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Rusow JA, Fletcher JB, Reback CJ. Sexual Venue Choice and Sexual Risk-Taking Among Substance-Using Men Who have Sex with Men. AIDS Behav 2017; 21:1149-1162. [PMID: 27905014 PMCID: PMC5370583 DOI: 10.1007/s10461-016-1630-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Commercial sex venues (CSVs) and public sex environments (PSEs) offer men who have sex with men (MSM) sexual privacy and anonymity. Sociodemographic characteristics (e.g., race/ethnicity, sexual identity, age, HIV status) are correlated with individuals' choice of sexual venue, potentially suggesting environmental associations with both sociodemographics and sexual risk. From March 2005 through March 2012, 1298 substance-using MSM provided information on their most recent sexual encounter; iterative logit models estimated associations between sociodemographics and sexual venue, and/or whether sexual venue was associated with sexual risk-taking while controlling for sociodemographics. More than a third of participants' most recent sexual encounters took place in either a PSE (23.0%) or a CSV (11.3%); anonymous, HIV-serodiscordant, and/or sex while on methamphetamine and/or marijuana was significantly more likely to occur in CSVs/PSEs than in a private location, even when controlling for sociodemographics. Findings demonstrate that socioenvironmental factors were associated with sexual risk-taking among high-risk, urban MSM.
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Affiliation(s)
- Joshua A Rusow
- Friends Research Institute, Inc., 1419 N. La Brea Ave, Los Angeles, CA, 90028, USA.
| | - Jesse B Fletcher
- Friends Research Institute, Inc., 1419 N. La Brea Ave, Los Angeles, CA, 90028, USA
| | - Cathy J Reback
- Friends Research Institute, Inc., 1419 N. La Brea Ave, Los Angeles, CA, 90028, USA
- David Geffen School of Medicine, Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, 90095, USA
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Qi J, Zhang D, Fu X, Li C, Meng S, Dai M, Liu H, Sun J. High risks of HIV transmission for men who have sex with men--a comparison of risk factors of HIV infection among MSM associated with recruitment channels in 15 cities of China. PLoS One 2015; 10:e0121267. [PMID: 25837667 PMCID: PMC4383540 DOI: 10.1371/journal.pone.0121267] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/29/2015] [Indexed: 11/19/2022] Open
Abstract
Objective While the HIV epidemic varies greatly by region and population group throughout China, the HIV incidence among men who have sex with men (MSM) continues to rise at an alarmingly fast pace. We seek to analyze the risk factors associated with HIV infection among MSM recruited from different channels in large urban centers across China, in an attempt to shed light on the design of future targeted intervention strategies. Methods A total of 33,684 MSM from 14 cities and one province were recruited from July to December 2011. Demographic (e.g. age, marital status, education) and behavioral (e.g. condom use, HIV testing history) data were collected using information collection cards. Blood samples were also collected to test for HIV and Syphilis. Results Participants were recruited from five different channels, and all demonstrated distinct characteristics. The overall rate of positive HIV screening was 6.27% and the rate of syphilis infection was 6.50%. Participants recruited from bathhouses had the highest HIV (11.80%) and syphilis infection rates (11.20%). Participants who were infected with syphilis had the highest HIV-positive screening rate (13.75%; 95% CI OR, 2.33-3.06). living in the southwest region of the country (11.64%; OR=2.76, 95%CI OR 2.19-3.47), Being >20 years of age (P<0.001), living in the southwest region of the country (OR=2.76, 95%CI 2.19-3.47), not having sex with female over the previous 3 months (OR=1.27, 95%CI 1.09-1.48), no condom use during the last anal intercourse (OR=1.54, 95%CI 1.39-1.70) and other factors were all associated with a higher probability of having an HIV-positive test result. Conclusion Depending on the way they are recruited, more targeted interventions are required to prevent the spread of HIV/AIDS among MSM with different characteristics and behaviors. Results from this study could provide evidence for researchers to conduct further studies and policy-makers to establish more effective and strategic interventions for MSM in China.
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Affiliation(s)
- Jinlei Qi
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dapeng Zhang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaojing Fu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chengmei Li
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Sining Meng
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Min Dai
- Bill & Melinda Gates foundation China Office, Beijing, China
| | - Hui Liu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiangping Sun
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail:
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Balán IC, Barreda V, Marone R, Avila MM, Carballo-Diéguez A. Venues, patrons, and alcohol use dynamics: the creation of a high risk sexual environment. AIDS Behav 2014; 18:2097-109. [PMID: 24691922 DOI: 10.1007/s10461-014-0759-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Venue-based HIV prevention interventions, especially in sex on premise venues, can disrupt high-risk sexual networks. However, prior to intervening, it is essential to understand the person-venue dynamics that contribute to HIV risk. As such, we conducted five ethnographic observations at each of six venues where alcohol is sold and sex occurs onsite (2 each porn theaters, sex clubs, and dance clubs) frequented by gay and other men who have sex with men (G&MSM) in the Buenos Aires metropolitan area. Alcohol use, sexual behavior, and person-venue dynamics differed markedly across venue types. In dance clubs, substantial alcohol consumption often preceded visits to the darkroom for sex which, at times, included unprotected anal and vaginal intercourse. Condoms, although available, were not easily accessible. HIV prevention messaging was generally non-existent. These venues are in critical need of interventions to reduce HIV transmission risk.
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Affiliation(s)
- Iván C Balán
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA,
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Pollack LM, Woods WJ, Blair J, Binson D. Presence of an HIV Testing Program Lowers the Prevalence of Unprotected Insertive Anal Intercourse inside a Gay Bathhouse among HIV-negative and HIV-unknown Patrons. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2014; 13:306-323. [PMID: 25383057 PMCID: PMC4219510 DOI: 10.1080/15381501.2013.864175] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study sought to determine whether the presence of HIV testing inside a gay bathhouse reduced sexual risk behavior among patrons. A two-stage, time probability, cluster sample design recruited men exiting a northern California bathhouse in the last 5 weeks of 2001 (N=440), when no HIV testing was offered inside the bathhouse, and again in the last 5 weeks of 2002 (N=412) when HIV testing was offered 5 days a week. Separate logistic regression analyses compared a 2002 HIV testing exposure subgroup to both a 2001 non-exposure subgroup and a 2002 non-exposure subgroup for differences in sexual risk behavior during the bathhouse visit. Prevalence of unprotected insertive anal intercourse was significantly lower in the 2002 exposure subgroup than in the 2002 non-exposure subgroup. Similar results obtained when HIV-positive respondents were excluded. These results indicate on-site HIV testing has a preventive effect on some sexual risk behavior inside the bathhouse.
