A recent study charting the prevalence of HIV among gay bathhouse patrons in Los Angeles has rekindled an old debate, and its embers have drifted southward, fueling a similar, yet smaller and still smoldering conflagration here in San Diego.
Los Angeles public health officials are currently working to come up with new ways to regulate bathhouses and sex clubs after a recent study funded by the Centers for Diseases Control showed that HIV infection rates among gay men who sought testing in bathhouses were double those of gay men tested elsewhere, and seven times higher than HIV rates among the county's general population. The findings come at a time when the CDC says HIV infection rates among gay men in America are on the rise after years of decline.
The same study also showed that 71 percent of patrons visited a bathhouse specifically to have anonymous sex, 16 percent said they had group sex and 10 percent said they had unprotected anal sex.
Additionally, more than one third of participants said they used drugs before visiting the clubs, most commonly a combination of methamphetamine and Viagra, and more than a third indicated that they had riskier sex in the baths than in other locations.
"Based on other literature, it indicates to me that these are higher risk men," said Trista Bingham, the Los Angeles County epidemiologist who conducted the study. "It doesn't say anything to me about whether they were infected in the bathhouse."
Nevertheless, some of the recommendations expected to be announced this week could include stricter enforcement of current laws requiring bathhouse patrons to use condoms, and may compel owners to provide information on safer sex and offer on-site testing for HIV and other sexually transmitted diseases. Many L.A. bathhouse owners voluntarily implemented some degree of these recommendations years ago, but county health officials have indicated that those bathhouses that do not comply could be closed. Others have suggested a more aggressive approach and think that all of the bathhouses should be shuttered.
That option is viewed as an attack by many in the gay community who believe bathhouses are an essential part of their culture, a link to their past and symbols of gay pride. Some say closures would raise civil-liberties concerns, violate the constitutional guarantee of freedom of association, infringe on the privacy rights of consenting adults to engage in legal behavior and discriminate against homosexuals.
Yet the current calls for closure aren't coming from the Bible-thumping right but from within the gay community itself and its supporters. Most notably, the left-leaning editorial board of the Los Angeles Times said in a March editorial that any health department recommendations were simply "wishful thinking and unenforceable" and called for the closure of the baths. The editorial said "public bathhouses aren't a civil right; they're a clear and growing health threat."
Since the 1980s, both New York and San Francisco have closed their bathhouses, but it doesn't seem likely that L.A. will take such an extreme measure, and supporters of the baths point out that past closures failed to solve the HIV problem. Several sources close to both bathhouse owners and public health officials in L.A. agree that an outright closure of existing baths isn't realistic.
The L.A. County Department of Health is expected to present their recommendations to the county Board of Supervisors in the next few days.
Although L.A. decisions won't impact San Diego's baths directly, their possible fallout is already being discussed. At least one local publication focusing on the homosexual community is abuzz with speculation of possible bathhouse closures and related debate.
In April, San Diego's Gay & Lesbian Times published an editorial and column in support of the baths, and readers with opinions on both sides of the issue have answered back. While there doesn't seem to be an organized group within San Diego's gay community advocating for either the closure or increased regulation of the baths, there are plenty of voices from the larger AIDS-prevention community and beyond that say the time has come for gay America to take a hard look at its bathhouses.
One of the loudest voices in that chorus belongs to Dan Savage, the gay editor of Seattle's alternative weekly The Stranger and syndicated author of the sex advice column "Savage Love."
"If straight girls were getting HIV or STDs in bathhouses at the appalling levels that gay men are, they would be shut already," Savage told CityBeat. "It's a way society demonstrates that it doesn't give a shit about us."
Currently, there are four private bathhouses operating in San Diego County and all are located within San Diego's city limits. Three of them, Club San Diego, Vulcan Steam and Sauna and Club Mustang limit their membership exclusively to men while The Tubs is for men and women.
All four bathhouses are regulated by a section of the city's municipal code, drafted in 1988, which charges the San Diego County Health and Human Services Agency with bathhouse regulation inspection and enforcement. The code also requires owners to provide educational programs and at least one employee-monitor to observe patron conduct. The municipal code also calls for the immediate expulsion of any person engaged in drug use or high-risk sexual activity, which it defines as anal, vaginal or oral sex.
Several local bathhouse owners, who declined to comment on the record, said CityBeat could visit their establishments to get a firsthand perspective, but reporters would be required to sign a membership contract stating, essentially, that what goes on in the bathhouse stays in the bathhouse. CityBeat reluctantly declined but interviewed several regular bathhouse patrons who reported that drugs and unprotected sex are nonetheless a common part of the local bathhouse experience, and some volunteered their opinion that they are more prominent here than in Los Angeles.
However, Bingham, who conducted the bathhouse study, said she wasn't sure if a similar study would yield similar HIV rates among San Diego's bathhouse patrons. And despite all of the talk within the gay community, San Diego's health officials aren't ready to make any moves yet.
"We are looking to see what [L.A. is] going to do, but the city is the one who has actually got the ordinance, so I'm not sure what the implications would be... but we are following it," said Nancy Bowen, public health officer with the San Diego County Health and Human Services Agency. "I'm not anticipating that we are going to change anything necessarily."
For Savage, who fears that the next fatal sexually transmitted disease could currently be incubating in a bathhouse, now is the time for officials to act.
"The only appropriate health message around bathhouses is "Don't go,' and the health departments know it and they won't say it because they are afraid of being called homophobic," he said. "Well, boo-fucking-hoo, they are the health department. Somebody has got to be daddy and somebody has got to stop worrying about what they will be seen as."
In the meantime, there seems to be agreement among San Diego's health officials and bathhouse owners that helping bathhouse patrons make smarter decisions about safe sex is mutually beneficial. And nearly everyone involved agrees that closing the baths won't serve that purpose, but instead push gay men into parks and other cruising areas where outreach workers can't access them.
Fran Butler-Cohen, president and CEO of Family Health Centers of San Diego, which provides education and outreach services to local bathhouses on the county's behalf, said they provide an excellent venue to make contact with an at-risk population. She added that those efforts enjoy the support and cooperation of area bathhouse owners.
She said other settings, like the Internet, are becoming an increasingly popular option for gay men looking for anonymous sex. Educating the men logging on to a popular San Diego cruising website-600 were logged on at 5 p.m. last Monday afternoon-also poses a significant challenge, and she hopes men will carry the safe-sex message with them.
But she said she thinks there could be room for improvement, particularly in the area of rapid result, onsite HIV testing that is not included under the current contract.
"I think each thing that we can put in our tool box that becomes an effective defense against the spread of HIV and AIDS is a good thing," she said.
One area bathhouse owner said he wouldn't be opposed to exploring the prospect of HIV testing in his bathhouse, but for now he is waiting to see what happens in L.A.