What is a bathhouse? Do people actually bathe?

So as I made a comment the other day, “Our library is like a bathhouse…all of these little rooms where people can walk around the hall..” it occurred to me that the majority of my class mates probably had no idea what a bath house really was like.  Sure, they have probably heard of it  in the context of HIV probably referenced to the ones that shut down in San Francisco decades ago, but I don’t think they know the true reality of the current state of bath houses, or that they currently still exist all around the world and contribute to the spread of HIV.

Much to my chagrin, the Spartacus Gay Guide still exists.  This was the same guide I used when I was 20 backpacking around Europe almost a decade ago.  Basically, anywhere in the world you go, you can use either the book (or apparently a iPhone app) to locate gay establishments such as bars, restaurants, and of course “saunas”. Most urban meccas in both the US an abroad (including, Europe and Asia) have at least one such bathhouse.  Houston, where I formally came from boasts 2.  One is part of the “Club Baths” franchise.  The Clubs is generally an upscale franchise, consisting of newly renovated saunas, steam rooms, pools and small rooms (I’ll get to this later). Generally such cities that have two bathhouse will usually have a nicer “upper echelon” one that is clean and somewhat hygienic and contains somewhat more upscale clientele, and a gross one that is filthy, skeezy, where you stick to the floor and it’s not advisable to not wear footwear.

Not all bathhouses are gross.  Some are QUITE deluxe.  The one I went to in Bangkok called “Babylon” was probably one of the nicest in the world with 3 bars, a full service restaurant, gardens, outdoor pools.  So the establishment can range from crab infestations to four star service.

So what exactly is a bathhouse? Wikipedia does a good job explaining to the novice in its article “gay bathhouse” (OOOOH and they even have a photo of the Crew Club in DC right near my house on 14th street. Did you really think the nation’s capital wouldn’t have a bathhouse?) especially in the “etiquette” and “layout” sections.  But for those of you that don’t have the patience to sift through such a gem I’ll get down to it briefly.  Basically most bathhouse operate on a “membership only” basis.  They call themselves “health clubs” and many do have a small (some extremely will equipped) weight area that they purport can be used for exercise (although I’ve generally only ever seen one person working out).  Even if a bathhouse boasts exercise equipment, most people come to a bathhouse to fuck.  There are usually also lockers (see below) communal showers, steam areas, sometimes an indoor or outdoor pool, and usually always small individual rooms, varying from simple with one small bed in a corner and minimal other room, to more deluxe, with a bigger bed, and TV playing porn.

Upon entering, you usually have to pay the “membership fee”.  Such fees can be one time only or you can usually get a 6 month membership if you plan on coming back and “working out” a lot.  You then have the option of purchasing either a “locker” or a “room”.   Both are assigned on an hourly basis, and you usually have about 12 hours or so (varies) in your room or locker.   With either option you are given a towel to change into.  Some more upscale places will also give you temporary footwear. If you buy a “locker” the only place to put your items is in your locker.  You will generally wander the hall, looking for someone to have sex with, either in their room, or in the sauna or some other communal place.  If you have a room you will proceed to your room and can leave your items there. See the photo to the left from the Crew Club for a typical price list.

Generally, paying the extra money for the room allows a client a little more privacy and flexibility with their evening.  They can decide who they want to invite in for sex, how they want to attract people for sex, who they want to have sex with etc.  The cheaper locker option, in my opinion limits flexibility.

Many bathhouses have also been places where gay men go to “party and play” or do drugs such as crystal meth and ecstasy and have sex.  Bathhouses have been known for their association with drugs and drug fueled sex, and still are venues where gay men may go to both seek and use drugs and to have sex.  Of course, such activity can lead to unprotected sex.  I know that any ads that the crew club has advertised in DC gay magazines have featured the phrase “No PNP” meaning “no party and play” i.e. no drug use tolerated.  I know they have also been doing much to crack down on bath house drug use.    However, its next to impossible to enforce these rules, as most bath houses have lax security, and given the nature of the establishments, unless you stick an undercover in the scene, its next to impossible to have someone patrolling private small rooms that patrons have sex in.

