Regulating the opportunities for gay men to have sex in “bath houses” (usually known as saunas in the UK and Europe) may reduce the likelihood that gay men will have unprotected anal sex in the venue, but makes no overall difference to the probability that a gay man will have unprotected anal sex, according to research conducted in four US cities and published in the 1st April 2003 edition of the Journal of Acquired Immune Deficiency Syndromes.
An early response to the AIDS epidemic amongst gay men was the closing or regulating of saunas used for sex, as they were identified as venues where men had unprotected anal sex with multiple partners. However, regulations differ between US cities. New York only allows saunas to provide opportunities for sex in private cubicles, whereas San Francisco prohibits these private spaces and only allows sex to occur in public areas such as steam rooms. Chicago allows both public and private spaces, and Los Angeles has saunas offering “a smorgasbord of space types.”
The investigators, from the Center for AIDS Prevention Studies at the University of California, San Franciso, wished to establish what effect the regulating of saunas had on the general HIV risk behaviour of gay men.
Telephone interviews were conducted with 827 gay men aged 18 years or older enrolled in the Urban Men’s Health Study who said that they had visited a sauna for sex in the past twelve months.
The men were asked to provide background demographic details including age, race, education, years of residency in their city, and if they had a partner. Data was also collected on HIV status.
Questions about sexual activity over the past twelve months were then asked, including total number of sexual partners, number of casual partners, and number of partners they had had oral or anal sex with, with or without a condom. Study participants were also asked to provide details of the type of sex they had had on a partner-by-partner basis to establish if they were having unprotected sex with a regular partner or casual sexual contacts.
Finally, respondents were asked if they had had sex in the past twelve months “in a public place like a bookstore, park, club, or bathhouse”. If they answered yes they were asked if they had had insertive or receptive unprotected anal sex in such a venue in the past year.
Approximately a third of gay men in the four study cities said they had visited a sauna for sex in the past year.
Ninety-eight percent of men reporting unprotected anal sex in a public venue also said that they had had this kind of sex with a casual partner. The prevalence of unprotected anal sex in a public setting was related to the frequency with which saunas were visited, but not other venues for public sex, suggesting to the investigators that most unprotected anal sex in public venues was occurring at saunas.
There were no significant differences in the overall sexual behaviour of men across the four study cities. Men had comparable numbers of total and casual partners, and comparable amounts of unprotected anal sex with casual partners. Nor was there any significant difference in the frequency with which men visited saunas.
However, there were differences between cities in the amount of unprotected sex occurring in saunas. San Francisco had the lowest prevalence (8.6%), followed by Chicago (14.1%), New York (18.3%), and Los Angeles (24.3%). These differences remained when the data were adjusted for age, race, years of residence, partner status and HIV status. Men who were white, HIV-positive, and had longer residence in their city were statistically more likely to have had unprotected anal sex in a sauna.
When investigators looked at the overall prevalence of unprotected anal sex in any public venue they found that rates were comparable across the four study cities, regardless of the rate of unprotected sex in saunas.
”Thus, it appears that city-specific public policies regulating the types of spaces allowed in gay bathhouses have little impact on the prevalence of overall risk behaviour engaged in by MSM [men who have sex with men] who visit these bathhouses.” Although a smaller number of men in San Francisco reported unprotected anal sex in saunas, they were just as likely to have had unprotected anal sex in another venue.
The investigators note that they did not question their sample about attendance at private sex parties, noting how popular these had become in New York since the 1990s, often “bareback parties” specifically organised around unprotected anal sex.
The investigators conclude by suggesting that policy should “encourage bathhouse owners to collaborate with health departments and community based orgaizations to identify and provide effective prevention efforts in bathhouses so that risk behaviour is reduced rather than moved elsewhere. Indeed, bathhouses provide a setting in which to reach the riskiest subset”.
Further information on this website
Unprotected sex - Factsheet
Woods WJ et al. Public policy regulating private and public space in gay bathhouses . JAIDS 32: 417-424, 2003.