Gay Snas and the Risks of HIV and Syphilis Transmissns Cha—Rults of a Meta‐Analysis - PMC

Contents:

• WHAT I LEARNED OM TTG MEN FOR HIV AT GAY BATHHO
• HIV TRANSMISSN RISK AT A GAY BATHHOE
• HIV TRANSMISSN RISK AT A GAY BATHHOE
• GAY SNAS AND THE RISKS OF HIV AND SYPHILIS TRANSMISSNS CHA--RULTS OF A META-ANALYSIS
• GAY SNAS AND THE RISKS OF HIV AND SYPHILIS TRANSMISSNS CHA—RULTS OF A META‐ANALYSIS
• VIS TO GAY SNA
• HIV AND ALL GAY AND BISEXUAL MEN
• REVIEWSGAY SNAS AND THE RISKS OF HIV AND SYPHILIS TRANSMISSNS CHA—RULTS OF A META‐ANALYSIS
• HIV PREVENTN GAY BATHHO AND SEX CLUBS ACROSS THE UNED STAT
• GAY BATHHOE HIV PREVENTN: THE E OF STAFF MONORG OF PATRON SEXUAL BEHAVR
• ACTIVE TARGETED HIV TTG AND LKAGE TO RE AMONG MEN WHO HAVE SEX WH MEN ATTENDG A GAY SNA THAILAND
• INTY, CONNECTEDNS, AND SEXUAL HEALTH THE GAY SNA
• GAY SNA & CISE CLUB GUI

WHAT I LEARNED OM TTG MEN FOR HIV AT GAY BATHHO

Keywords: gay bathhoe, gay men, HIV preventn, HIV risk behavrIntroductnThe disproportnate prevalence of HIV/AIDS among men who have sex wh men (MSM) ntu to be a major public health emergency the Uned Stat and many other parts of the world (CDC, 2009; UNAIDS, 2008). MethodSampleThe participants were a sample of men (n=852) leavg a northern California gay bathhoe over two 5-week data llectn perds separated by 1 year (the send data llectn perd was ed to evaluate an on-se HIV ttg program). Fally, the rponnt provid basic mographic rmatn, cludg home zip (first 3 digs) or cy of rincy, age, hight level of tn attaed, race/ethnicy, e, current work stat, his inty relatg to sexualy (rpons offered were gay, queer, bisexual, homosexual, heterosexual, straight, or somethg else; and if somethg else was selected, rponnts were asked to specify), whether he had a domtic partner (if so, whether partnership was registered), and his legal maral stat.

HIV TRANSMISSN RISK AT A GAY BATHHOE

7%(5)DiscsnPrr data showg that a mory of gay bathhoe patrons engage UAI the bathhoe, and that same mory tend to report multiple sex partners while at the bathhoe (Bgham et al., 2008; Reidy et al., 2009; Woods et al., 2007), supported ncerns that the venu reprent a signifint risk for acute outbreaks of new HIV fectns among MSM (Bayer, 1991; Bolton et al., 1992; Disman, 2003; Wohlfeiler & Potterat, 2005; Wohlfeiler et al., 2007).

Targetg HIV preventn the bathho would reach the segment of men at greatt risk for HIV Humphreys' groundbreakg study1 of sex between men “tearooms” (public rtrooms wh a reputatn as a place where homosexual enunters occur), social scientists have vtigated the environments outsi the home where men who have sex wh men (MSM) meet other MSM for sual, ually anonymo, sex. METHODSSampleThe data are om the Urban Men's Health Study, a telephone survey based on a probabily sample of men 18 years or olr who self-intified as gay or bisexual or who reported sexual ntact wh a man sce 14 years of age. In addn, multivenue ers were more likely than bathers or cisers to report engagg unprotected anal terurse a public settg and engagg group 2—Prevalence of Sexually Transmted Diseas (STDs), Dg Use, and Risky Sexual Practic Among Men Who Frequent Gay Sex Venu, by Venue Use: Urban Men's Health Study, 1997Cisers, % (n = 515)Bathers, % (n = 326)Multivenue Users, % (n = 481)STDs HIV posiveb13.