Then there’s the question of condom use.  Much like in any other sexual encounter,  condom use is up to the two partners involved.  Of course, drug use will lower inhibitions, and perhaps decrease condom use.  Also, since most of the time sex is anonymous it is likely that HIV status will not be discussed or disclosed during bath house encounters, and partners won’t know their true risk.  However, as a gesture, many bath houses provide condoms in common areas, and do all they can to encourage condom use.  However, what goes on between two consenting adults is something beyond their control.

So yes, technically one can bathe at a bathhouse, but more or less its a euphemism.

Salaam to HIV – MSM HIV Epidemic in the Middle East

Salaam alakoom friends (hello in Arabic).   In the first study of its kind, researchers from Cornell University in Qatar have concluded that concentrated epidemics (infection rates above 5 percent in a certain group) among men who have sec with men exist in Egypt, Sudan, Pakistan and Tunisia.  There is little data on this region where homosexuality is considered taboo.  According to one researcher quoted in the article, the region is like a “black hole” in the global HIV data since such little data is available.  The research has found “considerable and increasing epidemiological evidence on HIV and risk behavior among men who have sex with men” in the region.

The findings are not surprising  – in  2008 researchers found that  HIV transmission via anal sex among men was responsible for more than a quarter of notified cases of HIV in several countries in the region.  This is not surprising given the fact that sex, let alone homosexuality is rarely if ever discussed in the region.  Men who have sex with men have no resources to turn to for sexual health services, and like in many societies must have underground sex.  In such scenarios without education and intervention and acknowledgement from NGOs and the government HIV spreads outside of the MSM population to the general public – although the article states that in Lebanon and Pakistan NGOs have emerged to deliver services to this highly hidden population.  Education, education, education – remove the stigma of homosexuality and the barriers to service that prevail.  It won’t happen overnight – but neither did the spread of HIV. Oh yeah – I forgot its also illegal for men to have sex with men in 18 out of 21 countries in this region.

“Yes SIR Give me HIV SIR”: Leather and HIV

So on a whim, I recently googled “Leather and HIV”.  For those readers not aware of what leather has to do with homosexuality or MSM, in the gay (and heterosexual) community, there exists a subset of individuals who gather pleasure from dressing in erotic leather (i.e. chaps, harnesses) and having consensual sex with other leatherphiles.  Usually the sex will consist of individuals taking either a dominant or passive role playing “master” and “slave”.   In many large gay cities there is usually a “leather bar” where people with such interests can meet like minded people.  Here in DC, there is the DC Eagle.

The first hit was a recent study entitled HIV in the Leather Community: Rates and Risk-Related Behaviors The link to this article has the full text.   Interestingly, according to this study leathermen were 61% more likely to be HIV positive than non-leathermen.    The study also found that combined, HIV-negative and HIVpositive Leathermen were less likely to use condoms during receptive anal intercourse than non-Leathermen.  The same trend was found for insertive anal intercourse.   Additionally, role seemed to matter.  Combined, HIV-negative and HIV-positive leathermen who self labeled as “submissive” were less likely than those who self labeled as non-submissives to use condoms.

So next time you are hanging out at the leather bar, some food for thought.  I’d be interested to see some future studies.

HIV in the Leather Community: Rates and Risk-Related
Behaviors

Homofobia free Honduras?

Alto a la homofobia (Down with homophobia)

This past weekend I went to Tegucigalpa, which is the capital of the Central American country Honduras.  While cruising along down town (perhaps a bad choice of word – by cruising I mean walking) I luckily noticed some graffiti depicted in the images seen here.  One said “Alto a la homofobia” meaning “Down with homophobia”  and several others pictured a rainbow, the international symbol synonymous with the gay pride movement, with the words “Diversidad” (below), meaning diversity.  I was so taken aback, because such graffiti to me symbolized an awareness of gay rights and homophobia, and a desire to strive for equality.  I personally though this was huge in such a machismo society, where homosexuality is frowned upon, and rarely, if ever discussed.

