Gay father surrogacy families: relationships with surrogates and egg donors and parental disclosure of children's origins.

OBJECTIVE: To study the nature and quality of relationships between gay father families and their surrogates and egg donors and parental disclosure of children's origins. DESIGN: Cross-sectional study. SETTING: Family homes. PATIENT(S): Parents in 40 gay father families with 3-9-year-old children born through surrogacy. INTERVENTION(S): Administration of a semistructured interview. MAIN OUTCOME MEASURE(S): Relationships between parents, children, surrogates, and egg donors and parental disclosure of children's origins were examined using a semistructured interview. RESULT(S): The majority of fathers were content with the level of contact they had with the surrogate, with those who were discontent wanting more contact. Fathers were more likely to maintain relationships with surrogates than egg donors, and almost all families had started the process of talking to their children about their origins, with the level of detail and children's understanding increasing with the age of the child. CONCLUSION(S): In gay father surrogacy families with young children, relationships between parents, children, surrogates, and egg donors are generally positive.Wellcome Trust (Grant ID:097857/Z/11/Z)This is the final version of the article. It first appeared from Elsevier via http://dx.doi.org/10.1016/j.fertnstert.2016.08.01

Neuropsychological Changes in a Prospectively Followed Cohort of Homosexual and Bisexual Men With and Without HIV Infection

We evaluated neuropsychological test performance of 168 homosexual and bisexual men with and without human immunodeficiency virus (HIV) infection (113 HIV+ subjects and 55 HIV- controls) over 4.5 years of semiannual follow-up. Analyses of the longitudinal data were performed by applying generalized estimating equations (GEEs) to regression analyses with repeated measures. Compared with the HIV- men, the HIV+ subjects performed more poorly on memory testing. Performance on all tests tended to improve over time, but this improvement was attenuated or eliminated in the HIV+ group for tests of language and attention. Within the HIV+ subjects, improvement over time in tests of memory, executive function, language, and attention was attenuated or eliminated in patients with lower CD4 levels; more advanced HIV disease was associated with poorer memory and executive function and with attenuated or reduced learning effects for memory, motor speed, and language tests. Clinically significant neurologic findings were associated with worse memory and orientation and with attenuated or reversed learning effects for memory, language, and attention tests. There were 33 deaths in the HIV+ group. In the men who died, there was more rapid decline in executive, language, and attentional test performance. These observations remained significant after controlling for HIV disease severity. We conclude that HIV infecting the CNS results in progressive cognitive change that is closely associated with neurologic findings. In addition, our findings suggest a relation between more rapid cognitive progression and death

Neurologic Signs and Symptoms in a Cohort of Homosexual Men Followed for 4.5 Years

We traced the development of neurologic impairment in 207 homosexual men (123 human immunodeficiency virus [HIV]-positive and 84 HIV-negative controls) over 4.5 years of follow-up. We applied generalized estimating equations to logistic regression analyses with repeated measures to examine the differences between HIV-positive and HIV-negative subjects with respect to the likelihood of developing six neurologic outcomes derived from a factor analysis, significant neurologic impairment (modified Kurtzke disability score of ≥3), or significant neuropsycholog-ical impairment. We found that, over time, HIV-positive subjects were more likely to develop clinically significant ex-trapyramidal signs and frontal release signs than HIV-negative subjects. Controlling for age or education, as CD4 count declined, the odds of developing significant extrapyramidal signs, abnormalities in alternating movements, frontal release signs, and a Kurtzke score ≥3 increased. HIV-positive subjects were almost five times as likely (odds ratio [OR], 4.6; 95% CI, 1.6 to 13.4) as HIV-negative subjects to stay the same or worsen neurologically on the next visit, and those with CD4 ≥200 were 4.8 times as likely (OR, 4.8; 95% CI, 2.2 to 10.7) to maintain or worsen neurologically relative to those with higher CD4 counts. We conclude that neurologic impairment becomes increasingly apparent over time in HIV-infected men, especially in those with low CD4 counts