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Affiliation(s)
- Lance M Pollack
- Center for AIDS Prevention Studies (CAPS) at the University of California, San Francisco
| | - William J Woods
- Center for AIDS Prevention Studies (CAPS) at the University of California, San Francisco
| | | | - Diane Binson
- Center for AIDS Prevention Studies (CAPS) at the University of California, San Francisco
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Schrimshaw EW, Downing MJ, Siegel K. Sexual venue selection and strategies for concealment of same-sex behavior among non-disclosing men who have sex with men and women. JOURNAL OF HOMOSEXUALITY 2013; 60:120-45. [PMID: 23241205 PMCID: PMC3531913 DOI: 10.1080/00918369.2013.735945] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
In order to conceal their same-sex behavior, men who have sex with men and women (MSMW) who do not disclose their same-sex behavior to female partners must be cautious in their attempts to find potential male partners. This study interviewed 46 non-gay-identified, non-disclosing MSMW to identify the venues where they meet male sexual partners and the strategies they use to reduce the likelihood of discovery when at such venues. Most (74%) reported meeting a male partner in a sexual venue (e.g., bar or club, park) in the past year. Strategies to reduce the risk of discovery while seeking male partners included: a) avoiding certain venues, b) attending venues away from home, c) meeting partners on the Internet, d) preferring venues that have potential nonsexual uses, e) having sex at the partner's place, and f) limiting their onsite sexual activities. These findings provide insight into the coping strategies these men use to manage the conflicting needs to conceal their behavior and meet sexual partners.
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Affiliation(s)
- Eric W Schrimshaw
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA.
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Unprotected sex, underestimated risk, undiagnosed HIV and sexually transmitted diseases among men who have sex with men accessing testing services in a New England bathhouse. J Acquir Immune Defic Syndr 2012; 59:194-8. [PMID: 22027871 DOI: 10.1097/qai.0b013e31823bbecf] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
American men who have sex with men (MSM) continue to have increased rates of HIV and sexually transmitted diseases (STD). Between 2004 and 2010, 1155 MSM were tested for HIV and/or STDs at Providence, RI bathhouse. The prevalence of HIV was 2.3%; syphilis, 2.0%; urethral gonorrhea, 0.1%; urethral chlamydia, 1.3%; 2.2% of the men had hepatitis C antibodies. Although 43.2% of the men engaged in unprotected anal intercourse in the prior 2 months, the majority of the men thought that their behaviors did not put them at increased risk for HIV or STDs. Multivariate analyses found that men who engaged in unprotected anal intercourse were more likely to have had sex with unknown status or HIV-infected partners; have sex although under the influence of drugs; tended to find partners on the internet; and were more likely to have a primary male partner. Men who were newly diagnosed with HIV or syphilis tended to be older than 30 years; had sex with an HIV-infected partner; had a prior STD diagnosis; and met partners on the internet. For 10.5% of the men, bathhouse testing was the first time that they had ever been screened for HIV. Of 24 men who were newly diagnosed with HIV infection, only 1 was not successfully linked to care. These data suggest that offering HIV and STD testing in a bathhouse setting is effective in attracting MSM who are at increased risk for HIV and/or STD acquisition or transmission.
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Chen YJ, Lin YT, Chen M, Huang SW, Lai SF, Wong WW, Tsai HC, Lin YH, Liu HF, Lyu SY, Chen YMA. Risk factors for HIV-1 seroconversion among Taiwanese men visiting gay saunas who have sex with men. BMC Infect Dis 2011; 11:334. [PMID: 22136602 PMCID: PMC3295735 DOI: 10.1186/1471-2334-11-334] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 12/05/2011] [Indexed: 11/10/2022] Open
Abstract
Background Men having sex with men (MSM) accounts for 33.6% of all reported cases of HIV-1 infection in Taiwan. The aim of this study was to investigate the epidemiology of HIV-1 infection among MSM in gay saunas in Taiwan. Methods Patrons of 5 gay saunas were recruited for a weekly volunteer counseling and testing program from 2001 to 2005. Questionnaires were collected for a risk factor analysis. HIV-1 subtypes were determined using DNA sequencing and phylogenetic analyses. Results HIV-1 prevalence rates among MSM in gay saunas in 2001 through 2005 were 3.4%, 5.1%, 8.9%, 8.5%, and 8.3%, respectively. In total, 81 of 1, 093 (7.4%) MSM had HIV-1 infection. Fifty-two HIV-1 strains were genotyped, and all of them were subtype B. HIV-seropositive men were significantly younger than the seronegatives. Only 37.1% used condoms every time during sexual intercourse. A multivariate logistic regression analysis showed that the risk factors for HIV-1 were being uncircumcised (odds ratio (OR) = 2.19; 95% confidence interval (CI), 1.08~4.45); having sexual intercourse with at least 2 partners during each sauna visit (≥ 2 vs. ≤ 1, OR = 1.71; 95% CI, 1.02~2.89); and the role played during anal intercourse (versatile vs. an exclusively insertive role, OR = 2.76; 95% CI, 1.42~5.36). Conclusions Overall, 7.4% Taiwanese MSM participating in this study had HIV-1 subtype B infection. Uncircumcised, being versatile role during anal intercourse, and having sex with more than one person during each sauna visit were main risk factors for HIV-1 infection.
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Affiliation(s)
- Yen-Ju Chen
- AIDS Prevention and Research Center, National Yang-Ming University, Taipei, Taiwan
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8
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Solomon TM, Halkitis PN, Moeller RM, Siconolfi DE, Kiang MV, Barton SC. Sex parties among young gay, bisexual, and other men who have sex with men in New York City: attendance and behavior. J Urban Health 2011; 88:1063-75. [PMID: 21698548 PMCID: PMC3232420 DOI: 10.1007/s11524-011-9590-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Very little information exists with regard to sex party behaviors in young men who have sex with men (YMSM), often defined as men ranging in age from 13 to 29 years. The current analysis examines sex party attendance and behavior in a sample of 540 emergent adult gay, bisexual, and other YMSM in New York City, ages 18-29 years. Findings indicate that 8.7% (n = 47) of the sample had attended a sex party 3 months prior to assessment. Sex party attendees reported that parties included both HIV-positive and HIV-negative men; attendees also reported unprotected sex and limited access to condoms and lubricant. As compared with those who did not attend sex parties, those who did indicated significantly more lifetime and recent (last 3 months) casual sex partners, drug use (both number of different drugs used and total lifetime use), psychosocial burden (history of partner violence and number of arrests), and total syndemic burden (a composite of unprotected anal sex, drug use and psychosocial burden). These results indicate that while only a small percentage of the overall sample attended sex parties, the intersection of both individual risk factors coupled with risk factors engendered within the sex party environment itself has the potential to be a catalyst in the proliferation of the HIV/AIDS epidemic in urban settings. Lastly, given that sex parties are different than other sex environments, commercial and public, with regard to how they are accessed, public health strategies may need to become more tailored in order to reach this potentially highly risky group.