So, how then does this relate to HIV transmission?  In the second poorest country in the Western Hemisphere, HIV remains a concentrated epidemic, meaning it is centered largely at-risk populations, such as men who have sex with men and sex workers, although it is beginning to spread to the general population.  According to USAID, while the general prevalence rate in Honduras is .7 %, estimates on prevalence among MSM range from 4.5% to 9.7%.  MSM are obviously disproportionally affected by HIV in Honduras.    Reasons for this would include stigma against homosexuality, lack of availability of education regarding HIV available to MSM and lack of MSM friendly healthcare resources and providers available.  Many MSM may be forced into having sex in secret places, and may not be able to negotiate condom use, because either condoms are not made available to them, or they do not have the education to understand that unprotected sexual contact between two men could result in HIV infection.

If some small groups continue to work like they are working, and spread such messages of tolerance to the general public such as graffiti (I’m generally not a fan of graffiti but here I’ll make an exception) and  homosexuality begins to”come out of the closet” in Honduras, meaning people are encouraged to show tolerance and accept diversity, perhaps MSM will feel more comfortable seeking health services, and HIV programmers and the government will begin to target HIV prevention messaging and education to this currently stigmatized group.  Diversidad!

HIV is hottest at the start

In browsing the web, I cam across a new provocative and racy HIV testing campaign aimed toward MSM in Vancouver, British Columbia, Canada.  The campaign, called “HIV: It’s Hottest at the start”  compares acute early HIV infection to hot early relationship (or hookup?) sex.  Much like sex with a new partner has an element of thrill and spontaneity, the campaign goes on to state that HIV is extremely infectious in the early phases infection, and if one doesn’t know their status in the early phase and has unprotected sex, they can very easily pass the virus to others.  The ads encourage individuals to take a new HIV test (which I must admit I didn’t know existed) designed to detect HIV infection within the last 10 days.  The new test detects the HIV virus, as opposed to the traditional tests which detect antibodies, which may take up to three months after infection to appear.  The ads inform individuals that if they are fucking without condoms during this early “hot” phase of HIV infection it is easy to spread the disease.

The campaign is designed and carried out by HIM, Health Initiative for Men, a community health organization strengthening the health of gay men in Vancouver.

I am not sure how I feel about these ads.   It appears that they are targeted at men who bareback as the ad states ” If you fuck without condoms and aren’t completely sure of your partner’s HIV status, get tested.”   Somewhere deep inside of me (no pun intended) I feel like anyone fucking someone with or without condoms who doesn’t know the other individuals status should get tested.  However, I suppose in order to maximize resources, HIM has chosen to focus on the more risky population: those who bareback in sero-unknown partnerships.  And, the ad does encourage condom use as a means of prevention if you go on to read. I guess part of the idea was to eroticize HIV associating it with carnal sex, rather than stigmatizing it.  “Hey if I have hot wild sex unprotected sex with the man I just met in the elevator or bath house then maybe I should get tested since I (or he) can have HIV and not know it and spread it to others easily in its early phases.  Why not? I’ll know within 10 days of my risky exposure and then can continue the hot affair.”   HIM seems to say that they are promoting sex-affirmative and sex-positive messaging, and that such explicit campaigns have higher message recall.

I’m not against the sexual messages – hell I love hot men engaging in sex acts.  However, I just can’t quite tell what their message is.  Any thoughts?

Manhunt Cares

I know it has been ages.

So here I am in Roatan, Honduras, an island off the coast of Honduras working at a medical clinic.  I have finally encountered what is like to be  gay in a place of no gays, what so many readers experience on a daily basis.  While there are many expats here in Roatan, there is no gay bar or social gathering place.  No frank discussion about sexuality of any sort.  My boyfriend is coming to visit at the end of this month.  He is flying into San Pedro, the second largest city in Honduras after Tegucigalpa.  I am going a day early so I will be there to meet him at the airport the next day.  In an attempt to meet friends to show me around the city, I logged on Manhunt.  While presumably, the majority of people log onto this site for sex, I was hoping to meet a friend to show me around the city when I arrive and make sure that I don’t get mugged.   Although, I must admit, my picture on the site is an unsavory one from the days when I used to troll for sex.