HIV TRANSMISSN RISK AT A GAY BATHHOE

None of the other teractns tted achieved statistil 3—Relatnship Between Characteristics of Men Who Frequent Gay Sex Venu and Engage Unprotected Anal Interurse a Public Settg: Urban Men's Health Study, 1997OR (95% CI)Venue e patterns Cisers1. The aim of this study was to vtigate the associatns between HIV/syphilis prevalence and the typ of venu, namely snas, parks, gay bars, and the Inter, which are mostly ed for sourcg male sex partners by MSM Cha. AimsThe aim of this study was to vtigate the associatns between HIV/syphilis prevalence and the typ of venu, namely snas, parks, gay bars, and the Inter, which are mostly ed for sourcg male sex partners by MSM Cha.

Keywords: Men Who Have Sex wh Men (MSM), Gay Sna, Syphilis, HIV, Meta‐Analysis, ChaIntroductnThe human immunoficiency vis (HIV) prevalence among men who have sex wh men (MSM) Cha has been creasg sharply [1].

GAY SNAS AND THE RISKS OF HIV AND SYPHILIS TRANSMISSNS CHA--RULTS OF A META-ANALYSIS

Paradoxilly, such venu also provi a platform for offerg stctured venue‐based HIV terventns targetg MSM [10] of the surveys targetg MSM llected data om gay venu or via the Inter 11, 12, 13, 14, 15, 16, 17.

For stance, prev studi that were nducted Hong Kong and the Uned Kgdom showed that participants reced via the Inter had higher prevalence of risk behavrs such as unprotected anal terurse (UAI) and multiple partnerships, as pared wh those reced om other gay venu 18, 19. Other studi showed that participants reced om some venu, such as gay snas, had higher prevalence of HIV/sexually transmted disease (STD), as pared wh participants reced om other sourc 20, 21. The rults have important policy and programmg the 2008 natnal survey nducted Cha [2], a qutn asked about the type of venue where the MSM rponnts mostly sourced their sex partners (gay snas, gay bars, Inter, and parks).

DiscsnThe rults of this study suggt that those sourcg male sex partners mostly om snas the 10 ci Cha were at higher risk of ntractg HIV and syphilis, as pared wh those om gay bars or the Inter.

GAY SNAS AND THE RISKS OF HIV AND SYPHILIS TRANSMISSNS CHA—RULTS OF A META‐ANALYSIS

18% of the sampled MSM sourced male sex partners mostly om gay snas, their ndom‐e behavrs would have a high impact onto the HIV epimic among MSM Cha, as their risk of ntractg HIV and syphilis was higher than those mostly sourcg sex partners om the Inter and om bars. Published fal eded form as:PMCID: PMC3772683NIHMSID: NIHMS463296AbstractMany HIV preventn terventns have been lnched gay bathho and sex clubs sce the onset of the AIDS epimic, such as ndom distributn and HIV ttg. In the perd between the onset of gay liberatn (tradnally marked at about 1969) but before onset of the AIDS epimic among gay men (1981), gay bathho and sex clubs began to multiply dramatilly (Woods, Tracy, & Bson, 2003).

VIS TO GAY SNA

The gay spac provid a place of exploratn for the gay male sexualy and socialy that was safely removed om the reprsive gaze of heteronormative society (Halper, 1995; Rub, 2004; Tattleman, 1997; Wkler, 2006).

AIDS dramatilly changed the venu form and rponse to the AIDS epimic of the early 1980s, sexual behavr gay bathho drew signifint attentn om health officials, policians and journalists (Bayer, 1989; Bebe, 2003; Disman, 2003). The primary foc of this paper is an examatn and evaluatn of this monorg of specific typ of sexual behavr (pendg on lol regulatns) gay bathho as a strategy to prevent HIV transmissn. Clubs (Bson, Pollack, Blair, & Woods, 2010; Woods, Bson, Mayne, Gore, & Rebchook, 2001) beme clear that the AIDS epimic was entrenched among gay men, beme more and more difficult for public health officials simply to e the bathhoe as a means of providg important rmatn to men at risk (Bayer, 1989; Bebe, 2003; Disman, 2003; Shilts, 1987).

When I take re of a problem, I try to do such a way that don't shame or huiate the person I'm talkg to, particularly if has to do around safer sex issu… I thk people unrstand that I'm tryg … to fulfill the rponsibili that I have to the owners of the club and that they have to the Department of Public Health, and maybe [to the] larger society as a whole, but at the same time, be an advote for gay men.

HIV AND ALL GAY AND BISEXUAL MEN

G., beg “a policeman” – an ironic ment light of the fact that clubs origated as a way to pe the gaze of the state/police that ma homosexualy a crime) staff often found monorg dispirg bee ntributed to a transgrsive, tch-me-if-you-n dynamic between staff and patrons, patrons accepted monorg as the price for their abily to have sex clubs available to e.

