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Sex Networking of Young Men Who Have Sex With Men in Densely Connected Saunas in Hong Kong

Poon, Chin Man BSSc; Lee, Shui Shan MD

doi: 10.1097/OLQ.0000000000000052
Original Study

Background Some men who have sex with men (MSM) meet and have sex with male partners at gay saunas, the connections between which are little explored for designing HIV prevention measures. This study aims to describe the network configuration of gay saunas and explore its relationship with risk behavior of MSM in the respective sauna communities, in the city of Hong Kong.

Methods Using venue-based sampling, 205 MSM were recruited in 8 saunas in July 2011 for a cross-sectional anonymous questionnaire survey. A network of saunas was constructed based on the proportion of clients shared between them. Core saunas with higher intensity of linkages were delineated from core-periphery analysis. Men who have sex with men in core saunas were compared with those in peripheral ones in terms of their demographics and risk behavioral profiles.

Results Eight core saunas were differentiated from a highly connected sauna network, consisting of 13 saunas with a diameter of 2. Men who have sex with men visiting core saunas were more likely to be younger and users of the Internet for sex networking (odds ratio, 5.43; 95% confidence interval, 1.84–16.01). On average, they visited 1.7 saunas and had 2.6 sauna partners over a 1-month period, which were both significantly higher than those for MSM in peripheral saunas. However, there was no association between having unprotected anal sex and visiting core saunas. Sauna affiliation patterns were age dependent and geographically related.

Conclusions Saunas were not homogeneously connected with each other. Prioritization may be considered so that public health interventions can be targeted at saunas in denser networks. An assortative mixing in age among MSM in sauna community informs planning for client-specific venue-based prevention programs.

From a survey of men who have sex with men sampled in gay saunas in Hong Kong, extensive networking occurred among young members involving highly connected saunas, where HIV prevention program should be targeted.

From the Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China

This study is supported by General Research Fund, No. 470110, from Research Grants Council of Hong Kong, China. Data of this manuscript were analyzed by different approaches and presented in Eighth UKSNA Conference, Bristol, UK, and Seventh IAS Conference on HIV Pathogenesis, Treatment and Prevention 2013, Kuala Lumpur, Malaysia.

Conflict of interest: None.

Correspondence: Shui Shan Lee, MD, Postgraduate Education Centre, Prince of Wales Hospital, Room 205, Shatin, NT, Hong Kong, China. E-mail:

Received for publication June 7, 2013, and accepted September 23, 2013.

© Copyright 2013 American Sexually Transmitted Diseases Association