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OBJECTIVE: Describe sexually transmitted disease/human immunodeficiency virus prevention interventions targeting men who have sex with men (MSM) in commercial sex venues (CSV). STUDY: Compilation of descriptive and evaluation data from the CDC 8-city MSM Syphilis Response on interventions conducted in bathhouses/sex clubs, circuit parties, the Internet, male sex workers, and the adult film industry. RESULTS: Interventions in the commercial sex industry (CSI) often involved multiple collaborative efforts between public health departments (PHD), community-based organizations (CBO), and CSV owners and managers. Education and condoms were provided at multiple venues, including circuit parties, bathhouses, and sex clubs. CBO staff reported one-on-one street and CSV outreach to engage MSM at risk. Evaluation data demonstrate that MSM exposed to media campaigns were more aware of syphilis and more likely to have been tested for syphilis than MSM who did not see the campaigns. CONCLUSIONS: PHD and CBO are using multiple means of reaching MSM in the CSI. Evaluations are needed to determine which of these efforts decreases syphilis transmission.

Background This study examined venue-based networks constituted by affiliation with gay bars and street intersections where male sex workers (MSWs) congregate to find their sexual/drug-sharing partners and network influence on risky sexual behavior (e.g., unprotected anal intercourse [UAI]) and HIV infection. Methods Data collected in 2003 to 2004 in Houston, Texas, consists of 208 MSWs affiliated with 15 gay bars and 51 street intersections. Two-mode network analysis was conducted to examine structural characteristics in affiliation networks, as well as venue-based network influence on UAI and HIV infection. Results Centralized affiliation patterns were found where only a few venues were popular among MSWs, and these were highly interdependent. Distinctive structural patterns of venue-based clustering were associated with UAI and infection. Individuals who shared venue affiliation with MSWs who engage in UAI were less likely to have UAI themselves. This suggests a downhill effect; that is, individuals compensate for their risk of infection by adjusting their own risk-taking behavior, based on their perceptions of their venue affiliates. Conclusions Venue-based HIV/AIDs interventions could be tailored to specific venues so as to target specific clusters that are more likely to engage in risky sexual behavior.

Background Drug-using male sex workers (DUMSWs) are known to have large numbers of drug injection and sex partners. Goals The purpose of this study was to describe the assortative and disassortative drug injection and sexual mixing patterns of DUMSWs. Implications of the high rates of disassortative mixing patterns of DUMSWs for HIV infection are discussed. Implications of disassortative mixing of DUMSWS with regard to DUMSWs bridging disparate HIV risk groups are evaluated. Study design Data were collected from 89 DUMSWS. Data on up to six drug injection and six sex partners were collected from respondents. One hundred drug injection and 169 sex respondent/partner pairs were analyzed for the proportions of pairs that were concordant (like) or discordant (unlike) in gender, trading sex for money, race/ethnicity, and age cohort. For race/ethnicity and age, within-group differences were assessed with chi-square statistics. Results Data showed high proportions of discordant respondent/partner pairs for both drug injection and sex by gender, trading sex for money, race/ethnicity, and age. Significant within-group differences in rates of discordant pairs were found for both behaviors in relation to race/ethnicity and age. Minority persons and respondents 19 years of age or younger were more likely to be in discordant pairs. Conclusions Direct assessment of HIV risk posed by the mixing patterns was not possible. Elaborating the mechanisms by which DUMSWs might act as an epidemiologic bridge is complex and involves more variables than were explored in this study. Nevertheless, such a study would be worthwhile.

There is a discrepancy between self-reported sexual identity and sexual behavior. The magnitude of this discrepancy is unclear, as is its variation across race/ethnicity and gender.The goal of the study was to assess the range of discrepancy in self-reported sexual identity and sexual behavior in men and women of four racial/ethnic groups.Self-reported data on sexual identity (homosexual, bisexual, heterosexual) and sexual behavior in the past 3 months were collected from 1494 African American, Hispanic, Asian, and white men and women in public congregation places in Houston, Texas.Data indicated that concordance rates between self-reported sexual identity and sexual behavior varied widely across racial/ethnic groups, with the highest rates of concordance in Asian males and females and the lowest in African American females and white males. The largest discordant category was in those self-described heterosexuals who reported partners of both genders. Breakdown of data to exclude those who reported sex trade work or illegal sources of income improved the concordance rates for African American and Hispanic subsamples.Data indicate the importance of designing and targeting HIV risk interventions and clinical screening, based on behavior and not reported sexual identity.

Background and Objectives: Persons who participate in behaviors such as drug use and buying or selling sex are at elevated risk for sexually transmitted diseases (STD)/human immunodeficiency virus (HIV) infection. Goals: To describe the economic structure supporting drug use and the buying and selling of sex services in two urban Houston communities. Study Design: Residents of two Houston communities participated in street-intercept interviews to obtain information on sex and drug use behaviors. Results: Many members of the population reported having bought or sold sex. A history of crack use significantly predicted the trading of sex for money and drugs, and sellers of sex were more likely to have engaged in recent high-risk sexual behavior than those who had never sold sex. Conclusion: The data are suggestive of an underground economy for the exchange of sex for drugs or money, the existence of which facilitates the spread of STDs in high-risk communities.