Building an HIV/STI prevention program in a gay bathhouse: a case study.

Gay bathhouses have long been subject to community and public health pressures owing to the perceived link between the behaviors associated with these settings and various sexually transmitted infections. The straightforward solution of closing gay bathhouses has not worked for long when it has been tried. The more complex approach of working with management to develop holistic prevention programs can be problematic also, because developing successful HIV/STD prevention programs requires the collaboration of multiple stake-holders. Furthermore, to overcome the stigma associated with disease, the population, and bathhouse environments places significant, and sometimes awkward, demands on those who undertake such prevention programs. Nevertheless, a number of U.S. cities now have had years of experience with such efforts. This article provides an example of a collaboration of multiple stakeholders to develop a holistic prevention program. We examine our own process of building a collaborative team of bathhouse managers, health department officials, and academics to provide HIV/STD prevention programs in a bathhouse. We describe the process of developing the collaboration and offer recommendations for establishing mutually beneficial relationships among stakeholders.