HIV incidence estimates indicate that men who have sex with men (MSM) continue to have high rates of new HIV infections.1-4 These studies were based on MSM populations that access Sexually Transmitted Disease clinics, Anonymous HIV Testing Sites, and venue-based sites (bars, dance clubs, parks, and street-corners). However, there are no published studies that have estimated HIV incidence (or prevalence) among MSM populations that patronize bathhouses, despite the integral role they play in the sexual lives of some MSM. This is especially the case in Los Angeles County where approximately ten bathhouses (and sex clubs) currently operate.
The lack of information about HIV incidence and prevalence, risk behaviors, and psychosocial factors in bathhouse settings represents a critical gap in our understanding of the HIV epidemic as well as the specific prevention needs of this high-risk population. To close these gaps in knowledge, we conducted a study consisting of five research components: 1) formative research; 2) a prospective, record-based incidence study; 3) a laboratory-based incidence study using the Strategic Testing Algorithm for Recent HIV Seroconversion (STARHS); 4) a Supplemental Risk Behavior Questionnaire Survey; and 5) an Exit Survey.
The study was conducted in two phases. The objectives of the formative research were to:
- Guide the design and implementation of HIV counseling and testing program in bathhouses.
- Develop a risk factor questionnaire.
- Understand the unique population segments that may exist among bathhouse patrons.
The objectives of the epidemiologic study components were to:
- Develop standard methods for conducting HIV incidence studies in bathhouse settings.
- Estimate HIV incidence among patrons attending bathhouses who receive multiple HIV tests.
- Estimate HIV incidence among patrons attending bathhouses who accept HIV testing using STARHS testing methodology.
- Estimate prevalence of HIV, syphilis and hepatitis B among those bathhouse patrons who accept HIV testing.
- Describe HIV risk behaviors and psychosocial factors associated with a population of bathhouse attendees who seek anonymous HIV testing.
- Monitor trends in HIV incidence among patrons attending bathhouses.
- Monitor trends in HIV, syphilis and hepatitis B prevalence among patrons attending bathhouses.
- Monitor trends in HIV risk behaviors among patrons attending bathhouses.
- Describe HIV risk behaviors and psychosocial factors associated with recent HIV infection versus longstanding HIV infection versus no HIV infection among bathhouse attendees
The study was cross-sectional in design. We collected HIV prevalence and incidence data on 921 men who sought anonymous HIV testing, either by blood or oral mucosa. Demographic and risk behavior data for the prospective, record-based component was obtained by abstracting information for the State of California HIV Counseling and Testing (CT) Report Form database. CT program staff completed this mandatory risk assessment form on bathhouse patrons requesting anonymous testing services. In addition, because there was very little HIV risk behavior information currently available on MSM who frequent bathhouses, a supplemental risk assessment questionnaire was administered to all eligible, consenting participants. The questionnaire focused on identifying risk behaviors and psychosocial factors associated with HIV infection among bathhouse attendees.
Trista Bingham, Principal Investigator, 213-351-8175.
- Schwarcz S. Estimation of HIV incidence among anonymous testers using the 3A11DT dual test strategy: San Francisco, 1996-1997. Presented at the National HIV Incidence Studies Meeting, Prevention Services Research Branch, CDC, 1998.
- Valleroy L. A New Laboratory Method for HIV Incidence: Early Results From the Young Menís Survey. Presented at the National HIV Incidence Studies Meeting, Prevention Services Research Branch, CDC, 1998
- Weinstock H. HIV seroincidence among patients repeatedly tested for HIV attending sexually disease clinics, 1991-1996. Presented at the National HIV Incidence Studies Meeting, Prevention Services Research Branch, CDC, 1998.
- OíKeefe K, Stone BL, Evans MJ, Douglas J, Goggin M, Subiadur J, McGill W, Breese P. STD clinic record-based incidence study: Preliminary summary of results from Denver, Colorado. Presented at the National HIV Incidence Studies Meeting, Prevention Services Research Branch, CDC, 1998.