Bay Windows - National News, June 17, 1999
Bruce Mirken, Bay Windows correspondent

The decision was bolstered by a presentation of the scientific data by UCSF Center for AIDS Prevention Studies researcher Bill Woods, Ph.D. which challenged Katz's rationale for the present policy, which bans private rooms and requires that all sexual activity take place in open, monitorable spaces.

The vote came at an occasionally tumultuous HPPC public hearing held June 3 in the auditorium of a city high school. With a bare quorum of 17 out of 32 members appearing sharply divided on the issue facing an audience of at least 80 seemingly unanimous in favor of lifting the bathhouse ban, the stage was set for a confrontation.

Indeed, trouble was apparently anticipated, judging by the massive police presence inside and around the auditorium. "Was that scary or what?" complained HPPC member Shawn O'Hearn. "When I came in I literally counted 12 police officers."

Still, the meeting had a distinct only-in-San Francisco quality. Presiding, in full Sisters of Perpetual Indulgence drag, was Sister MaryMae Himm. Assisting was an outside co-facilitator, Jim Ludwig of the Community Dialogue Project, who alternated between stating the obvious ("I'm really feeling the tension in the room," he said at one point) to reciting what at times sounded like a bad parody of 1970s New Age psychobabble.

"Prove it"

But despite the anxiety level, the first part of the meeting went smoothly, beginning with opening statements from bathhouse supporters and opponents. Local activist Michael Petrelis ridiculed the monitoring policy, brandishing a flashlight and declaring, "Only in San Francisco is a flashlight an HIV barrier." He then pointed at Katz, seated in the front row, and challenged him to a public debate about the current HIV/AIDS epidemiological data.

He was followed by David Pasquarelli of ACT UP/San Francisco, who focused on DPH's lack of data. "The health department should have verifiable proof that this policy works, and they don't," he declared. "The government forces say we need to keep the baths closed to stop the spread of AIDS. We say, 'prove it.'"

David Attyah and Steve Filandrinos of Health Watch contested the theoretical basis for barring private rooms. They argued that successful AIDS prevention programs stress empowerment and self-efficacy ù that is, they support sound individual decision making ù while requiring that sexual activity be monitored undermines those values.

Katz got 15 minutes to defend the present policy. Indeed, he was the only speaker all night who defended the ban on private rooms.

He emphasized that the policy only applies to businesses and insisted that the department has not been needlessly rigid in enforcing the monitorability requirement. "Our staff has always been very flexible about working with people about what that means.," he said.

"Our goal," he continued, "is to make sure that unsafe sex does not occur, to help promote a community norm where people see, 'Oh yes, in San Francisco in the community the clubs that exist are so committed to safe sex that if I'm having unsafe sex someone is going to come up to me. Someone is going to say, 'I'm sorry, you have to put on a condom. We don't allow unsafe sex in this establishment.'"

Katz acknowledged the limited data regarding the influence of private rooms on HIV transmission or high-risk behavior in sex establishments. "Just because there's no proof one way or the other doesn't mean we don't have to make a decision," he argued.

Calling DPH's ban "a common sense approach," he then went on to make a statement that some found astonishing. "San Francisco has had essentially the same policy since 1984," he said. "To change it in some ways says, 'Well, the epidemic is different.' Well, the epidemic is different, but the prevention issues have not markedly changed." Katz ignored the torrent of recent literature ù such as Eric Rofes' book "Dry Bones Breathe" ù which argue that prevention issues have in fact changed dramatically along withh the epidemic.

The scientific evidence was key for many HPPC members, all of whom had received an extensive briefing packet about a week and a half before the meeting. The packet included a detailed chronology and summaries of studies on what are known as "public sex environments." Also included was a letter from the HIV Prevention Planning Council of Berkeley, where the Steamworks bathhouse is located.

"The HPPC considered the issue of locked doors at the Steamworks," the letter stated, "and found that locks on the rooms there are not a barrier to HIV prevention.... For a person using that facility who doesn't have the prevention message, open doors add no more protection and monitors bring no new messages."

Unintended consequences?

What seemed to carry the most weight, though, was an analysis of the scientific data compiled by Bill Woods and colleagues from UCSF and presented by Dr. Woods. The researcher explained that his group was asked "specifically to answer the question: Do private rooms result in increased risk behavior among customers?" Though he noted that "the best and safest single answer is: 'The data are not conclusive,'" Woods' talk laid out a clear scientific groundwork for believing that San Francisco's restrictions are actually harmful.

Woods focused primarily on what he called the only three studies that directly addressed bathhouse/sex club risk behavior after the AIDS epidemic began: a 1986 Los Angeles bathhouse survey, a 1995 CAPS survey of men patronizing three San Francisco sex clubs and the Windmills area of Golden Gate Park and a new, not-yet-published multi-city survey of bathhouse patrons. In the LA study 10 percent reported having unprotected anal sex, but were not asked if the sex occurred in closed or open areas. Notably, "most of those engaging in unprotected anal sex were under 30, Hispanic, never attended college, and earned less than $20,000 annually." There was less unprotected anal sex in the SF sample, but Woods noted that this may have been affected by the fact that one of the venues was a park and one sex club was specifically devoted to oral sex.

