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Biomedical subjects

G Marks

Publications and source records attributed to G Marks.

At least 55 records · Page 3Linked to original sources
PubMed1995

Peer consultation: a look at process.

After attending graduate nursing school, and being exposed to the concepts of peer supervision and consultation, six women formed a peer consultation group. A peer consultation group, simply stated, is a professional support group. In this article, evolution of the group process is described from personal experience and personal perspectives. The aim is to inspire other CNSs and nursing personnel involved in advanced practice to consider involvement in such a group to enhance their own professional growth and well-being. Although the format, group size, individual composition, and beneficial aspects of the group have varied throughout the 5-year tenure, group members unanimously agree that such a forum has been invaluable for their professional growth and development.

Consultants↗
PubMed1995

Women living with HIV: sexual behaviors and counseling experiences.

Seventy-two ethnically diverse women attending two outpatient HIV clinics in Los Angeles self-administered questionnaires. Nineteen women (26%) reported sexual activity in the two months prior to the survey; most were sexually monogamous and emotionally involved with live-in male partners. According to self-reports, 13 women (18% of the total sample and 68% of those who were sexually active) had engaged in at least one form of risky sexual activity. The majority (81%) of sexual partners were aware of the respondent's HIV infection, but most (67%) were seronegative. Post-test counseling was reportedly noncomprehensive (e.g., 47% of the respondents did not recall receiving information about using condoms correctly). Few women accessed HIV support services. Results underscore the need for more effective counseling and support interventions for this population.

Adult↗
PubMed1994

High-dose preoperative radiation and full thickness local excision: a new option for selected T3 distal rectal cancers.

PURPOSE: To assess the efficacy of high-dose preoperative radiation and full thickness local excision as an option for the management of selected distal rectal cancers. METHODS AND MATERIALS: Forty-eight patients with invasive distal rectal cancer have been treated with high-dose preoperative radiation (45-55 GY at 180 cGy/fx) followed 6 to 8 weeks later by full thickness local excision. Three groups of patients are included in this study. Group 1 (N = 15) Medically Compromised: patients with rectal cancers Stages T3 or > 3 cm in size and significant cardiorespiratory disease that precluded radical surgery. Group 2 (N = 18) Elective: patients suitable for local treatment by standard criteria (Stages < T2 and < 3 cm in size), and group 3 (N = 15) Staged: patients with Stages T3 or > 3 cm in size that postradiation were downstaged and met the criteria as in group 2. One patient in group 3 was found to be pathologically T3 following full thickness local excision and was converted to an abdominoperineal resection. Follow-up ranges from 6-96 months with a median of 40 months. RESULTS: The overall 5-year actuarial survival for the whole group is 83.5% and local recurrence is 10%. The 5-year survival is 74%, 92%, and 88% for Groups 1, 2, and 3 and 90%, 89%, and 50% for postradiation pathologic stages T0/T1, T2, and T3, respectively. Local recurrence rate by treatment groups are 20%, 11%, and 0% for groups 1, 2, and 3 and 11%, 0%, and 67% for postradiation Stages T0/T1, T2, and T3, respectively. Surgical complications, primarily wound healing, were observed in five patients (10%). Four patients required a subsequent colostomy (three for recurrence and one for a rectovaginal fistula). Sphincter function as measured by Parks criteria was good/excellent in 88% of patients. CONCLUSION: High-dose preoperative radiation and full thickness local excision appear to be a promising new option for the management of selected patients with invasive distal rectal cancers. Selected patients with Stage T3 cancers that as a result of preoperative radiation are downstaged and met the criteria for primary local therapy (T2 or less) appear to have an excellent survival with retained normal sphincter function following full thickness local excision.

Adenocarcinoma↗
PubMed1994

Downstaging of advanced rectal cancer following combined preoperative chemotherapy and high dose radiation.

