This led to a reemphasis in Flanders on an avoidance of specific and concrete policies on other sexually related issues, such as AIDS prevention. This is not the place to describe Belgian saunas in any detail, but a few comments are in order. The most popular baths in Brussels cater to a large clientele. One of these, for example, offers a free pass after ten visits, and the tile of this sauna contains cards for well over one thousand men who frequent the establishment with sufficient regularity to maintain a record of the nrrmher of their visits so as to qualify for the free pass.
Rut in addition to these clients, there are many who visit the sauna for one time only, and they include many international visitors who do not maintain a registration card. The two most popular baths in Brussels operate in large, multistorey buildings in the center of the city. One is particularly elegant with spacious lounges equipped with televisions and reading materials , a bar, and a res- taurant in addition to the usual steamroom, dry sauna, showers, tanning hooths, private rooms, orgy room, and jacuzzi. It is elegantly decorated w i t h art and elahorate floral arrangements.
Patrons may walk around in towels or they may rent white terrycloth robes. The second sauna is less chic, hut it has a swimming pool as an added feature. These two saunas can serve to illustrate the diversity of response to AIDS h y sauna owners. I n the former case, only w i t h i n the past two years has AIDS intruded visibly into the sauna. Previously, there was no sign of the epidemic evident in its operation.
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In the second case, however, not only were posters a h i t AIDS arid safe sex prominently displayed in the changing area but free condoms were available in a j a r at the bar. Participants for the study were recruited in the spring of throughout the Flemish region of the country. In order to constitute a cohort of gay and bisexual men that is as representative as possible of the population of Flemish men who have sex with men, a novel approach to recruitment was employed.
Initial publicity for the project was generated in both the print and broadcast media. Inter- views with J. Following this publicity campaign, the authors arranged to meet with members of gay organizations throughout Flanders to explain the project and to enlist the assistance of key persons who could serve as recruiters for the project. Key persons were asked to sign up individuals in their social network for the GSRP.
They were instructed to make every effort to achieve diversity in signing up participants; specifically they were asked to recruit individuals of different ages and lifestyles, e. While some individuals entered the cohort by volunteering directly as a result of exposure to the general publicity or from having seen announcements posted in bars and saunas, most of the final cohort men were recruited h y the key persons.
While it cannot be demonstrated that this cohort is fully representative of all Flemish men who have sex with men, we believe that this social network approach reduced some of the biases that have plagued other studies of gay and bisexual men which have relied primarily on indi- vidual volunteering or on recruitment from limited segments of the community e. In order to reduce another common bias in AIDS research, namely the tendency t o recruit individuals who are especially concerned about AIDS and health issues, the health components of the present study were placed in the context of a more comprehensive study of the gay subculture of Belgium.
This was particularly important inasmuch as resistance to the AIDS issue is markedly strong in some gay communities in Europe, and many of the par- ticipants would have refused to participate if the study had heen presented as one focusing on A I D S. Data sets were identified b y numbers which were supplied to participants for use in any future re-study using this cohort; key persons will then be asked to contact their recruits again to participate in follow-up research, which is planned.
No one was paid to participate in this project, but all participants were reimbursed for their travel expenses. Data collection took place in a university setting in a central location in the country Ghent , and participants came to the research site usually by automobile o r train. Demographic characteristics of the cohort can be seen in Table 1.
While The sexual orientation and identity of the men in the cohort is shown i n Table 2. Interviewing in this study was done I y computer, using an interactive program designed for use on personal computers. The research setting was a large classroom with eighteen personal computers arranged on desks in rows. All questions were closed-ended, and a participant could not review and change answers once entered.
Participants were given brief instructions on how to enter responses-experience with computers was not necessary since the design of the instrument mirrored the use of ATMs with which all informants were familiar. Sauna Attendance. Sexual Behavior. We measured insertive and receptive anal intercourse w i t h and without condoms as follows.
To obtain an ordinal scale for the frequency of anal intercourse, we collapsed categories I and 2. A gcneral measure of AIDS-related change in sexual behavior was calculated as follows. Behavior change was calculated as the proportion of changed behaviors ever engaged in. Social and Demographic Attributes.
The indicators for socio-demographic variables were as follows. A steady partner was defined as someone with whom the subject resided or someone he saw often. This variable was op- erationalized as a dummy variable with values 0 no steady partner and 1 steady partner.
Educational level was used as the indicator for socioeco- nomic status; scores were assigned on the basis of the number of years the respondent attended school beyond the legal minimum. Social Identity. The total score was obtained by summation. Two items measure gay socializing e. Five items measure gay group identification. The last variable reflects the idea of belonging to a group of men differing from het- erosexuals on more dimensions than simply sexuality.
Social Support. We used twenty-four items to measure social support.
All items refer to the perception of various aspects of social support during the past month. They were derived from a literature review, translated and adapted to the Belgian social context. The remaining components reflected perceived emotional conflict The perception of control was measured with seven items. Self-esteem was measured with eight items. Respondents rated each item on a scale ranging from 1 to 4. Typical items were feeling that one has a number of good qualities, taking a positive attitude toward oneself, being inclined to feel that one is a failure, not having much to be proud of.
We measured depression using fifty- nine items from the Hopkins Symptom Checklist. The first component of a principal components analysis measured depression. From this principal com- ponents solution we eliminated all items referring to interpersonal relations in order to restrict the confounding of the social support measures with the depression index.
The average inter-item correlation was. The depression index was constructed by summing up the individual scores. AIDS Knowledge. In this study we used t-tests for independent samples. We report on statistical findings in which the probability of the t statistic is equal to or less than 0. We calculated t-tests on both dichoto- mized versions of the variables as well as on the full range of values on the same variables.
Generally, the results were consistent with respect t o p levels; for only two sexual behaviors was there a discrepancy between the dichot- omized test and the full test, discussed below. Positive correlations exist between frequenting one type of venue and frequenting others; thus, different venues are for many gay men not alternative options but rather a set of complementary sites for finding sex partners. In other words, there is a tendency for men who go to saunas to go to bars and discos also and especially to public cruising areas.
Examining our demographic variables in relationship to sauna attendance, we did not find any statistically significant differences between sauna clients and nonclients with respect to age, educational level, religious affiliation, o r partnership status.
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While sauna clients had a higher average educational level, the difference was not statistically significant. Interestingly, their part- nership status was not related to sauna attendance: men with steady partners were as likely as men without steady partners to visit saunas see Table 1. The sexual orientation of the men in this cohort mostly varied from exclusively homosexual to predominantly homosexual with some heterosexual experience Kinsey 4 through 6.
There was no statistically significant difference between clients and nonclients in their placement on the Kinsey scale see Table 2. Clients and nonclients did not differ significantly on self-esteem. Likewise, in most of the sexual behaviors we looked at, there were no tlifferences twtween clients anti nonclients.
Sauna clients, however, not un- expec-teclly, did report an average of twice as many casual sex partners as nonvlients. Tahle 4 shows those behaviors in which significant differences were Significant differences were found between sauna clients and nonclients in thirteen sexual hehaviors.
No nc Ii e 11t s rep r t ec 1 more in v 1v emen t than c-lients, however, in unprotected anal intercourse, i.