Important note: Information in this article was accurate in 2009. The state of the art may have changed since the publication date.
Bay Area Reporter - September 3, 2009
Brian Gougherty
Agency representatives presented some initial findings from the Where study, which has collected feedback from nearly 200 one-on-one conversations - mainly with local gay men - concerning different ways to improve the environments of local bars, sex clubs, and cruising Web sites to create an atmosphere more conducive to safer sex.
This approach to HIV and STD prevention, known as structural intervention, is pioneering in that it places an emphasis on making changes at high-risk venues as a means to reduce the number of infections. It's more common that prevention strategies focus on altering high-risk behavior of individuals, not places.
Eventual structural intervention programs may include creating easier access to free water in bars, promoting Web sites for "protected sex only," or providing wrist bracelets at sex clubs reflecting sexual preference, desired acts, positions, or HIV status. The Where study includes over 50 such suggestions, all of which will be further evaluated before any pilot programs are implemented.
Jen Hecht, education director at Stop AIDS, said that the concept of structural intervention has seen notable success on a larger scale. For example, seatbelt laws are considered a structural intervention, as are policies allowing the addition of fluoride to public tap water to prevent tooth decay. Hecht and her team members are focusing on local solutions that use the same concept; creating practices beneficial to a broad spectrum of the community, without increasing the burden placed on any individual.
"A guiding question for this project was what if we could reduce the chance of someone getting HIV or STDs without changing the frequency of condom usage?" Hecht told an audience of about 20 who gathered August 17 at the LGBT Community Center for the agency's community report on HIV data.
While Stop AIDS will continue running and developing its other programs, including those focusing on safer sex practices for individuals, the staff is introducing the new approach as a complement to these programs. Stop AIDS reported that it is the first organization of its kind to be conducting an expansive exploratory study of the concept.
"Structural interventions are not new in public health discourse, but they are new in HIV prevention," said Executive Director Kyriell Noon. "Given the fact that the number of new HIV infections in San Francisco appears to have reached a tableau, we need to do something different to effect change.
"We believe that this study lays the groundwork for HIV prevention efforts that lead to healthier community outcomes with a minimum of individual behavioral change," Noon added.
Last month's forum focused on individual feedback to specific ideas for bars, clubs, and Web sites. Each survey participant was asked not only if they thought a certain idea was good or bad, but also if they would participate if the idea were implemented. For example, the majority of people felt that it was a good idea to have outreach workers inside of bars, but few said they would actually engage with them.
Hecht said this two-prong approach is essential and that Stop AIDS will continue to analyze not only the feasibility of each idea, but also whether or not people are actually going to use an idea if it's implemented.
"We might think something is a great idea," she said, "but if no one is going to use it, then it's not worth the energy it's going to take to set it up."
Other ideas that participants favored included on-site STD testing at sex clubs and paying an extra dollar for entry to a club if it's used to purchase prevention materials. Ideas that drew the most criticism included paying extra to enter a sex club without proof of a current STD test and ending "two for one" specials at bars.
The Where study is a collaborative project of Stop AIDS Project, University of California San Francisco, the San Francisco Department of Public Health and the California STD/HIV Prevention Training Center.
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