Introduction

Gay and bisexual men have historically utilized many environments, or venues, to meet potential sex partners including: public venues such as parks, adult bookstores, beaches, alleys, restrooms, sex parties, and gyms (Binson et al., 2001; Humphreys, 1975; Leap, 1999; Parsons & Halkitis, 2002; Reece & Dodge, 2003); commercial sex environments (CSEs) such as bathhouses (Elwood & Williams, 1998, 1999; Parsons & Halkitis, 2002; Tewksbury, 2002); and the Internet (Bolding, Davis, Hart, Sherr, & Elford, 2005; Chiasson et al., 2006; Grov, 2004; Ross, 2005; Tewksbury, 2003). The environmental context where gay and bisexual men meet sex partners has been related to sexual behaviors and communications (Baker, 2002; Bullock, 2004; Elwood & Greene, 2006; Leap, 1999; Silverstein & Picano, 2003), including condom use (Benotsh, Kalichman, & Cage, 2002; Binson et al., 2001; Elwood, Green, & Carter, 2003; Klausner, Wolf, Fisher-Ponce, Zolt, & Katz, 2000; Parsons, 2005; Parsons & Vicioso, 2005, Parsons et al., 2004; Taylor et al., 2004).

Recent studies have found the rates of sexual risk behaviors, such as unprotected anal intercourse, among gay and bisexual men have risen (CDC, 2003a, b; Chen et al., 2002a, b; Ekstrand, Stall, Paul, Osmond, & Coates, 1999; Kalichman, Rompa, Luke, & Austin, 2002; Stolte, Dukers, de Wit, Fennema, & Countinho, 2001; Van de Ven, Prestage, Crawford, Gulich, & Kippax, 2000), increasing potential for the spread of sexually transmitted infections (STIs), including HIV (CDC, 2002, 2003a, b, 2005a; Koblin et al., 2000). These data are alarming as gay and bisexual men are a social group with already disproportionate rates of HIV and AIDS. Based on data collected in 2004, the Centers for Disease Control reported that MSM accounted for 70% of all estimated HIV infections among male adults and adolescents in the US (CDC, 2005b). That same year, MSM accounted for 63% of all male adults and adolescents who received an AIDS diagnosis, and 46% of all people who received a diagnosis of AIDS (CDC, 2005b). These data exemplify the need to better identify and provide effective health education and prevention to men who may be most at risk for HIV transmission. A thorough understanding of where men who report sexual risk meet their partners, in conjunction with providing sexual health education and prevention services within these spaces, is one potential method for effectively reaching populations at risk (Blank, Gallagher, Washburn, & Rogers, 2005; Binson et al., 2001, Binson, Woods, Pollack, & Sheon, 2005; Bolding, Davis, Sherr, Hart, & Elford, 2004; Frankis & Flowers, 2006; Taylor et al., 2004; Woods, Binson, Mayne, Gore, & Rebchook, 2000; Woods, Binson, Mayne, Gore, & Rebchook, 2001).

Assessing Venue and Sexual Risk

Researchers have studied the sexual risk behaviors among MSM in a variety of contexts. Sampling methods have included both surveying men at locations where they met sex partners (i.e., interviewing men at bars, bathhouses, on the Internet) (Benotsch et al., 2006; Bolding et al., 2004, 2005; Crosby & Metty, 2004; Reece & Dodge, 2003; Tikkanen & Ross, 2003; Woods et al., 2001) or by self-report data, in which men were asked to recall where they met sex partners (Binson et al., 2001, 2005; Elwood & Greene, 2006; Parsons & Halkitis, 2002; Rietmeijer & Lloyd, 2005; Taylor et al., 2004). Some studies have compared sexual risk between venues (Binson et al., 2001, 2005; Bolding et al., 2005; Parsons & Halkitis, 2002; Rietmeijer & Lloyd, 2005; Woods et al., 2001) while others reported risks within a particular venue (Benotsch et al., 2006; Crosby & Metty, 2004; Elwood & Williams, 1998; Frankis & Flowers, 2006; Taylor et al., 2004; Tewksbury, 2002; Van Bended et al., 2002).

