Serosorting and sex clubs - Mark King's video blog takes us there

"Ever taken a guided tour of a gay men's sex club? Brace yourself," says Mark King. In his latest video blog entry, Mark gets a personal look at what these clubs are all about -- and dives into the controversial topic of whether it's OK for someone with HIV to have unprotected sex, as long as it's with someone else who's HIV positive.




When I was sleeping around, I gladly shared my HIV status because I preferred other poz partners. It meant less anxiety and probably unprotected sex, which I preferred. While my sex partner count has been reduced to 1 these days, it turns out my former sexual strategy has a name: serosorting. Seeking out partners who share your HIV status.

In one of life's ironies, I remember alarmists in the 80s suggesting that HIV-positive people be sent to an island or otherwise segregated so as not to infect others. Today, many gay men are essentially doing just that, by limiting sex to other poz men.

It's risk reduction in an epidemiological sense, but does it simply allow for risky sex that might promote other STDs? And what of the more psychological effect, that is, limiting our bodies (and our hearts) to only those "similarly afflicted"?

I'll tell you where I stand. Any practice that a) promotes HIV disclosure to partners, and b) reduces the chance of infecting an HIV-negative person, is fine by me. Yes, people lie. But as a general practice I believe it is solid risk reduction.

Sign up for Mark's blog.


Source - The Body.com

Test It, Check It, and Do the Terry Twist

Play Hard and Play Safe is the M.O. at Steamworks - a bathhouse chain with a branch right here in Sweeeeet Home Chicago. Playing Hard is a given - and as for Safe...

You can interact with outreach workers from 5 different local organizations AND get that HIV status updated with a rapid HIV test - or get screened for sexually transmitted diseases - 6 sexy nights of the week. See the schedule below.

You might also want to check out Mr. Sexx on Fridays - who sets up shop and offers one-on-one completely confidential counseling - for whatever you want/need to talk about, from 7p - 10p.


Tuesdays 4p-7p 
HIV/STD Screening and treatment open to the public and members provided by Howard Brown

Tuesdays 7p-10p 
Oraquick HIV Rapid Testing, STD and Hep C screening from BEHIV for members

Wednesdays and Sundays 3:30-6:30p
Outreach and Oraquick HIV Rapid Testing from CALOR for members

Thursdays 8p-11pm 
Outreach and Oraquick HIV Rapid Testing from Howard Brown for members

Fridays 7p-10p 
Mr. Sexx offers one-on-one confidential counseling for members PLUS Outreach and HIV Rapid Testing provided by TPAN

Fridays 10p-1a 
Outreach and Oraquick HIV Rapid Testing from CALOR for members

Saturdays 10p-2a
Outreach and Oraquick HIV Rapid Testing provided by Chicago House for members

Gay men often not accessing PEP despite risk of HIV exposure

via Aidsmap

Gay men may not be accessing HIV post-exposure prophylaxis in situations when its use would be warranted, a study published in the online edition of Sexually Transmitted Infections suggests.

Investigators in Brighton conducted interviews with 15 gay men who were currently taking, or had recently completed, a course of post-exposure prophylaxis after unprotected anal intercourse. They found that prior to accessing this treatment, the men generally had a poor understanding of what post-exposure prophylaxis involved.

The investigators also found that although the men described the sexual encounter leading to the accessing of post-exposure prophylaxis as unusual, they could almost all describe other circumstances where their risk behaviour was such that treatment with post-exposure prophylaxis would have been warranted. Furthermore, the interviews suggested that the men attempted to distance themselves from their risk behaviour, attributing it to the use of drugs and alcohol or in some way blaming their sexual partner.

Post-exposure prophylaxis (a short course of treatment with antiretroviral drugs after possible exposure to HIV) is becoming increasing available for individuals reporting sexual risk behaviour. The number of gay men presenting for such treatment has increased following targeted advertising campaigns and the publication of professional guidelines.