IntroductnGay snas (also referred to as gay bathho and steamho) are a mercial space which gay, bisexual, and other men who have sex wh men (MSM)Footnote 1 n meet for sexual enunters. There are rerds of gay men g snas for sex the fifteenth century but was the send half of the twentieth century that gay snas beme more wispread London, New York, and other major ci (Bébé, 1996) sexual health of sna ers has been a signifint foc of both rearchers and mentators (e. Yet, gay snas have now bee an important ntext for raisg awarens of safer sex and of enhancg HIV preventn has been limed rearch to the inti, experienc, and perceptns of gay sna ers (e.

In orr to addrs this lacuna rearch, this article foc on the meangs and experienc that gay men livg the English cy of Leicter attribute to the gay sna, the role of the sna their sense of inty, and how they nste their sexual behavr this Health Among Gay MenOf the 89, 400 people livg wh HIV the England 2016, 51% were gay men (PHE, 2018a), and, of the 4370 new HIV diagnos 2017, 53% (n = 2330) were among gay men (Nash et al., 2018). This epimlogil profile among gay men n be attributed to the high equency of sex, multiple sexual partners, and high prevalence of ndomls sex this populatn (Jaspal, 2019) Risk and Preventn the Gay SnaIn their survey study of 134 gay sna ers South Wt England, Horwood et al. (2016) found high rat of HIV risk behavr – participants reported higher numbers of sual sexual partners and higher equency of unprotected anal sex than muny sampl of gay men reced non-sna settgs.

REVIEWSGAY SNAS AND THE RISKS OF HIV AND SYPHILIS TRANSMISSNS CHA—RULTS OF A META‐ANALYSIS

(2005) noted that gay sna attendance was a signifint risk factor for hepatis A fectn, and that the vast majory of those fected had had sex a gay of the sexual health iativ gay snas clu the dissematn of sexual health knowledge, the provisn of STI screeng and HIV ttg, and awarens-raisg regardg PrEP and post-exposure prophylaxis (PEP).

In several studi, rearchers have found high acceptabily and effectivens of HIV self-ttg gay snas although they do acknowledge the need to ascerta the bt way of implementg this service wh the sna (Huebner, Bson, Pollack, & Woods, 2012; Woods, Lippman, Agnew, Carroll, & Bson, 2016). Ccially, HIV preventn gay snas n target subgroups of gay men who might not ordarily engage wh sexual health servic and who might therefore be missed through nventnal HIV preventn rout (Debattista, 2015), effective terventns should be rmed by social psychologil rearch that ptur the views, perceptns, and behavrs of the target populatn the target ntext, that is, the diverse inti of the people whom we wish to target (Fish, Papaloas, Jaspal, & Williamson, 2016).

When the prcipl are challenged, the dividual experienc threats to inty, which is aversive for psychologil has been some rearch that sheds light on the impact of the gay sna on the inti of ers. Drawg on semi-stctured terviews and archival data, Prr (2009) has argued that the gay sna played an important role the nstctn of a gay culture and inty Sydney, Atralia, partly bee enabled gay men to explore, velop, and exprs their sexual inti the face of the homophobic stigma they faced.

HIV PREVENTN GAY BATHHO AND SEX CLUBS ACROSS THE UNED STAT

The gay sna uld promote ntuy and self-teem on the basis of one’s sexual inty the face of external threats to this inty the form of social their terview study of gay sna ers Sydney, Atralia, Prr and Cack (2010, p. 93–94) found that the gay sna functned as a “relig-spirual space removed om the fluence of a domant relig stutn, ” which enabled s ers to engage pleasurable, self-thentitg acts away om the stigma of heteronormative Atralian society.

GAY BATHHOE HIV PREVENTN: THE E OF STAFF MONORG OF PATRON SEXUAL BEHAVR

134) their study of 23 ers of a gay sna Toronto, Hbrich, Myers, Calzavara, Ryr, and Medved (2004) found that ers emphasized the ease of accs to sex the sna ( ntrast to gay bars, for stance), that they valued the anonymy of sexual enunters and, importantly, that they felt safe there. Acrdgly, the prent study draws on tes of inty procs theory to explore the meangs and experienc that gay men livg Leicter attribute to the gay sna, the role of the sna their sense of inty, and how they nste their sexual behavr this ntext. They all believed themselv to be HIV-negative at the time of the terviews were guid by a semi-stctured terview schle that foced on the followg areas: self-scriptn, self-tegorizatn, motivatns for g the gay sna, sexual behavrs and experienc the gay sna, sexual inty, and sexual health perceptns.

