Facilities and HIV prevention in bathhouse and sex club environments

This project evaluated the extent to which businesses with a primary purpose of providing opportunities for sexual encounters between men (e.g., bathhouses and sex clubs) have implemented strategies that target their customers with important HIV and STD prevention messages. Between October 1996 and February 1997, we conducted structured telephone interviews with 63 businesses throughout the United States in order to describe their facilities and their HIV education and prevention efforts. Types of facilities offered were related to what businesses called themselves and the kinds of sex space they provided. All of the businesses reported that they provided condoms and lubricant on site; 95% provided educational materials such as posters and flyers about HIV/AIDS; and 40% provided HIV testing on site, with half of these also providing some type of STD testing. Although some level of HIV prevention and educational efforts by these businesses are described, further investigation into their efficacy is required.     

“Knowing Your Status and Knowing Your Partner’s Status Is Really Where It Starts”: A Qualitative Exploration of the Process by Which a Sexual Partner’s HIV Status Can Influence Sexual Decision Making

Gay and bisexual men are at disproportionate risk for human immunodeficiency virus (HIV) infection. While prevention efforts often emphasize consistent condom use, there is growing evidence that men are using seroadaptive safer-sex strategies, such as serosorting and seropositioning. This qualitative analysis of 204 HIV-negative and HIV-positive gay and bisexual men explored the ways that a sexual partner’s HIV status can influence safer-sex strategies and sexual decisions. The majority of the respondents reported that they were influenced by their partners’ HIV status. Those respondents who reported no influence discussed adhering to safer-sex rules that were not dependent on partner status and a lack of concern about HIV. Conversely, respondents who reported influence identified three primary areas of influence: psychological impacts, partner preference and selection, and specific behavioral intentions and strategies. A conceptual model explicating a potential process by which respondents use partner serostatus information in shaping sexual decisions is presented.     

Public health policy and gay bathhouses

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.     

HIV Transmission Risk at a Gay Bathhouse

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.     

A theoretical approach to bathhouse environments

HIV prevention guidelines have aimed primarily at the individual level, although recently the field of public health has begun to focus more on structural level interventions. This paper explores an application of Rudolf Moos' person-environment theory as one model that helps to provide an understanding of the dynamic relationship between bathhouse patrons and the environment within which they engage in sexual activities. Understanding how different dimensions of the environment affect behavior could be instrumental in revealing not just that a bathhouse intervention works, but how it works. Knowing more about how an intervention works would facilitate its application in other settings.     

The reflection of desire for revenge and revenge fantasies in drawings and narratives of sexually abused children

Whereas the desire for revenge for an unjust deed is considered natural, its use within the therapeutic setting is scarce, specifically in sexually victimized children. The study aimed to find how experiencing sexual molestation during childhood and the revenge fantasy is reflected in drawings and narratives of sexually victimized children. Following ethical approval and signing a consent form, 14 children who experienced sexual abuse and were psychologically treated (ages 11–18) were recruited. They were asked to draw two drawings: “draw an unjust event that had happened to you” and “draw what you would have liked to happen to the person that unjustly treated you.” At completion, participants were asked to give a narrative to each drawing. Phenomenological analysis of the drawings and narratives indicated that most participants refrained from using more than two colours, did not draw the perpetrator and drew schematic figures. The main themes that emerged in the drawings and the narratives were feeling of loneliness, aloneness, and the desire for role reversal.