This otherwise non-descriptive image is of a building that exists on the quiet end of a major street in my town, and I cannot imagine the number of times I have passed it without notice. There is no address, no sign, absolutely no indication of what lies inside. In passing, it seems quite limited from the street, but upon investigation, this is the entrance to a substantial facility. I recall on occasion noticing that, with the front door propped open, you catch a glimpse to the left of black & white tile and what seem to be lockers. I also recall thinking it to be a private health club or spa. But a patient pointed out to me the other day that this is, in fact, a "bath house"; and if you're thinking removing urban grime by "soaking in warm, scented luxuriance," think again.

If you even spent a moment with the above reference, you find that gay bathhouses are certainly nothing new, and, in fact, historically served a supportive social and psycho-sexual function for a significantly repressed and oppressed body of the community. But if you also lived and worked in healthcare in NYC in the 1980's & 1990's, the notion of "support" frighteningly morphs into a vision of the Prophet Micah: unmitigated contagion and holocaust. HIV & AIDS silently struck the core of a community that believed it had fought for and earned its right to "exist." For the decade and more that followed, the rest of us stood by, literally, with nothing to offer but what we now so euphemistically refer to as "palliative care." And the epidemic, so tragically, so shockingly, and so brilliantly recorded by Randy Shilts and Paul Monette seemed, individually and collectively, unforgettable.

While I will always entertain the argument, I do not consider myself naive. If only by virtue of working in corrections & reading the epidemiological data - as frequently as a weekly review - I am aware of trends, anecdote among clinicians, and activities in the community. Patients describe quick "hook-ups" through Craig's List, cruising specific areas in town, certain bars and clubs, blah, blah, blah. But I must admit the poigniancy, the shock I continue to feel at the revelation of the "bathhouse." Pursuing the issue, I found a published interview with the owner (manager?) of the bathhouse who indicated he was "scrupulous" in making condoms "available" (and one patient told me of a "punch bowl") and did not permit nor condone the use of methamphetamine (emerging as the single-most significant risk factor for unsafe sexual practices in this community), he concluded, as I suspect we all must, "You just can't force people."

The Centers for Disease Control's most recent publication of data regarding HIV & AIDS in the US is from 2007 (and comparing the period of 2003-2007), and was released on 02/18/09. I do not intend to make this an extensive analysis of a report you can read and/or download to read on your own but, it is striking that "From 2004 to 2007, there was a 26% increase in estimated annual HIV/AIDS diagnoses among [male-to-male sexual transmission]." And while noting that "incidence" (i.e. new infections) may be partially attributable to more accurate surveillance by the CDC, "[male-to-male sexual transmission] increased all four years of the analysis, with the largest occurring in the last year" (emphasis mine).

Further, the CDC released a report on 01/28/09 examining the effect anti-retroviral therapy (i.e. medications) had on the sexual transmission of HIV; meaning, if you are already infected with HIV, actively taking anti-retroviral medication, and apparently having unprotected sex, are you less likely to infect your sexual partner? "Observational studies" and "models" were inconclusive, with the notable exception of those persons with "complete viral suppression," but this was qualified with "as might be achieved by more potent and tolerable regimens [of ART]," obviously speaking to the ART of the "future." Finally, the CDC issued new guidelines for the prevention and treatment of oportunistic infections in HIV/AIDS on 03/28/09. If you need to address pretty much any horror occurring from the degradation and collapse of the human immune system, you'll likely find it there.

As near as I can tell, all of this voluminous data - so ironically reminiscent of Saramago's All the Names - is mockingly and pathetically summed up by the CDC in a "new" publication of 12/28/08:

Laboratory studies have demonstrated that latex condoms provide an essentially impermeable barrier to particles the size of STD pathogens.

Overall, the preponderance of available epidemiologic studies have found that when used consistently and correctly, condoms are highly effective in preventing the sexual transmission of HIV infection and reduce the risk of other STDs. Consistent and correct use of male latex condoms can reduce (though not eliminate) the risk of STD transmission. To achieve the maximum protective effect, condoms must be used both consistently and correctly.