Diseases in the Homosexual Male

206 Pages·1988·10.44 MB·English

by  J. Weeks (auth.)

The Bloomsbury Series in Clinical Science
Titles in the series already published:
Bronchoalveolar Mast Cells and Asthma
K. C. Flint
Platelet-Vessel Wall Interactions
Edited by R. Michael Pittilo and Samuel J. Machin
Oxalate Metabolism in Relation to Urinary Stone
Edited by G. A. Rose
Forthcoming titles in the series:
Disorders of Lipoprotein Metabolism
D. J. Betteridge
Immunology of Mycobacterial Infection
G.A. W.Rook
Herpes Simplex Virus
A. Mindel
The Blood Brain Barrier for Clinicians
Alan Crockard and Nicholas Todd
DISEASES IN THE
HOMOSEXUAL MALE
Michael W. Adler (ed.)
With 31 Figures
Springer-Verlag
London Berlin Heidelberg New York
Paris Tokyo
Michael W. Adler MD, FRCP, FFCM
Professor of Genito-Urinary Medicine and Honorary Consultant
Physician, Academic Department of Genito-Urinary Medicine,
University College and Middlesex School of Medicine, James Pringle
House, The Middlesex Hospital, London WIN BAA, UK
Series Editor
Jack Tinker, BSc, FRCS, FRCP, DIC
Director, Intensive Therapy Unit, The Middlesex Hospital, London
WINBAA,UK
Cover illustration: (Top left) Dark-ground photomicrograph of
Treponema pallidum. (Top right) CT scan: ring shadow of cerebral
toxoplasmosis with surrounding oedema. (Bottom) Electron
micrograph of an HBV carrier serum showing 42nm Dane particles
and smaller 22nm spherical forms and occasional filaments
(x 44BOO).
ISBN-13:978-1-4471-1636-3 e-ISBN-13:978-1-4471-1634-9
DOl: 10.1007/978-1-4471-1634-9
British Library Cataloguing in Publication Data
Adler, Michael W. (Michael William)
Diseases in the homosexual male.---(The Bloombury series in clinical science).
1. Male homosexuals. Venereal diseases I. Adler, Micheal W.
II. Series 616.95'1'008806642
ISBN-13:978-1-4471-1636-3
Library of Congress Cataloging-in-Publication Data
Diseases in the homosexual malelMichael W. Adler (ed.). p. cm.
(The Bloomsbury series in clinical science)
Includes bibliographies and index.
ISBN-13:978-1-4471-1636-3
1. Sexually transmitted diseases. 2. Gay men-Diseases.
I. Adler, Michael W. II. Series. [DNLM: 1. Homosexuality. 2. Men. 3. Sexually
Transmitted Diseases-complications. WC 140 D61l] RCZOO.7.G38D57 1988
616.9'5'08806642---dc19
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© Springer-Verlag Berlin Heidelberg 1988
Softcover reprint of the hardcover 1st edition 1988
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Series Editor's Foreword
The Bloomsbury Series in Clinical Science is growing and changing.
Its Editorial Board and contributors were all originally selected from,
or had links with, the University College and Middlesex School of
Medicine. Now, as the Series develops, board members and con
tributors alike identify with the wider reaches of Bloomsbury and
Islington.
The aims of the Series remain, however, to highlight, to review and
to record significant areas of research and development in the field of
clinical science. All contributors are experts in their particular field
and monographs may be the work of a single author or several, guided
by individual editors.
Diseases in the Homosexual Male is the third monograph in the
Series. Edited by Michael Adler, Professor of Genito-Urinary
Medicine at the University College and Middlesex School of
Medicine, it presents contributions from a number of distinguished
workers with special expertise. AIDS has perhaps highlighted the
problem but this monograph illustrates the wider profile and gives wit
ness to the multidisciplinary nature of clinical science.
London, July 1988 Jack Tinker
Preface
It is interesting to reflect that, prior to the advent of the acquired im
mune deficiency syndrome (AIDS), a book on diseases in homosexual
men might have been seen as of little importance. This is not so, of
course, as would be attested by those working in the field of sexually
transmitted diseases. This book is not about AIDS, even though we
have included two clinical chapters on the SUbject. Instead, it is written
to show the wide variety of clinical diseases apart from AIDS that can
occur among homosexual men and which can be acquired via the sexual
route. The fact that a disease and/or organisms can be spread sexually
has often been first realised in homosexual men. This occurred with
hepatitis B, protozoal infections, and of course, the human
immunodeficiency virus.
I have also felt it important to include two non-clinical chapters on
sociological and historical perspectives of homosexuality and AIDS.
This has been done to illustrate that "nothing is that new" and that im
portant lessons need to be learnt from history. The lessons show us
