Circuit parties - mammoth dance events held around the country and the world by and for gay and bisexual men - were born in the 1980s, in large part to raise awareness and funding for HIV and AIDS prevention. Today, the circuit parties - with up to 20,000 attendees - may be part of the problem rather than the solution, according to a Northwestern University study.

A study published in the Journal of the International Association of Physicians in AIDS Care concludes that the prevalence of unprotected sex at circuit parties, particularly by HIV-positive men, is increasing the risk of HIV/AIDS and causing a public health threat.

The circuit parties are causing a tension between building cultural identity for a subpopulation of gay and bisexual men and undermining the very basis of that community, according to co-investigators Amin Ghaziani, a Ph.D. candidate, and Thomas D. Cook, professor of sociology at Northwestern University in Illinois. They argue for intervention strategies to change the risky behavior, which they say is influenced by recent changes in party participants' attitudes and drug use, the latter of which enables the men to go without sleep for 24 hours or more.

The circuit party studies examined in this study show that more than two-thirds of attendees have some type of sex at the parties, and 47 percent reported participation in unprotected sex. HIV-positive men are overrepresented at the parties and more likely to have unprotected sex. Thus, the risk of HIV transmission is enhanced in a drug-laden environment where ordinary sexual mores lose sway.

"The parties are seen as gay celebratory events that elicit highly valued feelings of community by participants," Cook says. "That camaraderie, coupled with drugs, raises sexual appetites and distorts judgment in a setting where an overrepresentation of HIV-positive men are engaging in unprotected sex. In this party atmosphere, many forget about the immediate threat of HIV/AIDS or no longer care about it."

The study offers an ethnographic look at circuit parties, the sexual practices and drug use of gay men, and possibilities for intervention. Increasingly risky behavior at the parties is linked to newer party drugs, such as crystal methamphetamine, consumed in various cocktails; decreased worry about HIV because of treatments that now require only one to three pills a day, rather than numerous medications; and a sense of "de-individuation," or loosening of behavioral constraints that occurs in large groups.

The answer, the Northwestern study concludes, is not a crackdown on circuit parties. "Shutting down the parties would send them underground and possibly exaggerate risky behavior," Ghaziani says. "Rather, we extrapolate findings from existing public health literature and studies about drug use and sexual behavior to propose creative strategies to reduce the rates of potential HIV infection."

Drawing from intervention studies in non-party settings, Ghaziani and Cook offer a model to influence safe sex at circuit parties. The main focus is on recruitment of socially influential friends and peers - or opinion leaders - who would deliver key messages to reduce HIV infections.

The prevention messages argue that unsafe sex falsely promises eroticism and authenticity, certain drugs elevate libidos and distort cognition, more HIV men are present at the parties compared to other settings, and condom use does not betray intimacy or the party ethos.

The messages need to counter the feelings of invincibility that motivate party participants to engage in situation-sanctioned practices they would otherwise avoid, the study reports. They need to counter the celebration of the "tribe" through sensory-enhanced physical encounters with a clear message about the danger of HIV transmission.

"The point is not to demonize this particular subpopulation of gay and bisexual men," Ghaziani says. "Instead, we have to find healthier ways of celebrating community."

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