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Affiliation(s)
- Todd M Solomon
- Center for Health, Identity, Behavior, and Prevention Studies, The Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA.
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9
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Sherman SG, Lilleston P, Reuben J. More than a dance: the production of sexual health risk in the exotic dance clubs in Baltimore, USA. Soc Sci Med 2011; 73:475-81. [PMID: 21724311 DOI: 10.1016/j.socscimed.2011.05.036] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 05/19/2011] [Accepted: 05/22/2011] [Indexed: 11/30/2022]
Abstract
Women who exchange sex for money, drugs, or goods are disproportionately infected with HIV and have high rates of illicit drug use. A growing body of research has underscored the primacy of environmental factors in shaping individual behaviors. HIV/STI rates among sex workers are influenced by environmental factors such as the physical (e.g., brothel) and economic (e.g., increased pay for unsafe sex) context in which sex work occurs. Exotic dance clubs (EDCs) could be a risk environment that is epidemiologically significant to the transmission of HIV/STIs among vulnerable women, but it is a context that has received scant research attention. This study examines the nature of the physical, social, and economic risk environments in promoting drug and sexual risk behaviors. Structured observations and semi-structured qualitative interviews (N = 40) were conducted with club dancers, doormen, managers, and bartenders from May through August, 2009. Data were analyzed inductively using the constant comparative method common to grounded theory methods. Atlas-ti was used for data analysis. Dancers began working in exotic dance clubs primarily because of financial need and lack of employment opportunities, and to a lesser extent, the need to support illicit drug habits. The interviews illuminated the extent to which the EDCs' physical (e.g., secluded areas for lap dances), economic (e.g., high earnings from dancers selling sex), and social (e.g., prevailing social norms condoning sex work) environments facilitated dancers' engaging in sex work. Drug use and alcohol use were reported as coping mechanisms in response to these stressful working conditions and often escalated sexual risk behaviors. The study illuminated characteristics of the environment that should be targeted for interventions.
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Affiliation(s)
- Susan G Sherman
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA.
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Abstract
Latino men who have sex with men (MSM) constitute a group at high risk for HIV. Recent approaches to understanding sexual risk have emphasized the role that contextual factors can play in shaping behavior. This study examined sexual behavior of Latino MSM in private and public settings. First, a within-person comparison of behaviors performed in sexual encounters that occurred in public and private settings was conducted. Unprotected anal intercourse (UAI) and other sexual behaviors involving anal stimulation were more common in private settings; group sex was more likely in public settings. Second, a between-person analysis compared sexual behaviors of MSM who went to three different types of public sex settings during the past six months. The types were: (1) commercial sex venues (CSVs), which were defined as businesses with the function of providing a space where MSM can go to have sexual encounters, such as gay bathhouses; (2) commercial sex environments (CSEs), which were defined as businesses with another apparent function, but in which MSM sometimes have sexual encounters, such as gay bars or pornographic movie houses; and (3) public sex environments (PSEs), which were defined as free public areas where MSM can go to find partners for anonymous sex, such as parks or public restrooms. Results indicated that anal sexual behavior was most likely to occur in CSVs and least likely in PSEs, but the probability of UAI was not found to differ among the three types of settings. Behavioral differences were discussed in terms of structural conditions related to privacy and safety, and psychological factors related to intimacy.
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Abstract
Previous research found up to 14% of men who go to bathhouses engage in unprotected anal intercourse (UAI) and tend to have multiple sexual partners during their bathhouse visit, thus appearing to support concerns that such venues could foster acute outbreaks of new HIV infections. We conducted a two-stage probability sample of men exiting a gay bathhouse, and focused our analysis on whether the partnering patterns of the men who engaged in UAI present such a risk. Among patrons who had oral or anal sex during their visit (n = 758), 16.7% were HIV+, and 13.9% engaged in UAI. Although men had multiple sex partners during a visit, they had UAI with only one of those partners, on average, and withdrawal prior to ejaculation occurred in the vast majority of UAI incidences. Thus, the risk of sexual transmission of HIV during the bathhouse visit was typically within isolated dyads rather than patterns of multiple sexual encounters that might put many men at risk during a single visit, and men who did engage in UAI tended to withdraw prior to ejaculation, potentially mitigating the risk of HIV transmission.
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Affiliation(s)
- Diane Binson
- Center for AIDS Prevention Studies, University of California at San Francisco, CA 94105, USA.
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12
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Lyons A, Smith AMA, Grierson JW, von Doussa H. Australian men's sexual practices in saunas, sex clubs and other male sex on premises venues. Sex Health 2010; 7:186-92. [PMID: 20465985 DOI: 10.1071/sh09101] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Accepted: 03/15/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Sex on premises venues (SOPVs) where men have sex with men have been implicated in the spread of sexually transmissible infections, but few studies have described men's sexual encounters in SOPVs, particularly the degree to which men from different backgrounds engage in risky sexual practices. METHODS Interviewer administered surveys were conducted with 186 Australian men who have sex with men (MSM) within 48 h of visiting an SOPV. They reported their sexual practices, the characteristics of their partners and other circumstances surrounding their sexual encounters. RESULTS All analyses were based on the number of sexual encounters (n = 430). Oral sex was the most common practice, occurring in 74.9% of encounters, followed by massage, frottage or kissing (53.7%), solo or mutual masturbation (36.3%), and anal sex (32.1%). Multivariate analyses revealed age as a significant factor for having protected anal sex (P = 0.001), insertive anal sex (P = 0.004) and receptive anal sex (P < 0.001). These practices were more frequent in encounters among younger men, while masturbation (P = 0.03) was more frequent among older men. When men's sexual partners were affected by alcohol, encounters were less likely to involve unprotected anal intercourse (P = 0.006) and more likely to involve massage, frottage or kissing (P = 0.009). Men disclosed their HIV status in only 7.7% of encounters. CONCLUSIONS With the likelihood of risky sexual practices varying according to background, results from this study should be used to guide interventions aiming to promote safer sex in SOPVs.
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Affiliation(s)
- Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne, Vic. 3000, Australia.
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Downing MJ. Internet advertisements for public sexual encounters among men who have sex with men: are safe behaviors communicated? Am J Mens Health 2010; 5:386-94. [PMID: 20798144 DOI: 10.1177/1557988310376958] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Public and commercial sex venues typically provide easy access to sexual encounters that are often anonymous and, therefore, may facilitate HIV/STD transmission among those men who attend. Recently, researchers have suggested that men who have sex with men may be using the Internet to search for sexual encounters to occur within sex venues. The current study explored the extent to which men who advertise for public or commercial sexual encounters initially communicate to potential partners their safe-sex intentions. Advertisements for sexual encounters (n = 99) were collected from a publicly accessible website and examined for content related to venue type, sexual behavior, and indications of sexual safety or risk. Word frequencies were calculated to provide a closer investigation of how individuals negotiate safe sex within these communications. The findings revealed that approximately half of the men who advertised for sex in a public or commercial sex venue failed to communicate to potential partners in their initial advertisement a desire to be safe during sexual encounters involving oral and anal practices. Additionally, a small percentage of men advertised specifically for risky encounters (e.g., barebacking). Together, these findings suggest that men do use the Internet to coordinate public sexual encounters, some of which may be unprotected from HIV/STD transmission. Future research should address the process of condom negotiation among men who initially meet their male sex partners on the Internet for subsequent encounters in sex venues.
