Men Who Have Sex with Men’s Attitudes Toward Using
Color-Coded Wristbands to Facilitate Sexual Communication
at Sex Parties
Christian Grov & Jackeline Cruz & Jeffrey T. Parsons
Published online: 24 January 2014
#Springer Science+Business Media New York 2014
Abstract Sex parties are environments where men who have
sex with men (MSM) have the opportunity to have sex with
multiple partners over a brief period of time. Dim lighting and
nonverbal communicationarethecharacteristics ofsexparties
on qualitative data from 47 MSM who attended sex parties in
scenarios involving the use of color-coded wristbands to
communicate (1) condom use preferences, (2) sexual position
(e.g., top, bottom), and (3) human immunodeficiency virus
(HIV) status at sex parties. The majority had positive-to-
neutral attitudes toward color-coded wristbands to indicate
(1) condom use preference and (2) sexual position (70.8,
75.0 % HIV positive; 63.6, 81.8 %, HIV negative, respective-
ly). These men cited that wristbands would facilitate the
process of pursuing partners with similar interests while also
avoiding the discomforts of verbal communication. In con-
expressed unfavorable attitudes to using wristbands to com-
municate HIV status. These men cited the potential for HIV-
status discrimination as well as suspicions around dishonest
disclosure. Although participants were receptive to utilizing
color-coded wristbands at sex parties to convey certain infor-
mation, it may be unfeasible to use wristbands to communi-
cate HIV status.
Gay, bisexual, and other men who have sex with men (MSM)
are one of the only populations for whom human immunode-
ficiency virus (HIV) prevention efforts have been unable to
reverse the growing trends in national HIVincidence over the
past decade (CDC 2012b; Higa et al. 2013; Prejean et al.
2011). They accounted for 79 % of all new HIV diagnoses
among men 2011 (CDC 2013) and are one of the only groups
to see increased infections in recent years (CDC 2012b). One
study found that the mean incidence rate of HIVamong MSM
in the USA is 2.39 % per year, which, if sustained in a cohort
of young MSM, will result in 40 % of them being HIV-
positive by age 40 (Stall et al. 2009). Taken together, these
rates suggest that there remains an urgent need to create
innovative, evidence-based, and tailored approaches to HIV
prevention amongst this highly vulnerable group.
Studies have noted that the venues where MSM meet their
sex partnersmay have an influence onwhether theyengage in
unprotected anal intercourse (UAI) (Grov et al. 2013b; Grov
et al. 2007; Mimiaga et al. 2011; Pollock and Halkitis 2009;
Prestage et al. 2009). Early in the HIVepidemic, a lot of this
work focused on bathhouses (Shilts 1987); however, much of
this focus has shifted to the Internet (Chiasson et al. 2006),
C. Grov (*)
Department of Health and Nutrition Sciences, Brooklyn College of
the City University of New York (CUNY), 2900 Bedford Avenue,
Brooklyn, NY 11210, USA
C. Grov:J. T. Parsons
Doctoral Program in Public Health at the Graduate Center of CUNY,
New York, NY, USA
C. Grov:J. T. Parsons
The Center for HIV/AIDS Educational Studies and Training
(CHEST), New York, NY, USA
J. Cruz:J. T. Parsons
Department of Psychology, Hunter College of CUNY, New York,
J. T. Parsons
Doctoral Programs in Health Psychology, Basic and Applied Social
Psychology at the Graduate Center of CUNY, New York, NY, USA
Sex Res Soc Policy (2014) 11:11–19
particularly because of the high frequency with which MSM
meetpartnersonline(Grov etal. 2013b; Liauetal. 2006). Yet,
urban centers, including New York City (NYC), have seen
growth in private sex parties, and these environments poten-
tiate HIV transmission risks (Clatts et al. 2005; Grov et al.
2010; Grov et al. 2013c; Mimiaga et al. 2010; Mimiaga et al.
2011; Solomon et al. 2011).
