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Los Angeles Bathhouse Study: Elements of an Innovative HIV-Testing
Program
Trista
Bingham, MPH, MS
HIV
Epidemiology Program
Los Angeles County
Dept. of Health Services
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Los Angeles Bathhouse Study: Elements of an Innovative HIV-Testing
Program
Background and Context
• =
Bathhouses were never forced to clos=
e in
LA
• Co=
nditions
of operation: provide condoms and safer sex messages to patrons
• Pr=
evious
surveys indicate 10-11% unprotected anal sex among patrons (Van Beneden, 2002, Richwald, et al. 1988)
• An=
ecdotal
evidence of waning safer sex behaviors (HAART era) and 2000 syphilis =
outbreak
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Los Angeles Bathhouse Study: Elements of an Innovative HIV-Testing
Program
Bathhouse Study Objectives
• Co=
nduct
formative research
• Es=
timate
the incidence of HIV among patrons
• De=
scribe
patron risk profiles and attitudes
• Cr=
eate
an on-site HIV/STD testing clinic ultimately for CBO operation
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Los Angeles Bathhouse Study: Elements of an Innovative HIV-Testing
Program
Objectives for Today’s talk
• Bri=
efly
present formative research methods and findings
• Pr=
esent
findings of Epidemiologic Research phase (n=3D916, subset of 676)
• =
Describe Exit Survey and present
findings
• Di=
scuss
public’s reaction and public health response
• Tho=
ughts
and action for intervention work
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Los Angeles Bathhouse Study: Elements of an Innovative HIV-Testing
Program
Format=
ive
Research Methods
• St=
udy
sample:
– =
16 “systems interviews” of BH staff, =
outreach, management
– =
23 “key participant interviews” of BH =
patrons
• St=
udy
instrument: qualitative, semi- structured questionnaires
• An=
alysis:
CDC EZ-Text software for coding
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Los Angeles Bathhouse Study: Elements of an Innovative HIV-Testing
Program
Formative
Research Interview topics
• =
Typical bathhouse visit
• =
Sexual behavior and condom use
<=
/div>
• =
Sexual communication
• =
HIV serostatus disclosure & assumptions =
*
• =
Alcohol and drug use
• =
Attitudes & beliefs about testing clinic*
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Los Angeles Bathhouse Study: Elements of an Innovative HIV-Testing
Program
Formative
Research HIV Status Assumptions
• =
85% never discuss HIV status with =
partners before sex
• =
Healthy-looking men assumed HIV-
• =
“Bottoms” assumed HIV+
• =
“Tops” assumed HIV-
Los Angeles Bathhouse Study: Elements of an Innovative HIV-Testing
Program
Formative
Research Views on BH testing clinic
• Structural
• <=
/span>Privacy and anonymity important to patrons
• =
Clinic should be comfortable/casual
• =
Positive disclosures should occur off-site
•
• Incentives/Marketing
• Additional
incentives wouldn’t increase clinic use
• Additional
services (STD tests) would help
• Promotional
cards, ads, flyers, and signage to increase
awareness
<=
/span>
•
Los Angeles Bathhouse Study: Elements of an Innovative HIV-Testing
Program
Formative
Research Implications for Study
• Ch=
allenge
assumptions about partners’ HIV status
• Pr=
ovide
sex- & body-positive promotion of HIV testing services
<=
/div>
• Ad=
dress
multiple needs of patrons (STD testing, mental health, substance abuse)
=
• Rea=
lize
many patrons won’t mix sex with HIV testing
<=
span
style=3D'visibility:hidden'>•
<=
span
style=3D'visibility:hidden'>•
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Los Angeles Bathhouse Study: Elements of an Innovative HIV-Testing
Program
Bathho=
use
characteristics
• =
9 Bathhouses : Club 1350, Flex, Hollywood Spa, KLYT, Melrose Spa, Midtowne Spa, North Hollywood Spa, Roman Holiday Spa, Roman Holiday II
• =
3;
•
• Private
rooms
• Jacuzzis
• Saunas
• Showers
• Gyms
• Pools
• Steam
rooms
Los Angeles Bathhouse Study: Elements of an Innovative HIV-Testing
Program
Epidemiologic
Research Methods
• =
Cross-sectional HIV incidence design
• =
Anonymous HIV, syphilis, HBV tests
• =
Project RESPECT-2 counseling
• =
$15 entertainment vouchers for survey
<=
/span>
• =
Gonorrhea & chlamydia urine tests
<=
/span>
• =
In-person or phone results @ 1-week
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Los Angeles Bathhouse Study: Elements of an Innovative HIV-Testing
Program
Bathhouse #1
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