Experts Back Bathhouse Regulation

By: DUNCAN OSBORNE / Researchers and health policy experts are generally supporting the regulation of New York City sex clubs and bathhouses, saying the businesses are valuable for research, HIV testing, and prevention efforts.

“We have to up to 26 percent of non-gay identified people that we are testing,” said Dr. Demetre C. Daskalakis, a professor at New York University's School of Medicine. “A lot of them don't know where to go to get healthcare.”

Since 2006, Daskalakis has been conducting research funded by Bellevue Hospital in two of the city's bathhouses – the East Side Club and the West Side Club, both in Manhattan.

Daskalakis has tested roughly 1,000 men who have sex with men for HIV, screened some for sexually transmitted diseases, and referred men to health providers including Bellevue. What began as research has effectively become an ongoing clinic with these services available in both bathhouses for a total of 35 hours a week.

“The level of contact that we've created there has allowed us to access a population of men that we never would have surfaced,” Daskalakis said. “It would be a horrific mistake for New York City to close bathhouses because we will drive these people underground and we will not see them again until they show up with AIDS.”

In a November 2007 memo, Dr. Thomas Farley, a special advisor to Dr. Thomas R. Frieden, the city's health commissioner, presented four options for dealing with city sex clubs and bathhouses.

The options ranged from continued inspections and enforcement of a 1985 state health code that bans oral, anal, and vaginal sex in businesses with or without a condom; to aggressively moving against the city's bathhouses and sex clubs; to closing “all commercial sex venues;” to regulating these businesses by changing the code and allowing them to operate “under strict safe-sex rules” and other requirements.

Gay and AIDS groups that have weighed in favor regulation as have many of those who have commented on web sites, though some voices, notably sex columnist Dan Savage, support closing these businesses.

Gay City News spoke with eight experts. They do not say that regulation, by itself, will immediately reduce new HIV infections, but they do agree with Daskalakis that it makes men available for HIV testing and prevention messages.

“The current role of high-risk venues, such as bathhouses, in the HIV epidemic is not completely clear,” Dr. Robert S. Janssen, director of the Division of HIV/AIDS Prevention at the federal Centers for Disease Control and Prevention (CDC), said in a statement. “However, these venues do provide important opportunities to reach at-risk individuals who might not otherwise be reached by HIV prevention programs. CDC has provided funding that supports efforts in local communities to provide HIV testing, STD screening, and educational programs in bathhouses and other public sex environments.”

Dr. Perry N. Halkitis, a psychology professor at New York University and director of the Center for Health, Identity, Behavior, & Prevention Studies, agreed.

“We believe that the best policy for the city is to work with the bathhouses,” Halkitis said. “There are some people who are not going to present in an ER, there are some people who are not going to go to a doctor's office. You have to cast the widest possible net if you are going to capture people.”

Other experts either did not respond to calls and emails seeking comment or they noted that such discussions are often heated and declined to comment. Finding individuals who are knowledgeable about gay men and HIV and support closing such businesses is difficult.

Certainly, Farley once backed shutting bathhouses down. In a 2002 article published in the Washington Monthly magazine, he argued that such places allowed men to have large numbers of unsafe sex partners and that such encounters were fueling the spread of syphilis among gay men.

Farley wrote that closing bathhouses in San Francisco in 1984 resulted in “the number of gay men newly infected with HIV” declining “dramatically.” In 2002, he wrote that “it is once again time to take a hard look at the evidence and either radically change the way they do business or shut them down altogether.”

None of the experts saw regulation as a panacea. If the rules are seen as overbearing some men may seek out venues through the Internet that are unregulated.

“I can also see that an onerous set of restrictions could drive people to other venues,” said Lance Gable, a law professor at Wayne State University in Detroit who specializes in public health law. “I think that's certainly possible; of course, maybe it's a smaller population.”

What regulation will do is obtain the greatest benefit for the greatest number of people, experts argue.

“The fourth option is probably the most rational and probably the one that is most likely to be effective,” said Scott Burris, a law professor at Temple University who specializes in public health law. “There's nothing perfect. This is unsafe sex and people do it and they want to do it. The best stance is to reduce unsafe sex among the most people and a regulatory approach makes the most sense.”