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Affiliation(s)
- Martin J Downing
- Environmental Psychology, The Graduate Center, The City University of New York, New York, NY 10016, USA.
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Ko NY, Lee HC, Hung CC, Chang JL, Lee NY, Chang CM, Lee MP, Chang HT, Ko WC. Effects of structural intervention on increasing condom availability and reducing risky sexual behaviours in gay bathhouse attendees. AIDS Care 2010; 21:1499-507. [PMID: 20024729 DOI: 10.1080/09540120902923022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The study purpose was to evaluate the effectiveness of a structural intervention in reducing unprotected sexual behaviours, increasing condom accessibility and their relationship to the prevalence of HIV infection and sexually transmitted infections (STIs) in gay bathhouse attendees. A quasi-experimental study with a non-equivalent control group for comparison was conducted at nine gay bathhouses in Taiwan from 2004 to 2006. A structural intervention designed to increase condom distribution and accessibility inside the bathhouses was implemented at one bathhouse in each city. Bathhouse attendees were invited to complete a questionnaire and to be screened for HIV infection and STIs. Of 632 study participants, 270 were surveyed six months after the intervention was conducted. At the time of follow-up after controlling for baseline data, patrons attending bathhouses for which intervention was performed were more likely to report accessing condoms inside bathhouses than those attending control bathhouses (92.6% versus 81.3%, P = 0.016), and condoms were more likely to be available at the reception desk of the bathhouse entrance (87.5% in intervention bathhouses versus 69.4% in control, P = 0.047). In a multivariate analysis adjusted for age, access to condoms inside bathhouses (adjusted odds ratio (AOR): 4.35; 95% confidence interval (CI): 1.48-12.78) and attendance at bathhouses with intervention (AOR: 2.07; 95% CI: 1.07-3.97) were independently associated with consistent condom use during anal intercourse. There were no significant differences in the prevalences of HIV infection and STIs at the six-month follow-up. Bathhouses with structural intervention were associated with consistent condom use during anal intercourse among bathhouse patrons. Our findings highlight the importance of extension of condom distribution inside the bathhouses to increase condom use among bathhouse patrons.
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Affiliation(s)
- Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Schrimshaw EW, Siegel K, Downing MJ. Sexual Risk Behaviors with Female and Male Partners Met in Different Sexual Venues Among Non-Gay-Identified, Non-Disclosing MSMW. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2010; 22:167-179. [PMID: 22059106 PMCID: PMC3206637 DOI: 10.1080/19317611003748821] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Despite considerable interest in the sexual behavior of non-disclosing men who have sex with men and women (MSMW), little is known about where they meet their male and female partners and whether their sexual risk behavior differs with partners met in different sexual venues (e.g., bars, Internet, parks). These issues were examined among 46 non-gay-identified MSMW who had not disclosed their same-sex behavior to female partners (i.e., men on the "down low"). The prevalence of unprotected vaginal sex was nearly identical with women met in bars/clubs as with women met through friends, work, or the neighborhood. In contrast, the prevalence of unprotected anal sex was higher with male partners met on the Internet, in bars/clubs, and through friends/work/neighborhood as compared with partners met in parks/restrooms or gyms. This is largely due to MSMW avoiding anal sex in parks, restrooms, and gyms, in favor of oral sex. These findings provide important insights into the role of venues on sexual risk and the locations where risk reduction interventions for MSMW may be provided.
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Affiliation(s)
- Eric W Schrimshaw
- Center for the Psychosocial Study of Health & Illness, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University
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Mullens AB, Staunton S, Debattista J, Hamernik E, Gill D. Sex on premises venue (SOPV) health promotion project in response to sustained increases in HIV notifications. Sex Health 2009; 6:41-4. [PMID: 19254490 DOI: 10.1071/sh07087] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Accepted: 11/06/2008] [Indexed: 11/23/2022]
Abstract
BACKGROUND Due to increases in HIV notifications in Queensland, a health promotion outreach project was developed with sex on premises venues (SOPV) in Brisbane. METHODS A health promotion officer (HPO) promoted safer sex behaviours among SOPV patrons over 14 months, including providing information, counselling and skills to enhance safer sexual behaviours and providing referrals. Surveys were introduced to facilitate discussions regarding HIV/sexually transmissible infections, testing and safer sex practices. RESULTS The project demonstrated feasibility within this highly sexualised environment, and was enhanced by careful monitoring and revising the procedure to improve patron/staff responses to the project. The introduction of a survey instrument was a significant contributor to the project's effectiveness, providing opportunities for patrons to discuss a variety of key sexual health issues. CONCLUSIONS This initiative reflected effective partnering between the Health Department, a community HIV/lesbian, gay, bisexual and transgender organisation and private industry. Despite initial difficulties, the presence of a health worker within an SOPV was acceptable to patrons and allowed for brief interventions to be conducted. This project was deemed effective for a limited time period and within certain constraints.
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Affiliation(s)
- Amy B Mullens
- Sexual Health and HIV Service, 270 Roma Street, Brisbane, Qld 4000, Australia
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Daskalakis D, Silvera R, Bernstein K, Stein D, Hagerty R, Hutt R, Maillard A, Borkowsky W, Aberg J, Valentine F, Marmor M. Implementation of HIV testing at 2 New York City bathhouses: from pilot to clinical service. Clin Infect Dis 2009; 48:1609-16. [PMID: 19400690 DOI: 10.1086/598979] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Commercial sex venues (e.g., bathhouses) that cater to men who have sex with men (MSM) continue to function in most urban areas. These venues present a challenge to developing strategies to prevent the spread of the human immunodeficiency virus (HIV), but they also provide opportunities for interventions to reduce the risk and rate of disease transmission. Several cities in the United States have developed programs that offer HIV testing in these venues. Similar programs have not existed before in New York City. METHODS A pilot HIV testing program was implemented at 2 New York City bathhouses. Testing included rapid HIV testing, the use of the serologic testing algorithm for recent HIV seroconversion, and pooled plasma HIV viral load to detect and date incident and acute HIV infections. In addition to HIV tests, behavioral and demographic data were collected from 493 presumed HIV-negative participants. RESULTS The pilot program recruited MSM who were at high risk for HIV infection. Of the 493 men tested, 20 (4%) were found to be positive for HIV, and 8 (40%) of these 20 men demonstrated evidence of acute or recent HIV infection. The program tested men often not tested in more traditional medical settings. Significant disparities were demonstrated in the testing habits of MSM who reported having sex with women and had not disclosed same-sex activities to their caregivers. CONCLUSIONS Bathhouse-based testing for HIV infection can be implemented in New York City and would include a population of MSM who are at high risk for HIV infection. Because of the high rate of recent HIV infection, expanded testing in these venues may be a good strategy to reduce the forward transmission of HIV in this highly sexually active population.
