The proposed study will expand the science of structural interventions by investigating local prevention policy and programs directed at commercial risk settings where men meet and sometimes engage in behaviors known to transmit human immunodeficiency virus (HIV). For convenience we refer to these risk settings as """"""""clubs."""""""" In another study of clubs, we have looked at the club environment from the theoretical framework of Rudolf Moos, whose """"""""person environment"""""""" theory identified setting dimensions that shape a given environment, making significant contributions to the """"""""social climate."""""""" For Moos the social climate is the """"""""personality"""""""" of a setting. However preliminary analysis indicates that Moos's theory is limited in explaining the influence of """"""""outsiders,"""""""" i.e., health departments and community based organizations (CBOs), which make significant contributions to a club's HIV prevention environment. At the same time the influence of these outsiders appears to be both local and idiosyncratic, and therefore policy and programs vary greatly from city to city. In fact, the policy implementation to reduce HIV risk in one city can be the exact opposite of a policy to reduce HIV risk in another city. We propose to assess the process by which policy and programs are implemented and their impact on the club environment; building on Moos's theory we propose to study the influence of outsiders on the club environment by: 1) documenting the legal and policy environment in which clubs operate and the HIV prevention programs that have been implemented in clubs, 2) assessing intended and perceived impact of prevention efforts on the club environment, by building on Moos's theory of social climate, and, 3) describing the structure (interorganizational relations among clubs, health departments and CBOs) and the process (policy activism) of implementing (or not) HIV prevention policy and programs in clubs. To accomplish these aims, we will document the legal and policy environment, conduct field ethnographies, and interviews/focus groups among five stakeholders groups: club managers, health officials, CBO providers of HIV prevention services, community representatives on HIV prevention planning groups, and club patrons. ? ?

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Study Section
Special Emphasis Panel (ZRG1-AARR-G (02))
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Pequegnat, Willo
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University of California San Francisco
Internal Medicine/Medicine
Schools of Medicine
San Francisco
United States
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Woods, William J; Euren, Jason; Pollack, Lance M et al. (2010) HIV prevention in gay bathhouses and sex clubs across the United States. J Acquir Immune Defic Syndr 55 Suppl 2:S88-90