A community-based study of MSM in NYC and Los
Angeles reported that 24.9 % (of n=886) had met partners at
sex parties in the last 90 days (Grov et al. 2007). The study
compared MSM who met partners at private sex parties with
those who met partners at bathhouses and public sex environ-
ments, and found that men who attended private sex parties
had higher rates of UAI. In a second study, with sexually
active MSM in NYC, Grov et al., (2010) noted that HIV-
positive men (58 %) were more likely to have attended sex
parties than HIV-negative men (26 %). In a cross-sectional
survey of gym-attending MSM in NYC, Pollock and Halkitis
(2009) reported that 23 % had been to a sex party in previous
6 months, and 8 % had been to a sex party themed around
barebacking. A 2011 study of 540 NYC, MSM aged 18–29
noted 8.7 % had been to a sex party in the last 3 months, and
these men reported significantly more sex partners (lifetime
and recent) and were more likely to report drug use compared
to others (Solomon et al. 2011). And a 2012 US national
online survey of 2,063 MSM from a sexual networking
website found 45.2 % of men had been to a sex party in the
last year and an additional 23.3 % had been to one more than
12 months ago (Grov et al. 2014). Collectively, these findings
indicate that sex party attendance is not uncommon, and that
men who attend sex parties might be appropriate candidates
for targeted HIV prevention.
Interestingly, although available research suggests men
who attend sex parties are at greater risk for UAI, there has
been little work to investigate men’s actual behavior at sex
parties. Yet, sex parties can occur around themes—including
barebacking and “anything goes,” see www.cumunion.
com—suggesting these might be appropriate environments
to not only reach a vulnerable population, but also intervene
such to avoid HIV and sexually transmitted infection (STI)
transmission (Clatts et al. 2005; Grov et al. 2014). Likewise,
there islittle dataon the availability ofcondoms atsex parties.
One study noted that having condoms available at a sex party
was associated with decreased odds of serodiscordant UAI at
the event (Mimiaga et al. 2011); however, it would be neces-
sary to know what other strategies could be used to further
enhance condom use.
To our knowledge, there are no published studies reporting
on the number of sex parties that occur in NYC. In reviewing
online listings on sexual networking websites (e.g., craigslist,
adam4adam, and barebackrt), sex blogs (e.g.,
adventuresingroupsex), as well as event spaces that regularly
house sex parties, it appears that between 25 and 35 parties
occur each week in NYC. In our conversations with event
promoters to conduct the present study, we have learned that
these events can attract anywhere from 20 to 120 MSM.
Events take place at licensed commercial sex clubs as well
as private residences and hotel rooms (Clatts et al. 2005;
Mimiaga et al. 2010; Mimiaga et al. 2011; Solomon et al.
2011). In order to facilitate a sexually charged environment
andtoencourage rapid andfrequentpartnering,sexparties are
often characterized by low lighting, nonverbal communica-
tion, and sometimes loud music (Mimiaga et al. 2010). Group
sex, anonymous sex, and frequent partnering in the course of
the event increasethe riskofHIVandSTItransmission(Clatts
et al. 2005; Gwadz et al. 2006). Although some researchers
have turned their focus to sex parties (Mimiaga et al. 2010;
Mimiaga etal. 2011; Mullensetal. 2009; PollockandHalkitis
2009; Reisner et al. 2009; Solomon et al. 2011; Wilson et al.
2008), there are currently no evidence-based interventions
Similar to bathhouses, the low lighting and nonverbal
communication that are inherent characteristics of sex parties
may impede sexual communication and the ability of event
promoters to monitor condom use (Elwood et al. 2003;
Richters 2007). Thus, it is necessary to offer a novel way of
improving condom use or other harm reduction strategies
within the confines of these physical and social environments
(Cohen and Scribner 2000; Ko et al. 2009; Parker et al. 2000;
Wohlfeiler 2000). These may include communication around
condom use, HIV status disclosure, and sexual positioning
(e.g., top, bottom, versatile, and oral sex only). Intervening on
environmental factors (e.g., adding lighting) or social norms
regarding audible communication (e.g., encouraging men to
speak) are considered counterintuitive to nature of a sex party
(i.e., will “ruin the mood”) (Mimiaga et al. 2010). Thus,
alternate means to achieve that communication are warranted.
