The Institute of Medicine and others have strongly encouraged research on structural interventions. Outreach HIV/STD testing programs are an example of a structural intervention that have been studied for their individual level effects but not for structural level effects. Nevertheless, some anecdotal evidence suggests that this intervention may indeed have a structural level impact on risk behavior in at least one type of risk environment. Using secondary data analysis, the proposed exploratory study will expand the science of structural interventions by investigating the possible structural-level impact of a local prevention program at a club where men at high risk for HIV infection go and where risk behavior is known to occur. Although this subgroup of men are from a small proportion of the US population, they account for almost two-thirds (63%) of the AIDS cases nationwide. For an on-site HIV testing program to be a successful structural intervention, the critical question is whether the altered social climate results in change to the overall risk behavior in the club, even among those who did not test. Additionally, any observed change must not be due to unintended consequences, such as moving the high-risk men or behavior someplace else. Finally, it would be good to identify evidence that the structural-level changes anticipated are actually occurring in the club's social climate. Thus the Specific Aims of the proposed study are: 1) Compare risk behavior at the club during times with on-site-testing vs. times with no on-site-testing. 2) Assess indicators of unintended consequences (i.e., moving high-risk men and behavior elsewhere). 3) Describe the impact of the on-site testing programs on the club's social climate. This study proposes to conduct secondary analyses using multiple data sources from a single club: 1) Exit Surveys: two independent probability samples of men exiting the club, 2) Club Membership/Utilization Data: collected by club staff as members enter and leave the club, 3) Ethnographic Data: interviews with managers, staff and patrons about the social climate at the club, and 4) Process Data: interviews with managers, staff and patrons from an evaluation of the testing program at the club. The proposed study has the significant advantage of addressing the intervention's impact using multiple data sources and analyses, providing a robust assessment of our research question. The results could support designing a controlled clinical trial to test the efficacy of an on-site HIV testing program as a structural intervention to reduce high-risk behavior in clubs. ? ?
| Pollack, Lance M; Woods, William J; Blair, Johnny et al. (2014) Presence of an HIV Testing Program Lowers the Prevalence of Unprotected Insertive Anal Intercourse inside a Gay Bathhouse among HIV-negative and HIV-unknown Patrons. J HIV AIDS Soc Serv 13:306-323 |
| Huebner, D M; Binson, D; Pollack, L M et al. (2012) Implementing bathhouse-based voluntary counselling and testing has no adverse effect on bathhouse patronage among men who have sex with men. Int J STD AIDS 23:182-4 |
| Binson, Diane; Pollack, Lance M; Blair, Johnny et al. (2010) HIV transmission risk at a gay bathhouse. J Sex Res 47:580-8 |
| Woods, William J; Erwin, Kathleen; Lazarus, Margery et al. (2008) Building stakeholder partnerships for an on-site HIV testing programme. Cult Health Sex 10:249-62 |