PURPOSE: To assess the potential downstaging of advanced rectal cancer with combined preoperative chemoradiation. METHODS AND MATERIALS: Thirty-one patients with fixed rectal cancers (stage > or = cT3) were treated with concomitant preoperative chemotherapy and high-dose radiation in an effort to improve resectability. Three (10%) patients had partially fixed low rectal cancers, 24 (77%) patients had fixed tumors, and 4 (13%) had advanced fixation with pelvic sidewall invasion. Radiation was delivered to the whole pelvis using shaped anterior and posterior and lateral fields to 45 Gy followed by a boost to the tumor. Median total radiation dose was 55.8 Gy. Chemotherapy consisted of low dose continuous infusion of 5-FU (200-300 mg/m2/day) for the duration of radiation treatment. All 31 patients underwent surgical resection of tumor 6-8 weeks following treatment. Median follow up is 24 months (range 9-60). RESULTS: Twenty-three (74%) of the tumors were clinically downstaged following preoperative treatment. Of 24 fixed cancers, 11 (46%) became mobile, 6 (25%) became partially fixed, and 7 remained fixed. Of the four tumors with advanced fixation, two (50%) became mobile and two (50%) no longer had tumor extension to the pelvic sidewall. Two of the three initially partially fixed cancers became mobile and one remained partially fixed. Following surgery, the pathologic postradiation T-stages were as follows: T0: 10%, T1: 0%, T2: 32%, T3: 42%, and T4:16%. Seven patients (23%) were also node-positive (T0-2: 2, T3: 4, T4: 1), and two patients (6%) had liver metastases at surgery. Preoperative chemoradiation was well tolerated. There was no significant hematological toxicity. Acute grade 3 gastrointestinal toxicity was seen in six patients requiring a short hospitalization for dehydration and/or abdominal discomfort. No patient developed grade 4 toxicity. Five patients (16%) developed local recurrence of disease (T0-2: 0/13, T3: 1/13, and T4: 4/5). The actuarial 3-year survival is 68%. CONCLUSIONS: Concomitant preoperative chemoradiation using low dose continuous infusional 5-FU for advanced rectal cancer is relatively safe with acceptable morbidity. This approach is associated with considerable clinical and pathologic downstaging of cancer. Tumor resectability is improved with potential for improved local control of disease and survival.

Adult↗
PubMed1994

The importance of patient selection for adjunctive postoperative radiation therapy for cancer of the rectum. Patient selection in adjunctive therapy.

BACKGROUND: Clinical stage of disease is an important selection criterion for choice of primary treatment and strategies for adjunctive therapy for most cancers. For adenocarcinoma of the rectum, strategies for adjuvant treatment are based primarily on pathologic stage alone, without consideration of presenting clinical factors. This analysis was undertaken to assess the effect of patient selection on results of adjunctive therapy. METHODS: Three groups of patients with Astler-Coller Stage B2 and C rectal cancer were compared to assess the effect of patient selection factors on outcome of treatment after adjuvant postoperative radiation. Thirty-two patients in Group 1 received only 5 Gy preoperatively; 54 patients in Group 2 received low-dose (5 Gy) preoperative and high-dose (45 Gy) postoperative radiation; and 53 patients in Group 3 received high-dose (45 Gy) postoperative radiation. All patients have a minimum follow-up of 5 years. Whereas Group 1 and Group 2 patients were similar in distribution by clinical tumor characteristics, Group 3 had more patients with poor clinical features: higher median age, more men, and a higher proportion of tumors in the distal rectum. Group 3 also had a slightly higher percentage of C2 tumors compared with the other two groups. RESULTS: Treatment was well tolerated with minimal side effects. Patients in Group 1 had no long-term complications. Four percent of patients (2 of 54) in Group 2 and 6% of patients (3 of 53) in Group 3 experienced major small bowel complications. The incidence of local recurrence was 34% (11 of 32) in Group 1, 9% (5 of 54) in Group 2, and 21% (11 of 53) in Group 3. The incidence of distant metastasis was 28% (9 of 32), 22% (12 of 54), and 38% (20 of 53), respectively. Absolute 5-year survival rates were 54%, 72%, and 41% in these three groups, respectively. CONCLUSIONS: Low-dose preoperative adjunctive radiation alone (Group 1) resulted in a high incidence of local recurrence and poor survival compared with patients treated more appropriately with low-dose preoperative plus adjunctive postoperative irradiation (Group 2). In spite of postoperative radiation, patients with clinically unfavorable rectal cancer (Group 3) did worse than carefully selected patients, although both were nominally Stage B2 and C. Careful patient selection before surgery, histopathologic stage of disease postsurgery, and adequate adjunctive therapy are all important factors in obtaining the best results from adjunctive therapy.

Adenocarcinoma↗
PubMed1994

The Nambour Skin Cancer and Actinic Eye Disease Prevention Trial: design and baseline characteristics of participants.

