Optimism about combination HIV therapy and risk-taking behavior among Los Angeles bathhouse patrons

Bathhouses provide a unique and secure environment for men to seek sexual encounters with other men. From a public health perspective, it is important to understand the factors influencing unsafe sex behaviors in the bathhouse setting. We investigated the effect of optimism about combination therapy on unprotected anal intercourse (UAI).

The Los Angeles Bathhouse Study was a cross-sectional study of men who attended bathhouses and accessed on-site HIV/STD testing between May 2001 and December 2002. Interviewers collected information on demographics, sexual behaviors, and HIV-risk perceptions from 674 participants. We analyzed data on 376 respondents who reported anal intercourse during their last bathhouse visit. We used logistic regression to evaluate the association between HIV treatment optimism and UAI.

Sixteen percent of our sample reported UAI at their last visit despite a perception that 38% of their fellow patrons were HIV+. Compared with respondents reporting 100% condom use, those practicing UAI were more likely to report that combination therapies alleviated concerns about becoming HIV+ (30% vs. 13%). In a multiple logistic model adjusting for potential confounders, respondents reporting optimism about combination therapy had 3.3 times the odds of practicing UAI (95% CI: 1.3-8.5) compared to respondents with less optimism about treatment.

Respondents perceived a moderately high risk of exposure to HIV in the bathhouse but also reported a considerable amount of UAI. Optimistic attitudes about combination HIV therapies appear to be positively associated with UAI. HIV prevention efforts should address patrons' beliefs about combination therapy in the context of reducing HIV risk.