The role of commercial sex venues in the HIV epidemic among men who have sex with men.

Abstract

Commercial sex venues such as bathhouses and sex clubs have long been considered important facilitators of HIV transmission among men who have sex with men in the United States. Recent probability surveys of commercial-sex-venue patrons in King County, WA that included data on behavior both within and outside these venues provide an empirical basis for the development of mathematical models to estimate the role that commercial sex venues play in the HIV epidemic. We constructed deterministic compartmental mathematical models of HIV transmission to estimate both current incidence among King County men who have sex with men and incidence in 5 counterfactual scenarios in which commercial-sex-venues were presumed not to exist. We parameterized the models using a range of values for the proportion of commercial sex venues partnerships replaced in the absence of these venues, and the number of acts of unprotected anal intercourse per other types of partnership. Yearly attributable number was calculated as the difference between incident HIV cases in the main models and each corresponding counterfactual model. We performed extensive sensitivity analyses using Latin hypercube sampling. Replacement of 25% of commercial sex venue partners in the absence of these venues resulted in attributable number values near zero per year. Replacement of 50% or more of commercial sex venue partners resulted in negative yearly attributable numbers, indicating a net increase in incident HIV infections in the absence of these venues. Results of the sensitivity analyses were consistent with the main findings. Our findings imply that commercial sex venues contribute little to the burden of HIV among men who have sex with men in King County, WA.