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Homosexuality can be described as the orientation and inclination of a person to have sexual relations with a person of his or her own sex. The clustering of Acquired immune deficiency syndrome (AIDS) cases among male homosexuals in the initial phase of the HIV epidemic in the USA and a few other Western countries led to a misleading notion that the disease afflicted only "reckless" male homosexuals and it was often referred to as the 'gay plague' or 'gay cancer', 'gay' being the current vogue word for homosexuals. Very little is known about the practice of homosexuality in contemporary India. According to Ashok Row-Kavi, a self-acclaimed homosexual activist, the number of exclusively or predominantly homosexual men in India may be over 50 million. A vast majority of them are married and living with their wives. A culturally identifiable group known by the Urdu term "hijra" lives in most parts of India and are known to depend, at least partly, for their livelihood on working as male prostitutes. Most hijras are castrated males and dress as females. In addition to a large section of the hijra community, there are many full-time or part-time male prostitutes in India. Some of them live in red-light areas of metropolitan cities; many seek male clients by offering massage services in parks, beaches, hotels, and houses. Male prostitution is increasingly visible in India. In Delhi there are as many as twenty "agencies" offering "handsome masseurs" in the classifieds of the newspapers (Hindustan Times).

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Law and medical ethics are two disciplines with a considerable overlap. Law lays down the established rule for conduct, the violation of which creates criminal or civil liability; ethics is more about expected conduct, that is, what ought to be? The two key issues in medical ethics are confidentiality and consent. In no other disease scenario do these two take on such importance as in HIV and AIDS. The fact that often patients confidentiality and public interest come into conflict further complicates matters. Whether it is with regard to marriage or employment, there is no National Law yet, as to which can be used as a guideline. Different High Courts and the Supreme Court have at different times given judgments that vary vastly, and so the ­matter remains confusing. A National Initiative has requested lawyers to collectively draft a bill, to provide clarity, consistency, and predictability. The article examines the dynamics of such issues, citing examples from India and abroad and the present status of the draft bill prepared in 2006 is that it has been and submitted to the government.

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The asymptomatic nature of chlamydial genital infections coupled with the occurrence of severe sequelae in untreated patients, makes the laboratory evaluation of great importance in the diagnosis of the disease. Genital chlamydial infections are the leading cause of preventable sexually transmitted infections (STIs) worldwide, with 43 million new cases in Southeast Asia. The present study was designed to determine the prevalence of genital chlamydial infection in women attending a sexually transmitted disease (STD) outpatient department and to determine the association of the disease with other STIs. A total of 276 female patients with a complaint of genital discharge or ulcer were enrolled for the study. Genital discharge specimens (endocervical, vaginal, and urethral swabs) were collected from all the patients. The patients were investigated for the presence of antigen and antibody of Chlamydia trachomatis with the help of the Direct fluorescent Antibody test (DFA) and the Enzyme Linked Immunosorbant Assay (ELISA), respectively. Investigations for aetio-pathogens of other STIs were carried out using the standard methods. Chlamydial infection was found in 19.9% of the patients (10.1% by DFA technique and 10.9% by ELISA). Both the antigen and antibody were positive in only three (1.1%) cases. The overall incidence of other aetio-pathogens was low. In two (0.7%) cases multiple infections were seen. Chlamydia trachomatis was found to be most commonly associated with Candida albicans . However, there was no co-infection of Chlamydia trachomatis with Neisseria gonorrhoeae.

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Metastatic Crohn's disease is a rare granulomatous extraintestinal manifestation of Crohn's disease. We are reporting a case of a 22-year-old male with knife-cut ulcers in his groin, and a biopsy suggestive of Metastatic Crohn's disease.

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A 22-year-old married woman presented with multiple, asymptomatic, skin-colored raised lesions all over the body since two months. She also complained of recurrent fluid filled lesions over the genitalia associated with fever and malaise since three days. Cutaneous examination revealed multiple pearly white papules with central umbilication, measuring 3-5mm in diameter, and few lesions were >1 cm in diameter. Koebner's phenomenon was present. The lesions were distributed in a generalized pattern with sparing of hands and feet. Examination of her genitalia revealed multiple superficial erosions and few intact vesicles along with B/L inguinal lymphadenopathy. Histopathology of the skin lesion was consistent with molluscum contagiosum. Her hemogram was within normal range, HIV-I and II reactive, CD4 count was 49 cells/cumm, and VDRL and HBSAg negative. A final diagnosis of molluscum contagiosum with recurrent herpes genitalis was made. The patient was started on HAART, but did not show any improvement.

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Objectives: Trichomoniasis caused by protozoan parasite Trichomonas vaginalis , is the major nonviral sexually transmitted disease (STD). Clinical spectrum varies from an asymptomatic state to mild, moderate or severe symptoms. Methods: The study was planned to assess the prevalence of trichomoniasis in women with cervical intraepithelial neoplasia (CIN)/carcinoma cervix (n = 100), Human Immunodeficiency Virus (HIV) seropositive women (n = 100), and symptomatic (n = 140) and asymptomatic (n = 109) women for trichomoniasis, by direct examination and culture of vaginal washes and urine. Results: None of the cervical carcinoma or HIV seropositive Indian patients, including 30% HIV seropositive patients with CD4 ⁺ cell count less than 200/µl harbored T. vaginalis, while six (4.28%) symptomatic and four (3.66%) asymptomatic otherwise healthy subjects were found positive for T. vaginalis . Conclusion: Trichomoniasis was significantly associated ( P < 0.05) with being a housewife, belonging to the middle socioeconomic status, and nonuse of contraception. However there was no significant association with gravidity ( P > 0.05), HIV status or cervical carcinoma.

