Measuring a Novel STI Risk Environment: The Exotic Dance Club

Background: Exotic dancers have received little research attention although there is evidence of high rates of sexual and drug risk while dancing.  We hypothesize that the environment of exotic dance clubs (EDCs) creates and/or supports STI/HIV risk for dancers.  The first step in testing this hypothesis is the development of a risk environment index comprised of four domains (social, economic, drug, and policy). This study aims to develop and assess the reliability of a risk environment score.

Methods: Index items were developed from our previous experience researching the study population as well as the literature. In the summer of 2013, anonymous surveys were administered via A-CASI in EDCs (N=26) in Baltimore City and County among exotic dancers, bartenders, managers, and other staff (N=298). Surveys consisted of a brief demographic section followed by 65 statements with 4-point, Likert-scale responses (strongly agree to strongly disagree) for the four domains. Item examples for each domain are the following: “the management pressures dancers to sell sex” (social); “there are set prices for sexual services in this club” (economic); “Heroin snorting is common among the dancers in this club” (drug); and “Dancers can easily get condoms inside the club” (policy).

Results: We interviewed 106 dancers and 292 other staff.  The median age of dancers was 25 years old (range: 18-47) and the median length of time working in EDCs was 2 years (range: 6 months-23 years). The domains had the following alphas: social (alpha=0.87), economic (alpha=0.92), drug (alpha=0.89), and policy (alpha=0.66).  No significant differences were found between groups for any indicator.

Conclusions: We found high levels of internal consistency among four novel measures of the EDC risk environment. The results indicate a high level of STI risk for dancers in these environments and underscore the need for interventions that specifically target these high-risk environments.