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Sex on premises venues (SOPV) are commercial venues where men who have sex with men (MSM) meet other MSM for casual, usually anonymous, sex. These venues are challenging environments for traditional methods of behavioural research—for example, interviews. An alternative research method adapted from a study with sex workers in Nicaragua may be used in SOPVs.1,2 This study counted the number of used condoms per client as a measure of “safe” sexual behaviour. A pilot study in two parts was conducted at a Melbourne SOPV to determine the feasibility of this approach. The merit of this method was dependent on the consistency of the ratio of used condoms per SOPV patron, and consequently the method’s sensitivity to detect behaviour change.
Part 1 of this pilot aimed to establish a system of SOPV waste collection and condom counting. SOPV staff collected venue waste and research staff counted the number of condoms in the waste that were free from condom packaging. Part 2 piloted SOPV staff handing out anonymous, self complete questionnaires to patrons during the time periods when waste was being collected. The questionnaire only asked about anal sex and condom use during the participant’s visit at the SOPV.
Part 1 operated on 16 Saturdays and Sundays during the day. An overall ratio of 0.8 condoms per patron was calculated (95% CI: 0.7 to 1.1), and the ratio for each day ranged from 0.3 to 1.6. It was suspected that inconsistent collection of waste on Saturdays and Sundays contributed to the variability of the calculated condom to patron ratio each day. To have the same SOPV staff collecting waste each time and to avoid weekend functions at the SOPV, collection continued on the following nine Wednesday and Thursday evenings. For these evenings an overall ratio of 0.56 condoms per patron was calculated (95% CI: 0.4 to 0.7), and the ratio for each day ranged from 0.2 to 1.0.
Part 2 of this pilot operated on Wednesday and Thursday evenings of the following 8 weeks. Approximately 180 patrons were given a questionnaire by SOPV staff, of which 76 (∼40%) completed and returned the questionnaire (mean 43.8 (SD 13.3 years). Forty four participants reported engaging in protected anal sex during their visit to the SOPV (58%, 95% CI: 47% to 69%), with a mode of one episode of protected anal sex per visit. Using this proportion of 58%, a ratio of 1.4 condoms per patron engaging in protected anal sex was recalculated for the Saturday and Sunday collections. For all Wednesday and Thursday collections (Part 1 and 2) the ratio was 0.9.
The findings of this pilot study are inconclusive with respect to the value of this research method for behavioural study. Controlling for measurement and selection bias was difficult and resulted in a variable ratio of used condoms to patrons for each collection day. Research projects with more resources should look for greater control of bias, including encouragement of good communication with SOPV staff. However, this pilot study has demonstrated the potential of counting discarded condoms as a measure of safe sex behaviour in SOPVs. Counting condoms is an objective measure that doesn’t rely on self reports of behaviour, and condom collection can be conducted with minimal intrusion to patrons visiting the SOPV.
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