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Affiliation(s)
- Demetre Daskalakis
- Division of Infectious Diseases and Immunology, New York University Langone Medical Center, New York, New York 10016, USA.
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Reidy WJ, Spielberg F, Wood R, Binson D, Woods WJ, Goldbaum GM. HIV risk associated with gay bathhouses and sex clubs: findings from 2 seattle surveys of factors related to HIV and sexually transmitted infections. Am J Public Health 2009; 99 Suppl 1:S165-72. [PMID: 19218174 PMCID: PMC2724952 DOI: 10.2105/ajph.2007.130773] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2008] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We studied the HIV risk behaviors of patrons of the 3 commercial sex venues for men in Seattle, Washington. METHODS We conducted cross-sectional, observational surveys in 2004 and 2006 by use of time-venue cluster sampling with probability proportional to size. Surveys were anonymous and self-reported. We analyzed the 2004 data to identify patron characteristics and predictors of risk behaviors and compared the 2 survey populations. RESULTS Fourteen percent of respondents reported a previous HIV-positive test, 14% reported unprotected anal intercourse, and 9% reported unprotected anal intercourse with a partner of unknown or discordant HIV status during the current commercial sex venue visit. By logistic regression, recent unprotected anal intercourse outside of a commercial sex venue was independently associated with unprotected anal intercourse. Sex venue site and patron drug use were strongly associated with unprotected anal intercourse at the crude level. The 2004 and 2006 survey populations did not differ significantly in demographics or behaviors. CONCLUSIONS Patron and venue-specific characteristics factors may each influence the frequency of HIV risk behaviors in commercial sex venues. Future research should evaluate the effect of structural and individual-level interventions on HIV transmission.
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Affiliation(s)
- William J Reidy
- Department of Epidemiology, University of Washington School of Public Health and Community Medicine, Seattle, USA.
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Ko NY, Lee HC, Chang JL, Lee NY, Chang CM, Lee MP, Lin YH, Lai KY, Ko WC. Condom availability inTaiwanese gay bathhouses: the right things in the wrong places. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2008; 20:338-346. [PMID: 18673066 DOI: 10.1521/aeap.2008.20.4.338] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Gay bathhouses were identified as public venues where men having sex with men are more likely to engage in risky sexual behaviors. This study applied Binson and Woods's (Journal of Homosexuality, 44, 2003) theoretical framework of risk environment/bathhouse setting to (a) describe four domains of bathhouse environments, (b) investigate condom availability in bathhouses, and (c) identify barriers of condom distribution. An ethnographic study was conducted at eight gay bathhouses in Taiwan, including environmental observations, interviews of 16 staff members, and self-administered questionnaires of 409 bathhouse patrons. Condoms were provided upon request in eight bathhouses. Environmental observations showed a poor match between the places where condoms were distributed and where men had sex. Cost and police harassment were two barriers of condom distribution in bathhouses. Our findings highlight the importance of the extension of condom distribution at places where men have sex in gay bathhouses.
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Affiliation(s)
- Nai-Ying Ko
- Department of Nursing, Colege of Medicine, National Cheng Kung University, Tainan, Taiwan
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20
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HIV risk factors reported by two samples of male bathhouse attendees in Los Angeles, California, 2001-2002. Sex Transm Dis 2008; 35:631-6. [PMID: 18545142 DOI: 10.1097/olq.0b013e31816b475a] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We aimed to describe the use of voluntary HIV counseling and testing services, risk behaviors, and risk factors for unprotected anal sex (UAS) among men who have sex with men (MSM) who attended a bathhouse in Los Angeles during 2001-2002. METHODS Using 2 cross-sectional study samples, we compared (in order below) 458 of 640 MSM who used voluntary HIV counseling and testing in the bathhouse with 398 MSM surveyed upon exit. Within each group, logistic regression identified factors associated with UAS at their most recent bathhouse visit. RESULTS Of 640 MSM, 71 (11%) tested HIV-positive for the first time. Of the 50 HIV-positive MSM who completed a survey, 50% tested because of the convenient services. Similar proportions of MSM in both survey samples reported UAS (7%-8%) during their recent bathhouse visit. Risk factors associated with UAS in both survey samples were UAS with men outside the bathhouse and greater numbers of partners within the bathhouse. CONCLUSIONS Comprehensive prevention services provided within bathhouses may reduce undiagnosed HIV infections among MSM, and targeting HIV prevention at the bathhouse may reduce risks with partners both inside and outside the bathhouse.
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21
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Woods WJ, Binson D, Pollack LM, Cotten P, Neilands TB. Closing Bathhouses Unlikely to Decrease Number of Sex Acts and May Reduce Condom Use. J Acquir Immune Defic Syndr 2008; 47:264-6; author reply 266. [DOI: 10.1097/qai.0b013e31815c71df] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Grov C, Parsons JT, Bimbi DS. Sexual risk behavior and venues for meeting sex partners: an intercept survey of gay and bisexual men in LA and NYC. AIDS Behav 2007; 11:915-26. [PMID: 17206536 DOI: 10.1007/s10461-006-9199-y] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Accepted: 11/30/2006] [Indexed: 11/30/2022]
Abstract
Understanding the link between venues for meeting sex partners and sexual risk behavior is critical to developing and placing effective sexual health education and HIV prevention services. Non-monogamous gay and bisexual men (n = 886) were surveyed in New York and Los Angeles about the venues that they met recent sex partners: bathhouses, private sex parties, gay bars/clubs, the gym, via public cruising, and the Internet. Bars/clubs, bathhouses, and the Internet were the most endorsed venues for meeting partners. Men having met a majority of their partners (i.e., "preference") via these three venues were compared/contrasted. Those having preference for bars/clubs were dissimilar from men with preference for bathhouses or the Internet on multiple levels (e.g. age, number of sex partners, temptation for unsafe sex). However, these men were proportionally similar in whether they had engaged in a recent episode of unprotected anal intercourse (UAI). Logistic regressions predicting UAI suggested venues might not play a role in differentiating men who had preference for bars/clubs, bathhouses or the Internet. Additional regression analyses utilizing all six venues to predict UAI suggested other person-factors such as identity as a barebacker and temptation for unsafe sex better explain UAI. This research suggests HIV prevention and educational campaigns targeted within venues need also address socio-psychological person-factors in addition to environmental/venue contexts.