Researchers assessing sexual behavior within particular environments have often reported variant levels of risky sexual behavior. For example, researchers have found MSM sampled within bathhouses reported high levels of sexual risk (Elwood et al., 2003; Elwood & Williams, 1998). Meanwhile researchers analyzing public sex environments found some risky behavior within those environments (Frankis & Flowers, 2005, 2006; Reece & Dodge, 2003). Although these studies are informative, it is difficult to empirically contrast findings as sampling procedures and measures are rarely comparable.

Some researchers have compared sexual risk between venues. In a sample of 456 HIV positive MSM, Parsons and Halkitis (2002) compared risk behaviors between men having met sex partners via commercial sex environments (CSEs) (e.g., bathhouses and sex clubs) to public sex environments (PSEs) (e.g., cruising parks). Men having gone to CSEs were more likely to report unprotected anal sex than those at PSEs. Binson et al. (2001) reported on 2,881 MSM who went to CSEs or PSEs. In their analysis, men reporting partners only from PSEs were the least likely to report any risky sexual behavior. Meanwhile, men reporting partners from CSEs were more likely to report unprotected sex with non-primary partners. Both Binson et al. (2001) and Parsons and Halkitis (2002) found that, compared to HIV negative men, HIV positive men were more likely to have visited both CSEs and PSEs. Although these analyses have their strengths, they do not address the important fact that many men may meet partners in more than one venue (including those venues beyond CSEs and PSEs).

The Internet is a venue having recently emerged for MSM to meet sex partners (Chiasson et al., 2005; Grov, 2006; Ross, 2005). Liau, Millett, and Marks (2006) meta-analysis of MSM’s use of the Internet found that as much as 40% of MSM have met sex partners online (95% confidence interval [CI] = 35.2%–45.2%). Research of MSM who use the Internet to search for sex partners has found men online were younger (Benotsch, et al., 2002; Kim, Kent, McFarland, & Klausner, 2001; Tikkanen & Ross, 2003; Weatherburn, Hickson, & Reid, 2003), more likely to have had a previous STI (Elford, Bolding, & Sherr, 2001; McFarlane, Bull, & Rietmeijer, 2000), not identified as gay, and report sex with women (Tikkanen & Ross, 2003; Weatherburn et al., 2003). Likewise, some researchers have found men who seek partners online more likely to be Caucasian (Benotsch et al., 2002; Bull & McFarlane, 2000; Bull, Lioyd, Rietmeijer, & McFarlane, 2004; Hirshfield, Remien, Humberstone, Walavalkar, & Chiasson, 2004: Taylor et al., 2004; Weatherburn et al., 2003) while others found no differences in race or ethnicity (Elford et al., 2001; Kim et al., 2001).

Sexual risk behaviors among men who seek partners online have been investigated; however, with contradictory results. Some researchers have found men who seek partners online reported a greater number of partners (Benotsch et al., 2002; McFarlane et al., 2000; Taylor et al., 2004), were more likely to have had casual sex partners (Kim et al., 2001; Tikkanen & Ross, 2003; Taylor et al., 2004), and reported more unprotected sex (Benotsch et al., 2002; Elford et al., in press). Others have found men using the Internet were more likely to report condom use with their most recent partner (McFarlane et al., 2000) and some researchers found no differences in the rates of condom use (Bolding et al., 2005; Chiasson et al., 2005; Kim et al., 2001; Metty, Crosby, DiClemente, & Holtgrave, 2003). Nevertheless, there is a growing body of literature suggesting a link between the Internet and barebacking (intentional unprotected anal intercourse) among MSM (Grov, 2006; Halkitis & Parsons, 2003; Shernoff, 2005; Tewksbury, 2003).

Many studies of venues where men met sex partners typically focused exclusively on one or two venues, or broad classifications of venues (i.e., commercial sex environments). These data are limited in that they cannot be empirically contrasted to other venues. Further, with the novelty of the Internet as a resource to meet sex partners, much current research has transitioned to exclusively focus on the Internet as a “venue of risk.” Although informative, findings attributing sexual risk to the Internet have not been systematically contrasted to other venues for meeting sex partners. Further, our knowledge of the link between sexual risk behaviors and other venues such as gay bars/club or the gym has not been widely addressed.

