HIV Transmission Risk at a Gay Bathhouse

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.

The procedures for involvement of human participants and their informed consent were reviewed and approved by the Committee for Human Research, University of California at San Francisco. Funds for the secondary analysis were from the National Institute of Mental Health (Grant R21 MH71155), and data collection was supported with funding from the California State Office of AIDS (Grant 00-91772) and the National Institute of Mental Health (Grant R01 MH61162). We acknowledge the venue's owners, managers, and staff, without whom conducting the survey would have been impossible. We thank the club customers, especially those who took the time to participate in the survey. The study could not have been successful without the exceptional efforts of Bob Siedle-Khan and Paul Cotten, who directed data collection, as well as their teams of survey recruiters and interviewers, who established rapport and collected the data in this fast-paced environment. Diane Binson and William J. Woods contributed significantly to the original study idea, implementation, and the concept of the analysis presented in this manuscript. Lance M. Pollack contributed to the concept and statistical procedures of the analyses. Johnny Blair contributed the sampling design for the original studies. All authors contributed by writing sections of the text.

Notes

Note. N = 758.

Note. CI = confidence interval; UAI = unprotected anal intercourse.

^a Non-positive = respondent did not test positive for HIV.

^b Obtained from negative binomial regression regressing number of partners on HIV serostatus.

^c Had oral or anal sex during visit to club.

^d Respondent gave oral sex to his partner.

^e Respondent received oral sex from his partner.

¹Other significant correlates included feeling the effects of any drugs (other than alcohol or marijuana) during the visit, having fewer sexual partners in the last three months (five or fewer vs. six or more), engaging in unprotected anal intercourse in the last three months, visiting other sex clubs or bathhouses in the past 12 months, having tested for a sexually transmitted disease in the past 12 months, and having a higher income (> $100,000 vs. < $40,000).