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Differential HIV Risk in Bathhouses and Public Cruising Areas

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Differential HIV Risk in Bathhouses and Public Cruising Areas RESEARCH Differential HIV Risk in Bathhouses and Public Cruising Areas | Diane Binson, PhD, William J. Woods, PhD, Lance Pollack, PhD, Jay Paul, PhD, Ron Stall, PhD, MPH, and Joseph A. Catania, PhD 1 Since Humphreys’ groundbreaking study of Objectives. This report investigates differences in risk behaviors among men who have sex with men sex between men in “tearooms” (public rest- (MSM) who went to gay bathhouses, public cruising areas, or both. rooms with a reputation as a place where ho- Methods. We used a probability sample of MSM residing in 4 US cities (n=2881). mosexual encounters occur), social scientists Results. Men who used party drugs and had unprotected anal intercourse with nonprimary partners have investigated the environments outside the home where men who have sex with were more likely to go to sex venues than men who did not.Among attendees, MSM who went to pub- men (MSM) meet other MSM for casual, usu- lic cruising areas only were least likely, and those who went to both public cruising areas and bathhouses ally anonymous, sex. The variety of settings were most likely to report risky sex in public settings. is large, but they generally allow participants Conclusions. Distinguishing between sex venues previously treated as a single construct revealed a to secure a minimum of privacy, at least in significant association between pattern of venue use and sexual risk. Targeting HIV prevention in the terms of not being harassed or interrupted.2 bathhouses would reach the segment of men at greatest risk for HIV transmission. (Am J Public Health. Some of the venues are purely public spaces 2001;91:1482–1486) (e.g., parks, beaches, alleys, and toilets), and some are commercial environments that can also serve as sex venues (e.g., adult book- were more likely to report engaging in risk multiple data sources to identify geographic stores, pornographic movie houses, back behavior than men who did not go to these areas in New York, Chicago, Los Angeles, and rooms of bars, and traditional Turkish or venues. Curiously, none of these studies in- San Francisco that reflected residential clus- Japanese bathhouses). The general purpose vestigated differences in levels of risk be- tering of MSM populations.22 Using dispro- of all these venues is (or purports to be) tween the different types of sex venues (e.g., portionate and adaptive sampling techniques, something other than providing opportunities public cruising areas vs baths) or differences we then constructed a random-digit-dialed for sex. Consequently, MSM who frequent between men who visited only 1 type of sample for the designated target areas within these venues share them with people who venue vs those who went to several types. each city.23,24 With computer-assisted tele- are not seeking sexual encounters on the Given earlier ethnographic research in sex phone interviewing, we conducted 2881 in- premises, and MSM take certain risks in look- venues, one might expect sexual behavior terviews with MSMs in English or Spanish ing for sexual encounters, including risk of across venues to vary.1,15–19 However, no sys- (average time=75 minutes), achieving a com- discovery, physical harm, or arrest. Certain tematic risk behavior assessments across dif- pletion rate of 78%. We developed sample other commercial venues exist primarily to ferent types of venues have been conducted weights to reflect probability of selection, provide an opportunity for MSM to have sex either before or since the onset of the HIV nonresponse, and noncoverage, while main- with other MSM. These are usually called epidemic. taining proportionality between cities based gay bathhouses (or baths), although they go Using data from a probability sample of on the estimated size of each city’s MSM pop- by other names (e.g., sex clubs, tubs, saunas, urban MSM, the present analysis describes ulation. All data in this report are weighted. and health clubs).3 Generally speaking, gay the characteristics of men according to their baths provide relative physical safety for pa- pattern of sex venue attendance: whether Measures trons (although police harassment of bath- they went only to public cruising areas, only Interviews covered a range of social, psy- house and sex club patrons occurs, it has to baths, or to both public cruising areas chologic, and health-related topics, with an been relatively rare).2,4 and baths. emphasis on HIV-related issues. HIV status Because the association between HIV and was