This analysis sought to expand current research having investigated the relationship between sexual risk behavior and venues for meeting sex partners among men who have sex with men. It explored sexual risk and socio-demographic characteristics reported by men who met partners via the following venues: bathhouses, private sex parties, gay bars/clubs, the gym, via public cruising, and the Internet. As men may meet partners in a variety of venues, this broader approach sought to identify links to sexual risk both between and within venues.

Methods

Participants and Procedure

A cross-sectional street-intercept survey method (Miller, Wilder, Stillman, & Becker, 1997) was adapted to survey 1,258 gay and bisexual men at a series of gay, lesbian and bisexual (GLB) community events in New York City and Los Angeles in the fall of 2003 and the spring of 2004 through the Sex and Love v2.0 Project, which was approved by the Institutional Review Board of the authors. This approach to collecting data has been used in numerous studies (Carey, Braaten, Jaworski, Durant, & Forsyth, 1999; Chen et al., 2002a, b; Kalichman & Simbaya, 2004a, b; Rotheram-Borus et al., 2001), including those focused on GLB persons (Benotsch et al., 2002; Kalichman, et al., 2001) and has been shown to provide data that are comparable to those obtained from other more methodologically rigorous approaches (Halkitis & Parsons, 2002). Because this study was interested in sexual behavior with non-primary partners, only the data from single or non-monogamous partnered men (n = 886) were included for analysis.

At each two-day long community event, the research team hosted a booth, and a member of the research team actively approached each person who passed the booth. Potential participants were provided with information about the project and offered the opportunity to participate. The response rate was high, with 82.9% of those approached having consented. The survey required 15–20 min to complete, and to promote confidentiality, participants were given the survey on a clipboard so that they could step away from others to complete the questionnaire. Upon completion, participants deposited their own survey into a secure box at the booth. Those who consented and completed the survey were provided with a voucher for free admission to a movie as an incentive. Data were entered into an SPSS database and verified by project staff for accuracy.

Measures

The survey assessed a broad range of sexual behaviors, history of STIs, substance use, physical health, and a series of scales related to psychological health and well-being. Participants were asked “Of the men you had sex with in the last 3 months, how many did you meet . . .” with the following list of venues: bathhouses, private sex parties, gay bars/clubs, the gym, public cruising, and the Internet. Response choices were ordinal: 0 = none, 1 = few, 2 = about half, and 3 = most or all.

Demographic characteristics such as age in years, HIV serostatus, sexual identity, income in discrete categories and race/ethnicity were also assessed. Race and ethnicity response categories included African American, Asian/Pacific Islander, European/White, Hispanic/Latino, Middle Eastern/Arab, Native American, Mixed and Other/Specify. Due to the small sample size of Middle Eastern/Arab (n = 5), Mixed (n = 23) and Native American individuals (n = 12), these categories were collapsed and added to the “other” group.

Sexual Behavior and Health

Participants estimated their total number of sex partners in the last three months. The range for this varied greatly (range 1–300, M = 6.92, SD = 17.2); however, 96% of men reported 30 or fewer partners in the last 90 days. In an effort to restore some normality to the distribution of this variable, those 4% of men who reported more than 30 partners were recoded to 31 (M recoded = 5.67, SD recoded = 8.2). In addition, men also indicated if they had unprotected anal sex (whether receptive or insertive) with partners who were HIV serodiscordant or of unknown/undisclosed serostatus (1 = yes, 0 = no). Further, men also indicated if they identified as a barebacker, or a person who intentionally sought out sex without condoms (1 = yes, 0 = no).

Participants also completed the temptation of unsafe sex scale (Parsons, Halkitis, Bimbi, & Borkowski, 2000; Parsons, Halkitis, Wolitski, Gomez, & Seropositive Urban Men’s Study Team, 2003). The temptation scale assesses temptations for unsafe sexual behavior. It is a 10–item four-point Likert-type scale. It assesses different situations to which an individual may be tempted to engage in sex without a condom (i.e., think risk is low, really want affection, under the influence of alcohol or drugs) (Cronbach’s α = .89).

