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My current research activities fall into the general category of HIV prevention and tend to be related to one of three areas: substance use and treatment, HIV counseling and testing, and sexual risk environments such as bathhouses. Although my recent work tends to combine these areas, looking primarily at the risk environment with some focus on the presence of drug use and the impact of HIV testing in these environments.
Since starting at CAPS in the autumn of 1987, I have played a significant role in the writing and submission of fourteen federally funded grants, as well as four UARP grants and eight ACRC/CAPS Innovative grants. In addition to my work at CAPS, I have collaborated with investigators in the Department of Psychiatry and at the Institute for Health Policy Studies (IHPS). Much of my earlier work was related to HIV and substance abuse, particularly among gay men. As a licensed psychologist with a part-time private practice between 1988 and 1998, I also provided clinical services to these same populations, frequently using that clinical experience to inform and shape the research projects with which I was involved. For example, my clinical work suggested the value of measuring the impact of protease inhibitor medications on the sexual risk taken (PI: James W. Dilley, MD), and the preliminary results were published in NEJM .
Since 1995 I have advanced several studies on ideas I had for research in gay bathhouses. The first of these surveyed patrons entering and leaving sex clubs in San Francisco, as well as observing sexual behavior in the clubs. A second surveyed bathhouse managers across the US to determine the level of HIV education and prevention engaged in by these types of businesses. Since completing that survey, I have developed several proposals to study bathhouses and written several papers and conference abstracts using existing data, such as the Urban Men’s Health Study (PI: Joe Catania, PhD). In 2001 I was awarded a grant from NIMH (1 R01 MH61162-01A2) to study the contributions of the social climate of bathhouses to the sexual risk behaviors of patrons. The study builds on the work of Rudolf Moos of complex, institutional environments in which he identified dimensions of settings that shape the “social climate” of a given environment. For Moos the social climate is the “personality” of a setting or environment. The NIMH-funded study identifies the dimensions of the social climate associated with HIV risk behaviors in bathhouses, from which we develop a “social climate scale.” This study also led us to expand Moos’s theory, i.e., to study the influence of outside agencies (i.e., law, health departments, community based organizations) on the environment. I recently was awarded a new NIMH grant (5 R01 MH070311-02) to study these influences in 12 health jurisdictions across the United States .
In other related activity, I completed work with Drs. Diane Binson (PI) and Olga Grinstead (Co-PI) on a UARP funded evaluation of the California AIDS Office “High Risk Initiative Project.” The first grant, awarded in July 2000, provided an opportunity to investigate the benefits and barriers of HIV testing and counseling program of the Berkeley Health Department in a local bathhouse. We also just completed a second UARP-funded study to investigate a rapid testing program implemented at the same bathhouse. Dr. Binson and I also completed the first survey with a probability sample of men exiting a bathhouse. A year later we completed a second exit survey with probability sample from the same bathhouse. Using these and additional datasets, we successfully secured an NIMH grant award (1 R21 MH071155-01) to investigate the impact of HIV testing on the bathhouse environment among all men on the premises during testing – not just those who test.
Having been involved in the study of gay bathhouse and sex club environments, I was invited to serve as guest editor with Dr. Diane Binson of a special edition of the Journal of Homosexuality . The special issue also was published as a book titled Gay Bathhouses and Public Health , both published in 2003. As a result of my efforts on the special issue I was invited to join the editorial board of the journal.
HIV testing, drug and alcohol use/abuse, drug treatment, health risk and prevention behavior of gay and bisexual men, men who have sex with men, environmental influences on behavior, environmental and cognitive interventions in health promotion.
Stonewall Treatment Evaluation Project (STEP)
HIV Testing as a Structural Intervention
Community Prevention Policy & Programs in Risk Settings
Multi-Level Prevention in Culture & Context with Latino MSM
PART: Process Analysis of Rapid Testing
Exploring the Core of High Risk Networks