The Nambour Skin Cancer and Actinic Eye Disease Prevention Trial (the Nambour Trial) is a field trial conducted in an unselected adult population in Australia. Using a randomized 2 x 2 factorial design, the principal aim is to evaluate whether regular use of high-protection sunscreen and/or dietary supplementation with beta-carotene (30 mg daily) can alter the incidence rates of basal cell carcinomas and squamous cell carcinomas of the skin over a minimum follow-up time of 4.5 years. Changes in the incidence of solar keratoses and actinic eye disease and the rate of photoaging after intervention will also be investigated. In 1992, 1626 participants between the ages of 25 and 75 years were enrolled, all of whom had been randomly selected from residents of the southeastern Queensland township of Nambour for an earlier skin cancer prevalence survey. This paper describes the background to the trial and its design, with respect to evaluation of effects on actinic skin disease, and documents the baseline characteristics of participants recruited into the Nambour Trial.

Adult↗
PubMed1994

Formulation and intestinal absorption enhancement evaluation of water-in-oil microemulsions incorporating medium-chain glycerides.

We developed self-emulsifying water-in-oil (w/o) microemulsions incorporating medium-chain glycerides and measured their conductance, viscosity, refractive index and particle size. Formulation of Calcein (a water-soluble marker molecule, MW = 623), or SK&F 106760 (a water-soluble RGD peptide, MW = 634) in a w/o microemulsion having a composition of Captex 355/Capmul MCM/Tween 80/Aqueous (65/22/10/3, % w/w), resulted in significant bioavailability enhancement in rats relative to their aqueous formulations. Upon intraduodenal administration the bioavailability was enhanced from 2% for Calcein in isotonic Tris, pH 7.4 to 45% in the microemulsion and from 0.5% for SK&F 106760 in physiological saline to 27% in the microemulsion formulation. The microemulsion did not induce gross changes in GI mucosa at a dosing volume of 3.3 ml/kg. These results suggest that water-in-oil microemulsion systems may be utilized for enhancement of intestinal drug absorption.

Absorptiometry, Photon↗
PubMed1994

Long-term results of "selective sandwich" adjunctive radiotherapy for cancer of the rectum.

A total of 132 patients with adenocarcinoma of the rectum were treated in a program of "selective sandwich" adjunctive radiation therapy and have been followed for a minimum period of 5 years. All patients were given a single dose of preoperative radiation, 500 cGy, either on the day of or the day before surgery. At surgery, 12 patients with metastatic disease were treated palliatively. The remaining 120 patients underwent radical curative surgery. Patients were then staged histopathologically according to the Astler-Coller modification of Dukes' staging: 34 patients with stage A or B1 disease were followed with no further treatment; 54 patients with stage B2 or C cancer received a planned course of high-dose postoperative radiation (4,500 cGy in 5 weeks); 32 patients with stage B2 and C cancer received no further treatment. Radiation therapy was well tolerated with few long-term side effects. None of the patients receiving low-dose preoperative radiation alone had any complications. Two patients (4%) treated with the combined pre- and postoperative radiation experienced major small bowel complications. Local recurrence was observed in 11 of 32 patients (34%) with stage B2 and C disease receiving low-dose preoperative radiation alone, as compared to 5 of 54 patients (9%) of the combined pre- and postoperative radiation group. The absolute 5-year survival in these two groups is 54% and 72%, respectively. With follow-up now exceeding 5 years, the survival of patients treated with the planned approach of combined pre- and postoperative radiation continues to remain appreciably better than for patients receiving low-dose preoperative radiation alone.

Adenocarcinoma↗
PubMed1994

Anal intercourse and disclosure of HIV infection among seropositive gay and bisexual men.

Human immunodeficiency virus (HIV)-infected gay and bisexual men (n = 609) randomly selected from two HIV outpatient clinics in Los Angeles completed confidential, self-administered questionnaires at the clinics, reporting sexual activities and disclosure during the previous 2 months. Approximately 9% had engaged in unprotected insertive anal intercourse with one or more partners. This activity was 3.27 times more likely to have occurred with seropositive partners than with partners who were seronegative or whose serostatus was unknown. Fourteen men (2.3% of total sample) had engaged in unprotected insertive anal sex with 25 seronegative or unknown serostatus partners who were not informed of their risk of infection. Thirty-three men (5.4% of total sample) had engaged in this activity with 37 seropositive partners who were informed. Clinicians and other health professionals can play an important role in helping to control the HIV epidemic by discussing with seropositive patients the importance of using safer sex and informing sexual partners. Such discussion should include information about the potentially negative health effects of unprotected sex between seropositive persons.

