Diseases in the Homosexual Male PDF
Preview Diseases in the Homosexual Male
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 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, re-use of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data banks. Duplication of this publication or parts thereof is only permitted under the provisions of the German Copyright Law of September 9, 1965, in its version of June 24,1985, and a copyright fee must always be paid. Violations fall under the prosecution act ofthe German Copyright Law. © Springer-Verlag Berlin Heidelberg 1988 Softcover reprint of the hardcover 1st edition 1988 The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product Liability. The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. Typeset by Tradeset Photosetting Limited, Welwyn Garden City, Hertfordshire 2128/3916-543210-Printed on acid-free paper. 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.
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