From the early days of the AIDS epidemic, gay bathhouses and sex clubs have been the targets of community and public health ire as the cause of the spread of the disease among men who have sex with men [1–3]. In response to these concerns, one of the most consistent compelling arguments raised for keeping these venues open has been that they can provide important prevention messages to many segments of the population of men at risk of HIV [4,5]. Despite the debate, very little research on bathhouses, and the behavior that occurs in them, has been conducted to date. Studies that have been conducted have primarily looked at the risk behaviors in general of men who report having gone to bathhouses [6–8] or any of a wide variety of public sex environments [9–13], or the specific risk engaged in while frequenting such places [14,15]. Although there are some descriptions of the social/sexual context of bathhouses and sex clubs, they pre-date the HIV epidemic [16,17]. No recent studies have described the environments themselves, or identified the specific HIV education and prevention efforts that are in place in these venues.
In an effort to describe HIV education and prevention in US bathhouses and sex clubs, we conducted a telephone survey of managers. We identified businesses through listings in two guides for gay men, the 1996 Damron Address Book , and the 1996/7 Spartacus Guide for Gay Men , or through our contacts with these businesses, their patrons or our colleagues around the country. We identified 80 bathhouses and sex clubs that were still in operation; of these, 63 completed the interview, five refused to participate, and 12 could not be reached by 'phone, for a response rate of 79%. Nine of the participating businesses were located in the midwest region of the USA, 13 in the south and 14 each in both the northeast and the west. Structured interviews were conducted by 'phone between October 1996 and February 1997.
Table 1 shows the various categories of HIV education and prevention efforts we assessed. Both condoms and lubrication were available at 100% of the facilities we surveyed. Furthermore, 100% of the businesses provided condoms free of charge, and 67% provided lubricant for free. Many businesses (40%) offered HIV testing on-site, with approximately half of those also offering sexually transmitted disease (STD) testing.
The results of the 'phone survey suggest that a minimum HIV/STD prevention effort of condom and lubricant distribution were in place at establishments across the United States. Similarly, HIV/AIDS information brochures and posters were reported to be available in the vast majority of venues, although we collected no information that would indicate to what extent these materials were easily accessible and were actually acquired or viewed by patrons. The concern that condoms and information about HIV/AIDS would not be tolerated by owners and would scare away patrons has not played on into the 1990s .
A number of businesses reported additional prevention efforts. These clubs also produced special educational programs that offer patrons specific events related to HIV and STD risks (e.g. condom demonstrations by local community-based organizations), or provided testing services on site for HIV or for both HIV and STD. Although many of these activities were in place throughout the country, an assessment of their efficacy was beyond the scope of this project. Nevertheless, these data suggest that the willingness of many owners and managers to do more with regard to HIV/STD prevention can be used as a model for those businesses that do much less. Furthermore, although these results do not describe the response of patrons to these efforts, it is at least clear that businesses that employed them continued to attract patrons.
In summary, we found that condom distribution was the primary prevention service provided throughout all the clubs, and that a number of them also extended their HIV/STD education and prevention programs by providing additional services, such as fliers, special events and testing. A number of important questions remain unanswered, especially regarding the efficacy and value of the programs that clubs used to reduce disease transmission among their patrons.
William J. Woodsa
Diane K. Binsona
Tracy J. Mayneb
L. Robert Gorec
Greg M. Rebchooka
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