Legal aspects of regulating bathhouses: cases from 1984 to 1995

Modeling structural, dyadic, and individual factors: the inclusion and exclusion model of HIV related behavior

Changing HIV-related behaviors requires addressing the individual, dyadic, and structural influences that shape them. This supplement of AIDS & Behavior presents frameworks that integrate these three influences on behavior. Concepts from these frameworks were selected to model the processes by which structural factors affect individual HIV-related behavior. In the Inclusion/Exclusion Model, material and symbolic inclusions and exclusions (sharing versus denying resources) regulate individuals' ability and motivation to detect, prevent, and treat HIV. Structural interventions create inclusions that increase one's ability or motivation to perform these behaviors or exclusions that hinder one's ability or motivation to execute counterproductive behaviors. The need to expand research regarding multilevel influences on HIV-related behavior is also discussed, particularly concerning further understanding of sustained behavior change and effective dissemination of evidence-based intervention strategies.

The role of commercial sex venues in the HIV epidemic among men who have sex with men

BACKGROUND

Commercial sex venues such as bathhouses and sex clubs have long been considered important facilitators of HIV transmission among men who have sex with men in the United States. Recent probability surveys of commercial-sex-venue patrons in King County, WA that included data on behavior both within and outside these venues provide an empirical basis for the development of mathematical models to estimate the role that commercial sex venues play in the HIV epidemic.

METHODS

We constructed deterministic compartmental mathematical models of HIV transmission to estimate both current incidence among King County men who have sex with men and incidence in 5 counterfactual scenarios in which commercial-sex-venues were presumed not to exist. We parameterized the models using a range of values for the proportion of commercial sex venues partnerships replaced in the absence of these venues, and the number of acts of unprotected anal intercourse per other types of partnership. Yearly attributable number was calculated as the difference between incident HIV cases in the main models and each corresponding counterfactual model. We performed extensive sensitivity analyses using Latin hypercube sampling.

RESULTS

Replacement of 25% of commercial sex venue partners in the absence of these venues resulted in attributable number values near zero per year. Replacement of 50% or more of commercial sex venue partners resulted in negative yearly attributable numbers, indicating a net increase in incident HIV infections in the absence of these venues. Results of the sensitivity analyses were consistent with the main findings.

CONCLUSIONS

Our findings imply that commercial sex venues contribute little to the burden of HIV among men who have sex with men in King County, WA.

HIV risk associated with gay bathhouses and sex clubs: findings from 2 seattle surveys of factors related to HIV and sexually transmitted infections

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.

HIV risk factors reported by two samples of male bathhouse attendees in Los Angeles, California, 2001-2002

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.

The role of bathhouses and sex clubs in HIV transmission: findings from a mathematic model

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.