Through my sifting through the weeds of Manhunt, which I just discovered through Wikipedia has over 4 million profiles, I discovered that they have a campaign called “Manhunt” cares.  For all the gross things that happen on the site, I applaud the site for at least taking the effort to provide information on HIV and STDs to such a large audience.  I must admit I couldn’t watch the whole video due to bandwidth issues but it looked like it was pointing individuals in the right direction.  The links to organizations also feature several international locations which is always great to see (although must note Honduras is not on there).

So when you’re busy hunting for men  you can also hunt for places to get tested for HIV!

Sex and HIV in the age of GRINDR

So I must admit I am an Android boy in a committed relationship for the past six years, so I have not had the experience of using the iphone application GRINDR to seek out sex partners.  However, from what I understand, if I wanted to, I could find someone with 300 feet of me to suck my dick and fuck me, and know his exact location, all in the span of about 4 seconds.  According to their website, GRINDR “uses GPS technology in your iPhone or BlackBerry and Wi-Fi in your iPod touch or iPad to determine your exact location and instantly connect you with guys in your area.”

This instant sex is not anything new, as we have had sites like Manhunt, Adam4Adam and gay.com (wow I have not visited those sites until now for several years since my single days; visiting them now provokes an eerie spookiness for multiple reasons).  However, this GRINDR business takes a whole unnecessary chat equation out of play.  I don’t have to ask you your location, as I already know it from the phone.  I don’t have to ask you to send a picture, as I already see your picture.  And much like online chat, when I talk to you on GRINDR, much like when I talk to you on gay.com, I will not ask you about your HIV status. Perhaps I will lie about my status on my GRINDR page, saying I am negative when I am not.   While it’s difficult to say if GRINDR has created additional risk for HIV transmission, perhaps, just perhaps, it brought instant sex to a newer generation who had not stumbled upon or used sites like Manhunt. And with sex with strangers, there is always the risk of HIV transmission, unless 100 percent of the people meeting on GRINDR engage in safe sex with their GRINDR mates 100 % of the time.  And perhaps, just perhaps, if I am looking for multiple sex partners, while doing a drug such as crystal meth, I will find more partners more quickly, with the use of a mobile device as opposed to sitting at my computer.

Then of course, there’s my passion, the global tilt.  According to Wikipedia, GRINDR has been reported activity in countries as far reaching as Iran, Iraq, Israel and Kazakhstan.  In such countries, there is indeed potential for GRINDR to contribute to the HIV epidemic.   In countries where homosexuality is taboo, many times homosexual activity is conducted underground in secret without protection. Individuals who have access to cellular networks, but not the Internet and computers will be able to find immediate sex partners and engage in sex.  

What ever happened to going to the bar to find a nice man and getting to know him before getting in his pants? Ah, technology.

Can lube actually increase risk of HIV transmission?

So, as my post on anal douching was one of the highest read, I have decided to try to make the blog a little more ‘titillating’ so to speak.  Something of interest to all of us men who have sex with men (and basically all individuals who have sex) is lubricant, more affectionately referred to as ‘lube’.    So many different kinds that when you go to your nearest sex shop you may feel like a lost kid in a candy store.

Last year, an article in POZ magazine discussed the results of a very small trial which showed that individuals who used lubricant  were more likely to acquire rectal STIs and HIV.  This flies in direct contrast of everything I think I was ever taught about harm reduction, mainly that water or silicone based lubricants may help to decrease the risk of acquiring HIV transmission due to the lubrication.  Additionally, the study investigated the safety of several popular lubes, and found that some even wipe out colonies of good bacteria or epithelial cells in the rectum, which would explain some of the reason why such lubricants would increase the risk for HIV transmission.

While I don’t have enough evidence to state whether lube or not is best for bareback anal sex (I can sure as hell say lube makes it more comfortable) the one thing I can say with certainty is that condom sex is best.  And don’t forget to only use water or silicone based lubricants with condoms.  So what’s your favorite lube?

