Cruise control: bathhouses are reigniting the AIDS crisis. It's time to shut them down.

• Author: Farley, Tom

JUDGING FROM THE DESCRIPTIONS I'VE read and heard, the bathhouse I visited not long ago is fairly typical. Pay $8 to the clerk behind the Plexiglas window and he'll give you a towel and buzz you in. Inside are hallways of private rooms for sex, each about six by six feet, or just big enough for a thin mattress and a little maneuvering beside k. The rest of the bathhouse is mostly comprised of different areas for men to "cruise"--to check out the other bodies and decide which one to bring back to a room. These include a gym (complete with free weights, Nautilus equipment, and aerobic trainers), a sauna, Jacuzzi, and group showers. Elsewhere, gay porn videos play to help men get aroused. For those who like to watch, be watched, or have group sex, there are also orgy areas, including a fantasy "jail," a picnic table for men to lean over when receiving anal sex, and "slings" into which men can strap themselves to expose their anus for anyone who happens by.

Bathhouses are wholly designed to facilitate anonymous sex--sex as a purely physical act, without context, past, or future. But the most anonymous areas of all are the "maze" and the "glory hole" booths. The maze is completely black, a tangle of paths and dead ends defined by vertical sheets of darkly painted plywood where men grope until they find one or more receptive bodies. The booths are paired and separated by plywood through which fist-sized holes have been cut at hip level. Men manage to have not just oral but also anal sex through these holes, guaranteeing that each hasn't the slightest idea with whom he is copulating. With the act of sex stripped to its essential physical steps, it is easy--and quite common--for patrons to have sexual contact with several men in a single visit.

Even beyond their physical designs, baths influence their patrons' behavior by maintaining certain clear-cut rules. "Most bathhouse cruising is non-verbal," advises a bathhouse Web site, which also makes it clear that "most of the time you don't learn each other's names" "Conversations in the orgy rooms should be kept to a minimum," advises another site. Also, "It is considered embarrassing to make it with someone you already know," and "It is uncommon to use condoms during oral sex." One bathhouse Web site even has its own Miss Manners, a column called "Ask Towel Boy" in which a veteran gives practical answers to such questions as "Is it a social misdeed to walk around nude all the time?" and "How do I refuse someone's advances without offending them?"

Although they are small in number, bathhouses have an impressive reach. One survey found only about 80 bathhouses and sex clubs in the entire United States. But a recent study of gay men in major cities revealed that nearly one-third had visited such a place in the previous year. Furthermore, surveys of men who frequent baths confirm what their surroundings encourage: On average, bathhouse patrons have had sex with more than 30 different men in the previous six months. Baths can serve thousands of men per week, and major gay gatherings such as New Orleans' "Decadence" and Mardi Gras attract men from all over the country. Not surprisingly, this makes them critical hotspots for the spread of sexually transmitted diseases, including HIV.

Bathhouses like the one I visited became infamous for their role in spreading the AIDS virus in the 1980s. The. disease raced through gay men in magnet cities like San Francisco, Los Angeles, and New York because it was so easily spread through the dense sexual networks centered in the baths. Many bathhouses were shut down at the time in an effort to contain the epidemic. But while the number of bathhouses is lower now than in the 1980s, most major U.S. cities still have at least one, and the behavior of customers has grown steadily riskier in recent years, to the point where there is now an explosion of syphilis among bathhouse clientele. When I was medical director for the HIV and STD program at the Louisiana Office of Public Health, part of my job was to keep an eye open for such outbreaks, since syphilis--which causes open sores on the genitalia and makes it easier to transmit disease--often presages an outbreak of HIV. If public health officials don't respond effectively, the current syphilis outbreak could cause HIV to again spread through communities like wildfire. Today, more than two decades after the start of the AIDS epidemic and 15 years after public health officials and bathhouse owners first clashed over the problem, it is once again time to take a hard look at the evidence and either radically change the way they do business or shut them down altogether.

Sex in the City

The last time public health officials worried about syphilis outbreaks among gay men was in the late 1970s and early 1980s, when bathhouses were in their prime. Syphilis rates hit a decade-long peak during the unfolding tragedy of the then-mysterious AIDS epidemic in 1983. At the time, a French-Canadian flight attendant named Gaetan Dugas was a loyal bathhouse customer. According to Randy Shilts, the reporter who wrote the history of the early AIDS epidemic, And the Band Played On, Dugas was blond, handsome, and ravenous for partners. His job took him to cities throughout North America, where, by his own claim, he had sex with 250 men a year for at least three years. Later, when he became one of the first men diagnosed with the "gay cancer" of Kaposi's sarcoma, William Darrow, a disease control specialist for the Centers for Disease Control and Prevention, managed to link Dugas to 40 of the first 248 AIDS cases diagnosed in this country in 10 different cities. Although Dugas is infamous for his role in spreading HIV, AIDS researchers believe that if he hadn't, many others could have taken his place, This is because of the way gay men were having sex at the time. Bathhouses, which had been small, seedy, and advertised only by word of mouth in the 1950s and early 1960s, flourished...