Physical and Social Influences of Sex Venue Behavior: An Ecological Psychology Approach to Studying HIV Risk among Sexual Minority Men

By Downing, Martin J., Jr.; Hirshfield, Sabina | North American Journal of Psychology, August 2015 | Go to article overview

Physical and Social Influences of Sex Venue Behavior: An Ecological Psychology Approach to Studying HIV Risk among Sexual Minority Men


Downing, Martin J., Jr., Hirshfield, Sabina, North American Journal of Psychology


Men who have sex with men (MSM) remain disproportionately affected by HIV in the U.S., where 67% of new infections in 2012 were among this population (Centers for Disease Control and Prevention, 2014). Despite considerable attention to the sexual health of MSM since the beginning of the epidemic, much of this work has focused on individual characteristics while minimizing environmental influences (Flowers, Hart, & Marriott, 1999). However, commercial and public sex venues (e.g., bathhouse, sex club, park or other public cruising areas) are known to provide MSM with access to casual sexual encounters that may facilitate the transmission of HIV and other sexually transmitted infections (STIs). Although the prevalence of HIV within these venues may vary by location and type, a report of MSM bathhouse attendees who accessed onsite HIV counseling and testing services documented an 11% incidence rate (Bingham et al., 2008). Moreover, findings from U.S. probability samples of MSM estimated that 14%-21% of bathhouse attendees (Binson et al., 2001; Grov, 2012; Reidy et al., 2009; Woods et al., 2007), 9% of bar/club attendees (Grov, 2012), and 13% of public sex venue attendees were HIV-positive (Binson et al., 2001). Furthermore, recent HIV infection has been associated with meeting partners at bathhouses/sex clubs and bars/dance clubs (Thiede et al., 2009).

Researchers have documented that MSM do engage in high-risk behaviors (i.e., anal sex without a condom) during venue attendance (see Bingham et al., 2008; Frankis & Flowers, 2006; Reidy et al., 2009; Woods et al., 2007; Xia et al., 2006). Further, evidence suggests that men who attend parks (Horvath, Bowen, & Williams, 2006), bars/clubs (Flores et al., 2009; Grov, Parsons, & Bimbi, 2007), and bathhouses/sex clubs (Horvath et al., 2006; Parsons & Halkitis, 2002) are more likely to engage in sexually risky behaviors with their male partners, in general, compared to men who do not attend these venues. Moreover, a probability sample of MSM found that men who had sex with partners they met in both public cruising areas and bathhouses were more likely to report condomless anal sex with those partners compared to men who only had partners from one venue type (Binson et al., 2001). This suggests the impact of multivenue use on risk behavior. These efforts to study venue-based sexual risk-taking among MSM have contributed significantly to our understanding of venue-based behavioral patterns as well as the development of effective interventions and recruitment strategies that access difficult-to-reach populations. Nevertheless, much of this work has not accounted for contextual features that drive venue attendance, support on-site behavior patterns, and potentially contribute to the transmission of HIV and other STIs.

Theoretical Framework

Few studies to date have applied a person-environment model to understanding sex venue risk behavior (see Balan et al., 2014; Binson & Woods, 2003; Ko et al., 2008). Ecological psychology emphasizes the importance of considering an individual's perceptions and behavior in relation to the immediate environment (Barker, 1968, 1987; Heft, 2001). Together, Barker's theory of behavior settings and Gibson's theory of affordances (1986) conceptualize this relationship and provide a framework to investigate HIV risk behaviors in both commercial and public sex venues.

Sex venues as behavior settings. Behavior settings are self-regulated ecological units located in time and space that can be encountered and reencountered (Barker, 1968; Heft, 2001). They contain stable patterns of behavior as well as temporal, spatial, or occupancy limits. Commercial sex venues can be considered persistent behavior settings because of their precise location and hours of operation by which patrons observe or engage in sexual activity (Balan et al., 2014; Binson & Woods, 2003). Public sex venues, on the other hand, represent a challenge to the prescribed social order (Tewksbury, 1995) wherein attendees rely on various forms of concealment to maintain their privacy and anonymity, including physical boundaries and public perceptions that only designated functions (e. …

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