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Affiliation(s)
- Christian Grov
- Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA
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23
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Faissol DM, Swann JL, Kolodziejski B, Griffin PM, Gift TL. The role of bathhouses and sex clubs in HIV transmission: findings from a mathematic model. J Acquir Immune Defic Syndr 2007; 44:386-94. [PMID: 17279050 DOI: 10.1097/qai.0b013e31803220dd] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Bathhouses and sex clubs were identified as primary venues for HIV transmission during the original HIV epidemic. Because HIV incidence is increasing in some high-risk groups, their potential role in HIV transmission is being examined again. We present an extension of the Bernoulli process model of HIV transmission to incorporate subpopulations with different behaviors in sex acts, condom use, and choice of partners in a single period of time. With this model, we study the role that bathhouses and sex clubs play in HIV transmission using data from the 1997 Urban Men's Health Study. If sexual activity remains the same, we find that bathhouse closures would likely lead to a small increase in HIV transmission in the period examined by this study, although this impact is less than that which would be achieved through a 1% change in current condom use rates. If, conversely, bathhouse closure leads to a reduction of the sexual activity that was in the bathhouse by at least 2%, HIV transmission would be lowered.
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Affiliation(s)
- Daniel M Faissol
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA 30332-0205, USA
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24
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Woods WJ, Binson D, Blair J, Han L, Spielberg F, Pollack LM. Probability Sample Estimates of Bathhouse Sexual Risk Behavior. J Acquir Immune Defic Syndr 2007; 45:231-8. [PMID: 17417103 DOI: 10.1097/qai.0b013e318055601e] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Previous research links high rates of unprotected anal intercourse (UAI) with men who go to bathhouses; however, the literature provides no prevalence estimates. An exit survey of a probability sample was conducted to describe the prevalence of risk activity at the bathhouse. METHODS Data are from a 2-stage probability sample of men exiting a gay bathhouse (n = 400). RESULTS During their visit, 91.5% of men had oral sex and 44.2% had anal sex (11.1% reported UAI and 5.5% reported unprotected receptive anal intercourse). In the prior 3 months, 85% reported having anal sex, which was more likely to be unprotected when it occurred in a private home or hotel as opposed to a public setting (P < 0.001). Moreover, having UAI at home was a significant correlate of risk during the bathhouse visit (P < 0.001). CONCLUSIONS Most men at the bathhouse engaged in oral sex rather than anal sex, and most anal sex included use of condoms. Furthermore, men were more likely to have UAI in a private home than in any public setting. The bathhouse seems to have facilitated condom use when anal sex occurred on-site.
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Affiliation(s)
- William J Woods
- AIDS Research Institute, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA 94105, USA.
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25
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Holmes D, O'Byrne P, Gastaldo D. Setting the space for sex: Architecture, desire and health issues in gay bathhouses. Int J Nurs Stud 2007; 44:273-84. [PMID: 16426616 DOI: 10.1016/j.ijnurstu.2005.11.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Revised: 11/25/2005] [Accepted: 11/29/2005] [Indexed: 11/22/2022]
Abstract
This aim of this study was to describe and compare the physical design, as well as the atmosphere of urban gay bathhouses, and reflect on how desire operates within these premises when it intersects with the bathhouse environment and health imperatives. Three bathhouses were studied for a total of 147 h of observation. Men's desire for other men has created a landscape of spaces (real and virtual) where sex takes place in parks, alleys, restrooms, rest stops, adult theatres, video arcades, bookstores, bars, gay bathhouses and finally, the Internet. Although the Internet is perceived as an easy way for encountering sexual partners, gay bathhouses remain the most popular and convenient way, for men having sex with men to meet for regular or casual sex. This paper presents the descriptive results of an ethnographic nursing study that took place in three gay bathhouses located in two Canadian metropolitan areas. Gay bathhouses offer patrons a space within which a wide range of interactions, sensations and pleasure can be experienced. This paper highlights the specific features of three gay bathhouses, compares settings according to their specific architectural features and related sexual activities, and finally, proposes some changes in light of certain health issues.
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Affiliation(s)
- Dave Holmes
- Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ont., Canada K1H 8M5.
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26
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Taylor MM, Aynalem G, Smith LV, Montoya J, Kerndt P. Methamphetamine use and sexual risk behaviours among men who have sex with men diagnosed with early syphilis in Los Angeles County. Int J STD AIDS 2007; 18:93-7. [PMID: 17331279 PMCID: PMC6783809 DOI: 10.1258/095646207779949709] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Methamphetamine use has been associated with risky sexual behaviour and sexually transmitted disease (STD)/HIV transmission among men who have sex with men (MSM). Field interview records for MSM early syphilis (ES) patients were reviewed for factors associated with methamphetamine use during January 2001 through December 2004. There were a total of 2915 ES cases reported during the study period. Of these, 1904 (65%) were MSM. Of these MSM, 167 reported methamphetamine use. Methamphetamine use was associated with having multiple sex partners (prevalence ratios [PR] 1.8, 95% confidence interval [CI] 1.4-2.4), not using condoms (PR 2.0, 95% CI 1.3-2.5), having anonymous sex partners (PR 1.1 95% CI 1.03-1.2), history of recent incarceration (PR 5.4, 95% CI 3.3-8.7), and meeting sex partners via the Internet (PR 1.6, 95% CI 1.3-2.1), at bathhouses (PR 1.6, 95% CI 1.2-2.0) and on the streets (PR 2.6, 95% CI 1.7-4.0). In multivariate analysis having multiple sex partners, not using condoms, recent incarceration and meeting sex partners at bathhouses were significantly associated with methamphetamine use. In conclusion, effective STD risk reduction interventions targeting MSM methamphetamine users are needed to curb risky sexual behaviour.
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Affiliation(s)
- Melanie M Taylor
- Division of STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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27
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Xia Q, Tholandi M, Osmond DH, Pollack LM, Zhou W, Ruiz JD, Catania JA. The Effect of Venue Sampling on Estimates of HIV Prevalence and Sexual Risk Behaviors in Men Who Have Sex With Men. Sex Transm Dis 2006; 33:545-50. [PMID: 16735957 DOI: 10.1097/01.olq.0000219866.84137.82] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to investigate differences in HIV prevalence and sexual risk behaviors among men who have sex with men (MSM) according to their gay venue visit patterns. METHODS In a cross-sectional survey, a population-based sample of men aged 18 to 64 years who self-identified as gay or bisexual were interviewed by telephone regarding their sexual behaviors, HIV serostatus, and gay venue visit patterns. RESULTS A total of 398 men were recruited for the study. The results showed that frequent gay venue visitors were more likely to engage in high-risk sexual behaviors. Among gay venue attendees who visited different types of gay venues, men who visited sex clubs/bathhouses reported the highest rates of 5 or more male sexual partners and unprotected anal intercourse (UAI) with secondary partners (62.6% and 34.6%, respectively), gay bar/club attendees and cruisers reported higher rates of having sex with women (8.5% and 14.8%, respectively), and circuit party attendees reported the highest HIV prevalence (40.4%) and serodiscordant UAI (30.2%). CONCLUSIONS MSM who visited different types of gay venues and with varied visit frequency showed marked differences in sexual risk behaviors, and the differences suggest the importance of weighting procedure to obtain unbiased estimates in venue-based studies.