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Objectives: To assess the baseline knowledge and awareness among young men and women about HIV and its transmission in the Vadodara urban areas and to make a comparison between young men and women about the knowledge of HIV. Methodology: Thirty urban clusters (slums) were selected using the cluster sampling technique. Three hundred and fifty young men and 563 young women, in the age group of 15 - 24 years, were selected after taking consent. Results and Discussion: The family was the most common source of information for reproductive health information. About 72% of the men and 47% of the women had heard about HIV. Television, radio and newspapers (mass media) were the most common source of information, as suggested by young men and women. Responses for knowledge regarding mode of transmission were sexual acts followed by needle and blood transfusion. Sixty-four percent of the youth responded that it could be prevented. Three-fourth of the men and half the women thought HIV could be prevented. For preventing HIV, having a single partner, using condoms, avoiding commercial sexual workers, and blood checkups were the commonest methods mentioned both by men and women. Only 50% knew that HIV could be present in apparently healthy looking persons. Recommendations: It demands systematic education efforts with complete, correct, and comprehensive scientific information offered to them in an environment that is acceptable to them and conducive to their learning ability.

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Almost a third of all people with Human Immunodeficiency Virus (HIV)/(AIDS) Acquired Immunodeficiency Syndrome are between the ages of 15 and 24. Every minute, six young people under the age of 25 become infected with HIV. This study of HIV infection was carried out over a two-year period with 33 HIV-positive adolescents, at SSG hospital, Vadodara. The most common mode of transmission (MOT) was the vertical route in 21(64%) cases followed by the sexual route in four (12%) cases. The mean time for disease progression was 13 years in cases acquiring infection through vertical transmission (VT). Reasons for slow progression in these cases, in spite of the high prevalence of malnutrition and infectious diseases in a developing country like India, should be studied. Both parents were positive in 12 of 21 VT cases and eight were orphans. Multiple cases in the same family made treatment and care difficult. Only eight of the 21 VT cases were tested, due to positivity in their parents, while the rest were tested on being symptomatic, suggesting delayed testing. Late diagnosis led to a delay in the initiation of antiretroviral treatment (ART), influencing the growth and development of adolescents. Twenty-one cases sought treatment when they had already developed AIDS, thus preventing us from early intervention. Nine cases were on ART. These cases faced problems like dose adjustments, adherence, and availability of pediatric formulations.

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Nocardia infections rarely occur in normal individuals. Most infections occur in an immunocompromised host. Here we report a case of pulmonary Nocardiosis due to Nocardia asteroides in an HIV-infected person presenting as a cavitatory lesion in the lungs.

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A 35-year-old HIV-reactive female presented to us with multiple erythematous plaques on her face, trunk, and limbs, since five days. Bilateral ulnar and lateral popliteal nerves were thickened and tender. ­Antiretroviral drugs (d4T, 3TC, NVP) had been started one month prior. Slit skin smear was negative. Skin biopsy from infiltrated lesions showed ill-defined, noncaseating epitheloid granulomas, confirming the diagnosis of ­borderline tuberculoid leprosy, with reversal reaction. In the setting of the recent Antiretroviral Therapy (ART) this is considered clinically as Immune Reconstitution Inflammatory Syndrome (IRIS).

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Background : Lipodystrophy (LD) is potentially stigmatizing and contributes to poor adherence to ­antiretroviral therapy. Objectives : To find out the prevalence and pattern of LD among Acquired Immune Deficiency ^­ Syndrome (AIDS) patients receiving Highly Active Antiretroviral Therapy (HAART), and to assess the ­psychological distress related to LD. Materials and methods : A cross-sectional study was designed after institutional ethical clearance and informed consent from 50 AIDS patients on HAART. Data collected were physical examination and response to a standardized questionnaire (Assessment of Body Changes and Distress questionnaire). They were analyzed using SPSS 14.0. Results : All subjects were on lamivudine, stavudine, and nevirapine (82%) or efavirenz (18%). The prevalence of LD was 28% (M = 5; F = 9) and ­significantly more among women ( P = 0.019). The pattern of LD perceived by patients and assessed on physical examination were abdominal obesity in 50 and 38%, breast hypertrophy in 28 and 14%, wasting of buttocks in 22 and 26%, lipoatrophy of arms in 24 and 28%, and wasting of facial muscles in 20 and 32%, respectively. The overall perceived changes were 68%, while assessed were 62%. The body changes caused significant psychological distress to the patients ( P = 0.001), although compliance was good. Conclusion : The study calls for early detection of LD and treatment or provision of alternative medicines and counseling of these patients, to reduce the physical and psychological burden.

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