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• Rapid HIV Testing at gay venues, a view from the front line: Real benefits, little trouble
  Demetre C Daskalakis
  Published on: 11 April 2007

• Published on: 11 April 2007

  Rapid HIV Testing at gay venues, a view from the front line: Real benefits, little trouble

  • Demetre C Daskalakis, Clinical Investigator/Physician
  • Other Contributors:
    • Kyle Bernstein

  Dear Editor,

  The article by Prost el al.[1] entitled ‘There is such a thing as asking for trouble’: Taking rapid HIV testing to gay venues is fraught with challenges” is an important addition to the growing literature focusing on HIV testing at entertainment venues catering to men who have sex with men (MSM). Their ethnographic approach to exploring the complexity of such programs adds further dimension to this topic,...

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  Dear Editor,

  The article by Prost el al.[1] entitled ‘There is such a thing as asking for trouble’: Taking rapid HIV testing to gay venues is fraught with challenges” is an important addition to the growing literature focusing on HIV testing at entertainment venues catering to men who have sex with men (MSM). Their ethnographic approach to exploring the complexity of such programs adds further dimension to this topic, however their experience should not discourage others from integrating HIV (and other STI) screening in such venues.

  In their article, Prost et al [1] identified confidentiality, the apparent disconnect between a serious medical issue and gay life, post-test support, and venue-specific concerns as potentially damaging to venue based testing for MSM. Since February 2006, the NYU School of Medicine Center for AIDS Research has been conducting a study in New York City bathhouses to assess the feasibility of HIV testing in these venues; to date we performed 406 tests. Many of the points that the authors have made regarding implementation of such a program influenced our study design well before we ever performed our first test. Privacy, risk-reduction counseling, and clear paths connecting those found to be HIV positive to care were central to our design and the design of any successful HIV testing program at bathhouses, saunas, and other commercial venues. Before we approached the management of the two remaining bathhouses in Manhattan, we studied models described by similar programs successfully functioning in Seattle and Los Angeles.[2] All of these observations are valid issues facing non-traditional venue HIV rapid testing. It is the charge of the organization developing a venue-specific program to predict these issues rather than to respond to them. Each issue can be dealt with to create a program that is acceptable and effective.

  • Confidentiality
  In creating our program, we followed many of the dictums laid out in a successful bathhouse testing program in Seattle.[2] To create an effective program, community ties and the relationship with venue management need to be developed. The testing program becomes a service that is provided by a healthcare or research group in close association with the staff and management of the venues. Maintaining a sustainable program requires working within the culture and environment of the venue, not against it. With the support of the venue management, we converted unused space into discreet, soundproof, confidential testing rooms.

  • HIV testing is “too serious” for an entertainment venue.
  In our survey of the men attending one Manhattan bathhouse, nearly 80% of men responded that HIV testing was appropriate in the bathhouse setting. As demonstrated in one study, bathhouse testing may impact behaviors associated with HIV risk.[3] Part of HIV stigma is the compartmentalization of sexuality from health. We believe that HIV testing at the bathhouse in a model acceptable to venue staff and patrons makes sexual health an important reality for these MSM. Rather than too serious, our service is just serious enough. This is evidenced by the fact that many men who choose not to be tested through our program approach testing staff to ask questions about safer sex and HIV exposure. Furthermore, the testing staff report overwhelmingly positive feedback from venue patrons, staff, and management.

  • Post-test support/Venue Specific Concerns
  No HIV testing program should exist without a good post-test plan. When we discussed our program with venue management, they expressed concern about connection to care and the risk for self-destructive behavior for men with preliminarily positive tests. Ninety-three percent of our positives have been successfully connected to HIV primary care. Additionally, we have in place a clear and discreet plan to remove anyone from the bathhouse upset by a result. Despite a 5.1% seroprevalence rate among testers there have been no such “evacuations” necessary [4]. Additionally there is no data to support that people newly diagnosed with HIV are at increased risk of suicidal behavior.

  The data presented in the study by Prost et al1 confirms many of the assumptions we made in designing a testing protocol in bathhouses in New York City. This valuable addition to the literature should be used to help guide and design such testing programs rather than be used as evidence for why they should not exist. A close understanding of the community of clients such programs will reach as well as a close working relationship with venue management is central in a lifestyle-competent testing program. Connection to care and safety concerns need to be assumed and planned for in the design of any non-traditional rapid testing program.

  The challenge of venue based testing programs is that each city and venue represents its’ own culture. What works in one venue, may not translate well to a different venue. Prost et al [1] identified several critical components in their evaluation of the acceptability of HIV testing in commercial sex venues in the UK. However, for every venue based HIV testing program that is not accepted by its clients, there are ones that succeed. Our bathhouse screening program in New York has been not only well received by the clients its serves, but also by the larger prevention community. We hope that readers of Prost et al see opportunities to improve and expand venue based testing programs, and not reasons to abandon them all together.

  References

  1. Prost A, Chopin M, McOwan A, et al. "There is such a thing as asking for trouble": Taking rapid HIV testing to gay venues is fraught with challenges. Sex Transm Infect 2007

  2. Spielberg F, Branson BM, Goldbaum GM, Kurth A and Wood RW. Designing an HIV counseling and testing program for bathhouses: the Seattle experience with strategies to improve acceptability. J Homosex 2003;44:203-20

  3. Huebner DM, Binson D, Woods WJ, Dilworth SE, Neilands TB and Grinstead O. Bathhouse-based voluntary counseling and testing is feasible and shows preliminary evidence of effectiveness. J Acquir Immune Defic Syndr 2006;43:239-46

  4. Daskalakis DRSRHKB, PhD; Richard Hutt, RN; Dylan Stein; Timothy Neithercott; Ancil Brown; Fred Valentine, MD; Michael Marmor, PhD. Correlates of Incident HIV Diagnosis, Knowledge of Chemoprophylaxis, and Burden of Acute and Recent Infection among Patrons of new York City Bathhouses, a Pilot Study. In: Conference on Retroviruses and Opportunistic Infections. Los Angeles, CA, 2007

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  Conflict of Interest:
  None declared.

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