There is robust evidence that post-exposure prophylaxis can prevent infection with HIV. But there have been reports of HIV infection despite its use following possible sexual exposure to the virus. In many instances these infections can be attributed to ongoing sexual risk behaviour.

Investigators wished to gain a better understanding of the factors and rationale leading gay men to access post exposure prophylaxis. They were hopeful that the results of their study could lead to the development of health promotion campaigns targeting men who are not accessing this treatment after possible exposure to HIV.

Read the whole Aidsmap article.

Learn more about PEP availability in Chicago.

NYC Bathhouses: Safe Sex Allowed

"Being able to do this type of work in venues where people are
actually congregating is invaluable."

New York City's Prevention Planning Group endorsed changes to a state code that regulates sex clubs and bathhouses that would allow sex with condoms in those businesses and said that such businesses are "important sites for HIV/STD/harm reduction interventions."

With 29 members in favor, none opposed, and two abstaining, the 50-member group, which advises the city on HIV prevention initiatives, backed a proposal from the Commercial Sex Venues Coalition that wants to change the 1985 code from its current ban in businesses on oral, anal and vaginal sex, with or without a condom, to prohibitions that are "directed specifically towards unprotected sexual activity," a coalition briefing paper said.

Read the rest in Gay City News.

Releasing the Pressure at Steamworks with a Little Feast of Foolery

Last Friday your favorite podcast and LifeLube's - The Feast of Fools, moved their mixing boards and microphones to Chicago’s stylish place where men workout, relax and play - Steamworks - and taped a live show in front of dozens of men in their towels and other dedicated male listeners and pre-op trannie friends. Guests included adult film star Vinnie D’Angelo, Sal-E, LifeLube's Jim Pickett (telling tall New Delhi tales and pushing, as usual, rectal microbicide research news), Teri Yaki and Tracy Tyler.

It was a blast!

Click here to read more, and listen to the podcast.

Straight Guy Goes to a Bathhouse, Hilarity and Fear Ensue

NYC Dept of Health - ??? on Bathhouse Policy

More on the NYC bathhouse - do we hold 'em, do we fold 'em story... from Gay City News

After meeting with senior city health department officials, gay and AIDS groups are saying that the agency appears to be open to regulating sex clubs and bathhouses and has not decided to shut those businesses down.

"They were saying that they were entertaining everything, that they were looking for a direction," said Terry Evans, public health outreach coordinator at the Positive Health Project, an AIDS group. "They were very open to our suggestions and to having additional meetings."

Evans and representatives from five AIDS, gay, and research organizations met for nearly two hours with health department officials, including Dr. Isaac B. Weisfuse, deputy commissioner for disease control, and Dr. Thomas Farley, a special advisor to Dr. Thomas R. Frieden, the city's health commissioner, on February 12.

Read the rest.

UCSF Bathhouse Experts Clock NYC Commish in Open Letter

Remember, you read it on LifeLube!


Read the full text of this open letter below, from two researchers at the University of California San Francisco's Center for AIDS Prevention Studies to NYC Health Commissioner Frieden (r) regarding his hardline, and misguided, misinformed, approach to bathhouses.



January 16, 2008

Thomas Frieden, MD MPH
Commissioner
Department of Health and Mental Hygiene
New York City

RE: Policy Regarding Bathhouses and Other Commercial Sex Venues in New York City

Dear Commissioner Frieden:

In the last week we received several emails concerning a story in Gay City News related to a report addressing public health policy in bathhouses and other venues. As two researchers published in this area and cited in the report, we have a responsibility to comment. Because the overall thrust of literature does not support the conclusions drawn in the report, we write this open letter to correct any misperceptions the public may have acquired from reading the report and to ensure that your department has the opportunity to formulate policy decisions based on the available data.

The report’s summary of the literature was often incomplete. For example, it is technically correct to say, “Bathhouses attract high-risk clients” [1]. But because most people are unfamiliar with these environments, it easily creates a misperception equivalent to saying, “bars attract alcoholics.” The available data consistently show that the typical bathhouse client does not have unprotected anal sex at the bathhouse [1-7]. Most importantly, men at high-risk go to many venues for sex [1] and their high-risk behavior is most likely to occur at home [7]. Further, it is a small minority of men who engage in high-risk sex at the bathhouse; while the majority of men engage in behaviors that promote a social norm of safer sex.

