Background:  Commercial sex venues catering to men who have sex with men (MSM), such as bathhouses, are a potential target for HIV prevention. Although New York City (NYC) remains the domestic epicenter of the HIV epidemic, a bathhouse screening program has previously not been implemented there. To assess the influence of such an intervention, we established a pilot HIV testing study in NYC bathhouses.

Methods:  We enrolled 222 MSM in a voluntary HIV screening study at bathhouses in NYC. HIV was tested via a rapid test; dates of infection for all confirmed positives were estimated by the Serologic Testing Algorithm for Recent HIV Seroconversions (STARHS); evidence of acute HIV infection among HIV-negatives was sought by pooled HIV polymerase chain reaction (PCR). Participants completed demographic and behavioral surveys; p-values were generated with Fisher’s exact test.

Results:  Overall, 55% of the 222 men tested were non-white and 11.7% had never been tested for HIV; 21% reported having sex with female partners; 22.5% did not identify as gay. Participants averaged 12.9 sex partners (IQR 12.5) in the last 90 days; 12 (5.4%) were newly diagnosed with HIV based on serology and self-report of prior unknown (4) or negative (8) status; 5 (41.7%) of these positives demonstrated evidence of recent infection using STARHS; 64% of men tested had never heard of post-exposure prophylaxis (PEP). No acute infections have been identified using HIV PCR. Being newly diagnosed with HIV was associated with non-white race (p = 0.014), income <$25,000/year (p = 0.022), lack of prior HIV testing (p = 0.038), and being uncircumcised (p = 0.038). Lower-income men (p = 0.003) and non-gay-identified men (p = 0.011) were more likely unaware of PEP. Of men previously tested for HIV, the mean interval between tests was 21.1 months (IQR 19.8 months), median 10.9 months.

Conclusions:  Screening for HIV at bathhouses accesses a population often missed by traditional testing and preventive programs. Nearly half of those testing HIV⁺ were recently infected. Given the data implicating early infection with increased infectiousness, this finding highlights the potential effect of early identification on transmission. Additionally, bathhouse interventions, such as this one, may influence HIV transmission to other susceptible populations, given the frequency these MSM reported sex with women. Many of these men test less frequently than recommended by guidelines and are unaware of approved preventive interventions.