self-reported. Respondents were asked a baths was identified early in the epidemic,5–11 METHODS series of questions related to frequenting spe- investigators have given considerable atten- cific sex venues in the past 12 months. First, tion to sex venues generally. Their studies Sample men were asked how often they went to “a were of 2 types: men leaving a selected The data are from the Urban Men’s Health sex club or bathhouse,” then how often they venue (e.g., tearooms12 ) were surveyed about Study, a telephone survey based on a proba- went to “a public cruising area,” such as a their recent sexual risk behaviors, or samples bility sample of men 18 years or older who park, beach, tearoom, or bookstore. They also of gay men were asked both about their sex- self-identified as gay or bisexual or who re- were asked to describe their same-sex sexual ual risk behavior and whether they visited ported sexual contact with a man since 14 practices for the past 12 months, including any sex venue.13 ,14 Results suggested that HIV years of age. Detailed descriptions of the number of partners, number of “one-night risk behavior occurred in all types of sex ven- methods for this study are provided else- stands,” whether they engaged in unprotected ues and that men who went to these venues where.20,21 Briefly, the sample design used anal intercourse, and whether such inter- 1482 | Research Articles | Peer Reviewed | Binson et al. American Journal of Public Health | September 2001, Vol 91, No. 9 RESEARCH course occurred in group or in public settings TABLE 1—Percentage of Men Who Have Sex With Men (MSM) Who Frequented Sex Venues or outside the confines of a primary relation- in the Last Year, by Demographic Characteristics, Drug Use, and Sexual Behavior: Urban ship. To control for a major cofactor of HIV Men’s Health Study, 1997 risk behavior, we included in this analysis usage of 4 drugs that tend to be associated MSM Who Frequent Sex Venues with casual sex: poppers (i.e., nitrites), ecstasy, n % (95% CI) methamphetamines, and other party drugs (such Total 2478 54.6 (52.0, 57.1) as ketamine and rohypnol). Age, y** 18–25 185 66.4 (57.7, 74.1) Statistical Analysis 26–35 1001 58.4 (54.2, 62.4) For the analyses in this report, the sample 36–45 786 51.6 (47.3, 56.0) was limited to men who reported having sex 46–55 336 51.0 (44.6, 57.2) with a man in the past year (n = 2478). Chi- ≥56 159 38.2 (29.6, 47.7) square tests were used to evaluate the associ- Education** ation between attending a sex venue (either High school 698 58.6 (54.0, 63.1) baths or public cruising areas) in the past 12 College 1152 56.4 (52.5, 60.2) months and various correlates, including de- Master’s/doctorate 622 46.6 (41.9, 51.4) mographic characteristics, HIV status, drug Race/ethnicity usage, and a gross index of HIV risk behav- White 1943 52.8 (49.9, 55.7) ior. Among men who did attend a sex venue African American 108 58.4 (47.6, 68.5) χ2 (n = 1331), tests were then employed to in- Latino 246 61.8 (53.8, 69.3) vestigate differences between “cruisers,” Asian/Pacific Islander 102 65.5 (52.8, 76.4) “bathers,” and “multivenue users” on indices Native American 60 54.8 (39.6, 69.1) and indicators of risk behavior. Finally, we Domestic partnership status** used logistic regression to examine the statis- Partnered 906 43.0 (38.6, 47.6) tical relationship between the 2 primary in- Single 1421 61.6 (58.6, 64.6) dependent variables (patterns of sex venue City of residence use cruisers, bathers, and multivenue San Francisco 554 53.2 (49.2, 57.2) users and frequency of attendance of sex New York 1104 56.5 (52.0, 60.9) venues) and unprotected anal intercourse in Los Angeles 612 53.0 (47.9, 58.0) a public setting, while controlling for the ef- Chicago 204 52.8 (46.5, 59.0) fects of drug use and serostatus. Venue, fre- Serostatus* quency of venue attendance, and their inter- HIV positive 402 61.8 (55.6, 67.6) action were entered in the equation first, HIV negative 1906 52.8 (49.9, 55.8) followed by frequency of drug use and HIV Used any of 4 party drugsa** serostatus. In the last step, all other 2-way in- Used drugs 771 72.1 (68.0, 75.9) teractions (except the venue-with-drug use in- Did not use drugs 1528 45.9 (42.8, 49.1) teraction, which would have resulted in an UAI with nonprimary partner** empty cell) were given the chance to enter Had UAI 608 76.3 (71.9, 80.2) the model via a backward stepwise proce- Did not have UAI 1824 47.8 (44.9, 50.8) dure. The final model achieved good fit as assessed by the Hosmer–Lemeshow good- Note. CI=confidence interval; UAI=unprotected anal intercourse. aPoppers, ecstasy, methamphetamines, and other party drugs such as ketamine and rohypnol.
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