The report cited published statistics but did not present the overall findings from cited studies. For example, the report cited two statistics from our bathhouse exit survey [7]. By saying that 11% of the men report unprotected anal sex and that the average number of partners at the bathhouse was 3.2, the report implied that there was a much greater level of risk-taking among bathhouse clients during a visit than the study data revealed. The report did not mention, as we discussed in the paper, that the 11% may overestimate the true rate of risk for HIVtransmission. Further, we stated in the sentence that presented the mean of 3.2 (as well as the median, 3.0, mode, 1.0, and range, 1-30), the figure represented only men who had oral or anal sexual partners. By excluding men who had zero partners (10%) and not mentioning that the majority (56%) of men did not engage in anal sex at all, the report significantly misrepresented the number of partners men had at the bathhouse and the overall risk that occurs there.

The report mentioned that “public health officials have been concerned that gay bathhouses and other commercial sex venues may facilitate spread of the infection.” Although a link can be established between men who frequent bathhouses and infection with sexually transmitted diseases, it is only a link, not a cause, because men who are likely to have an STD are likely to have to any number of places where men meet for sex [1]. Our exit survey data demonstrate how this might work: many of the men who reported unprotected anal sex during the previous 3 months did not engage in the behavior during the visit and men who engaged in unprotected anal sex did so wherever they had sex [7]. This finding was corroborated in a mathematical modeling analysis using population-based data from the Urban Men's Health Study that included four U.S. cities (New York, Chicago, Los Angeles and San Francisco), which showed that anal intercourse in bathhouses was more likely to involve a condom than the same behavior in other settings [8]. These results suggest that bathhouses, particularly those that promote consistent condom use, actually facilitate risk reduction. Regardless of local health policy, all bathhouses in the U.S. provide condoms [9, 10], thereby reinforcing condom use as a social norm.

Finally, the options for remedy presented in the report included only policies that generate antagonistic relations between health departments and owners with threats to close businesses that fail to control their clients' sexual behavior. The report did not include policies based on collaborative approaches in evidence across the country. Although the report stated that policy studies could not be found, such studies are available [11-18]. Using data from the Urban Men's Health Study, an analysis of local policy differences across New York, Chicago, Los Angeles and San Francisco suggested that policies made no difference in overall risk behavior, though they may have moved risk behavior elsewhere [15]. Moreover, published studies show that bathhouse may increase condom use [8] and that a collaborative relationship between a health department and a bathhouse resulted in an on-site HIV testing program that reduced risk behavior among testers [16-18].Scientific studies consistently conclude that bathhouses can be used to reach the small segment of the population responsible for transmission or at risk for becoming infected [1-8], and that over-regulating or closing bathhouse moves the behavior to other sex venues [15, 19]. But compared to other sex venues like parks and private sex parties (easily created over the internet in minutes), bathhouses and sex clubs are the most stable and secure locations where men go to meet for sex. A public health department, working with bathhouse management, can target at-risk men with interventions to help prevent the spread of infection, not just at the bathhouse, but whenever and wherever men have sex. Based on our data on policies in 12 health jurisdictions across the country,we draw two conclusions: 1) regulations limit prevention opportunities as they tend to generate antagonistic relations among stakeholder (i.e., health officials, club managers, prevention providers,and clients); and 2) policies that facilitate collaborative relations among stakeholder expand prevention opportunities, some of which have been demonstrated to reach at-risk men with prevention materials and interventions [9, 10, 16-18].

We wish you well in your efforts to tackle this complex situation and hope our response to the report will contribute to your department's policy review.

Sincerely,

William J. Woods, PhD
Associate Professor
Department of Medicine

Diane Binson, PhD
Associate Professor
Department of Medicine

Read more bathhouse posts on LifeLube.

