Gay bathhouses/sex clubs are the public settings with the highest concentrations of sexual risk behavior. HIV-positive men are more likely to frequent these sites and to engage in UAI while there than are HIV-negative men. Yet no study to date has investigated in-depth the ways in which the bathhouse/sex club environment influences sexual risk behavior. Moreover, the Institute of Medicine review of AIDS research and other experts have called for intervention studies to incorporate environmental change to reduce HIV risk. The purpose of this proposal is to assess the dimensions of the environment associated with sexual risk in bathhouses/sex clubs and then to develop and validate a tool to measure those environmental dimensions. Such a tool would make possible comprehensive evaluations of the person- environment interaction as well as public policy and structural interventions aimed at reducing sexual risk behavior in these venues. Moos and colleagues have studied complex environments and have identified dimensions of settings that shape the """"""""social climate"""""""" of a given environment. For Moos the social climate is the """"""""personality"""""""" of a setting or environment. Each setting tends to have a unique """"""""personality"""""""" or social climate that has been shown to affect a person's behavior and feelings. Applying this theory to the bathhouse/sex club environment, we would hypothesize that a number of setting characteristics contribute to a particular social climate, which in turn affects the sexual behavior of patrons. The first task in applying the model, however, is to identify the dimensions of the social climate associated with risk behavior and then to develop and validate a social climate scale. Therefore the two specific aims of this proposed study are to: 1. Identify the dimensions of bathhouse/sex club social climate associated with sexual risk behaviors; and 2. Develop and validate a social climate scale for bathhouses/sex clubs. To achieve these aims, we will: (1) conduct field observations in all bathhouses/sex clubs in three HIV epicenters (New York, Los Angeles, and San Francisco); (2) conduct in-depth interviews with bathhouse/sex club managers and front-line staff members; (3) conduct in-depth interviews with bathhouse/sex club patrons; and (4) conduct follow-up observations and then recruit 300 patrons (10 from each of 30 venues) to complete a self-administered social climate scale (developed from data from phases 1-3 and comprised of 70-100 items).
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