Adult↗
PubMed1993

Reirradiation for rectal cancer and surgical resection after ultra high doses.

PURPOSE: Local recurrence of rectal cancer following high-dose pelvic radiation presents a difficult management challenge. Conventional wisdom suggests that reirradiation should be avoided and radical pelvic surgery is hazardous after ultra high-dose radiation. METHODS AND MATERIALS: In a unique Phase I/II pilot study, 32 patients with recurrent rectal cancers following previous pelvic radiation underwent planned reirradiation to the pelvis. Initial radiation doses had ranged from 30-64.87 Gy (median dose 45 Gy). Seventeen patients underwent reirradiation followed by radical resection. Fifteen patients were reirradiated for palliative relief of symptoms. Treatment techniques consisted of two lateral fields (7 x 7 to 12 x 10 cm) encompassing the tumor with 2 cm margins. Reirradiation doses ranged from 19.80-47.66 Gy, (median 34.2 Gy). Patients also received concurrent low-dose continuous infusion chemotherapy, (5-FU 200-300 mg/day). Total cumulative radiation doses ranged from 70.6 to 111.6 Gy. RESULTS: Treatment was well tolerated. Four patients had radiation interrupted/discontinued for diarrhea or leukopenia. Follow-up ranges from 6 months to 36 months. No late sequelae of radiation have been observed to date. Seventeen patients underwent surgical exploration 6-8 weeks following reirradiation. Two patients had extensive disease and were not resected. Fifteen patients underwent radical resection of residual tumor (4 posterior exenterations, 6 APR, 3 transanal abdominal transanal proctocolectomy with coloanal anastomosis (TAATA), and 2 LAR). No patients died postoperatively. No excessive edema, hemorrhage, or adhesions were observed. Two patients developed pelvic abscess and one developed a coloanal stricture. Eleven of 15 resected patients are alive from 6 to 36 months with a 2-year survival of 66%. Of the patients treated palliatively, symptomatic relief was observed in 13/15 patients. No objective complete response was observed, but 6/15 patients had measurable partial response. Median survival in this group was 14 months. CONCLUSION: Based on this experience, we believe that in selected patients radical surgical resection after cumulative ultra high doses (70-90 Gy) of radiation can be performed safely. A viable anastomosis is also possible in spite of these high doses. Planned reirradiation for palliative relief of symptoms can be effective without unusual risks of complication. Long-term effects of such ultra high dose radiation and surgery continue to be monitored.

Adenocarcinoma↗
PubMed1993

A selective approach to adjunctive therapy for cancer of the rectum.

PURPOSE: To present results of a selective approach to adjunctive therapy and surgery based on a new model of clinical staging for rectal cancer. METHODS AND MATERIALS: Three hundred and sixty-two patients with rectal cancer treated with adjunctive radiation therapy and surgery have been analyzed to define patient selection criteria based on clinical assessment of disease. Clinical prognostic features of tumor mobility and level of lesion in the rectum with reference to the anorectal junction were used. Mobile, early fixed (partial), advanced fixed (total) and frozen pelvis are defined as clinical Stages I, II, III, and IV. Tumors above 6 cm (middle valve), 3-6 cm (inferior to middle valve), 0-3 cm (anorectum to inferior valve), and into the anal canal are defined as levels a, b, c, d, respectively. Based on this model, patients with mobile tumors of the proximal rectum (CS Ia, b) are treated with 500 cGy preoperative radiation and selective postoperative radiation (4500 cGy) for Stages B2 and C cancer. All other patients are treated with escalating doses of preoperative radiation. Follow-up in these patients ranges from 1 year to 14 years with a median of 5 years. RESULTS: Overall 5-year survival of the total group of patients is 69%. Survival by pathological stage is 82% for O, A, B1, 67% for B2, 74% for C1, and 51% for C2. Survival by clinical stages is 77% for CS I, 67% for CS II, 57% for CS III, and 21% for CS IV. Overall local recurrence is 43/362 (12%). L.R. by pathological stages is 5% for O, A, B1, 18% for B2, 10% for C1, and 17% for C2. L.R. by clinical stages is 9% for CS I, 14% for CS II, 17% for CS III, and 50% for CS IV. CONCLUSION: An integrated adjunctive therapy and selective surgical approach based on careful clinical staging of rectal cancer results in a global improvement in overall local control and survival of patients.