Historically, some MSM have taken to using the “hanky
code,” whereby a handkerchief is worn in the rear pocket of a
man’s pants with the color and location (right pocket or left)
indicating something about his sexual interests; however, this
has often been relegated to men into leather, sadism, and
masochism, or other kinky behaviors (Kulick 2000; Patton
2002; Perkins and Skipper Jr 1981). Yet, perhaps there is
something to be gleaned from the hanky code for implemen-
tation at sex parties? To the extent that verbal communication
may be difficult in sex parties, use of similar nonverbal codes
could facilitate finding a partner with congruent interests. At a
sex party, this could include color-coded wristbands.
However, before the efficacy of such an intervention can be
tested, it is necessary to determine its feasibility and accept-
ability among the target population.
To that end, we conducted qualitative interviews with 50
MSM who attend sex parties in NYC, querying them with
distinct hypothetical scenarios about the use of color-coded
12Sex Res Soc Policy (2014) 11:11–19
wristbands at sex parties to indicate (1) condom use prefer-
at sex parties, as well as to determine differences based on a
person’s HIV status. Since this area of research is relatively
new, the questions posed in this study were framed in order to
how MSM will respond and accept HIV prevention efforts in
sex parties can influence policies regarding the way these
efforts are delivered and implemented. As MSM in urban
centers across the US continue to attend sex parties, it is
important to develop policies regarding acceptable and appro-
priate methods to improve sexual communication and avert
HIVand STI transmission.
Participants and Procedures
The data used for this study were taken from Project Score, a
study investigating the venues where MSM meet their sex
partners. One aim was to interview 50 MSM who were
recruited via sex parties. Eligibility criteria included the fol-
stable, and reported having two or more casual male sex
a face-to-face interview at our research office.
The participants for this study were recruited via partner-
ship with sex party promoters. The promoters either used
passive recruitment methods—such as leaving informational
materials with details about the study attheir events(e.g.,near
the clothing check)—or by circulating study materials elec-
tronically via their list serves. Given the pilot nature of this
study, there were insufficient resources to conduct active on-
site recruitment (i.e., project staff at the event). Those inter-
ested in joining the study contacted us and were screened by
research staff. Eligible participants were scheduled to com-
plete an assessment (target n=50). All procedures were ap-
proved by the City University of New York Institutional
Participants completed an audio-recorded face-to-face semi-
structured interview at our research office. These interviews
were approximately 45 min. Interviews were transcribed ver-
batim and reviewed for accuracy by research staff.
Participants were queried about their attitudes toward three
distinct hypothetical scenarios involving the use of color-
coded wristbands to facilitate sexual communication at sex
parties. This included a scenario in which wristbands would
indicate condom use preferences (e.g., one color signified “I
always use condoms,” a second signified “ask me” or “let’s
discuss,” and a third that signified “I never use condoms”). A
secondscenarioinvolvedthe use ofcolor-codedwristbandsto
indicate sexual positioning (e.g., a color for top, bottom,
versatile, or oral sex only). A third scenario involved using
color-coded wristbands to indicate one’s HIV status. We were
unable toutilize three interviews due to interviewer error, thus
the final sample size for the current study was 47 qualitative
Following the guidelines of thematic analysis, the research
staff reviewed the transcriptions around narratives describing
attitudes toward using color-coded wristbands in various sce-
narios at sex parties. Studies have shown that thematic anal-
ysis is very useful in assessing qualitative data (Miles and
Huberman 1994; Patton 1990). The research team reviewed
responses to the three scenarios and first broadly coded them
into three categories, “favor”, “neutral”, and “oppose”.
Examples included, “That’s awesome! I think that’s cool”
(Favorable), “I don’t think I would have a problem with that”
(Neutral), and “Actually, I think it’s a bad idea” (Oppose).
Subthemes within codes were then identified. A second mem-
ber of the team verified all coding and discrepancies (e.g.,one
reviewer coded as “neutral” and the other coded as “favor”)
coder(s) and the principal investigator. All the themes shown
in the results were commonly expressed by a number of
participants. Adjacent to quotes are men’s ages and their
self-reported HIV status.
The participants ranged in age from 18 to 71 years (M=41.5,
SD=13.8) (see Table 1). Forty-four percent were MSM of
color and 51.1 % were HIV positive. One participant did not
know his status. The majority (85.1 %) identified as gay, six
(12.8 %) as bisexual, and one (2.1 %) who indicated “other”.