Neuropsychological Changes in a Prospectively Followed Cohort of Intravenous Drug Users with and without HIV

We followed a cohort of 223 intravenous drug users (99 HIV and 124 HIV+) for up to 3.5 years, examining change in performance over time as a function of HIV status, disease severity, and neurological signs and symptoms. Analyses were performed by applying generalized estimating equations (GEE) to regression analyses with repeated measures, and controlled for age, education, and length of substance use. None of the subjects had AIDS at baseline. There were 147 men (85 HIV+ and 62 HIV) and 76 women (39 HIV+ and 37 HIV). Memory performance was worse in the HIV+ than HIV− women. In the men, performance on the memory, executive, language, and attention factors improved significantly overtime, but this improvement was attenuated in the HIV men for the attention and orientation factors. In the HIV+ women. AIDS was associated with worsening performance on attention tests. The presence or onset of clinically significant neurological findings was associated with poorer language and motor speed performance. In the HIV+ men, memory performance was worse when the CD4 count fell below 200: it declined over time in men with AIDS but not in those without. A learning effect for language was attenuated in men who developed AIDS. The presence or development of a clinically significant neurological sign was associated with poorer memory, executive, language, attention, and motor speed performance. Our findings parallel those that we previously reported in a prospectively followed cohort of gay men. In combination, our studies of gay men and IDU cohorts suggest that (a) HIV can affect cognition early, even when the patient is medically asymptomatic; (b) cognitive difficulties worsen as the severity of HIV infection increases; and (c) the advent of clinically significant neurologic signs is associated with progression to more severe cognitive deficits. Our data suggest that the neurological and neuropsychological changes are both manifestations of the central effect of HIV on the CNS

Multidisciplinary Baseline Assessment of Homosexual Men with and without Human Immunodeficiency Virus Infection. Iii. Neurologic and Neuropsychological Findings

We explored the possibility that neurologic and neuropsychological changes constitute the earliest detectable manifestations of human immunodeficiency virus (HIV) infection. Without knowledge of HIV status, we assessed neurologic signs and symptoms and administered a battery of neuropsychological tests to 208 homosexual men, of whom 84 were HIV negative, 49 were HIV positive and asymptomatic, 29 were mildly symptomatic, and 46 had significant medical symptoms but not the acquired immunodeficiency syndrome. There was no difference between the HIV-negative and HIV-positive men in the frequency of neurologic signs or of defective or borderline performance on any neuropsychological test. However, HIV-positive men performed slightly but significantly worse than HIV-negative men on tests of verbal memory, executive function, and language. Similar results were obtained when comparisons were limited to HIV-positive medically asymptomatic and HIV-negative men. There was no degradation of neurologic status or neuropsychological performance across stages of HIV severity, but neurologic and neuropsychological summary scores correlated with CD4/CD8 ratios in the HIV-positive group. Ratings of neurologic signs and symptoms correlated with neuropsychological summary scores in the HIV-positive group only. Cognitive complaints were more frequent in the HIV-positive men; they correlated with actual test performance in the HIV-positive but not HIV-negative men. The constellation of subjective and objective neuropsychological and neurologic findings suggests the possibility of a definable syndrome associated with HIV infection in asymptomatic individuals

Risk of Human Immunodeficiency Virus Type 1-Related Neurologic Disease in a Cohort of Intravenous Drug Users