For the endnotes from the above letter, send us an email.

Experts Back Bathhouse Regulation

By: DUNCAN OSBORNE in Gay City News

01/17/2008

Researchers and health policy experts are generally supporting the regulation of New York City sex clubs and bathhouses, saying the businesses are valuable for research, HIV testing, and prevention efforts.

"We have to up to 26 percent of non-gay identified people that we are testing," said Dr. Demetre C. Daskalakis, a professor at New York University's School of Medicine. "A lot of them don't know where to go to get healthcare."

Since 2006, Daskalakis has been conducting research funded by Bellevue Hospital in two of the city's bathhouses - the East Side Club and the West Side Club, both in Manhattan.

Daskalakis has tested roughly 1,000 men who have sex with men for HIV, screened some for sexually transmitted diseases, and referred men to health providers including Bellevue. What began as research has effectively become an ongoing clinic with these services available in both bathhouses for a total of 35 hours a week.

Read the rest.

Read more LifeLube posts on bathhouses.

City Will Move to Shutter Bathhouses

another chapter in the nyc batthouse drama...

by Duncan Osborne for Gay City News 01/10/2008

Even as the city health department maintains it has not decided whether it will regulate the city's sex clubs and bathhouses, continue its current policy of aggressively inspecting these businesses, or try to close them all down, a senior department staffer said the agency's goal is to shut them down.

"They are very much looking at this from a medical model and the medical model says shut them down," said Joshua Volle at a January 7 meeting of AIDS and gay groups at the Lesbian, Gay, Bisexual and Transgender (LGBT) Community Center. "They don't have the resources to do it, but their intent is to shut them down... These are my words, they are on a witch hunt."

With his last day at the city's health department coming on January 11, Volle, the director of community HIV prevention planning and programs, was more blunt than a city employee might normally be.

Read the rest on Gay City News.

Wash your mouth out with soap!

Here's to illuminating strategies to protect ourselves and the ones we love and lust for...

When “pulling apart” is said in the context of male-male sex, what I hear is
“segregate and stigmatize.”

by Mark Hubbard - only on LifeLube

[Mark Hubbard, aka middle - pictured below right - is a community organizer, educator, and activist in Nashville, Tennessee. He gleefully reports that he met his husband 18 months ago on a popular hook-up website]

In the weeks leading up to the recent U.S. National HIV Prevention Conference, I listened in on a sort of “think tank” call held by a favorite advocacy group. The focus was analysis of sexual networks to help identify new types of HIV prevention structural interventions.

I’m onboard with the idea that such research could lead to a new category of intervention. My experience resonates with the description of certain MSM sexual networks that mix “low risk” individuals and “high risk” individuals.

But when I flipped to a slide indicating one idea was to “develop interventions to reduce disassortive mixing,” my activist mind went on red alert. When it was stated that a guiding principle of a network intervention could be “pulling apart” "high-risk" and "low-risk" individuals, I got riled.

When “pulling apart” is said in the context of male-male sex, what I hear is “segregate and stigmatize.” My mind reels with the image of Jerry Falwell aiming a garden hose at two men caught in the act. The phrase brings to mind religious fundamentalists, moralizing politicians, homophobes, promoters of stigma, and other sex-negative pundits. You know – all those who make it their business to “pull us apart.”

I know I was not in the presence of the enemy. I assume that the people involved have excellent credentials, are are very intelligient, dedicated to the cause, and honestly want to help. In their defense, human rights and maintaining freedom of choice were also listed as guiding principles.

Yet as an experienced, long time poz treatment activist, I believe this group of motivated and caring people needs a reality check. Language matters, sensitivity matters, and I think others will react similarly.

Beyond the language issue, I’m dubious about practical applications. Of the three examples presented to illustrate the concept, two were utterly unconvincing.

The first was the existence of two bathhouses in a city where only one (supposedly) enforces a ‘no unprotected sex’ policy. Another caller asked how such a policy is enforced - but forget that. The assertion that “high risk” gay men will be drawn to a “high risk” bathhouse and vice versa demonstrates a serious lack of understanding about how the culture works.

