men used to find other men for “close or intimate sexual contact,” according to health officials. But for more than half of the men sickened by meningitis, there was no evidence that the men had used any of these means to encounter other men, according to public health officials.

The specific strain linked to all the cases in New York City is part of serogroup C. It’s the same strain that first surfaced when a woman came down with meningitis in New York City back in 2003. The speed in which meningitis kills has complicated the search for people at risk.

In New York, “we’ve had several cases who have been actually found dead in their apartment before they’d even gone to see a medical provider. So that is, to us, absolutely terrifying,”  Dr. Jay Varma, the New York City Deputy Commissioner for Disease Control in the Department of Health and Mental Hygiene, told The Edge Boston in early March.

Last week, health officials in West Hollywood, Calif. warned members of the public to be alert after the death of Brett Shaad, 33, from meningitis infection. Three other cases of meningitis, including two deaths, had been identified among Los Angeles-area gay men since November.

NBCLosAngeles: Two more Southern California meningitis deaths come to light

Public health officials in Los Angeles are being careful not to cause alarm. “Right now we do not have an outbreak of meningococcal disease in LA County,” Dr. Jonathan Fielding, director of Public Health for the Los Angeles County Health Department, told NBC, citing outbreak definition requirements from the Centers for Disease Control and Prevention.

Courtesy Shaad family via Facebo

Brett Shaad died within a week of developing symptoms of meningitis.

Shaad, an otherwise healthy lawyer, died within a week of developing symptoms. Elizabeth Ashford, a spokesperson for the family, expressed concern that the fact that Shaad was gay has been used to unfairly target him and others affected with meningitis. Allegations that Shaad was involved in any parties or other risqué activity are false, Ashford said.

“This is not a gay disease, but this is a deadly disease and that is why people should be conscientious about this disease,” she said.

Initially, meningitis symptoms may resemble the flu, with worsening headache, vomiting, and a sudden high fever (over 101.3). Over hours to days, patients develop difficulty thinking and may fall into a coma.

Meningococcal disease, caused by the bacteria Neisseria meningitidis, infects the lining around the brain. Once someone becomes sick, without treatment it is always fatal — even with treatment, up to a third of patients die, Fielding said. There is a vaccine that can prevent illness, and both the Los Angeles County Department of Public Health and the New York City Department of Health and Mental Hygiene have listed clinics offering free vaccines on their websites.

Varma is concerned the outbreak is getting worse. There were a total of thirteen known cases of bacterial meningitis among men last year (triple the total in 2011). But already in the first three months of 2013, four men have been hit, not including Shaad and others in Los Angeles.

“Normally people think of an outbreak as a lot of people getting sick at one point in time – but here the number of cases is much higher than we normally expect,” said Varma.

The rate of meningitis in gay men in New York City has spiked to 60 times higher than their straight counterparts. Last fall health officials advised vaccination for some HIV-positive men, but recently expanded the recommendation to include all gay men statewide who have “traveled to the City” and “met through an online website, digital application (“app”), or at a bar or party” since September 1, 2012.

“Many people are scared,” said Anthony Fortenberry, the director of nursing at Callen-Lorde Community Health Center, which serves New York’s lesbian, gay, bisexual, and transgender communities.

Reports of a strange illness affecting gay men in two major cities may conjure images of the early years of AIDS — as well as the stigma that surrounded patients with HIV. But experts are quick to note the differences, especially since meningitis infection can be stopped.

Dr. Mike Osterholm, the director of the University of Minnesota’s Center for Infectious Disease Research and Policy, understands the “fear factor,” but “this is very different,” he said. “With HIV/AIDS we never had the hope of eliminating it, we didn’t even know what was causing it initially. This, we know what is causing it. We have vaccines and antibiotics that can greatly reduce or eliminate carriage,” and stop the spread of the disease, Osterholm said.

At first, the meningitis outbreak in New York City seemed to infect only HIV positive men, but by March half of the men sickened were HIV negative. Three of the last five men sickened have died.

It is unclear why the current outbreak, so far, is affecting only gay men. Only two of the men knew each other and there is no evidence they infected each other, Varma said.

“Many of the outbreaks happen in settings where a lot of people live or socialize together, like college dorms or army barracks,” Osterholm said.  “When an outbreak occurs in one of these settings, health officials can track down everyone who lives in the setting, can vaccinate them and provide prophylactic medications.”

Getting the vaccine is not “outing” yourself. “It does not mean you are gay or that someone you know is gay. It is about protecting yourself,” said Fortenberry.

Osterholm agreed. “This has nothing to do with being gay,” he said.

The bacteria is spread by close contact – such as kissing, or sharing a toothbrush, a cigarette or even a coffee cup.

To date an estimated 6,700 people have been vaccinated in New York City since the start of the outbreak;1,182 people in March alone.

The Centers for Disease Control and Prevention currently recommends that children and teenagers get vaccinated but immunity wanes, leaving most adults unprotected.

Varma warns that the outbreak will likely continue until at-risk men get vaccinated. People interested in getting vaccinated can find clinics through a website run by New York City’s department of health. In Los Angeles, locations for free vaccines for the uninsured can be found here.

Kristina Krohn, MD, is an Internal Medicine and Pediatrics Resident at the University of Minnesota and the 2012-2013 Stanford NBC News Media and Global Health Fellow.

Care2

A recently introduced Louisiana bill would define away the LGBT community’s right to sue over anti-LGBT workplace discrimination and, in identifying those suits as “frivolous,” would effectively reward discriminatory companies by making it easier for them to claim damages if such suits were attempted.

Introduced by Republican Rep. Alan Seabaugh, HB 402 would mean that “suits filed for employment discrimination for any reason other than age, disability, race, color, religion, sex, national origin, pregnancy, childbirth and related medical conditions, sickle cell trait, and genetic discrimination shall be dismissed and considered frivolous.”