An Examination of Bathhouse Outreach Efforts through the Opinions and Experiences of Outreach Workers

Background: The controversial existence of bathhouses has reemerged due to concerns over the documented reoccurrence of sexual risk behaviors in these venues, and their connection to rising HIV/STI infection rates amongst men who have sex with men (MSM). The effectiveness of bathhouse-specific education/prevention outreach programs from public health and community based organizations (CBOs) have also been called into question. This study sought to investigate if bathhouses are an impediment to addressing HIV/STI-risk in MSM.

Methods: From March-May 2006, 30 bathhouse outreach workers from public health and CBOs in the United States, Canada and England were contacted for interviews. In total, 20 interviewees participated. Semi-structured qualitative interviews were conducted via telephone with interviewees in the U.S. and Canada, while face-to-face interviews were conducted in England. All interviews were recorded, transcribed, and the data analyzed using grounded theory.

Results: Three beneficial themes concerning bathhouse outreach were identified: 1) access to high risk populations, 2) environments conducive to communicating sexual issues, and 3) outreach as a cultural norm within bathhouses. Two themes were identified regarding the obstacles of bathhouse outreach: 1) the continued practice of high risk sexual behaviors in bathhouses and 2) establishing trust between venues, patrons and outreach organizations.

Conclusions: Overall, bathhouses are an effective vehicle for communicating safer sex messages to help curtail HIV/STI rates in MSM, and for offering sexual health services and support. Bathhouses can be locations where high risk sexual activity takes place, yet these locations offer unique, advantageous environments for outreach programs.