HIV-positive gay men who conceal their sexual identity from society experience a more rapid progression of their illness than do gay men who are open about their sexual orientation.

In a recent study that strongly supports the connection between physical health, immune system functioning, and psychological factors, UCLA researchers found that gay men who were "in the closet" suffered more rapid declines in the number of CD4 lymphocyte cells and progressed more quickly to AIDS and death than did a comparison group who did not endure the stress of keeping secret a fundamental aspect of their identity.

The research team, headed by psychologist Steve W. Cole, Ph.D., followed 80 seropositive gay men in the Los Angeles area who had volunteered for the a phase of the national Multicenter AIDS Cohort Study (MACS) that evaluates cognitive, emotional, social, and behavioral aspects of HIV infection. The 80 study participants were in the earliest stages of HIV infection but in good health; they were well-educated, largely Caucasian, and their median age was 34. They were assessed at six-month intervals for nine years, beginning in 1987.

All participants completed scales evaluating anxiety, affective disorders, and the degree to which they concealed their homosexual identity.

Subjects who reported being either entirely, mostly, or "half" in the closet saw their CD4 cells drop to critically low levels 44 percent faster than did men who were mostly or entirely open about their sexual orientation, according a report of the research in the May/June issue of Psychosomatic Medicine. In addition, those concealing their orientation experienced a 38 percent reduction in time to AIDS diagnosis and a 21 percent reduction in time to death compared with subjects who were open about their sexuality.

The researchers were able to rule out links between disease course and traits such as substance abuse, exercise, smoking, medical treatment, sexual activity, social supports, and anxiety and depression levels.

That there was no significantly more rapid disease progression in those who were "mostly out of the closet" than in those who were "completely out of the closet" points to the likelihood that it is "moderate to high levels of concealment that may be associated with significant acceleration in disease progression," say the UCLA researchers.

Cole pointed out that their findings do not indicate that being in the closet causes the faster deteriorating course seen among this subgroup in the study. They do hypothesize that individuals possessing an inhibited personality type that drives them to keep their sexuality hidden and who are unduly concerned about what others think of them may be more vulnerable to infectious diseases.

"To the extent that living in the closet requires gay men to inhibit the expression of subjectively significant thoughts, feelings, and social behaviors, the present results are consistent with hypotheses suggesting a causal influence of psychological inhibition on physical health," the researchers state.

(Psychiatric News, September 20, 1996)