that the punitive approach to minority groups has never worked.
November 1987 M.W.A.
Contents
1 Male Homosexuality: Cultural Perspectives
J. Weeks ............................ 1
2 Bacterial Infections
A. McMillan .......................... 15
3 Viral Infections
A. Mindel . . . . . . . . . . . . . . . . . . . . . . . . . . .. 41
4 Protozoal Infections
E. Allason-Jones 59
5 Hepatitis
1. V. D. Weller . . . . . . . . . . . . . . . . . . . . . . . .. 77
6 Genital Warts
J. D. Oriel ........................... 99
7 Syphilis
J. S. Bingham . ......................... 111
AsPects
8 AIDS: Epidemiology and Clinical
M. W. Adler and 1. V. D. Weller . ........ . 129
9 AIDS: Counselling and Support
Part 1: L. Glover and D. Miller. . . . . . . . . . . . . . . . . 163
Part 2: T. Whitehead . . . . . . . . . . . . . . . . . . . . . . 175
10 AIDS and Homosexuality in Britain: A Historical Perspective
J. Austoker . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Contributors
M. W.Adler
Academic Department of Genito-Urinary Medicine, University
College and Middlesex School of Medicine, James Pringle House,
The Middlesex Hospital, London WlN 8AA
E. Allason-Jones
Academic Department of Genito-Urinary Medicine, University
College and Middlesex School of Medicine, James Pringle House,
The Middlesex Hospital, London WlN 8AA
J. Austoker
Wellcome Unit for the History of Medicine, 45-47 Banbury Road,
Oxford 0X2 6PE
J. S. Bingham
Department of Genito-Urinary Medicine, James Pringle House,
The Middlesex Hospital, London WlN 8AA
L. Glover
Department of Genito-Urinary Medicine, James Pringle House,
The Middlesex Hospital, London WlN 8AA
A. McMillan
Department of Genito-Urinary Medicine, Royal Infirmary, Lauriston
Place, Edinburgh EH3 9YW
D. Miller
Academic Department of Genito-Urinary Medicine, University
College and Middlesex School of Medicine, James Pringle House,
The Middlesex Hospital, London WlN 8AA
A. Mindel
Academic Department of Genito-Urinary Medicine, University
xii Contributors
College and Middlesex School of Medicine, James Pringle House,
The Middlesex Hospital, London WiN BAA
J. D. Oriel
Department of Genito-Urinary Medicine, University College
Hospital, London WCiE 6AU
J. Weeks
26 Dresden Road, London N19 3BD
I. V. D. Weller
Academic Department of Genito-Urinary Medicine, University
College and Middlesex School of Medicine, James Pringle House,
The Middlesex Hospital, London WiN BAA
T. Whitehead
Terrence Higgins Trust, BM AIDS, London WCiN 3XX
Chapter 1
Male Homosexuality: Cultural Perspectives
1. Weeks
This much has become certain: deviancy isn't just a waste product of society, and nor is it
intrinsic to the deviant subject. It is, rather, a construction, one which, when analysed, says
less and less about the individual deviant and more and more about the society - its structure
of power, representation and repression - identifying or demonising him or her.
(Dollimore 1986 p 179)
Introduction
Anyone writing on homosexuality, especially male homosexuality, in the 1980s does
so under the shadow of AIDS. This is not because it is a peculiarly "gay plague" , as
the more scabrous of the popular press would have it; nor, on a world scale, are gay
men the chief sufferers of the disease. As a newly recognised, and potentially devas
tating, phenomenon in the early 1980s AIDS would, moreover, have made a major
impact wherever it came from and whoever were identified as its victims. Yet, it is
surely undeniable that a major part of the symbolic power of AIDS stems from its
association with a still stigmatised sexuality and an unpopular sexual minority in the
industrialised countries of the "advanced" West. To that extent, AIDS and homosex
uality are today intertwined in a difficult and complicated history.
"History", the black American writer James Baldwin has said, "is the present -
we, with every breath we take, every move we make, are History - and what goes
around, comes around (Baldwin 1986 P xiv)". The association between AIDS and
homosexuality, and its resultant effect on the way AIDS has been perceived and
responded to by everyone from vocal minorities of the fundamentalist Christian
Right to prison wardens, theatrical staff, restaurateurs, refuse collectors, undertak
ers, laboratory technicians, government officials and ministers, is shaped by a living
history, by what can be best described as an unfinished revolution in attitudes to
homosexuality and lesbian and gay life-styles (Weeks 1985). Although attitudes to
homosexuality have liberalised over the past two decades, the subject still trails
clouds offear, prejudice and misapprehension.