CROI: HIV testing in New York's bath houses is feasible and reaches men missed by traditional prevention

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HIV testing in New York’s gay bath houses is acceptable to patrons and owners, and may be a way of providing HIV prevention information and reaching gay and non-gay identified men who have sex with men who do not access traditional prevention and testing services, according to research presented to the Fourteenth Conference on Retroviruses and Opportunistic Infections in Los Angeles last week.

New York closed its gay bath houses (usually called saunas in Europe) in 1985 in response to the emergence of HIV amongst gay men, although subsequent research suggests that such regulation actually has little impact on the sexual risk behaviours of gay men.

Two bath houses were allowed to open in Manhattan in the late 1990s. Although sexual risk behaviours may take place at commercial sex venues such as bath houses, these venues are also thought to provide an opportunity for HIV prevention work. Investigators from New York University wished to establish if HIV testing would be in feasible in bath houses. They therefore started offering HIV testing at each of the bath houses on a weekly basis.


post-exposure prophylaxis (PEP)

A month-long course of antiretroviral medicines taken after exposure or possible exposure to HIV, to reduce the risk of acquiring HIV.

acute infection

The very first few weeks of infection, until the body has created antibodies against the infection. During acute HIV infection, HIV is highly infectious because the virus is multiplying at a very rapid rate. The symptoms of acute HIV infection can include fever, rash, chills, headache, fatigue, nausea, diarrhoea, sore throat, night sweats, appetite loss, mouth ulcers, swollen lymph nodes, muscle and joint aches – all of them symptoms of an acute inflammation (immune reaction).


Refers to the mouth, for example a medicine taken by mouth.

confirmatory test

A second test, to show that the result of a previous test was correct. Because the diagnosis of HIV infection is so important, a second (confirmatory) test, is done. The confirmatory test should be of a different type than the first test.


Receptive anal intercourse refers to the act of being penetrated during anal intercourse. The receptive partner is the ‘bottom’.

Although patrons were told that HIV testing was available at the venue, the initiative to come forward to test rested with them - testing staff did not approach patrons and promote testing.

By the end of 2006 a total of 350 HIV tests on 292 individuals had been performed (an average of six per week). Rapid, oral HIV tests were conducted at the venue, and the results were confirmed using traditional HIV antibody blood tests. Analysis of blood samples was also undertaken to determine if any of the individuals testing positive had recent HIV infection, and blood samples from individuals testing HIV-negative were subjected to pooled HIV PCR testing to identify acute infections.

As well as undergoing HIV testing the men provided demographic and sexual risk behaviour to the testing staff.

The 292 men were aged between 18 and 72, with a median age of 38, and two thirds were white or Hispanic. Almost three-quarters were educated to university level, and a third had a postgraduate degree. This level of educational attainment was reflected in the employment and income of the individuals, with 85% in paid employment and most having an income of between $25,000 - $75,000 per annum.

Just over three-quarters of the men identified as gay and the number of reported sexual partners in the previous three months was between zero and 180 with a median of six.

When the investigators looked at the sexual behaviour of the men, they found that 86% reported anal sex in the previous three months, with 49% reporting unprotected insertive anal sex in this period and 42% unprotected receptive anal sex. Sex with both men and women was reported by 14% of the men and 9% said that they had had sex with a man who they knew to be HIV-positive.

Although three-quarters of men reported serosorting behaviours, 88% said that they had not asked their sexual partners on the night of their HIV test about their HIV status.

In total 15 men (5%) tested HIV-positive. Of these, 60% had chronic HIV infection and 40% had recent infection, with one of these being acute. When told the results of their oral test, the men did not become overly distressed and all returned for their confirmatory test results.

Factors significantly associated with testing HIV-positive were no previous HIV test (p = 0.02), unprotected anal intercourse (p = 0.038), inconsistent condom use (p = 0.044), and a lower level of educational attainment (p = 0.04). Non-white/Hispanic ethnicity was of borderline significance (p = 0.054).

Most of the men - 71% - had never heard of either post-exposure prophylaxis (PEP) or pre-exposure prophylaxis (PrEP). Lack of knowledge of PEP and PrEP was significantly higher amongst non-gay-identified men (p = 0.01). PEP had been used by 3% of the men, but nobody said that they had ever taken PrEP.

The investigators concluded that HIV testing in bath houses accessed a population often missed by traditional testing and prevention programmes. They plan to offer HIV testing at both venues three times a week.


Daskalakis D et al. Correlates and incident HIV diagnosis, knowledge of chemoprohylaxis, and burden of acute and recent HIV infection among patrons of New York City bathhouses: a pilot study. Fourteenth Conference on Retroviruses and Opportunistic Infections, abstract 152, Los Angeles, 2007.