Adenocarcinoma↗
PubMed1993

High-dose preoperative radiation for cancer of the rectum: impact of radiation dose on patterns of failure and survival.

PURPOSE: A variety of dose-time schedules are currently used for preoperative radiation therapy of rectal cancer. An analysis of patients treated with high-dose preoperative radiation therapy was undertaken to determine the influence of radiation dose on the patterns of failure, survival, and complications. METHODS AND MATERIALS: Two hundred seventy-five patients with localized rectal cancer were treated with high-dose preoperative radiation therapy. One hundred fifty-six patients received 45 Gy, +/- 10% (low-dose group). Since 1985, 119 patients with clinically unfavorable cancers (fixed, low-lying, or deeply ulcerated) were given a higher dose, 55 Gy, +/- 10%, using a shrinking field technique (high-dose group). All patients underwent curative resection. Median follow-up was 66 months in the low-dose group and 28 months in the high-dose group. Patterns of failure, survival, and complications were analyzed as a function of radiation dose. RESULTS: Fourteen percent (38/275) of the total group developed a local recurrence; 20% (31/156) in the low-dose group as compared with 6% (7/119) in the high-dose group. The actuarial local recurrence rate at 5 years was 20% for the low-dose group and 8% for the high-dose group, and approached statistical significance with p = .057. For tethered/fixed tumors the actuarial local recurrence rates at 5 years were 28% and 9%, respectively, with p = .05. Similarly, for low-lying tumors (less than 6 cm from the anorectal junction) the rates were 24% and 9%, respectively, with p = .04. The actuarial rate of distant metastasis was 28% in the low-dose group and 20% in the high-dose group and was not significantly different. Overall actuarial 5-year survival for the total group of patients was 66%. No significant difference in survival was observed between the two groups, despite the higher proportion of unfavorable cancers in the high-dose group. The incidence of complications was 2%, equally distributed between the two groups. CONCLUSION: High-dose preoperative radiation therapy for rectal cancer results in excellent local control rates. However, in clinically unfavorable cancers a higher dose (55 Gy) of preoperative radiation can be given safely with significantly improved local control. Careful clinical staging is helpful in selectively treating patients with unfavorable tumors to a higher preoperative radiation dose and thus optimizing their outcome.

Adenocarcinoma↗
PubMed1993

The reality of radical sphincter preservation surgery for cancer of the distal 3 cm of rectum following high-dose radiation.

PURPOSE: The inordinately high rate of locoregional recurrence following sphincter-preserving surgery for cancer of the distal rectum led to the conviction that restorative surgery was inappropriate for the low level cancer. A rectal cancer management program initiated in 1976 that selectively uses high-dose preoperative radiation and sphincter-preserving surgery produced lower than expected local recurrence rates. Exploring the safety of extending the indication for sphincter-sparing surgery to include post-radiation mobile cancers as low as the 0.5 cm level is the purpose of this report. METHODS AND MATERIALS: Of 218 rectal cancer patients treated with high-dose preoperative radiation and sphincter-preserving procedures, 69 had radical curative surgery for cancers at or below the 3 cm level. Data regarding the first 52 patients whose ages ranged from 39 to 77 years form the basis of this report. Fifty-seven percent were men. Twenty-five (48%) patients had post-radiation unfavorable cancers (B2, C1, C2). Forty-five to sixty Gy high energy photon radiation was administered over 4 1/2 to 6 weeks followed by a similar interval prior to radical proctosigmoidectomy with anastomosis in the distal 1 cm of rectum. Temporary fecal diversion was performed in all patients; colostomies were closed after 8 weeks. RESULTS: There was zero mortality and two self-limiting anastomotic leaks. Local recurrence developed in 6/43 (14%) patients followed for 24 months or longer. By stage, there were 0/21 (0%) recurrences among O, A, B1 tumors; 6/22 (27%) among unfavorable tumors. By distal margins 1/9 (11%) occurred in .3-1 cm; 4/13 (31%) 1.1-2 cm; 1/18 (5%) 2.1-3 cm. Five-year Kaplan Meier actuarial survival for the 52 patients was 85%. CONCLUSION: Our data indicates that sphincter preservation can be accomplished in cancers of the distal 3 cm of rectum if high-dose preoperative radiation is administered and fixed cancers are excluded. This is the first reported study of sphincter-preserving surgery for the distal rectal cancer after high-dose radiation. The data are important to the design of new treatment options.

