Research linking psychological inhibition to physical illness led us to examine whether
human immunodeficiency virus (HIV) infection might progress more rapidly among gay
men who conceal their homosexual identity than among those who do not. We also sought
to determine whether any accelerated course of HIV infection among "closeted" gay
men might be attributable to differences in health-relevant behavior (e.g., health
practices, sexual behavior) or psychosocial characteristics (e.g., depression, anxiety,
social support, repressive coping style). Data came from a longitudinal psychosocial
study associated with the Los Angeles site of the Multicenter AIDS Cohort Study. Eighty
gay men, HIV-seropositive but otherwise healthy at study entry (CD4 T lymphocytes
= 30-60% of total lymphocytes), were examined at 6-month intervals for 9 years. Indicators
of HIV progression included time to a critically low CD4 T lymphocyte level (15% of
total peripheral blood lymphocytes), time to AIDS diagnosis, and time to AIDS mortality.
On all measures, HIV infection advanced more rapidly in a dose-response relationship
to the degree participants concealed their homosexual identity. Sample characteristics
and statistical controls ruled out explanations based on demographic characteristics,
health practices, sexual behavior, and antiretroviral therapy. Mediational analyses
indicated that observed effects were not attributable to differences in depression,
anxiety, social support, or repressive coping style. HIV infection appears to progress
more rapidly in gay men who conceal their homosexual identity. These results are consistent
with hypotheses about the health effects of psychological inhibition, but further
research is required to definitively identify the psychosocial, behavioral, and physiological
mechanisms underlying these findings.