Analytic Plan

This analysis occurred in two phases. In the first phase of analysis, the three most endorsed venues for meeting sex partners were identified (i.e., gay bars/clubs, the Internet, and bathhouses). Next, men who reported meeting a majority of their recent sex partners (i.e., had preference) uniquely via these venues were systematically identified. For example, men who reported meeting half or more of their partners via the Internet and a “few” partners from bathhouses or a “few” partners via the gym were coded as having preference for the Internet. In contrast, men who reported meeting half or more partners via bathhouses and “few” partners via other venue combinations were coded as having preference for bathhouses, etcetera. Men who reported an equal share of partners (i.e., half or more partners) via both bathhouses and the Internet (or Internet–bars/clubs, or bathhouses–bars/clubs) were not included in this first phase of analysis. Men who reported meeting any combinations of “none” or “some” partners (n = 208) from the remainder venues were also included in first phase of analysis and served as a reference group of individuals with no clear venue preference.

Those men identified as having preference for bars/clubs (n = 107), the Internet (n = 153), bathhouses (n = 71), or “no preference” (n = 208) were next compared and contrasted using ANOVA, χ2, and difference of proportion statistical tests (Daniel, 1996). Finally, to better explore the confounding impact of additional variables into this analysis (e.g., number of recent sex partners, temptation for unprotected sex, barebacker identity, HIV serostatus), a five-step logistic regression was conducted to predict a recent episode of UAI with HIV serodiscordant (or unknown/undisclosed) partners (1 = yes). All analyses in Phase I were conducted among this sub-sample of 539 men.

The second phase of this analysis sought to address relationships between having met a recent sex partner (1 = yes) via any one of the six venues (bar/club, bathhouse, Internet, public cruising, private sex party, and the gym); while controlling for other variables (e.g., HIV serostatus, barebacker identity, temptation for unsafe sex, number of venues a person may have utilized to meet sex partners). These analyses were also conducted using a 5-step logistic regression, whereby UAI with HIV serodiscordant (or unknown/undisclosed) partners was the dependent variable (1 = yes). Both phases of analyses were conducted with SPSS version 12.0.

Results

The sample was diverse with more than one third being a person of color. A large majority (93.5%) of the sample identified as gay, while a smaller portion (6.5%) identified as bisexual. Ages ranged between 18 and 84 (Mean = 38.5; SD = 11.1). Approximately 12.5% (n = 111) of the men were HIV positive and 13.2% (n = 117) identified as barebackers, or men who intentionally sought sex without condoms. Finally, 39.9% of men reported having engaged in at least one recent episode of unprotected sex. See Table 1 for full demographics.

Table 1 Participant characterstics (N = 886)
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Bars/clubs (54.8%), the Internet (53.5%) and bathhouses (40.3%) were the most frequently endorsed venues for having met at least one sex partner recently. They were also the most commonly reported venues for having met about half or greater sex partners (see Table 2). Public cruising, the gym, and private sex parties followed. Note that the percentage totals for where men reported meeting half or more of their recent sex partner exceeded 100%. Men were asked to estimate “approximately half” such that they could have indicated meeting about half of their partners in more than one venue. Nevertheless, the data indicated that the Internet, bathhouses, and via bars/gyms were the most commonly endorsed venues for having met a majority of partners.