The second example was a similar comparison of a bareback and safe sex focused websites. Naive. As someone who’s spent serious time on such sites, I’d love to say I’ve found a reasonably populated safe sex website. Newsflash: one doesn’t exist.

Finally, the focus fell on a very popular hook-up site where users can indicate aversions to specific kinds of risk and clearly identify what they believe is their HIV status.

Terrific. I support that. It’s an opportunity for truth. It’s a stab at inoculating against denial. But it’s not “pulling apart.” It’s not even “reducing disassortive mixing.” It does relate to another stated guiding principle - “help individuals make more informed choices.”

Right on. Let’s call it “illuminating.”

If we want to intervene in a network that has high and low risk members, let’s shed light on the reality of the network without shaming anyone involved, support open discussion about the real ways we meet and interact, and do what we can to focus on wellness in the context of choices made.

So, here’s to 2008.

Here’s to taking care with language.

Here’s to participatory research.

And here’s to illuminating.

il·lu·mi·nate /v. ɪˈluməˌneɪt; [v. i-loo-muh-neyt] –verb (used with object)

1.	to supply or brighten with light; light up.

2.	to make lucid or clear; throw light on (a subject).

3.	to decorate with lights, as in celebration.

4.	to enlighten, as with knowledge.

What do you think?

Happy Town: I Met Angel in a Bathhouse in Bilbao

By Jim Pickett, originally published in Positively Aware, May/June 2005



We thought it was appropriate to resurrect this item from the archives today, what with the memo from the NYC Department of Health...

Let's not throw
the fairy out with
the bathhouse water.

I slipped away from a group with whom I was traveling through Spain several years ago, caught a taxi in front of my hotel after a noshie dinner of tapas and Rioja, and had the driver drop me at the so non-descript as to be practically invisible front entrance to Bilbao's bathhouse. After I paid the fare -- in pre-euro, pre-bad exchange rate pesetas -- I had a fleeting panic attack, thinking I had somehow gotten the address wrong in my previous night's club crawling/info gathering excursions around the city. But, wait, there was the address I was looking for, there was the buzzer and sure enough, it worked, someone let me in, and yep, yep, yep, this was a bathhouse alright.

I can't remember the name of the place -- so let's just call it Happy Town.

This was my second bathhouse in Spain. I had managed a brief escape from museums and straight people in Barcelona several days prior and thoroughly enjoyed one of the many spas -- and one of the many gorgeous men (this one no doubt married with children) -- in my favorite city before an evening group tour through one of Gaudi's masterpiece buildings, La Pedrera on the Passeig de Gracia.

So ... checking into Happy Town, they ask me my shoe size. "Just what are you trying to find out kind sir?" I think to myself in mangled Spanish, batting my eyes. You know what they say about big hands, right? Big gloves. But the question isn't some kind of weird come-on, it's so you can tip around in a pair of appropriately-sized flip flops and protect your tootsies from icky foot fungals. There are no private rooms to rent, just lockers so I get a key to one of those. I strip down to towel and flip flops and clip clop all about, getting a lay of the land, so to speak.

There's a dry sauna, steam room, and plenty of rooms with doors that don't lock but which you can move into with a willing romantic interest for a minute or more. There is a very social lounge area with a bar where you can order a beer and a grilled cheese while watching bad game shows on the television and chit chatting with the bartender in mangled Spanish. "There sure are a lot of X's and K's in the Basque language," you say. "¿Que?" he says. Everything is clean, well-lit, and there are a number of men -- varying degrees of hotness on the prowl.

I'm in the steam room in my flip flops. My towel is on a hook outside, so you know this Yanqui is tryin' to get busy. Okay? And I "meet" Angel. We reach for each other and start fooling around in the very, very, hot steam. To avoid heart failure, we move the action into the showers, and then continue in one of the rooms. We do everything, all very natural, uninhibited and sexy and fun. Preservativos (condoms) are unrolled when required. And after a lot of moans and a few shouts/grunts/howls in neither English or Spanish, we've completed Act One.