Adult↗
PubMed1993

Patterns of recurrence following high-dose preoperative radiation and sphincter-preserving surgery for cancer of the rectum.

High-dose preoperative radiation with new sphincter-preserving surgical options for the management of distal and unfavorable cancers of the rectum is gaining recognition as an alternative to abdominoperineal resection and permanent colostomy. From 1976 to 1989, 161 patients with cancer of the rectum were entered into a program of high-dose preoperative radiation and radical sphincter-preserving surgery. Selection was based on prospective clinical staging of unfavorability or tumor location at a low level in the rectum. All patients received a minimum dose of 4,000 to 4,500 cGy over 4 1/2 weeks in fractional doses of 180 to 250 cGy. Patients with tumor fixation were given an additional boost of 1,000 to 1,500 cGy for a total of 5,500 to 6,000 cGy using a coned-down field. Surgery was carried out four to eight weeks following completion of radiation. Fourteen patients, found at surgery to have liver metastasis, were treated by palliative resection. One hundred forty-seven patients underwent radical curative surgery with sphincter preservation. The surgical procedures performed were combined abdominotranssacral resection (63), transanal-abdominal-transanal resection (53), and anterior resection (31). Follow-up ranged from a minimum of two years to 15 years, with a median of five years. There was no perioperative mortality. Anastomotic failure occurred in three patients, two of whom were reconstituted. Late diversion was required in 10 other patients, primarily for recurrent disease. One hundred thirty-four of the 147 patients (91 percent) maintained long-term normal sphincter function. Pelvic-perineal recurrence was observed in 18 patients (12.4 percent), 12 of whom had fixed tumors located below the 6-cm level of the distal rectum. Median time to local recurrence was 24 months. Distant metastasis with or without local recurrence occurred in 35 patients, 22 of whom had fixed tumors below the 6-cm level of the rectum. Median time to distant metastasis was 17 months. Forty-three patients have died, 32 of disease. The overall five-year Kaplan-Meier actuarial survival for the total group of patients is 79 percent, with a disease-free survival of 73 percent. The findings of this study indicate that high-dose preoperative radiation used in combination with radical sphincter-preserving surgical techniques results in excellent local control of disease, improved survival, and enhanced quality of life with retention of normal anal sphincter function.

Actuarial Analysis↗
PubMed1993

Role of health locus of control beliefs in cancer screening of elderly Hispanic women.

This study examined the health locus of control beliefs of elderly Hispanic women and relation between frequency of breast self-examination (BSE), attention to health-related information, and recency of Pap smear and physician breast examination. As hypothesized, holding a belief that health outcomes are controlled by oneself (internal control) was positively related to screening behaviors over which one has a high degree of personal control, such as frequency of BSE and attention to health-related information. Belief that medical professionals control health outcomes was positively related to physician-dependent screening activities, such as recency of Pap smear and physician breast exam. The findings confirm the specificity of association between health control beliefs and preventive behaviors and demonstrate the importance of these beliefs in medical screening by Hispanic women.

Aged↗
PubMed1992

Self-disclosure of HIV infection: preliminary results from a sample of Hispanic men.

We examined self-disclosure of HIV infection among 101 seropositive Hispanic men residing in Los Angeles. Results indicated that disclosure was highly selective and presumably influenced by the social, psychological, and material consequences of informing others about one's medical condition. Subjects tended to inform significant others such as parents, friends, and lovers than less significant others such as employers, landlords, and religious leaders. There was a relatively high rate of disclosure (75%) to doctors/dentists who were not treating subjects for HIV infection. Gay and bisexual subjects (89% of the sample) were more inclined to disclose their HIV serostatus to homosexual or bisexual others than to heterosexuals and to inform those who were aware of their sexual orientation. Disclosure increased with severity of disease independently of length of time since testing seropositive. Self-rated negative changes in appearance correlated with disclosure to less significant others. The role of cultural attitudes and values in self-disclosure of HIV infection is discussed.

Adolescent↗