Background: Although the proportion of cases of acquired immunodeficiency syndrome related to intravenous drug use has increased dramatically over the past decade, there has been no longitudinal examination of primary neurologic disease in this group. Objective: To study the development of neurologic disease in human immunodeficiency virus (HIV)—negative and HIV-positive men and women who were intravenous drug users over a 3.5-year period. Design: Prospective observational cohort study. Setting: Subjects were recruited from an infectious disease clinic at a New York City Hospital or from a methadone maintenance program. Participants: Ninety-nine HIV-negative (62 men and 37 women) and 124 HIV-positive (85 men and 39 women) intravenous drug users volunteered. Main Outcome Measure: The development of clinically significant manifestations in six neurologic domains. Results: With multivariate adjustment for current and past substance abuse, age, education, and head injury, we examined the odds of developing HIV-related neurologic disease. Extrapyramidal signs and reduced motor ability became increasingly apparent over time in HIV-infected men as their CD4 cell count declined and as the subjects developed the acquired immunodeficiency syndrome. Fewer neurologic signs were seen in the women. Conclusions: The impact of HIV infection among intravenous drug users parallels that in homosexual men and is independent of alcohol and other drug use

Intricacies and inter-relationships between HIV disclosure and HAART: A qualitative study

This study aimed to understand whether and how highly active antiretroviral treatment (HAART) affects views and patterns of disclosure and how disclosure interacts with treatment decisions. One hundred and fifty-two HIV-positive adults (52 MSM, 56 women and 44 IDU men) from four US cities participated in two to three-hour, semi-structured interviews in 1998–99. Results indicate that HAART interacts with and shapes HIV disclosure issues in several ways. Medications may ‘out’ people living with HIV. Thus, in different settings (e.g. work, prisons, drug rehabs and public situations), some try to hide medications or modify dosing schedules, which can contribute to non-adherence, and affect sexual behaviours. Disclosure of HIV and/or HAART may also result in antagonism from others who hold negative attitudes and beliefs about HAART, potentially impeding adherence. Observable side effects of medications can also ‘out’ individuals. Conversely, medications may improve appearance, delaying or impeding disclosure. Some wait until they are on HAART and look ‘well’ before disclosing; some who look healthy as a result of medication deny being HIV-positive. Alternatively, HIV disclosure can lead to support that facilitates initiation of, and adherence to, treatment. HIV disclosure and adherence can shape one another in critical ways. Yet these interactions have been under-studied and need to be further examined. Interventions and studies concerning each of these domains have generally been separate, but need to be integrated, and the importance of relationships between these two areas needs to be recognized

Multidisciplinary Baseline Assessment of Homosexual Men with and without Human Immunodeficiency Virus Infection. I. Overview of Study Design

Although much is known about the virus believed by most experts to be the cause of the acquired immunodeficiency syndrome and about its pathogenic actions, major areas of ignorance remain. Among these are the reasons for the varying time between infection with human immunodeficiency virus and development of acquired imunodeficiency syndrome, the relationship between neurologic and medical aspects of the disease, the time course of neuropsychological findings, and the prevalence of psychiatric morbidity. We assessed 124 homosexual men who were positive for human immunodeficiency virus and 84 who were negative for the virus. In this article we describe the study design, method of recruitment, and medical and demographic characteristics of the cohort, which will be followed up for 5 years

It's not just what you say: Relationships of HIV dislosure and risk reduction among MSM in the post-HAART era

In the post-HAART era, critical questions arise as to what factors affect disclosure decisions and how these decisions are associated with factors such as high-risk behaviors and partner variables. We interviewed 1,828 HIV-positive men who have sex with men (MSM), of whom 46% disclosed to all partners. Among men with casual partners, 41.8% disclosed to all of these partners and 21.5% to none. Disclosure was associated with relationship type, perceived partner HIV status and sexual behaviors. Overall, 36.5% of respondents had unprotected anal sex (UAS) with partners of negative/unknown HIV status. Of those with only casual partners, 80.4% had >1 act of UAS and 58% of these did not disclose to all partners. This 58% were more likely to self-identify as gay (versus bisexual), be aware of their status for <5 years and have more partners. Being on HAART, viral load and number of symptoms were not associated with disclosure. This study—the largest conducted to date of disclosure among MSM and one of the few conducted post-HAART—indicates that almost 1/5th reported UAS with casual partners without disclosure, highlighting a public health challenge. Disclosure needs to be addressed in the context of relationship type, partner status and broader risk-reduction strategies