Public Policy Regulating Private and Public Space in Gay Bathhouses

Ethnographic data collected before the outbreak of AIDS established that gay bathhouses afforded more opportunities to engage in anal intercourse with greater numbers of partners than did other public sex venues (e.g., parks, public toilets, adult movie houses, and bookstores, sometimes collectively known as "public cruising areas" [PCA]). Epidemiologic studies repeatedly linked AIDS in gay men with multiple partnership and engaging in anal intercourse without condoms.

As a result, several U.S. cities developed various policies to regulate bathhouses. What resulted was a divergence of policies creating cities with very different types of venues in terms of public and private spaces for sex. Public spaces for sex include mazes, orgy rooms, and steam rooms. Private spaces are generally rooms with lockable doors that are rented or made available to guests. In a traditional gay bathhouse, both public and private spaces would be available.

The current study presents data from a probability sample of gay and bisexual men living in four U.S. cities who visited a bathhouse in the past year. One city has only private spaces (New York), while another has only public spaces (San Francisco). The third city (Chicago) has only mixed spaces (i.e., public and private in each venue). Finally, the fourth city (Los Angeles) has a smorgasbord of space types. The analyses seek to identify differences by city in numbers of sex partners, one-night stands, and visits to bathhouses and the prevalence of risk behavior, as an index of the effectiveness of local bathhouse policy.

There was no significant statistical difference in the prevalence of bathhouse attendance in the past year (Los Angeles, 31 percent; Chicago, 32 percent; New York, 33 percent; San Francisco, 37 percent; p=.37) among sexually active MSM (n= 2,478; attendants= 827) interviewed by telephone in the Urban Men's Health Study. More than 98 percent of respondents who reported unprotected anal intercourse (UAI) in a public setting -- in either a bathhouse or PCA -- also reported UAI with a casual partner. Chi-square analyses were used to examine the differential relationship between UAI prevalence in public settings and bathhouse/PCA attendance (divided into quartiles) for multivenue users. UAI prevalence in a public setting was statistically related to the frequency of bathhouse attendance but not with PCA, suggesting that most UAI in public occurred in bathhouses.

Generally, among MSM who frequented bathhouses, there were no statistically significant differences in sexual behaviors across the four cities. Regardless of city of residence, male respondents were equally as likely to have as many male sex partners and one-night stands, and frequent bathhouses. The only significant difference was frequency of PCA visits. Men in New York went to PCAs more often than men in Los Angeles did.

Univariate analysis revealed significant city differences in UAI prevalence in a public setting (San Francisco, 8.6 percent; Chicago, 14.1 percent; New York, 18.3 percent; Los Angeles, 24.3 percent). In multiple logistic regression analysis, San Francisco residents had significantly lower odds than did men living in the other three cities. Significantly higher odds were also found for men who were white, were HIV-positive, visited a PCA in the past year, and lived in the city 6-10 years and were inversely related to education.

The researchers concluded that city-specific public policies regulating the types of spaces allowed in gay bathhouses have little impact on the prevalence of overall risk behavior engaged in by MSM who visit bathhouses. MSM were equally likely to report UAI with a casual partner in both cities with and without rules about the physical arrangement of space in bathhouses.

"Results from the two cities with policies that regulate physical structures (i.e. San Francisco and New York) may support the argument that these policies simply move risk behavior to a different place. That is, even if men did not report UAI in a public place, similar proportions of men reported UAI in all cities. ...Thus, another approach to policy would encourage bathhouse owners to collaborate with health departments and community-based organizations to identify and provide effective prevention efforts in bathhouses so that risk behavior is reduced rather than moved elsewhere. Indeed, bathhouses provide a setting in which to reach the riskiest subset, MSM who go to both bathhouses and public cruising areas," the authors concluded.

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