TowelTalk

What is the Program?

Community service organizations have long worked with bathhouses to provide HIV and STI testing and information to patrons. TowelTalk takes bathhouse outreach one step further by providing professional walk-in counselling in the bathhouse, with the possibility of follow-up counselling off-site for longer-term support. Counsellors address specific psycho-social issues that affect some of the men who use bathhouses, which may affect the men’s ability to make informed and healthy decisions about sex. The goal of the program is to increase the ability of men to make informed decisions about risk related to sex in a bathhouse setting, ultimately to help decrease HIV transmission and acquisition.

Why Was the Program Developed?

TowelTalk was inspired by the Mr. Sexxx Program, an HIV prevention program that provides one-on-one sexual health counselling in bathhouses in Berkeley and Chicago. Though the Mr. Sexxx Program had not been formally evaluated, it was seen as an innovative way to address the complex psychosocial issues that shape gay, bisexual and other men who have sex with men’s vulnerability to HIV in a bathhouse setting.

Based on this program, the Ontario Ministry of Health and Long Term Care’s AIDS Bureau formed a project advisory committee that included individuals representing a broad range of organizations and sectors, including AIDS service organizations, public health, mental health and research. A therapeutic counselling program was developed in the style of the Mr. Sexxx Program and adapted according to the unique needs of men in Toronto. The adapted program included an evaluation component, follow-up counselling and referrals support.

How Does the Program Work?

Location and timing of outreach

TowelTalk takes place in several bathhouses in Toronto with counselling taking place in a private room.  ACT was able to gain access to these venues through its membership in a network of gay men’s health bathhouse outreach workers called M2M Network. By drawing on the network’s long-established relationship with several bathhouses in Toronto, TowelTalk was able to negotiate the weekly use of a single private room during regular set times.

Whenever possible, the counsellor establishes and maintains hours in each bathhouse at key times when men may experience a heightened need for counselling, such as at the end of a weekend when those “coming down” off various substances are likely to experience depression along with concerns over risky behaviours engaged in over the course of the weekend. Times must be pre-established with bathhouse owners and managers.

During the set hours, the counsellor is present in the room assigned to him, displaying the availability of his counselling services on the door. In some bathhouses, the presence of the counsellor may also be announced by posting a sign at a strategic place in the bathhouse (such as the check-in counter) indicating the presence and location of the counsellor.  

Recruitment and engagement

Flyers are posted at busy locations in participating bathhouses and at other community venues such as bars, cafés and community centres. Most clients, however, discover the counsellor’s presence in the bathhouse by happening upon him. Often discussion with the counsellor is initiated by a client through a flirtation with the counsellor.

Counselling and referrals

TowelTalk provides men in the bathhouse with access to anonymous counselling sessions lasting between 10 and 45 minutes, as well as referrals to other health and social services.

Uniquely, counsellors can also provide up to eight short-term follow-up sessions offsite to clients who desire and demonstrate a need for them (e.g., drug or alcohol dependency, mental health issues or chronic depression). Based on the counsellor’s knowledge of community services and partnerships with other service providers, they can also provide clients with streamlined referrals to more extensive counselling services offered by some community partners.

By maintaining excellent relationships with community service providers, the counsellor is able to provide men in need of more extensive services with speedy access to them. This can be critical for reaching men who may be reluctant to follow through with accessing services requiring long wait times or complex intake procedures. The counsellor can also schedule more in-depth follow-up counselling outside the bathhouse setting in his office for a later date to any clients who require and desire it.

Common themes arising in counselling sessions include sexual health, risk reduction behaviour, substance use, relationship issues, guilt and shame, homophobia, HIV/AIDS, loneliness and isolation, anxiety and stress, immigration and settlement issues, sexual identity, trauma and other mental health concerns.

Required Resources

Human resources

A professional counsellor experienced in working with gay, bisexual and other MSM and comfortable relating to men in a highly sexually charged setting is the only human resource required.

Most clients who access counselling services in this setting begin their interaction with the counsellor through a flirtatious exchange, so the counsellor must not only be intimately familiar with emotional, sexual and psychological issues faced by men in a bathhouse context, but he must be comfortable receiving sexual advances from men who are naked while he remains dressed and respectfully addresses but does not participate in these advances (essentially, “behaving as a professional” in this sexualized space). He must be able to engage the client at a personal, human, nonjudgmental level to allow the person the opportunity to open up in a short time.

The counsellor must also maintain excellent relationships with bathhouse staff and community service providers so the former will grant continued access to the premises and the latter will provide expedited access to referral services. 

Material resources

• Evaluation forms
• Literature on sexual health

Challenges

The sexually charged environment of a bathhouse can make it challenging to transform the sexual dynamic that can initiate a counsellor/client relationship into a therapeutic one, requiring the counsellor to maintain a delicate balance between personal and professional.

Evaluation

An evaluation carried out from April 2009 to August 2010 included:

• a needs assessment survey with bathhouse patrons
• a follow-up survey of 89 bathhouse patrons conducted 10 months after the program started
• pre and follow-up interviews/focus groups with bathhouse management and staff as well as outreach workers and volunteers
• feedback forms completed by men who used the service
• interviews with program staff
• program data collected in the first year of the program

The evaluation indicated that the program was largely successful in meeting its objectives. In its first year, the services of TowelTalk were accessed by 88 men, with eight men accessing follow-up counselling at ACT and one continuing on to longer-term counselling through the streamlined referral process.

Ten months after the start of the program, 89 bathhouse patrons (including those who accessed the counsellor and those who did not) were surveyed – the feedback was very positive: 79.8% of all patrons surveyed felt it was a good idea to have a counsellor in the bathhouse setting, and 58% said they would consider accessing the service. Bathhouse staff, meanwhile, noticed a positive effect of the program on the behaviour and mood of its clientele, citing a reduction in the incidence of “intense conversations” with patrons during the hours that TowelTalk was on the premises.

A further feedback form was completed by 40 of the men who used the counselling service: 95% agreed with the statement “I am satisfied with my counsellor,” while 68% wrote specific comments describing their overall experience as a successful one. Some, however, indicated they found it difficult to assess the effectiveness of the experience.

The evaluation contained suggestions for improving the program, including establishing more concrete evaluation tools, better advertising of the program and finding ways to attract men who the program wasn’t yet reaching by targeting their specific needs.

Lessons Learned

• Working with the sexual dynamic of the bathhouse environment rather than disrupting the sexual atmosphere helps to engage men and create a comfortable space
• Ongoing communication with bathhouse managers/owners about the value of the program without being intrusive is critical to maintaining support for the program 
• Like other therapeutic relationships, establishing an alliance with the client is important for success
• Development and maintenance of a streamlined referral system for follow-up support services supports uptake of services out of the bathhouse
• The counsellor must bring to the role in depth understanding of the complexities of the setting, the population and therapeutic counselling modalities

Program Materials

• TowelTalk Protocol
• TowelTalk Evaluation Report
• Bathhouse Counselling Session Notes
• TowelTalk Promotional Posters
• TowelTalk Participant Feedback Form

Contact Information

For more information on the TowelTalk program, please contact:

Marco Posadas, MSW, RSW
Bathhouse Counsellor/Program Coordinator
AIDS Committee of Toronto
399 Church Street, 4th Floor
Toronto, Ontario, Canada
M5B 2J6
tel: 416-340-8484 ext. 289
fax: 416-340-8224
mposadas@actoronto.ca
toweltalk@actoronto.ca