Structural and environmental HIV prevention for gay and bisexual men

HIV prevention efforts for gay and bisexual men in the United States began as community-mobilizing efforts, but have drifted towards focusing more on the individual. Given lowering prevalence and incidence, it is unreasonable to expect continued community support for high levels of prevention activi ty. Structural and environmental interventions present one useful, compleme ntary set of alternatives to support prevention efforts. This paper reviews the gay community's relationship with these interventions, including its i ntensely debated approaches to reducing HIV transmission within bathhouses. The implications for HIV prevention for gay men of larger societal factors , including economic development and economic motivation, migration, and le gislation, are then considered. Individual rights, community and public-hea lth interests must be given particularly cautious consideration when design ing and implementing structural and environmental interventions. (C) 2000 L ippincott Williams & Wilkins.