The clu (1) inty thenticy the gay sna; (2) social nnectedns among sna ers; (3) sexual risk and sexual health the sna; and (4) protectg the inty functns of the gay Soc-Spatial Characteristics of the SnasEach gay sna has s own soc-spatial stcture, characteristics, and cultural “norms” which turn fluence and gui the behavr of s ers, staff members, and sexual health service provirs, such as Natnal Health Service (NHS) nurs, muny workers, wh the premis. For stance, a sna may be known among s clients for attractg a particular subgroup of gay men, such as younger gay men or those wh particular sexual terts, and there may be different norms relatn to ndom e among A is the largt and newt of the three snas and has a social space on the ground floor and a space for sexual activy on the first floor.

ACTIVE TARGETED HIV TTG AND LKAGE TO RE AMONG MEN WHO HAVE SEX WH MEN ATTENDG A GAY SNA THAILAND

Sexual health outreach is offered by a lol sexual health B is the smallt of the three snas and is also known for beg equented by non-gay intified MSM, trans women, and cross-drsers.

Inty Authenticy the Gay SnaSeveral participants discsed the need to nceal aspects of their sexual inty, such as their sexual orientatn or sexual preferenc, social settgs outsi of the sna environment. (Olly, gay)Like Olly, participants scribed their experience the sna metaphorilly terms of the abily to “let yourself go” and to bee “a different person, ” potentially enhancg their sense of distctivens.

Moreover, there was a sense of shared, superordate social inty the gay sna built around a mon goal: “you’re here for the same thg, ” that is, pursu of a sexual enunter wh another man. This uld facilate feelgs of ers ntrasted their experience the gay sna wh the “outer world” that was perceived as heteronormative and judgmental toward norms and practic associated wh homosexualy:Then you go here, and everyone is really iendly, which mak even easier.

INTY, CONNECTEDNS, AND SEXUAL HEALTH THE GAY SNA

(Karim, straight-cur)Karim, who intified as “straight-cur, ” reported a sense of rejectn and excln om some social spac outsi of the sna settg due to his sexual inty – not least the gay scene where he rived no sense of belonggns. ” Karim’s acunt reerat the wispread perceptn among terviewe that the mastream gay scene was not nducive to a sense of inty thenticy, but that the gay sna perceptn of the gay sna as a sexual space was elaborated to pture s clivy and open-mdns.

” His acunt reerated the wispread nstal of the gay sna as an clive sexual space which inty thenticy was renred possible, but also which his ntuy (between private and public inti) and belonggns uld be Connectedns Among Sna UsersAs Olly dited his acunt, thenticy was also related to the sense of nnectn and monaly among sna ers.

The data show that social nnectedns was a key goal for most, view of the psychosocial strsors faced by some gay men, such as sexual inty issu and low levels of sexual inty disclosure, other social environments, such as bars and nightclubs, may be perceived as ls nducive to social nnectedns and to the formatn of iendships. For stance, some were unfortable wh the fact that alhol was served gay bars and nightclubs due to their relig fah, while others simply believed that the gay sna was more nducive to nversatn and terpersonal munitn than gay bars. (Stt, gay)In short, the gay sna nstuted a space which ers were able to velop a sense of thenticy and to tablish effective and satisfyg social nnectns wh other men, which provid rpe om the feelgs of lonels and prsn that some reportedly experienced.

GAY SNA & CISE CLUB GUI

The gay sna was generally nsted as a relaxg, clive and acceptg environment, which the “social pretense” of other gay ntexts, such as gay bars and clubs, was not necsary (Hbrich et al., 2004). Perhaps, as a rult of this posive nstal of the gay scene, all of the terviewe reported beg receptive to sexual health rmatn the snas that they Risk and Sexual Health the SnaInterviewe perceived the gay sna as a risky environment due to the availabily of multiple sexual partners and the high prevalence of ndomls sex. Siarly, John referred to ndomls sex the gay sna as “dicg wh ath, ” highlightg his perceptn of HIV as a adly vis:Snas, particularly the London area or abroad, do not e many ndoms to tell you the tth.

Like several other participants, Karim rived a feelg of ease om the visible culture of safer sex the gay terviewe acknowledged that there was sexual risk-takg the ntext and they too had had “slip ups” relatn to ndom e.