Participants provided descriptive narratives about sex parties
that included details about meeting partners, venue character-
istics, and discussing condom use and HIV status with part-
ners. We asked participants to express their attitudes toward
using color-coded wristbands to identify their condom use
preferences (i.e., always, ask me, and never), sexual position-
ing (i.e. top, bottom, and versatile), and HIV status (see
each wristband scenario. Across all three scenarios, and
whether participants thought they were a good idea or not,
there was overall agreement that wristbands would be an
Sex Res Soc Policy (2014) 11:11–19 13
effective way to circumnavigate norms against audible com-
munication at sex parties.
Condom Use Preferences
With regard to how men felt about using color-coded wrist-
bands to identify condom use preferences, seven participants
(14.9 %) expressed favorable attitudes mainly indicating that
verbally communicate with partners. Five of the participants
were HIV positive and two were HIV negative. Most of these
participants communicated a discomfort that exists in
discussing condom use among partners:
If I saw that [wristbands], I’d agree, because that’s a
message that says ‘I’m positive.’ In other words, when I
sayIdon’twanttouse a condom,then[I’msaying]‘I’m
positive.’ It’s an elegant way. (38, HIV positive)
That’s a good idea… [because] then you don’t have to
ask the person. (47, HIV positive)
Both participants agreed that the wristbands would reduce
the need for verbal communication between partners; howev-
er, the first participant conflated condom use communication
with implicit/tacit HIV status disclosure.
Three participants (6.4 %) believed that it would save them
time in pursuing partners whose preferences complimented
their own on condom preference. Of those three participants,
one was HIV negative, one was HIV positive, and one did not
know his status.
It would save a lot of people time pursuing other people
that aren’t into [safe sex]. (30, HIV negative)
Two HIV-negative participants (4.3 %) felt that men could
lie about their preferences for reasons not explained. There
was one participant who considered the wristband discrimi-
natory toward his own personal condom use preference.
However, he admitted to evaluating the risk of engaging in
sexual intercourse with sex partners based on their condom
I almost [want to] say it would be a little discriminatory
because people are [going to] judge you based on, on
whether or not you choose to use condoms. I know
personally, if I [see] someone with a wristband saying,
“I never use condoms,” I probably wouldn’t want to
sleep with them, just because I’d be afraid—especially
at a sex party—I’d be afraid of what I would be putting
myself at risk for. (32, HIV negative)
With regard to scenarios in which wristbands communicated
sexual positioning (e.g., top, bottom, versatile, and oral sex
only), one HIV-positive participant considered the wristband
helpful in decreasing the verbal conversation traditionally
necessary between partners as it “cuts to the chase”:
That would be great too, yeah [because] then yeah, that
would be great. (46, HIV positive)
Table 1 Sample characteristics
Race or ethnicity
Multiracial and “other”
High school or less
Four-year college degree
Age (mean, SD)
Table 2 Attitudes toward using color-coded wristbands to communicate
(1) condom use, (2) sexual position, and (3) HIV status at sex parties
(1) Condom use
(2) Sexual position
(3) HIV status disclosure
aOne participant’s response could not be coded (i.e., did not respond to
14Sex Res Soc Policy (2014) 11:11–19
Three participantsdescribed how they did not favor the use
of wristbands sexual positioning because they believed in
encouraging verbal communication between sex partners.
One of the three participants was HIV positive and two were
you’re at public party with lots of people, you’re not
going to do it with everybody there. (64, HIV positive)
Fourteen men (29.8 %) favored the use of color-coded
wristbands to identify sexual positioning, predominantly stat-
ing that it would not only make it easier to search for compat-
ible partners, but it would also eliminate the need to guess
their partners’ preferred position. Eight of the 14 participants
were HIV negative.
I love all of that [wristbands], absolutely…everything is
up front, there is no guesswork. You don’t end up
working on a guy for 20 or 30 min and then realize
you are both bottoms. (44, HIV positive)
The participant’s statement is one that was similar to other
participants expressing favorable attitudes. Most felt that the
wristbands were a good way to easily indicate their personal
positioning preferences faster and more efficiently without
having to make any inferences.
