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The January CDC report also found that incidents of male rectal gonorrhea -- a good barometer of condom usage and future HIV rates -- are rising in San Francisco, after a long period of decline. And having gonorrhea makes one even more susceptible to HIV infection.
"The initial HIV explosion in the early 1980s was the result of lots of unprotected sex, lots of partners, and an epidemic of gonorrhea," says the Stop AIDS Project's Robert Perez. "We want to prevent that same recipe from replicating itself again."
The Stop AIDS Project, however, has not taken a stand on the bathhouse issue. Perez says the group hopes to maintain discussion, and not alienate segments of the gay community.
Perez also says the latest data on unprotected sex, while "disturbing," is a far cry from the trends of nearly two decades ago that sparked the AIDS crisis. "Yes, rectal gonorrhea cases are increasing, and that's not good," he says. "But we're talking 200 cases predicted this year, compared to 5,000 per year in the early 1980s."
Among the men in this year's CDC survey who admitted having unprotected anal sex with multiple partners, 68 percent said they did not know the HIV status of all their partners. That statistic in particular commands the attention of health officials, especially since the city's latest HIV consensus report indicates that one in three gay men living in San Francisco is thought to be HIV-positive.
"That's troubling," Perez says. "The one time you might slip up and not wear a condom in San Francisco, chances are it's going to be with someone who is HIV-positive."
Though the survey data indicates that most risky activity takes place at home, Katz says continuing to ban private rooms in bathhouses will at least help prevent "slip-ups" in sex establishments under the Health Department's watch.
"A profit-making business, where people come to meet others and have sex, has the responsibility to the community to ensure the highest standards that people are having safe sex," Katz says. "Our rules only apply to businesses. Individuals can have unsafe sex in their home and are free to invite others over for unsafe sex."
Increasingly, that is precisely what is happening within select circles. Bay Area health officials say they are worried about the recent development of underground networks of private sex parties, some of which are exclusively "barebacking" events, where men only engage in unprotected anal sex. HIV status is not always announced. Some parties are limited to only HIV-positive or -negative men, while others play sexual Russian roulette, with everyone's status kept secret.
Berkeley's HIV/AIDS program director, Leroy Blea, says he is far more concerned about barebacking parties than what may go on in the private bathhouse rooms that his city allows. At a city-approved bathhouse, Blea says, there is at least a chance to educate patrons.
"People will find a way to have unsafe sex if they want to, whether there are doors at a bathhouse or not," Blea says. "What we need to do is empower individuals to make healthy decisions. At a bathhouse, I can target a group of people I normally couldn't reach."
In San Francisco, both Carrazza and ACT UP's Pasquarelli tout bathhouses as ideal places to push the safe-sex message.
Katz agrees. "Are sex clubs good places to educate and inform? Absolutely they are," he says. "But I believe maintaining a peer norm of no unsafe sex in the clubs strengthens that message."
At sex clubs like Eros, patrons can get free, anonymous HIV testing and counseling. At each bunk bed there is a basket of condoms, and a soap dispenser filled with lubricant is an arm's length away. There are also signs that post lesser-known safe-sex tips, like not brushing your teeth four to eight hours prior to engaging in oral sex so that tender or bleeding gums won't help promote HIV transmission.
For Carrazza, having private rooms is about creating a more desirable space for socializing, in addition to recreational sex.
In San Francisco's sex clubs now, there is little or no talking. Loud music plays as men silently cruise each other for sex. While Eros has a bathhouse feel -- and some space for conversation -- with its steam room, sauna, and a small lounge area, other clubs offer much less. Men wear street clothes and wander through dimly lit mazes of wooden panels set up in large warehouse spaces. There are cubbyholes and stalls for stand-up sex.
The Power Exchange, a four-story sex club that caters to both straight and gay crowds, tries to make up for the lack of privacy with creatively themed areas on different floors. There are S/M rooms in a basement "dungeon," while other rooms are decorated for role-playing fantasies, like the medieval King Arthur's Court complete with throne. In the gay area, a Disney-like "enchanted forest" offers fake trees lining a winding trail, lit with fluorescent black light. A campground of dome tents along the way affords semiprivacy, but the zippered doors are removed.
Carrazza complains that the sex clubs cannot compare to bathhouses in other major cities like Los Angeles, where the establishments often are full spas with gyms, lounges, pools, hot tubs -- even theme restaurants -- as well as private rooms, with televisions. Carrazza also argues that bathhouses are important because they provide secure outlets for sexual encounters among closeted men, or those who do not live alone.