Los Angeles Times - August 1, 2003
Olga R. Rodriguez, Times Staff Writer

In response, health officials suggested that an increase in such voluntary testing and in safe-sex education at the bathhouses would discourage risky behavior there.

"It's a great place to do more intervention and prevention work," said Trista Bingham, director of the study and an epidemiologist with the county Department of Health Services. The bathhouse setting is an especially good place to test and educate men who might not otherwise identify themselves as gay or bisexual or agree to be tested in a more public setting, she added.

The results of the study were announced this week, as the federal Centers for Disease Control and Prevention reported an unsettling 7.1% increase in HIV infections among homosexual and bisexual men in 2002, compared with the previous year.

The infection rate rose for the third year in a row after declining for several years. The CDC report included data from 25 states, though California and New York were not among them.

National experts said the increases in HIV infections are a dangerous sign that a younger generation has become more complacent because of medical advances that allow many HIV-infected people to live longer without progressing to AIDS.

The Los Angeles County study found that, of 916 men tested at two Los Angeles bathhouses between May 2001 and December 2002, 102 of them, or 11%, were diagnosed with HIV. By comparison, 5.5% of men who took the test at public clinics and community-based agencies in Los Angeles in 2000 were HIV-positive.

In addition, fewer than half of the bathhouse customers who tested positive followed up by seeking their test results, according to the study.

Bingham said the data did not show why bathhouse customers might have a higher infection rate. But she said the health department recognizes the baths as places where some men engage in unprotected sex.

She said that such behavior might change if infected men find out they are HIV-positive.

Scott Campbell, who runs three bathhouses in Los Angeles County, including one involved in the testing program, said the higher rate was cause for concern and that he hoped more men would take advantage of the counseling, free condoms and free HIV testing his clubs offer.

Campbell denied that the bathhouses are riskier than any other place for men to meet. "If they are going to be unsafe here, they are going to be unsafe at home too," he said.

Men in their 20s and 30s, Campbell said, are more likely to engage in risky sex. "People of my generation - and I'm close to 50 - had a lot of friends who died, and lived through the worst parts" of the AIDS epidemic, he said. "Unfortunately, with the younger generation, it doesn't sink in."

That opinion was echoed on Santa Monica Boulevard, the main drag in the heart of West Hollywood's large gay community. Ads for safe sex there feature healthy-looking, attractive men who reportedly are infected with HIV.

"We're not seeing footage of people looking like skeletons, like they did in the '80s," said Alex Hernandez, 33, who sells his own line of men's underwear and exercise clothes to a shop on the boulevard. "My personal experience is that people think it's a manageable disease. You have all these cocktail drugs, so people think, 'I can just take a couple of pills and be OK.' "

Men tested at the bathhouses were offered the option of getting the results by telephone or in person, Bingham said. Only 40% of those who were HIV-positive did.

The fact that it took a week for the results to be available may have contributed to that low response rate, Bingham said. That might change, she said, with the use of OraQuick, a rapid test now available in California that provides results within minutes.

The 40% follow-up rate for test results is "a sobering figure, given the potential positive impact that knowing their HIV status can have for an individual," said Lee Klosinski, director of programs at AIDS Project Los Angeles. "As helpful as it is to know, if you're HIV-positive it's still a scary thing to actually find out."

The L.A. County study was funded by the CDC as part of a national effort to bring HIV testing to nontraditional settings.

Tracking infections in the state is being aided by California's HIV reporting system, which started up last summer. Without using names, the system collects data from patients diagnosed with the virus. Previously, the state gathered information only on patients whose infections had progressed to AIDS.

So far, 20,943 HIV cases have been reported, including some going back years. Based on that number, it is estimated that 80,000 people are infected in California. Of the cases recorded, 60% were attributed to male-to-male sexual contact.

Times staff writer Errin Haines contributed to this report.

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