In contrast, three participants (6.4 %) felt that the imple-
mentation of sexual positioning wristbands would eliminate
the mystery and spontaneity that comes along with meeting
new sexual partners at sex parties. Two of the three partici-
pants were HIV positive and one was HIV negative:
It sounds like it would take the fun out of the situation
seeing where things go and where they don’t go—you
know. Yeah, a little bit more spontaneity—is called for.
(48, HIV positive)
HIV Status Disclosure
Finally, we report on participants’ attitudes toward using
color-coded wristbands to communicate HIV status at sex
parties. One HIV-negative participant stated that he does not
want to engage in oral sex with anyone who is HIV positive.
Therefore, the use of wristbands to communicate HIV status
HIV-negative partners. Although most participants (n=26,
55.3 %) expressed positive to neutral attitudes toward using
the HIV status wristband, the most common themes emerged
from the participants who expressed strongly unfavorable
For 23.4 % of participants (n=11), dishonesty was a com-
mon sentiment for opposition. Seven of the 11 participants
were HIV negative and one did not know his status.
for all different kinds of reasons and if you’re making a
decision of your behavior and relaxing your risk toler-
ance or, you know, doing anything like that based on
that information, I think is ultimately destructive. (45,
Guys can say whatever they want to, but unless there’s
like a doctor or medical note there along with them,
‘here’s my last test’ type of thing… wouldn’t affect me
eitherway.Again,I wouldstill goupandask them what
their status is, just because I don’t trust what a little
bracelet says. (27, HIV negative)
Both participants responded that they would not put much
confidence and trust in the wristbands primarily because peo-
ple could lie about their HIV status. The second participant,
however, suggested that the wristbands would hold greater
credibility if the HIV status was confirmed by a doctor via a
medical report. Yet, there were participants who deemed the
wristbands pointless since they already assume that everyone
attending sex parties are HIV positive:
I mean, that, in a situation like that it, it would be
unnecessary, [because] you just assume that everybody
is [HIV-positive], so, why do we need to tell anybody
what we are? (64, HIV positive)
I don’t think that would be useful because I always
presume somebody either knows that they’re positive
or doesn’t know that they’re positive. (34, HIV
For these men, HIV status disclosure was considered un-
necessary because individuals should practice universal pre-
cautions. If a person engages in sex without a condom, it is
having sex with HIV-positive individuals.
Three men (6.4 %) also disagreed with the wristband use,
a personal choice, not an obligation. Two of these three
participants were HIV negative, and one was HIV positive:
demarcation with color or outside kind of marking,
doesn’t really allow the person…for you to get to know
that person. (58, HIV negative)
People have to make it their own decisions, they do.
Everybody makes their own; we’re all adults. We all
know what we’re doing. Everybody knows the risks or
Sex Res Soc Policy (2014) 11:11–1915
not, but I don’t think you can brand somebody or tattoo
them, which is really what [the wristbands are]. (37,
The first participant illustrated that HIV-status disclosure is
something that is best carried out as a conversation, while the
second participant saw it as “branding” or “tattooing”. For
both these men, their concerns were more out of interest to
protect HIV-positive men from experiencing HIV stigma, a
sentiment shared by others.
Five participants (10.6 %) thought that the color-coded
wristbands to specify HIV status would discriminate against
men who are HIV positive. All five men were HIV negative.
further increase the stigma surrounding HIV-positive people.
on, you would get less opportunities to get [oral sex], I
feel like, or people would just automatically put that
stigma on you. (33, HIV negative)
This participant reiterated the sentiment of alienation and
stigma that many others also expressed; however, he also
mentioned that the wristband would decrease the prospects
of engaging in sex simply based on their HIV-positive status.
