Community Summit: Group B session

This group was charged with discussing the role of bathhouses and other public sex venues (PSVs) in HIV prevention.

1.	What have you noticed/heard about baths and PSVs and HIV prevention? The group was aware of several outreach and clinic services in the baths. Owners said that initially prevention workers put off clients but now they may actually attract clients. All studies aggressively recruited as well as served; other clinic services have had more passive recruitment. Owners/managers expressed frustration that activities were too concentrated and not spread out enough over different days and hours. There was discussion around the differences between baths and sex clubs, and it was noted that there were no representatives present from the video/arcade shops.
2.	What services have been effective? The group did not identify specific effective service components but noted that there were different interventions at different clubs. All community agencies need to make service provision in PSVs a goal, and have common agreements about effective services. There were no negative feelings about research per se. Does research equal prevention? For example, HATS did a study on accuracy of an oral fluids test, but wasn't allowed to give out results because the test was not licensed. This wasn't billed as testing, but as research. Perhaps research raises awareness.
3.	Could baths and PSVs make more condoms and lube available? Condoms are being handed out at the door, but some felt condoms should also be available in the rooms and throughout establishments. Owners described difficulties getting condoms with today's increasing prices. Baths want to continue to provide them, but costs are a problem. The coalition of bathhouse owners/manager, community-based organizations (CBOs), and Public Health must explore cost issues. Who is responsible for paying for condoms and lube? Group felt that we need to get bars and retailers involved in purchasing. We also need to get more messages out around norms about condoms; there is currently no norm about using condoms in baths.
4.	Disclosure of status The group discussed norms around disclosure. This is a big hot button. The current norm is not to talk. Did that lead to unprotected sex? Some people go to baths to socialize, but most others are there to have sex. Do visitors bring in STD? How do we address non-community members? Everyone needs to assume that anyone could be of a different HIV status. HIV positive men may go there because disclosure is not an issue - many people don't talk in baths.
5.	How can the provision of prevention services most effective? The group believed that better efforts must be made to reach HIV positive men and provide more sex-positive messages. If the word "responsibility" is used in a campaign, it must be geared at both positives and negatives. Another message should be compassion for your partners along with disclosure. Some voiced concern that many of the messages are perceived as anti-sex. Sex = death messages were not popular.
6.	How could partnerships between owners/managers, Public Health, and community leaders be strengthened? Is the current collaboration coalition adequate? The group favored strengthening the existing coalition, having newsletters, more outreach & co-outreach (multiple agencies involved), building up an expanded volunteer force to provide services, developing messages like the Hep A/B Campaign. Messages need to be less wordy. We also need to have more awareness and realize that sex starts before guys get to the baths. If information can be found in bars, we will create more of a community norm around safety. More people need to participate in the coalition, including the Men's Anal Health Study and bar owners.
7.	What kinds of environmental changes would be suggested? Examples of possible environmental changes included taking off doors and/or changing lighting. No one wanted to address this question at this meeting. People thought this was a larger issue and that these changes wouldn't be effective.

Recommendations:

Expand current bathhouse coalition to include other public sex venues and bar owners. Coalition must develop a common agenda and recommend specific programs to implement.
Increase funding to expand services to include more education, greater outreach and a more comprehensive array of services.