Table 2 Locations where partners were met
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Phase I

Men who reported meeting a majority of their recent sex partners uniquely via the three most endorsed venues (i.e., had preference) were identified. Table 3 reports differences between men who met a majority of their partners via bathhouses versus the Internet versus bars/clubs versus those who indicated no clear venue preference. Men who “preferred” the Internet averaged a greater number of recent sex partners (m = 8.7, SD = 9.5) than men who preferred bars/clubs (m = 5.4, SD = 7.0) and men who had no clear preference for any venues (m = 2.9, SD = 5.4). Men who preferred bars/club tended to be younger on average (m = 34.7, SD = 9.3), while men who preferred bathhouses tended to be older on average (m = 44.9, SD = 12.3). Further, men who preferred bathhouses (m = 17.6, SD = 18.4) or the Internet (m = 17.0, SD = 7.4) averaged higher scores on temptation for unsafe sex, while men with no clear preference (m = 14.7, SD = 7.2) and those preferred bars/clubs (m = 14.6, SD = 6.4) averaged the lowest scores.

Table 3 Across venue comparisons
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A significantly larger proportion of men who preferred bathhouses were HIV positive (20.3%) compared to men who preferred the Internet (15.2%), bars/clubs (6.7%), or had no clear preference (8.3%). Men with no clear venue preference were the least likely to report a recent episode of unprotected sex with a HIV serodiscordant or unknown/undisclosed status partner (27.9%). In contrast, men who preferred the Internet (46.0%), bars/clubs (38.0%), or bathhouses (39.2%) were the most likely to have reported UAI.

Although it seemed a smaller portion of men who preferred bars/clubs identified as barebackers (7.9%) (compared to the proportion of men who preferred the Internet that identified as barebackers [15.8%]), neither χ2 nor difference of proportion tests could detect a significant difference (95% CI = 0.0−0.16). Further, although χ2 did not detect a significant difference in the proportions of men of color, a difference of proportion test indicated a greater proportion of men of color among men who preferred bars/clubs (40.6%) compared to the proportion of men of color who preferred bathhouses (23.9%). There were no significant income differences.

Using the same sub-sample of 539 men, (n = 208 who indicated no clear venue preference and n = 311 who specifically reported having a preference for bars/clubs, bathhouses, or the Internet) a five-step logistic regression was conducted to predict a recent episode of unprotected sex with a partner of HIV serodiscordant or unknown/undisclosed status (see Table 4). Controlling for the effects of other variables (such as HIV serostatus, barebacker identity, income, race, number of recent sex partners, temptation for unsafe sex) having met partners predominantly via bathhouses, the Internet, or bars/clubs offered little to explain a recent episode of sexual risk behavior with a partner of HIV serodiscordant or unknown/undisclosed status. In step four of the logistic regression, it seemed both HIV serostatus and number of recent sex partners predicted sexual risk; however, the strength of HIV serostatus to predict sexual risk behavior was better explained by barebacker identity and temptation for unsafe sex (see step 5). Restated, controlling for where men reported having met a majority of their sex partners, number of recent sex partners, barebacker identity, and temptation for unsafe sex were the best “predictors” of recent sexual risk behavior.

Table 4 Selected venues, logistic regression predicting a recent episode of UAI, B (exp. B)
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Phase II

As many men reported partners via a variety of venues, and some men reported at least a few partners via all the venues analyzed in this study, the following analyses were conducted with the data from all non-monogamous men (n = 866). Table 5 reports on a series of five logistic regressions predicting a recent episode of sexual risk behavior. In the first step, demographic characteristics were entered into the model. The second step introduced the six potential venues were men may or may not have met a recent sex partner (1 = yes). Step three controlled for the potential confounding effects of those men who may have met partners in multiple venues. Finally, steps four and five introduced socio-psychological and demographic variables related to sexuality and sexual behavior.

Table 5 All venues, logistic regression predicting a recent episode of UAI, B (exp. B)
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Step one of this regression provided little in way of explaining sexual risk behavior. Controlling for the effects of other variables, age, income, sexual orientation, and being Caucasian (versus not) provided little in terms of predicting a recent episode of unprotected sex. The second step of adding different types of venues in which men may have met a recent sex partner did provide some predictive ability in way of explaining sexual risk behavior. Having met a partner via a bar/club, private sex party, or the Internet seemed to “predict” a recent episode of unprotected sex with a HIV serodiscordant or HIV unknown/undisclosed partner; however, these strength of these effects were somewhat mitigated once controlling for the number of venues where participants met partners (see step 3).