Instead of smiling and nodding -- "Don't let the door hit ya on the way out" -- we introduce ourselves. "Hi, I'm Jim. And you are?" And we end up talking and laughing, and Angel offers to buy me a beer in the lounge. His English is much better than my Spanish, but his Basque accent is pretty heavy, so this communication stuff is a challenge. We're both up for it. We mostly just look at each other and laugh. Everything is funny -- he has a joie de vivre that is, for lack of a better word, contagious.

Our towels start to tent up again (oh my!) so we retire to a different room from Act One and commence Act Two. The whole process is repeated for an Act Three and Four, with side trips to the steam, sauna and showers. Lot's of flip flopping. This is really a blast.

Finally, we have wrung as much pleasure either of our bodies can produce, and an early morning agenda is looming, so Angel offers to give me a lift back to my hotel. We exchange contact info and kiss each other goodbye.

We stay in touch, remember each other's birthdays, call on holidays and make plans to meet. Approximately a year after our Happy Town hook up, we meet in Madrid, hang out for a day there, and spend almost a week together at his home in Aretxapuleta, just south of San Sebastian. We sort of fooled around once and that was it. Clearly we had sort of moved into a more platonic -- but very affectionate -- friendship. We hung out with his sister and her boyfriend, did the tapas bars in San Sebastian, drove around in the mountains, spent a day at a "legit" spa on the North Atlantic that was just incredible, went to the movies, and ate incredible meals in restaurants and in his home.

I would never have made this great friend, and never would have been exposed to all the things he taught me and shared with me about his life and his country, had we not gotten down, and up and down and up and down, at a bathhouse. That's where we met, that's how we began to communicate, that's how we bonded. How frickin' gay is that?

With crystal mania overtaking us, and hysteria shouting from the pages of the mainstream and gay press, screeching and finger waggling about gay men's supposedly increased risky sexual practices. Can you say demonization? Scapegoat? Wanton hedonist? Yet another backlash is upon us, both from outside our community and more scary, from within. I am hearing "close the bathhouses" once again, from within, and I am hearing lots of fear and judgment, and ya know what, it makes me sad, makes me hurt deep in my soul. Gay men need to embrace and be proud of our articulate, creative and responsible sexuality that is a joyous and magnificent part of gay culture. Our gay sexuality is a gift we have shared with the broader society and with which we have had great, positive influence. Our gay sexuality is something of which we should be proud and protect and nourish.

As a positive man, I made sure to protect Angel and myself as we explored every nook of each other's bodies. As a negative man, he did likewise. The guys getting wasted and taking the loads of hundreds of anonymous partners notwithstanding, most of us in fact practice our sexuality in a much more responsible, thoughtful, compassionate and yes, loving manner. We ain't always perfect, and we could always improve. That's where the vast majority of us are -- trying to do our best as we navigate our sexuality through turbulent times. As we try to engage the small minority of men creating some pretty big problems for themselves and our community, as we try to support their movement on the continuum to healthier behaviors, let's not diminish or demean an integral part of our gay culture and our humanity.


POST SCRIPT:

In March of 2006, I attended Angel's wedding in Aretxabaleta, Spain. He married the man of his dreams, Javi, in the town's courthouse. The wedding was presided over by the town's Mayor. When we all came out from the ceremony, tears streaming down our faces, the ENTIRE TOWN was in the square singing, dancing, setting off fireworks and shooting confetti. The trick Angel met at a bathhouse - me - was treated like family by everyone, and included in everything. I stayed at their house before, during and after, and as the only foreigner, was given the best room. - jp

Examining Bathhouse Policy, NYC Says HIV Infections Up - and Points the Finger

Health dept. memo suggests sex clubs could be closed with circumstantial evidence

After saying for years that new HIV infections among gay and bisexual men are high, but stable, a city health department memo given to Gay City News is asserting that new HIV infections among those men are increasing.