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Affiliation(s)
- Qiang Xia
- California Department of Health Services, Office of AIDS, Sacramento, California, USA
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28
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Ko NY, Lee HC, Chang JL, Lee NY, Chang CM, Lee MP, Lin YH, Lai KY, Ko WC. Prevalence of Human Immunodeficiency Virus and Sexually Transmitted Infections and Risky Sexual Behaviors Among Men Visiting Gay Bathhouses in Taiwan. Sex Transm Dis 2006; 33:467-73. [PMID: 16543861 DOI: 10.1097/01.olq.0000204512.15297.5f] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to investigate the prevalence of human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) and predictors of risky sexual behaviors among men visiting gay bathhouses. STUDY DESIGN A cross-sectional study was conducted at 8 gay bathhouses in Taiwan. Bathhouse attendees were invited to complete a questionnaire and to be screened for HIV/STIs. RESULTS Of 451 men recruited for the study, 339 (75%) completed the questionnaire and were screened for HIV/STIs. The study indicated that seroprevalence rates of anti-HIV-1 antibody, specific Treponema pallidum antibodies detected by hemagglutination assay, surface antigen of hepatitis B virus, IgG antibodies for hepatitis A virus, antibody for hepatitis C virus, and indirect hemagglutination antibody for Entamoeba histolytica (serum titer > or =1:128) were 8%, 18%, 16%, 38%, 3%, and 6%, respectively. Prevalence rates for chlamydial and gonococcal infections reflected by nucleic acid amplification tests in urine samples were 7% and 4%, respectively. Irregular use of condoms during oral sex, condom inaccessibility at bathhouses, unprotected sex at public venues, no prior HIV test, and 5 or more visits to bathhouses every month were independently associated with unprotected anal intercourse. CONCLUSION Men attending gay bathhouses report engaging in unsafe sex practices and are at substantial risk of acquisition of HIV/STIs. These findings highlight the need for more comprehensive prevention efforts at gay bathhouses.
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Affiliation(s)
- Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Taylor M, Montoya JA, Cantrell R, Mitchell SJ, Williams M, Jordahl L, Freeman M, Brown J, Broussard D, Roland E. Interventions in the commercial sex industry during the rise in syphilis rates among men who have sex with men (MSM). Sex Transm Dis 2006; 32:S53-9. [PMID: 16205294 PMCID: PMC6785736 DOI: 10.1097/01.olq.0000180453.31255.2d] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Describe sexually transmitted disease/human immunodeficiency virus prevention interventions targeting men who have sex with men (MSM) in commercial sex venues (CSV). STUDY Compilation of descriptive and evaluation data from the CDC 8-city MSM Syphilis Response on interventions conducted in bathhouses/sex clubs, circuit parties, the Internet, male sex workers, and the adult film industry. RESULTS Interventions in the commercial sex industry (CSI) often involved multiple collaborative efforts between public health departments (PHD), community-based organizations (CBO), and CSV owners and managers. Education and condoms were provided at multiple venues, including circuit parties, bathhouses, and sex clubs. CBO staff reported one-on-one street and CSV outreach to engage MSM at risk. Evaluation data demonstrate that MSM exposed to media campaigns were more aware of syphilis and more likely to have been tested for syphilis than MSM who did not see the campaigns. CONCLUSIONS PHD and CBO are using multiple means of reaching MSM in the CSI. Evaluations are needed to determine which of these efforts decreases syphilis transmission.
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Affiliation(s)
- Melanie Taylor
- Division of STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, USA.
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Frankis J, Flowers P. Men who have sex with men (MSM) in public sex environments (Pses): a systematic review of quantitative literature. AIDS Care 2005; 17:273-88. [PMID: 15832876 DOI: 10.1080/09540120412331299799] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We systematically review quantitative research relating to the sexual behaviours of MSM in PSEs. We examine the methodological rigour of these studies to determine an appropriate framework for future PSE-based research and quantify sexual behavioural trends therein. Medline, BIDS, Web of Science and recent HIV/AIDS conferences were searched according to a systematic inclusion criteria. Nine papers were included for review. Recruitment of participants' outwith PSE settings, and low response rates (6%) of participants contacted in situ, question the validity and generalizability of current evidence. Most PSE users were gay or bisexually identified and half of men in the gay community reported recent PSE use. Around 10% of men reported casual status-unknown/serodiscordant unprotected anal intercourse (UAI) within PSEs. HIV testing rates amongst PSE users were similar to the wider gay community, though the proportion of men who tested positive was twice as high. Rates of casual UAI suggest that PSEs represent important sites for HIV prevention. However, since extant evidence is scant and methodologically flawed, further research is urgent. Such work must recruit participants in situ, and obtain satisfactory response rates, to be generalizable to the wider population of men who cruise.
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Affiliation(s)
- J Frankis
- School of Health and Social Care & Department of Psychology, Glasgow Caledonian University, Scotland.
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31
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Crosby R, Mettey A. A Descriptive Analysis of HIV Risk Behavior Among Men Having Sex With Men Attending a Large Sex Resort. J Acquir Immune Defic Syndr 2004; 37:1496-9. [PMID: 15602128 DOI: 10.1097/01.qai.0000127065.61454.b4] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study assessed the prevalence of various HIV-associated risk behaviors among men who have sex with men (MSM) attending a popular sex resort in the southern United States. One hundred fifty men completed an anonymous self-administered questionnaire (91% response rate). Men currently resided in 14 states. One sixth reported being HIV-positive. During a typical resort visit, men averaged 4 sex partners. About two thirds of the men had anal sex during a typical resort stay; of these, 21% reported never using condoms and 41% reported always using condoms. HIV risk behavior over the past few months was also assessed. Men averaged 10 sex partners. Meeting partners by means of the Internet (57%) and bathhouses--excluding sex resorts--(40%) was common. Most men (62%) reported having group sex. About one half (49%) engaged in unprotected anal sex. Significant differences in recent frequency of unprotected anal sex between HIV-positive and HIV-negative men were not found (P = 0.74). Among those using condoms, 20% reported not using condoms from start to finish of sex, 7% reported breakage, and 6% reported slippage. Twenty-three percent had anal sex without lubrication. Fisting and the use of nonprescription sildenafil citrate (Viagra) was reported by about one sixth of the men. The findings suggest that MSM attending sex resorts may experience substantial risk of HIV infection. Sex resorts may be an important venue for HIV prevention.
