Facilities and HIV Prevention in Bathhouse and Sex Club Environments

Journal of Sex Research, Feb, 2001 by William J. Woods, Diane Binson, Tracy J. Mayne, L. Robert Gore, Greg M. Rebchook

Person-environment theory posits that behavior may be explained not only by individual characteristics, but also by the environment in which the behavior occurred (Walsh, Craik, & Price, 1992). Research in the area of HIV risk behavior has tended to focus on person factors, though some researchers have given attention to particular contexts, settings, and situations (Diaz, Stall, Hoff, Daigle, & Coates, 1996; Fullilove, 1995; Heckathorn, 1995; Koopman, 1996; Leap, 1999; Tawil, Verster, & O'Reilly, 1995). Among men who have sex with men (MSM), gay baths and sex clubs have been related to disease risk since the first cases of AIDS were identified among gay men in the early 1980s (Turner, Miller, & Moses, 1989). Nevertheless, very little research on contextual factors of bathhouses has been reported. Studies that have been conducted measured two separate spheres of behavior: sexual risk and visiting bathhouses (Bolton, Vinke, & Mak, 1992; de Wit, de Vroome, Sandfort, & van Griensven, 1997; Martin, 1986; McKusick, Horstman, & Coates, 1985; van de Ven et al., 1998) or any of a wide variety of public sex environments (Church, Green, Veamals, & Keogh, 1993; Coates et al., 1996; Dowsett, 1996; McCoy & Inciardi, 1995; Ridge, Plummer, & Minichiello, 1994a, 1994b). Only one of these studies examined a bathhouse setting (McCoy & Inciardi, 1995), and only two (Elwood, Williams, & Bowen, 1996; Richwald et al., 1988) assessed sexual behavior that took place within these settings. Although there are some descriptions of the social/sexual context of bathhouses and sex clubs, with one exception (McCoy & Inciardi, 1995) these descriptions predate the HIV epidemic (Brodsky, 1993; Delph, 1978; Weinberg & Williams, 1975).

To consider adequately the context of bathhouses and sex clubs, it is important to provide some background and to detail their similarities and differences. Early in the 20th century, bathhouses frequented by men in search of sex with men were not promoting safe havens for sexual activity but rather were public baths, Turkish baths, saunas, and the like, which generally frowned on any sexual behavior on their premises (Chauncey, 1994). By the late 1970s gay bathhouses (referred to in the gay vernacular as "the baths") were a significant part of the gay subculture and gay pride, celebrating gay sexuality (Berube, 1996). Some of these gay baths provided orgy rooms and mazes, clearly allowing overt sexual activity not only in closed private rooms but also in open areas of the facility (Rumaker, 1979; Weinberg & Williams, 1975). At about the same time gay sex clubs appeared (Brodsky, 1993). A sex club is usually distinguished from the baths by several features. In the baths, sex may occur in a privately rented room. Sex can also be had in a number of open areas, such as orgy rooms or mazes (similar to a traditional maze, except the intricate passageways are usually dark to pitch black), sometimes equipped with glory holes (holes of varying sizes used to allow oral sex between men on opposite sides of a wall or door) or slings (suspended in the air in such a way as to provide easy maneuvering for multiple oral and anal sexual encounters). Sex clubs have been compared to a cross between a bathhouse and a backroom at a bar (Lindell, 1996). (A backroom is an open area, usually dark to pitch black, used by bar patrons for sexual activity.) Like a bar, patrons of a sex club generally wear their street clothes throughout (at the baths, men remove their street clothes in exchange for a towel wrapped around their waists). In sex clubs the option for sex lying down is less likely than in the baths since, like backrooms, sex clubs generally have no closed rooms. In sex clubs, open areas tend to be similar to those found in the baths (i.e., with glory holes and mazes). Both venue types provide opportunities to find a large number of men looking for sexual encounters and to engage in numerous, episodic sexual encounters.

Even before AIDS, public health authorities and gay leaders reported concerns about alarming rates of STDs among gay men, and the number of partners gay men could accumulate facilitated by the gay bathhouses and sex clubs (Merino, Judson, Bennett, & Schaffnit, 1979). Thus, with the onset of the AIDS epidemic, the stage was set to target these venues for closure by public health officials, journalists, and politicians, including some within the gay community itself (Bayer, 1991; Rotello, 1997; Shilts, 1987). In 1984, the debates about closing the baths reached their full force, resulting in an attempt to shut down completely all bathhouses and sex clubs of San Francisco, California (see Bayer, 1991; Helquist, 1984; Shilts, 1987). Some businesses ordered to close took their case to court. The judge ruled that the local government could not force businesses to close as long as anyone could monitor customer behavior to ensure that they did not engage in unprotected anal intercourse (Bayer, 1991; Helquist, 1984). Thus, in San Francisco, owners could remain in business by providing only spaces where all sex was in the open. Ironically, in New York the state legislature formulated an opposite policy, such that businesses that allowed sex to occur in the open could be closed down by the health department (Bayer, 1991). Though neither policy relied on any research evidence, they clearly assumed that the structural environment might have contributed to individual behavior and risk practices.