Date: Thu, 11 May 1995 10:48:50 -0400
From: Gabo3@aol.com

New York Newsday - Thursday, May 11, 1995
WHAT HAPPENS WHEN BATHS ARE CLOSED?
by Gabriel Rotello
	New York - The controversy in New York's gay community over the city's new
policy on sex clubs - which is to warn establishments where health inspectors
see repeated instances of unsafe sex, and close those that fail to clean up th
eir acts - has become so heated that fist fights are breaking out between
AIDS activists who support the policy and those who don't.. 
	Some of the panicked opposition stems from a perception that the policy will
only make things worse. "Wholesale closure," says a recent statement by the
Gay Men's Health Crisis, "would not cause unsafe sex to disappear but would
disperse such activity to parks, alleys, underground clubs and other covert
locales where participants would be subject to arrest or violence and where
HIV prevention interventions could not easily reach." 
	It's odd that GMHC is raising the specter of "wholesale closure," since
neither prevention activists nor administration officials have proposed
anything that draconian. But what's really odd is the fact that GMHC and
others are touting a "dispersal" theory that was decisively debunked a decade
ago in both New York and San Francisco. 
	Back then activists and health officials indeed proposed wholesale closure
of sex establishments, and no one knew what the results might be. But when
widespread closures eventually occurred in both cities in the mid 1980s, it
was during a period when gay sexual behavior was the subject of intense
research. Thousands of sexually active gay men had responded to the AIDS
crisis by enlisting in cohort studies in which they reported to researchers
every few months, took blood tests and recounted their sexual activity in
great detail. Those studies covered the periods before, during and after the
closure of sex establishments in both cities. Thanks to them, it is now
possible to look back and see what actually happened. 
	In fact, it was the opposite of what was feared. For example, HIV prevalence
in the San Francisco Men's Health Study more than doubled, from 22.8 percent
at the end of 1982 to 48.6 percent at the end of 1984, despite growing panic
in the gay community during those years. But when the city shuttered its
baths and sex clubs at the end of 1984, new infections stopped in their tracks
, remaining "stable at approximately 50 percent" thereafter. In a different
San Francisco study, approximately 11 percent of gay male subjects became
infected each year from 1980 up to the end of 1984, when the baths closed.
Then new infections dropped off so dramatically they actually reached zero
percent in 1987. 
	If, as some argued, closure simply drove unsafe sex underground, then
researchers expected to find a similar level of multiple partners before and
after closure. Instead there was a huge decline. One San Francisco study, for
example, compared the average number of partners in the last six months
before bath closure in 1984 to a six month period two years later. This
"before and after" snapshot documents drastic decreases in overall numbers of
partners, including a 60 percent decrease in the number of men who had ten or
more partners in each period, the group then at greatest risk for AIDS. 
	Here in New York gay men had almost 90 peecent of their sexual partners in
"extradomestic" locations such as baths and sex clubs before the epidemic.
These places remained open in New York a year longer than they did in San
Francisco, and during that extra year -1985- new infections continued to rage
out of control. 
	A major  study completed here in late 1985 just before the baths were closed
reported that its "most disturbing observation" was that "the incidence of
[HIV] seroconversion has remained persistently high throughout the five year
study period." In other words, right up through the the year of Rock Hudson's
illness, new infections in New York's gay community continued unabated. Then
the baths and sex clubs were closed, new transmissions dropped to negligible
levels and remained there for years. 
	Some now argue that any connection is coincidental, since gay men began
decreasing their unsafe sexual activity before closure. They did indeed, but
researchers say it was nowhere near enough to offset the increased risk that
came from rising prevalence. By contrast, the years immediately after closure
are now regarded as almost a golden age of successful prevention, when new
infections were close to zero. 
	Why didn't men simply relocate to alleys and parks and carry on as before,
as so many argued back then (and argue now)? One reason may be gleaned from
studies showing that two of the main attractions of sex establishments are
"comfort" and "safety," qualities not readily found in dark alleys. Then
there was fear and growing AIDS awareness, prompted in part by the bath house
debate itself, which was enormously educational, a visceral reminder of no
more business as usual. So while a small percentage of determined men
undoubtedly continued to seek out multiple partners in dangerous,
uncomfortable locations, the vast majority did not. They simply reduced their
number of partners - and their risk. 	
	No one argues that closure alone produced the safer environment of the late
1980s. And no one in New York is arguing for wholesale closure now, since
many sex establishments have proven they can be run safely and responsibly,
and contribute to safer sex. But neither should anyone argue that if a few
notoriously unsafe venues are closed, gay men will flock en masse to dark
alleys. The available evidence - collected with so much time, effort and
expense on the part of so many gay men - points decisively the other way.

(Gabriel Rotello's column appears every Thursday in New York Newsday. His
email address is gabo3@aol.com)