Hey there Mate,

Last night my partner Nick and I were out at our local pub. It’s been darn hot so most people were outside enjoying the cool when Nick got chatting with a couple as tends to happen in these environments. As the conversation evolved it was established that one partner was a doctor. Nick mentioned myself and was shocked to hear the response from the doctor’s partner, “Yes, I stopped reading Dr George’s site when he started advocating risky behaviour”.

Nick was floored and honestly wondered if they were joking. Nick mentioned that I was a very firm safe sex educator, and had to ask how he had the impression that I was promoting risky behaviour?

After a bit of to and fro it was established that there were concerns about how my blogging about sex-on-premises venues was promoting promiscuous and potentially unsafe behaviour.

Moral judgements aside I was genuinely interested in this impression. I remember when the HIV crisis first erupted there was huge focus on sex venues of the day for their involvement in the spread of the virus. To quote, “The AIDS crisis: a documentary history” by Douglas A. Feldman, Julia Wang:

In the United States, the debate on the gay baths has political as well as public health aspects. With the support of some members of the gay community, New York City’s public health officials closed the St. Mark’s Baths and eventually nine of thirteen other gay baths in 1986 because they felt that the risks outweighed any other considerations. In 1984, the San Francisco Health Department closed gay baths and other gay commercial establishments. These actions were challenged in court. New York City’s action to close the St. Mark’s Baths and the other bathhouses was upheld. San Francisco’s right to regulate sexual behavior in the baths was upheld, but it could not legally close the baths. The effect, nevertheless, was to close the baths.

At the time of these legislative changes there was no clear cause or vector of the the spread of this illness other than it was happening to gay men who were having frequent sexual encounters. The concept of safe sex was not developed, nor was a full understanding of HIV prevention, treatment and care for those living with HIV.

Today is a different story. Gay saunas and sex venues have become places not only of hedonism but also education. A study published in the Journal of Acquired Immune Deficiency Syndromes shows that managers of sex venues have embraced the importance of sharing the safe sex message:

All the bathhouses provided free condoms, and nearly all displayed educational posters in public areas and had informational pamphlets available for patrons. A few of the bathhouses offered outreach services and counselling services. Almost all promoted testing for HIV/sexually transmitted infection (which included providing information about where to get tested), and 75.5% had HIV testing programs in their venues. Most of the HIV testing programs were started during the past 5 years, initiated by the bathhouse management or a community agency, and operated by community-based agencies. About one third of the programs offered rapid HIV testing.

While education is one aspect, it does not clearly explain if attending sex venues actually leads to increased rates of HIV infections.

Each year in Australia a comprehensive study is conducted, The Seroconversion Study, and consists of detailed interviews of men who have seroconverted  to HIV positive. Or in plain English, have been infected with the HIV virus.

Part of the interview includes questions about “When was the most  likely time that you had a sexual encounter that would have lead to infection?”. Over 80% of participants where able to identify a particular sexual episode that could have lead to their infection, just under one half were able to recall more than one episode.

The questions were quite detailed, going into with whom the encounter was with, how they had met, where the encounter happened and details of the identified “high risk event”. Of most interest to me was the location of the encounter.

Before going into the data I wanted to check what the lay of the land was with regards to sex on premise venues.  To get an impression of people’s perceptions of sex-on-premises venues, I posed the question to readers on The Healthy Bear’s Facebook page.

The question posed. Please ignore my appalling spelling!

As you can see in the image the vast majority responded that they felt that HIV infection was likely to have occurred at home whether that was the individual’s home or the home of their partner. I was actually surprised to see that sex-on-premise venues where not given a high vote.

With this data I went into The Seroconversion Study to see if their data compared. To get to the salient facts here are the findings, and the majority of the identified “high risk events” were:

• casual encounters
• who met via the internet
• occurring at the home of the new sexual partner, not the home of the person in the study.

For those who like graphics here is a quick summary of percentages and comparison between The Seroconversion Study and my questions asked via Facebook.

The Seroconversion Study has been able to confirm the findings of my Facebook survey that indeed the majority of episodes of high risk sex occur in the settings of the home. The only difference is that while my survey participants felt it might be in the home of person newly infected, it was more likely to be in the home of the new sexual encounter.

This introduces two interesting questions. Why is it that when you are visiting a casual partner’s house you may be more likely to have high risk sex? And is the easy availability of condoms, lube and safe sex educational materials in sex venues increasing the chance of grabbing a condom?

The answers to these questions are another post entirely! In the meantime I would encourage to think about your own choices, thoughts and beliefs around HIV, safe sex, and how you choose to express your sexuality. You might just be surprised.

Stay safe and if you are visiting a new friend don’t be afraid to pack some condoms and lube. Some people choose to put them out at the beginning of the encounter to make access easy and affirm your choice of preference to have a safe encounter. Remember using condoms does not have to be an interruption. I’ve enjoyed many encounters where the introduction of the condom was a great opportunity to “get to know my partner even better”. Try it out some time

Yours in good health.

Dr George