"New York City is now experiencing an increase in syphilis and an increase in HIV infection in men who have sex with men," Dr. Thomas Farley, a special advisor to Dr. Thomas R. Frieden, the city's health commissioner, wrote in the November 2007 memo.

The six-page memo, titled "Policy Regarding Bathhouses and Other Commercial Sex Venues in New York City,"was drafted for Frieden and explores the options for dealing with sex clubs and bathhouses.

Read the rest in Gay City News.

Read Joe.My.God's post titled "NYC Mulls Closing Bathhouses, Sex Clubs."

This is an unfortunately hard line approach. What do you think? Would you want to see bathhouses shut down in your city?

California study contests belief that saunas facilitate HIV transmission

“...most men at the bathhouse did not engage in risk behaviour anywhere at all – not at the bathhouse, not at other sex settings, and not in private settings such as a home or hotel...Surprisingly, a number of men who reported recent high-risk behaviour in other settings actually reported safer sex during their current bathhouse visit. These study results contradict the assertion that the bathhouse facilitates large-scale high-risk sex."

Edwin J. Bernard, for aidsmap

Most gay and bisexual men do not engage in high-risk HIV transmission behaviour in saunas or bathhouses according to a study from the University of California, San Francisco published in the June 1st edition of the Journal of Acquired Immune Deficiency Syndromes. The study’s results – which found that some men who reported recent high-risk behaviour in other settings actually had safer sex at the sauna – contest the long-held belief that saunas facilitate HIV transmission on a large scale.

It has been a long-held assumption that saunas (known in the United States as bathhouses) facilitate high-risk sex amongst gay and bisexual men. Although previous studies have suggested that saunas attract men who visit a variety of public sex environments, a recent study from Australia suggested that there are different kinds of risk attached to particular types of public sex venues, and that men who had sex in the backroom of a bar or club were nine times more likely than men who had sex in saunas to have unprotected anal intercourse (UAI).

Investigators from the Center for AIDS Prevention Studies, at the University of California, San Francisco used a rigorous probability sampling method to ascertain for the first time men’s HIV risk behaviour while at the sauna, compared with their HIV risk behaviour elsewhere in the three months before their sauna visit.

The study was conducted in the last five weeks of 2001 in what the investigators describe as a “typical North American gay bathhouse”. The participants were a sample of men who were chosen at random on their way out of the sauna. Their responses were weighted to make sure these men were as representative as possible of the entire sauna-visiting population. Participation was voluntary, anonymous, and reimbursed.

Almost one in twelve of the 440 respondents reported that they did not have any sex (i.e. anal or oral sex) during the visit, and the rest (91.5%) reported that they engaged in oral sex during their visit. A total of 44% reported anal sex: 33% had protected anal sex only, and 11% reported UAI. Of these 44%, more men reported having insertive anal sex (29% protected only and 7% unprotected at least once) rather than receptive anal sex (14% protected only and 5.5% unprotected at least once). Among the 158 men who engaged in insertive anal sex, one in five reported doing so without a condom at least once. Among the 85 men who engaged in receptive anal sex, 28% did so without a condom at least once. Just over half (52%) of the 24 men who had receptive UAI were HIV-positive, whereas fewer than one in three (29%) of the 31 men who had insertive UAI were HIV-positive.

In contrast, more than one in four of the 440 men (27.5%) reported having UAI in the three months before their sauna visit. Almost twice as many men reported having had UAI in private than in public (21.5% versus 12.5%; p <> Of the men who engaged in UAI in the previous three months, a quarter (24%) also engaged in UAI during their visit to the sauna, whereas only 5% of the men who did not engage in UAI in the previous three months engaged in UAI during their visit to the sauna (p <>

Of the 403 men who reported oral or anal sex at the sauna, men who reported UAI in private or in public in the past three months, and men had been to a sauna in the past year, were more likely to report UAI during the current visit.