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Affiliation(s)
- Richard Crosby
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Taylor M, Aynalem G, Smith L, Bemis C, Kenney K, Kerndt P. Correlates of Internet use to meet sex partners among men who have sex with men diagnosed with early syphilis in Los Angeles County. Sex Transm Dis 2004; 31:552-6. [PMID: 15480117 PMCID: PMC6763621 DOI: 10.1097/01.olq.0000137902.71284.b0] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate use of the Internet to solicit sex partners by men who have sex with men (MSM) who were diagnosed with early syphilis infection. STUDY Field interview records for syphilis patients were reviewed for factors associated with Internet use. RESULTS Internet users were more likely to be of white race (prevalence ratio [PR], 1.6; 95% confidence interval [CI], 1.4-1.8), to report anal insertive sex (PR, 1.1; 95% CI, 1.1-1.2), sex with anonymous partners (PR, 1.2; 95% CI, 1.1-1.3), intravenous drug use (PR, 2.7; 95% CI, 1.1-6.7), and nonintravenous drug use (PR, 1.4; 95% CI, 1.1-1.8). Controlling for race and sexual risk behaviors, white race (odds ratio [OR], 2.8; 95% CI, 1.8-4.6), having anonymous sex partners (OR, 3.4; 95% CI, 1.6-7.0), and nonintravenous drug use (OR, 1.6; 95% CI, 1.1-2.6) were associated with meeting sex partners through the Internet. CONCLUSIONS Effective sexually transmitted disease risk reduction interventions using the Internet are needed to reach Internet-using, sex-seeking MSM populations engaging in high-risk behaviors.
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Affiliation(s)
- Melanie Taylor
- Division of STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Paz-Bailey G, Meyers A, Blank S, Brown J, Rubin S, Braxton J, Zaidi A, Schafzin J, Weigl S, Markowitz LE. A Case–Control Study of Syphilis Among Men Who Have Sex With Men in New York City. Sex Transm Dis 2004; 31:581-7. [PMID: 15388994 DOI: 10.1097/01.olq.0000140009.28121.0f] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to determine factors associated with syphilis among men who report sex with other men in New York City. DESIGN, SETTING AND STUDY SUBJECTS: We conducted a case-control study among 88 men who reported sex with men in the previous year, 18 to 55 years old and diagnosed with primary or secondary syphilis during 2001; and 176 control subjects frequently matched by age and type of health provider. RESULTS HIV prevalence among syphilis cases was 48% compared with 15% among control subjects (P <0.001). Variables associated with syphilis in a multivariate model were HIV infection (odds ratio [OR], 7.3; 95% confidence interval [CI], 3.5-15.4), income >$30,000 per year (OR, 2.7; CI, 1.4-5.2), and barebacking (OR, 2.6; CI, 1.4-4.8). The median time since HIV diagnosis for HIV-positive was 6 years for cases and 7 years for control subjects (P = 0.70). Among HIV-infected participants, syphilis cases were more likely than control subjects to report being on antiretroviral therapy (69% vs. 44%, P = 0.05) and to report having undetectable viral load (58% vs. 24%, P = 0.02). CONCLUSION HIV infection was strongly associated with syphilis in this study. High-risk behavior reported by both cases and control subjects indicates the potential for increased HIV transmission.
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Affiliation(s)
- Gabriela Paz-Bailey
- Division of STD Prevention, NCHSTP, Centers for Disease Control and Prevention, Mail stop E-04, 1600 Clifton Road, Atlanta, GA 30333, USA.
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Crosby R, DiClemente RJ, Mettey A. Correlates of recent unprotected anal sex among men having sex with men attending a large sex resort in the South. Sex Transm Dis 2004; 30:909-13. [PMID: 14646640 DOI: 10.1097/01.olq.0000088342.49343.b0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Published studies have not investigated sexually transmitted disease-associated risk behaviors among men who have sex with men (MSM) attending U.S. sex resorts. GOAL We conducted an exploratory study to identify demographic and behavioral correlates of recently engaging in unprotected anal sex (UAS) among MSM attending a sex resort in the southern United States. STUDY DESIGN A cross-sectional survey of 150 men. RESULTS In multivariate analyses, men were more likely to practice risky sex if they also recently engaged in the practices of having group sex (adjusted odds ratio [AOR], 3.0), rimming (AOR, 2.0), or if they used public restrooms to meet potential sex partners (AOR, 2.6). UAS was also more likely among men vaccinated against hepatitis B (AOR, 1.9). Men who reported having primary partners and men who reported being HIV-positive were no less likely than other men in the sample to report recent UAS. CONCLUSION Sex resorts can be an important venue for sexually transmitted disease and HIV prevention among MSM. Tailored prevention messages could be warranted for men who report group sex, rimming, meeting partners in public restrooms, or being vaccinated against hepatitis B.
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Affiliation(s)
- Richard Crosby
- Rollins School of Public Health, Department of Behavioral Sciences & Health Education, Emory Center for AIDS Research, Atlanta, Georgia 30322, USA.
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Kim AA, Kent CK, Klausner JD. Risk Factors for Rectal Gonococcal Infection Amidst Resurgence in HIV Transmission. Sex Transm Dis 2003; 30:813-7. [PMID: 14603087 DOI: 10.1097/01.olq.0000086603.55760.54] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rectal gonorrhea in men has been increasing in San Francisco since 1995. GOAL The goal was to determine behavioral risk factors associated with rectal gonorrhea (RGC) among men who have sex with men (MSM) by HIV serostatus. STUDY DESIGN All men reporting receptive anal sex in the last 6 months are screened for RGC, regardless of reported condom use, at San Francisco's municipal sexually transmitted disease (STD) clinic. We surveyed a convenience sample of men screened for RGC at the clinic. RESULTS Among 564 MSM surveyed, 7.1% had RGC. HIV-positive MSM were significantly more likely (relative risk, 3.5, 95% confidence interval, 1.9-5.8) to have RGC. Behavioral risks for RGC infection varied significantly by HIV serostatus. HIV-positive MSM engaging in anonymous sex were at highest risk for RGC infection. Drug use during anal sex was the strongest risk factor for RGC infection among HIV-negative or unknown HIV status MSM. CONCLUSION Our data suggest that STD and HIV prevention efforts among MSM in San Francisco must consider the role that HIV serostatus plays in acquisition of new infections.
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Affiliation(s)
- Andrea A Kim
- San Francisco Department of Public Health, California, USA
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Abstract
Public health policy on bathhouses has been limited and poorly documented. This volume is intended to expand policy-makers' and prevention-professionals' knowledge and awareness about gay bathhouses. The present paper provides a context and an overview for the volume by describing the bathhouse environment and how it differs from other public sex environments, and by describing public policies that have been implemented.
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Affiliation(s)
- William J Woods
- Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, 74 New Montgomery Street, Suite 600, San Francisco, CA 94105, USA.
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