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Of the remaining 1, eligible patrons, Once again this time period defined 3-hour recruitment shifts of which 90 Unlike most other places where men have sex in public, gay bathhouses are subject to government-imposed health regulations. Respondents were also asked if they had tested for HIV and the result of their most recent test. The second data collection period occurred during the last 30 consecutive days of and the first 6 consecutive days of During each sampled shift, exiting patrons were selected with equal probabilities.
Results During the two data collection periods, 1, patrons exiting the bathhouse were selected for participation. The spread of these infections among gay men stimulated the public health community to seek ways to combat them. Of the remaining 1, eligible patrons, The sample of visits was then weighted to convert it to a sample of individual visitors. Using two comparable exit survey samples from a single bathhouse, we examined data to determine if the conditions for potential widespread transmission of HIV were present inside the bathhouse. Implementing such a design can be costly because it often requires extensive observation needed to inform the sampling frame and methodology , long periods of data collection, and extra staffing because enumeration of the population from which the sample is drawn men exiting a bathhouse must occur contemporaneously with data collection. In order for rapid, widespread transmission of HIV to occur in a bathhouse setting a non-zero proportion of patrons must be HIV-positive, patrons must report multiple sex partners, and patrons' sexual behavior patterns during the visit must create potential transmission networks either directly HIV-positive men reporting multiple insertive UAI partners or indirectly patrons reporting multiple receptive UAI partners which would expose succeeding receptive UAI partners to the semen of preceding receptive UAI partners. All subsequent analyses were restricted to this subsample of sexually active patrons. Of the men surveyed, Thus, the risk of sexual transmission of HIV during the bathhouse visit was typically within isolated dyads rather than patterns of multiple sexual encounters that might put many men at risk during a single visit, and men who did engage in UAI tended to withdraw prior to ejaculation, potentially mitigating the risk of HIV transmission. It was not possible to weight the data to adjust for demographic variables, such as age or education, because such data were not available for the total patron population. In the first stage, each day of the week was divided into eight 3-hour recruitment shifts the bathhouse operated 24 hours a day, seven days a week and a sample of shifts was selected; in the second stage, patrons exiting the establishment during those shifts were sampled. HIV serostatus group differences in mean number of sexual partners were assessed using negative binomial regression via the SVY: Of course, AIDS was a different matter in a different time. However, patrons who visited the club more often during the data collection period had a proportionately higher chance of selection. By early , the once rare call for closure had gained a powerful voice as well as support in powerful gay circles. Differences between patrons sampled in and patrons sampled in were evaluated by an F test yielded by a Rao and Scott second-order correction of the Pearson chi-square statistic as calculated by the SVY: Respondents were also asked if they had tested for HIV and the result of their most recent test. Recruitment and Data Collection Three-man teams were assigned to each randomly selected shift, one man served as counter and the other two were available for recruiting and interviewing each nth man checking out of the club. After recruitment, men were taken to a private room in the club, and, after giving verbal consent to participate, completed an interviewer-administered questionnaire. Although there appears to have been some mention of closing bathhouses as an approach, the predominant message was to educate, test, and treat. For each place he had sex, we followed up with two questions: This means that, as a group, frequent visitors would be over-represented unless corrective actions were taken. Statistical Analysis All data were weighted for statistical analysis unless otherwise specified. Sample Characteristics Table 1 provides information on the demographic characteristics and recent 3 month sexual behavior of the sexually active men exiting the bathhouse. All statistical analyses employed computational algorithms that correctly adjusted standard errors for weighted data. During each sampled shift, exiting patrons were selected with equal probabilities.
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