The investigators note that “most men at the bathhouse did not engage in risk behaviour anywhere at all – not at the bathhouse, not at other sex settings, and not in private settings such as a home or hotel...Surprisingly, a number of men who reported recent high-risk behaviour in other settings actually reported safer sex during their current bathhouse visit. These study results contradict the assertion that the bathhouse facilitates large-scale high-risk sex.”

They argue that, “the vast majority of the sexual activity that occurred in the setting would not contribute to HIV transmission, even though some men at the bathhouse persist in risk behaviour not only at the bathhouse but in private and other public settings.”

Pointing out that “men who engaged in UAI tended to do so wherever they had sex,” they conclude that saunas are “a point of access to reach these men with appropriate intervention” and that “public health has the opportunity to design innovative prevention interventions that men can take with them and that target reducing their risk behaviour not only at the bathhouse but wherever they have sex.”

See the article on the aidsmap site here.

Reference Woods WJ et al. Probability sample estimates of bathhouse sexual risk behavior. Journal of Acquired Immune

Do Public Sex Play Spaces Make Public Health Sense?

via guest LifeLube blogger Mark Hubbard de Nashville

They have lots of names: Bath houses. Sex clubs. Back rooms or dark rooms. Regardless, it seems like every so often this question is raised. Most recently, it was asked on a gay men’s health email group.

Each question on the subject leads to another. Will closing a sex play space improve the overall health of the community? Do guys engage in behavior in these spaces that they don’t, can’t, or wouldn’t elsewhere? Is the likelihood of someone having multiple risky exposures greater in these spaces? (more bluntly put, do more people take multiple loads anally in these spaces?) Does this result in higher “disease burden” for the community?

I can’t answer these questions in a scientific way. I suspect that doing valid research on this subject would be difficult, expensive, and controversial. One list member indicated that such a project is underway, and I’d be very interested in the results.

Meanwhile, I wanted to describe what it’s like when there are no "public" sex play places legitimately allowed.

I live in Tennessee, where there hasn’t been a legal bathhouse since the very early 80's. What we do have are boothstores, private parties, and the net (sites, chats, and groups, etc.) Over the last few years one of the private parties in Nashville rose to the level of being a de facto bath house [complete with lockers, an orgy room, multiple big screen videos, open bars and other party supplies, a huge pool, and more.]

Boothstores go through cycles of being more or less vigilant about rules, but sexual activity is always a reality. Condoms and lube must be purchased which may arouse suspicion from staff. Recent legislation and enforcement crackdowns have reduced the number of these venues.

Although the hosts of the mentioned "pseudo-bathhouse" always provided condoms and lube, and while its rules poster encouraged people to "take responsibility for their own health and protection," the only real safety message in the space was about using Viagra and poppers. Significant opportunities to engage the clientele onsite did not realistically exist.

At least in this region, those who are cruising online certainly create opportunities for themselves to bottom multiple times in a night. In addition to using the above venues, they do it by organizing parties of various sizes in their own homes or hotels. They do it at regularly scheduled events organized via yahoo groups and the like. They do it by renting cheap motel rooms close to the interstate, logging on, and asking for what they want.

My feeling is that it would always be preferable to nurture collaboration between the venue and authorities. What comes to mind are basic things like making lube and condoms easily accessible, providing a minimum amount of lighting and resources for cleanup, and providing access for outreach and education efforts.

I also have friends who live in Atlanta that I've regularly visited over the years. There was no bathhouse nearly a decade. While that may have had a temporary effect in reducing exposures, what eventually happened was that parties of the type I’ve discussing emerged (with and without the use of the internet) and some evolved into semi-permanent underground sex clubs. These often are completely unlicensed firetraps, discourage discussion of self-care, make access to condoms and lube difficult if not impossible, and barely have enough bathroom capacity (forget about showers).

No, I don’t have supporting data, but I have always believed that having a regulated, legal public sex venue in my community would reduce harm.

mark

Mark Hubbard, Nashville

Photos in this post are from the site Bathhouse Addict

"Your online guide to bathhouses & other sexy places."