As with the first series of regressions listed in Table 4, steps four and five indicated there was a strong relationship between barebacker identity and temptation for unprotected sex in predicting risky sexual behavior. Further, these factors diminished the strength of the relationship between HIV serostatus and reported sexual risk behavior. Refocusing to venues for meeting sex partners, these findings suggested that by controlling for other variables (including HIV serostatus, barebacker identity, number of venues with which a person could have met a partner, demographic characteristics, etc.), there was still a marginally-significant (p < .10) association between three specific venues for meeting sex partners and sexual risk behavior: bars/clubs, private sex parties, and the Internet. Finally, net for the effects of other variables, having met partners via the gym, bars/clubs, or public cruising provided little in way of explaining a recent episode of sexual risk behavior.

Discussion

The social environment in which MSM meet sex partners has been implicated not only for impacting the decision to use a condom (Benotsh et al., 2002; Binson et al., 2001; Elwood & Greene, 2006; Elwood et al., 2003; Klausner et al., 2000; Parsons, 2005; Parsons & Vicioso, 2005, Parsons et al., 2004; Taylor et al., 2004), but it also has been an effective outlet for reaching at-risk men (Binson et al., 2001, 2005; Bolding et al., 2004; Taylor et al., 2004; Woods et al., 2000, 2001). Researchers have informed how MSM frequenting within different environments reported variant levels of sexual risk behaviors, however our knowledge of how this may have varied across multiple venues is limited. Further, there are seemingly contradictory findings within academic literature in relation to sexual risk among men who meet partners specifically from the Internet.

Within this analysis, three particular venues were the most frequently endorsed for meeting sex partners: gay bars/club, the Internet, and bathhouses. Specifically comparing and contrasting men who met a majority of their partners (i.e., had preference) via these venue types to each other found those whom had preference for bars/club were most “dissimilar” from the men having preference for the Internet or bathhouses. Meanwhile, men having preference for bathhouses or the Internet were more similar on both socio-demographic and socio-sexual variables. Regardless of which of these three venues men had “preference” for, they were fairly similar in the proportion that reported UAI.

Men with no clear venue preference tended to differ most from men who “preferred” any of these three venues and they were also the least likely to have reported UAI. This could be the result of lack of opportunity to engage in UAI as these men reported fewer partners and utilized fewer venues (as assessed in this analysis). Multinomial logistic regression found no relationship between having a preference for either of these venues (bathhouses, the Internet, or bars/clubs) and sexual risk behavior. In fact, and as would be expected, identity as a barebacker and temptation for unsafe sex were the best indicators of actual risky sexual behavior.

Many researchers have agreed that sexual health education and HIV prevention initiatives within venues such as bathhouses and bars/clubs are not only feasible, but also effective (Binson et al., 2001, 2005; Blank et al., 2005; Lister et al., 2005; Parsons, 2005; Taylor et al., 2004; Woods et al., 2001). Meanwhile, there is a growing body of research suggesting the same of the Internet (Bolding et al, 2004; Chiasson et al., 2006; Liau et al., 2006). The findings from this analysis suggest it may be necessary to enhance specialized HIV prevention and educational efforts within bars/clubs and on the Internet in an effort to more effectively reach those few men whom engage in sexual risk behavior; and in particular barebackers. For barebackers, emerging medical technologies, such as Pre-exposure Prophylaxis (PrEP), might be a necessary harm reduction strategy worthy of exploring (Cohen, 2006; Costello, 2005; Kellerman et al., 2005; Youle & Wainberg, 2003).

In Phase II, the analysis was expanded to include men who may have met partners via a variety of venues (and not necessarily those who had a particular preference). Findings suggested men who met a partner via the Internet, bars/clubs, or a private sex party might be at greater risk for UAI. This was the case even when controlling for a variety of factors including the number of venues a person may have met a partner, their HIV serostatus, whether they were a barebacker, the number of recent sex partners they had, and their level of reported temptation for unprotected sex. Nevertheless, caution is needed before these findings can be extrapolated, as the relationships between venues and sexual risk behavior in Phase II were only marginally significant (p < .10), introducing the opportunity for a Type I error.

