NEW YORK (Reuters Health) - If the activities at one gay bathhouse are any indication, risky sexual behavior appears to be less frequent at these establishments than in the past. But health officials warn that gay and bisexual men who do report having unsafe sex in bathhouses are more likely to be HIV positive.

The findings highlight the importance of targeting bathhouses for educational interventions to reduce HIV spread, the researchers say.

After the explosion of HIV infection among gay and bisexual men in the mid-1980s, a large number of gay bathhouses were shut down, amid much controversy, largely because of their association with the spread of HIV infection.

Now, more than a decade later, the bathhouse is slowly making a comeback, especially in larger US cities, according to lead author Chris A. Van Beneden of the Centers for Disease Control and Prevention in Atlanta, Georgia.

"Gay bathhouses have been described as 'licensed men's health clubs that provide a setting for impersonal homosexual sex,"' the authors write in August 15th issue of the Journal of Acquired Immune Deficiency Syndromes.

From a public health perspective, AIDS experts are often on the lookout for ways to reduce or eliminate the spread of HIV in the community. While some take the view that gay bathhouses should be shut down, others see them as an opportunity to reach out to the otherwise unreachable patrons that visit these establishments in an effort to alter risky sexual behavior.

In the current investigation, Van Beneden and colleagues surveyed upwards of 900 men who frequented a bathhouse in Portland, Oregon, where such establishments, including private sex clubs, are legal.

Among the group, 86% reported having oral sex and 51% reported having anal sex within the month before being surveyed. Of these, 21% of men acknowledged that they had not used condoms while having anal sex during the previous month, the report indicates.

"Although most bathhouse patrons engaged in lower risk activities, those reporting unprotected anal sex were more likely to report HIV infection and to have multiple sexual partners," the authors write.

"Well into the HIV epidemic, bathhouses remain venues for ongoing spread of HIV and opportunities for intervention," Van Beneden and colleagues conclude.

Commenting on the study, J. E. Miles, Jr., a spokesperson for the not-for-profit group Gay Men's Health Crisis in New York City, said he thought the study confirmed his own experiences when speaking with gay men at such establishments.

"We have found the same thing, that, for the most part, the majority of men going to bathhouses are practicing safe sex and are using condoms that are provided," said Miles, who is involved in outreach programs targeting sex clubs and bathhouses.

He also noted that "the study's findings highlight the fact that for some reason some men are still engaging in risky behavior.

"Let's try and learn more about the men who still have unprotected sex. If we can better identify these individuals...we can make a more targeted effort with our (outreach programs)," he told Reuters Health.

SOURCE: Journal of Acquired Immune Deficiency Syndromes 2002;30:522-526.