HIV+ gay man to be deported back to Uganda

A Ugandan gay men who is HIV positive has been fighting to not be returned to his native Uganda.  The 40 year old man, currently residing in London, has made repeated attempt to prevent his deportation to Uganda, a country known to be particularly hostile to gay individuals.  Homosexuality is punishable by up to 14 years in prison in Uganda, and a currently pending bill would impose the death penalty in certain instances, for example if there is evidence to show that the gay individuals transmitted HIV to others via sex.  The full article from the Advocate online cane be found here.  The UK government has denied that  the asylum seeker is gay, despite the evidence that he presented, including participation in a gay support group. All requests for asylum have been denied, and Mr. Said is set to be deported this weekend.

The anti-gay, HIV criminalization environment in Uganda is not new.  This past January, gay Ugandan activist David Kato  (pictured left)  was murdered for advocating for increased rights for sexual minorities .   In the US, there was controversy this past February when President Obama, spoke at the Fellowship prayer breakfast, as a member of the Fellowship, David Bahati , was the individual in Uganda responsible for drafting the anti-gay, HIV criminalization bill.

As this blog focuses on HIV, all of this leads to the larger discussion of criminalization of HIV.     Should an individual fear for their lives and not be able to live freely in their homeland because they have HIV?  In the opinion of this author, HIV criminalization serves no purpose.  Instead of educating individuals about HIV transmission and how to protect themselves, criminalization creates added stigma to HIV and makes it even more difficult for positive individuals to come forward tos eek the services that they need.  Criminalization also prevents individuals from being tested for fear of stigma. I do ponder that criminalization may be appropriate in instances where an individual knowingly transmits HIV to an individual, but I do not know enough legally about such a scenario to make an accurate judgment.   I do know that  I am sad that Mr. Said need to return to a country where he needs to fear for his life due to his sexual orientation and HIV status.

Hep C, syphilis, gonorrhea, oh my!

So it has been quite a while since my last post.  I must admit med school is kicking my ass, but I must find time to write since HIV prevention among MSM is my passion.

So in the HIV community we tend to solely focus only on HIV prevention and fail to realize that other nasty bugs are transmitted between MSM.  Many of these, co-occur in individuals with who already have HIV and may place further stress on an already damaged immune system.

As I live in a large urban city, I have come across several individuals that are infected with Hepatitis C and currently undergoing treatment.  While I have understood that Hep C is sexually transmitted, physicians and other individuals have engrained into my head that Hep C is mostly prevalent among drug users and transmitted by intravenous drug use, with occasional sexual transmission.    Perhaps individuals will mention that Hep C can be transmitted sexually, but then go on to quantify the statement saying it’s not likely.  A new study has found that in a cohort of HIV positive individuals followed, 75 percent of new Hep C infections occurred in individuals with no history of injection drug use.  Thus, the infections in this group must have been acquired sexually.  Hep C leads to liver damage, and potential liver disease, and if left untreated can be lethal.

Hep C is not the only thing that those who bareback (have sex without a condom) should be concerned about.  syphilis is on the upswing.  Over the past several years there has been a huge surge in syphilis cases among men who have sex with men in several urban centers. Primary stages of syphilis may cause painful sores and chancres, and such sores if left untreated can increase the probability of acquiring HIV.  MSM are also at increased risk for acquiring chlamydia and herpes.

But not all providers will test individuals for STIs aside from HIV, and will not test already positive HIV individuals for STDs.  I think many HIV testing centers due to resource constraint will not screen for STIs unless a specific request is made.  I came across a great article from the NY times (although it’s from 3 years ago).  Only about a third of gay men surveyed in urban cities reported being tested for syphilis and gonorrhea. Providers do not test these populations as frequently as they should, or follow national guidelines set out regarding testing for STI.

Bottom (no pun intended) line: Educate MSM to engage in safer sex.  Not only will this prevent HIV but it will help to decrease rates of Hep C, gonorrhea, syphilis and a range of other STIs.  HIV is not the only enemy.  But we can protect ourselves from other STIs in the same way that we do HIV.  HIV prevention programs should educate MSM about HIV in addition to other STIs and how to overall protect themselves and remain sexually healthy.