One participant also added that the wristbands would be
detrimental both emotionally and psychologically even
though he acknowledged the good intention behind the im-
plementation of the wristbands, which is preventing the trans-
mission of HIV:
I would not like to be in a [sex party] like that, but it
being part of a community that would, you know, make
that, even though it’s for the greater benefit of, you
know, preventing HIV. (31, HIV negative)
Yet when it came to the actual implementation of the
wristbands at sex parties, three HIV-positive participants
(6.4 %) responded that while they tolerated the idea of using
the HIV-status wristbands, they would either not use them or
would not attend sex parties where wristbands are made
I wouldn’t go if I had to mark, you know? Because uh
I’m not into that risk…but there are a lot of people that
[are uninformed] about [HIV], for example, all the
[HIV-negative people], they [do] not really have inside
information because they are not [HIV-positive], so…
the [HIV-positive men] for themisa ‘No! Definitely no’
and [sex with an HIV-positive person is] not that dan-
gerous, if you do it with precaution. (61, HIV positive)
This participant’s explanation for choosing not to wear a
wristband denoting HIV statusstems fromthe beliefthatmost
people are not educated about the HIV virus and thus do not
fullyunderstandit.As aresult,hefeelsthatHIV-negative men
would decline engaging in sexual intercourse because they
will perceive having sex with an HIV-positive partner as
Based on the qualitative interviews with a diverse sample of
47 MSM recruited from sex parties in NYC, this study ex-
plored the attitudes toward the use of color-coded wristbands
at sex parties to facilitate nonverbal sexual communication.
Most participants expressed neutral or favorable attitudes
toward using the wristbands to indicate interest in condom
use and sexual positioning preferences. These men highlight-
ed that the wristbands would allow them to circumnavigate
norms against verbal communication at sex parties, thus com-
municating their own desires/interest, and more effectively
identifying partners who have similar interests. The use of
color-coded wristbands to communicate sexual positioning
may contribute to increased sexual satisfaction and sexual
self-efficacy at sex parties. Meanwhile, the use of color-
coded wristbands to communicate condom use preferences
may help to reduce unwanted UAI. Clearly more work is
needed to determine the logistics of feasibly implementing
color-coded wristbands to communicate sexual positioning or
condom use preferences, as well as their efficacy. Yet, this
initial study suggests promise for acceptability.
Interestingly, one participant confounded condom use in-
tentions as tacit disclosure of HIV status (i.e., wearing a
wristband to indicate “I never wear condoms”, is indication
that one is HIV positive). More research into this type of
attribution would be needed prior to implementing wristbands
that indicate condom use preferences. Likewise, it is recog-
nized that the extent to which wristbands for condom use
preferences would help men who want to use condoms find
ed UAI) could facilitate encounters between men who do not
want to use condoms (thus facilitating wanted UAI,
barebacking). All told, caution is needed if one’s goal is to
use color-coded wristbands to avert both unwanted and
In contrast, fewer participants considered the use of wrist-
bands to communicate HIV status to be acceptable. Common
themes around unacceptability included concerns about dis-
about further alienating HIV-positive men. Interestingly, all
the participants who felt that the wristbands would increase
stigma and discrimination of HIV-positive individuals were
HIV negative. Although there were many HIV-positive men
who opposed the use of wristbands, none specifically men-
tioned that they would feel stigmatized or alienated. Instead,
16 Sex Res Soc Policy (2014) 11:11–19
HIV-positive men indicated that they would not be bothered
by the implementationof the wristband; however, they would
personally choose not to wear it and preferred not attending
sex parties mandating its use. This finding reflects the belief
that status disclosure should not be required and remains both
2013a; Overstreet et al. 2012).
A prominent theme among both HIV-positive and HIV-
negative participants was the belief that other men would not
accurately report their HIV status (as “HIV negative”, when
HIV-negative men than HIV-positive men—presumably an
HIV-negative man has more to personally “lose” if his partner
is dishonest than does an HIV-positive man (Grov et al.
2013a). Participants cited that motivations for dishonesty
could include being unsure of one’s true status (and thus
misattributing) and avoiding discrimination and/or rejection
from HIV-negative men. It was suggested by several partici-
pants that in order for the wristband indicating HIV status to
functionmoreeffectively, men shouldeitherbetestedorbring
medical proof of status. Yet, interestingly, none of the partic-
such that one may test HIV-antibody negative after a recent
findings bring to bear the numerous challenges individuals
face if attempting to serosort their partners (Golden et al.
approaches are warranted.
There are important limitations to consider in this study.
