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7 These probabilities were then revised to reflect observed patron volumes during the first weeks of the survey. For the 2004 survey, we first based probabilities for selecting each VDTU on estimates of patron volume at times throughout the week observed during a previous study of these 3 venues. The sampling events were conducted during randomly selected, 4-hour venue, day–time units (VDTUs), with the probability of random selection proportional to the size of the patron population in the specific VDTU. We used a time-venue probability-proportional-to-size cluster sampling design 22 in each survey to schedule sampling events across club hours of operations. The observed similarity of these populations would assuage concerns about selection bias in the in-depth 2004 survey. A secondary intent was to evaluate the comparability of the 2004 survey population, which achieved a low level of participation (30%, or 373 of 1252 eligible patrons), with the respondents to the much briefer 2006 survey, which enrolled 61% (199 of 20) of eligible patrons. Our main intent was to describe the populations who visited these venues on any given week during these periods, report the frequency of HIV risk behaviors among these populations, and identify the correlates of high-risk behaviors. We conducted 2 cross-sectional, observational surveys in 20 of patrons of the 1 sex club and 2 bathhouses located in Seattle, Washington.
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Sex occurs in open areas, often facilitated by architectural features such as labyrinth-like hallways, small closets, and glory holes (holes in the walls between closets or hallways, primarily used for quasi-anonymous oral sex). 18, 19 Sex clubs have been described as “a hybrid of bars and bathhouses.” 20 Most commonly, sex clubs have no private spaces provided for sex, and patrons typically remain clothed. Sex takes place in private rooms as well as in open areas. Bathhouses typically offer private rooms for rent and shower facilities and expect that patrons undress and wear only a towel during visits. 17 These venues differ in their physical features and amenities. 14– 16Īpproximately 100 bathhouses and sex clubs were recently found to be in operation within the United States. 4, 6– 13 Although several investigators attempted to enroll representative samples of bathhouse patrons, these samples were always limited to a single venue. Much of the published research involving visitors to commercial sex venues was based on convenience samples. 5 Yet, despite the central role commercial sex venues were suspected to play in the epidemics of HIV and other sexually transmitted infections in the United States, little epidemiologic research of bathhouses or sex club patrons was done until recently. 1 With the identification and rapid spread of HIV in the early 1980s among men who have sex with men, these commercial sex venues were quickly thought to be key factors in the epidemic 2– 4 and were soon the targets of government intervention. Gay bathhouses and sex clubs-2 key types of commercial sex venues catering exclusively to men-have operated in the United States since at least the first decade of the 20th century.
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Future research should evaluate the effect of structural and individual-level interventions on HIV transmission. Patron and venue-specific characteristics factors may each influence the frequency of HIV risk behaviors in commercial sex venues. The 20 survey populations did not differ significantly in demographics or behaviors.Ĭonclusions. Sex venue site and patron drug use were strongly associated with unprotected anal intercourse at the crude level. By logistic regression, recent unprotected anal intercourse outside of a commercial sex venue was independently associated with unprotected anal intercourse. Fourteen percent of respondents reported a previous HIV-positive test, 14% reported unprotected anal intercourse, and 9% reported unprotected anal intercourse with a partner of unknown or discordant HIV status during the current commercial sex venue visit. We analyzed the 2004 data to identify patron characteristics and predictors of risk behaviors and compared the 2 survey populations. Surveys were anonymous and self-reported. We conducted cross-sectional, observational surveys in 20 by use of time–venue cluster sampling with probability proportional to size. We studied the HIV risk behaviors of patrons of the 3 commercial sex venues for men in Seattle, Washington.