Differential HIV Risk in Bathhouses and Public Cruising Areas, Diane Binson et al., 91 American Journal of Public Health, 1482 (2001)

This report investigates differences in risk behaviors among men who have sex with men (MSM) who went to gay bathhouses, public cruising areas, or both. It finds that men who used party drugs and had unprotected anal intercourse with non-primary partners were more likely to go to sex venues than men who did not. Among attendees, MSM who went to public cruising areas only were least likely, and those who went to both public cruising areas and bathhouses were most likely, to report risky sex in public settings. The study concludes that distinguishing between sex venues previously treated as a single construct revealed a significant association between pattern of venue use and sexual risk. Targeting HIV prevention in the bathhouses would reach the segment of men at greatest risk for HIV transmission. This fact is particularly noteworthy, given that HIV prevention programs have not successfully reached men at highest risk for HIV transmission. Further, HIV interventions proximate to sexual activity probably have the best chance of being successful. Conducting HIV prevention in baths would reach bathers as well as the men who report the most risky behavior. The article also concludes that the challenge in the next generation of prevention efforts is to unravel the complex interaction between individual characteristics and the environment, including the physical structure of bathhouses. This article may be useful in considering the regularly revived call to shut down bathhouses to reduce the rate of HIV transmission among men who have sex with men.