Private sex parties are often organized in private spaces such as homes, hotel rooms, or venues that have been otherwise rented by a private promoter and are closed to the public (see Clatts, Goldsamt, & Yi, 2005). This presents an inherent greater challenge for community groups and health educators seeking to provide outreach within these settings. Further, because many private sex parties are themed (e.g., sado-masochism, urophilia [water sports], barebacking), traditional outreach strategies might not be as effective.

Sex party promoters are essentially gatekeepers to the men who attend their events. As a suggestion, those seeking to provide outreach to private sex parties might consider partnerships with these promoters/hosts in efforts to develop rapport, as promoters could serve as HIV prevention or harm reduction peer educators/leaders. In lieu of a condom-only approach, harm reduction strategies could be incorporated for those private sex parties that eschew condoms or promote/provide substance use (Shernoff, 2005).

The univariate analyses conducted in the first part of Phase I indicated 46% of men who preferred the Internet had engaged in recent unprotected sex. Many researchers have investigated and found men who meet partners online report greater instances of sexual risk behaviors. Adjusting for the effects of other variables, by using multi-step multivariate analyses, confounded the interpretation of these preliminary univariate analyses. This suggests the simple correlation found between venues for meeting sex partners and subsequent sexual risk might be better explained by other factors outside the context of the venues themselves.

These findings raise important implications related to the development and refinement of HIV prevention and health education policy/strategies. For example, a minimalist approach to HIV education and prevention (such as educational posters/advertisements and a bowl of free condoms) in venues where MSM encounter sex partners may not be enough to address the variety of socio-psychological person-characteristics that comprise the complex decision making process impacting UAI. As such, it is necessary for both researchers and health officials/community groups to fully evaluate the social, environmental, and psychological components of sexual behavior. These analyses indicate temptation for unsafe sex and identity as a barebacker might be two good starting points.

Limitations and Future Directions

Researchers having investigated venues for meeting sex partners and sexual risk behavior among MSM have often narrowed their focus to only one or two types of venues. Although this analysis found a select set of venues (i.e., bars/clubs, bathhouses, Internet) were more often endorsed for having met recent sex partners, it is particularly important to highlight that many men reported having met partners in multiple venues. As such it is essential to understand that the venues analyzed within this analysis are neither mutually exclusive nor exhaustive. Although parts of this analysis “controlled” for the number/variety of venues with which men met partners, some of the sexual risk reported was “shared” among other venues, including those venues not assessed (i.e., partners met through friends, social groups, school, work, gay resorts) (Benotsch et al., 2006). This analysis does not provide a definitive indication of specifically where sexual risk may occur, but rather an indication where men who reported risky sex met their partners. As such, this type of analysis informs about where men who report sexual risk might be easier to locate and hence provide comprehensive sexual health education and HIV prevention services.

The survey method used in this analysis was able to capture a broad variety of individuals including more than one hundred HIV positive men. Nevertheless, some statistical power is diminished when conducting analyses among smaller sub-samples; hence some caution is urged before these results can be widely extrapolated. For example, targeted sampling of HIV positive men might be necessary to both secure more statistical power and to better understand the relationship between sexual behavior and venue.

As with most survey research, these data are limited to the individuals who attended the large-scale GLB events and participated in the study (i.e., a self selection bias). Although efforts were made to ensure confidentiality, data were gathered in public places. The reporting of sensitive information could result in socially desirable responses. Data were collected at large-scale GLB community events in NYC and LA. At these types of large-scale events, GLB individuals are accessible to community groups, service providers, and researchers. The findings from this study can assist these groups and service providers with developing or refining prevention messages and sexual health educational programs that are designed to reach the types of men whom attend these types of large-scale events.

These data do not reflect all gay and bisexual men, or individuals who may not attend large-scale GLB events. Other variables such as class, education, cultural influences, norms, alcohol, drugs etc. also play important roles in sexual behavior and this analysis does not wish to discount this myriad of variability. Nevertheless, this analysis contributes further to our knowledge of the relationship between environment and behavior.