Gentlemen don't speak: communication norms and condom use in bathhouses

The theory of reasoned action (TRA) focuses on attitudes, norms, behavior, and intentions in explaining a behavior. This study provides a qualitative, detailed description of TRA components applied specifically to condom use for STD prevention among men who have sex with men (MSM) in bathhouses. Using a detailed, semi-structured interview guide, MSM acknowledged an existing norm for condom use for all anal intercourse and reported perceiving that bathhouse sexual partners were more likely to be infected with HIV and other STDs than men met in other settings. They also, however, reported a norm for silence in bathhouse public areas; this norm facilitated efficient and anonymous sexual encounters but precluded the ability to negotiate condom use verbally. Condom use lapses were generally attributed to this silence norm. Norms regarding silence appeared more strongly related to condom use than attitudes toward condom use. Implications for prevention, practical applications, and future research are discussed. KEY WORDS: gay men, condom use, HIV prevention, norms, silence, Theory of Reasoned Action, MSM