Implementation of HIV Testing at 2 New York City Bathhouses: From Pilot to Clinical Service

Abstract

Background Commercial sex venues (e.g., bathhouses) that cater to men who have sex with men (MSM) continue to function in most urban areas. These venues present a challenge to developing strategies to prevent the spread of the human immunodeficiency virus (HIV), but they also provide opportunities for interventions to reduce the risk and rate of disease transmission. Several cities in the United States have developed programs that offer HIV testing in these venues. Similar programs have not existed before in New York City. Methods A pilot HIV testing program was implemented at 2 New York City bathhouses. Testing included rapid HIV testing, the use of the serologic testing algorithm for recent HIV seroconversion, and pooled plasma HIV viral load to detect and date incident and acute HIV infections. In addition to HIV tests, behavioral and demographic data were collected from 493 presumed HIV-negative participants. Results The pilot program recruited MSM who were at high risk for HIV infection. Of the 493 men tested, 20 (4%) were found to be positive for HIV, and 8 (40%) of these 20 men demonstrated evidence of acute or recent HIV infection. The program tested men often not tested in more traditional medical settings. Significant disparities were demonstrated in the testing habits of MSM who reported having sex with women and had not disclosed same-sex activities to their caregivers. Conclusions Bathhouse-based testing for HIV infection can be implemented in New York City and would include a population of MSM who are at high risk for HIV infection. Because of the high rate of recent HIV infection, expanded testing in these venues may be a good strategy to reduce the forward transmission of HIV in this highly sexually active population.

Counselor-Based Rapid HIV Testing in Community Pharmacies

“…26 Venue-based testing in bathhouses has shown success where, of the 493 men tested, 4% were found to be HIV positive. 27 The bathhouse testing study tested a large proportion of White non-Hispanics (45.4%) and White Hispanics (27.6%); 23 in comparison, our current study was able to test a much larger proportion of minorities, specifically Blacks (58.0%) and Hispanics (59.1%). These studies and our data demonstrate the importance of venue-based testing to target unique high risk populations successfully.…”

Partner Characteristics and Undiagnosed HIV Seropositivity among Men Who Have Sex with Men Only (MSMO) and Men Who Have Sex with Men and Women (MSMW) in Baltimore

“…A previously reported analysis of the study presented in this article found that among HIV positive MSM, MSMW were more likely to have an unrecognized infection compared to MSMO in unadjusted analyses (PR 1.24 (1.08-1.41) [8]. Several studies indicate that MSMW are less likely than MSMO to be tested for HIV [9,10]. Despite the potential increase in risk of undiagnosed seropositivity among MSMW and the potential for MSMW to bridge MSM and WSM (women who have sex with men) sexual networks, no studies have assessed multivariate associations with undiagnosed seropositivity among this sub-group of MSM.…”

“…Many black MSM do not regularly test for HIV [67,68], and black MSM may be tested later in their infection than MSM of other races [69]. MSMW are less likely to have been tested than MSMO [9,10]. HIV prevention programs should address stigma and discrimination and should be community led to ensure they are culturally relevant.…”

Sex Parties among Young Gay, Bisexual, and Other Men Who Have Sex with Men in New York City: Attendance and Behavior

“…25,36,37 Research has demonstrated that venue-based interventions can serve as viable and effective methods for reaching high-risk populations. [38][39][40] Our findings indicate that sex party attendees reported higher risk in a number of important individual factors such as sexual risk taking, drug use, intimate partner violence, and arrests, as compared with nonattendees. This combination of risk factors creates an overall profile in sex party attendees that is significantly different from that of their peers.…”