The San Francisco sample was older, wealthier, whiter and better educated than the LA bathhouse patrons. "It may be," Woods said, "that several classes of men in San Francisco, who could also be at high risk, simply don't go to sex clubs, but have sex elsewhere. This raises another important issue: One possible unintended consequence of not allowing closed spaces is that men will simply take their sexual behavior someplace else that is perhaps less safe in terms of HIV."

And, Woods continued, preliminary analysis of the third study, which looked at sex club patrons in New York, Chicago and San Francisco, "suggests that, in fact, by restricting these spaces in some ways the behaviors are simply pushed to other places." The study is noteworthy because it compares venues operating under three distinct sets of rules: San Francisco allows sex in open areas only with no private rooms; New York does precisely the opposite, allowing sex in private rooms but not in the open. Chicago establishments allow sex in both open and closed spaces.

Woods and colleagues compared the rates of unprotected anal intercourse and group sex and the number of partners for men who patronized clubs in each of the three cities: "We found no significant difference across the three cities for any of these behaviors," he noted. "If the policies regulating types of spaces permitted for sex made a real difference in sexual behavior, one might reasonably expect to see a significant difference across the three cities ù which we did not find."

San Francisco men did have less unprotected sex in public sex environments than New York men, but there was no such difference between San Francisco and Chicago. "And," he noted, "even though it did not occur in a public setting, the [overall] risk behavior among men in San Francisco and New York did not differ." In other words, San Francisco's rules may simply have moved unsafe sex out of the clubs and into other locations.

Woods wound up by reminding the audience that bathhouses and sex clubs are valuable because they provide education and prevention close to where sex actually takes place, "and at least one study suggests these venues also provide an opportunity to reach men who otherwise are not reached by prevention efforts. Thus," he concluded, "it is reasonable to think that the safer course ù for HIV prevention ù is to be sure that these venues are not restricted in ways that would deter at-risk populations from patronizing them. Our survey of the San Francisco sex clubs suggests that, in fact, the populations that do not attend San Francisco sex clubs are the younger men, men with less education, lower income men and men of color. This sounds like the men we have long been saying are at highest risk of infection in San Francisco and elsewhere."

Classism as public health?

After a period of impassioned but polite public comment in which none of nearly two dozen speakers came to Katz's defense, it was the council's turn to talk. Maria Rinaldi spoke forcefully, comparing the issue to the situation in her native Argentina, where abortion is illegal. Here, where the procedure is legal, she said, "abortions are not more common, but they are safer. You can't improve public health by prohibiting things." To wild applause, she then moved that the HPPC recommend to the health commission that bathhouses and sex clubs with private spaces be allowed to reopen.

But the crowd's happiness was quickly squelched when Father River Sims moved to table Rinaldi's motion, postponing a vote till the following week. Sims' motion to table passed by a vote of nine to seven, over angry shouts from the audience.

Then, in a somewhat odd procedure, the commission proceeded to discuss the original motion, as well as the tabling they had just agreed to. HPPC community co-chair A. Toni Young said, "I've not seen enough information way or another" to vote on Rinaldi's proposal, adding that she wanted "more input from communities of color."

Rinaldi shot back that "we received the material in plenty of time." To loud applause she added, "I have never seen 60 people in the room when we discussed any issue" and called the notion that the council hadn't had enough input "just outrageous."

O'Hearn then lit into his colleagues, blasting "the level of fear on this council, the inability to stand up and take a stand that's the right stand." Those who voted to table the proposal, he seethed, "don't have the guts to vote for the public health."

Following up on Woods' presentation, John Newmeyer from the Haight-Ashbury Free Clinic, noted that the wealthy can use private rooms in hotels for their sexual trysts, while others can't afford to. "As in the substance use area, this thing has the stench of classism about it."

The public then got another chance to speak, and this time the comments were so venomous that Dredge Byung'chu Kang asked if he could move to rescind the tabling. Rinaldi promptly seconded the move and this time the vote was nine-to-seven to untable Rinaldi's proposal.

With the time allotted for the meeting nearly gone, Sister Mary moved quickly to a vote ù with a roll call rather than a mere show of hands, at O'Hearn's insistence. The count was nine in favor of Rinaldi's motion, one against and seven abstentions. The audience cheered wildly.

Woods, whose presentation was clearly influential, was pleased that the possible unintended consequences of the present policy may now get more attention. "I think what the council has done may help move that agenda forward and recognize that is important to look at," he said.

O'Hearn, though happy with the final outcome, was angry at his colleagues. Of the unusually high number who failed to show up, he snapped, "To me it spoke volumes about whether these people should be serving in a leadership capacity in this city." Regarding the many abstentions, he noted that many HPPC members work for agencies funded by DPH. "They're afraid they're going to lose funding. The easiest thing to do is kiss up and let the thing die."

The council's three co-chairs, Young, Kang and Larry Meredith of DPH, will now formulate a letter to the Health Commission conveying the recommendation, which the full group will approve June 10. Because the HPPC's role is strictly advisory, the commission is not required to act on the recommendation, though bathhouse advocates are expected to press it to do so.
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