The sample included MSM who attended sex parties in NYC,
thus limiting generalizability. Yet, our sample was similar in
age (Clatts et al. 2005; Mimiaga et al. 2010) as well as HIV-
status distribution (Mimiaga et al. 2010) to other studies of
MSM recruited from sex parties. Given the “underground”
nature of sex parties, future researchers should carefully con-
sider the best methods for ensuring representativeness. This
may include partnering with a diverse array of event pro-
moters and taking advantage of multiple recruitment ap-
proaches such as field recruitment, respondent driven sam-
pling, and electronic media (e.g., list serves).
Additionally, participants were asked to reflect more gen-
erally on their thoughts about color-coded wristbands, rather
than directly asking whether the participant would use the
wristbands themselves. Such an approach allowed us to tap
into participants’ thoughts more broadly while perhaps
avoiding some social desirability. Yet still, many participants
reflected both upon their using wristbands themselves, as well
as what they thought about it more generally. In addition,
future research should consider determining how wristbands
could be used in tandem with men’s current communicative
strategies at sex parties.
We posed three scenarios for participants; however, there
are other scenarios that could also be considered, for example,
the combination of condom use with sex role (e.g., “I use
condoms if I bottom, but not if I top”). Taking cues from the
historical Hanky Code (Kulick 2000; Patton 2002; Perkins
and Skipper Jr 1981), it may be that future researchers should
assess the feasibility and acceptability of using different arms
(left vs. right) to indicate sex role (top, bottom, and both arms
for versatile), with the color of the wristband specifying con-
dom use preferences. And, although in the minority, some
participants indicated that they did not favor wristbands be-
cause they believed in encouraging verbal communication
between sex partners.
Although this was not the focus of the present study, it
would be worth assessing the feasibility and acceptability of
other methods to facilitate verbal communication (e.g., en-
couraging promoters to turn the music down). And, of course,
there are many other approaches to improve sexual commu-
nication and reduce HIV and STI transmission at sex parties
that should be considered, perhaps in tandem with using
wristbands. For example, some participants indicated that
using wristbands to communicate HIV status would be more
effectively been used in bathhouses (Daskalakis et al. 2009),
an environment that shares some commonalties with sex
Despite these limitations, these results offer insight into
potential intervention approaches at sex parties—reaching a
population that is at critical risk for HIVand STI transmission
(Grov et al. 2007; Pollock and Halkitis 2009; Solomon et al.
2011). This study found that nearly half of participants
expressed unfavorable attitudes toward color-coded wrist-
bands to indicate HIV status and suggests that alternate ap-
proaches are warranted. Meanwhile, our findings regarding
the acceptability of wristbands to indicate condom use prefer-
ences are promising for the development of HIV and STI
prevention intervention and policies for sex parties. Proven
effective, such an approach may also prove to be a cost-
effective method for averting HIVand STI transmissions.
The MSM who attend sex parties are extremely vulnerable
to HIVand STI transmission. This includes with their partners
at sex parties, as well as the potential to then inadvertently
pass HIVor STIs to partners outside sex parties (i.e., partners
who may otherwise be at low risk of infection) (Pollock and
Halkitis 2009). To our knowledge, there are currently no
demonstrated effective behavioral interventions (DEBI) that
have been developed for sex parties. Yet, the CDC currently
supports one (condom distribution) that could be applied in
sex parties (CDC 2012a). This DEBI seeks to improve the
has been demonstrated effective in bathhouses (Ko et al.
2009). Implementation of color-coded wristbands to indicate
condom use preferences has the potential to enhance condom
distribution through providing a means to effectively commu-
nicate condom use preferences. Added, this may effectively
Sex Res Soc Policy (2014) 11:11–19 17
target other known factors that contribute to condom use such
as subjective norms, self-efficacy, and behavioral intentions
of Health (SC2 AI 090923: PI—Christian Grov), and research activities
were conducted at the Center for HIV/AIDS Educational Studies and
Training (CHEST). Special thanks to the study team: Michael Adams,
A. Golub, Sitaji Gurung, Kevin Robin, Amy LeClair, Kristi Gamarel,
Chris Hietikko, Anna Johnson, H. Jonathon Rendina, Arjee Restar, Joel
Rowe, Inna Saboshchuk, Anthony Surace, Ana Ventuneac, Andrea C.
Vial, and the recruitment staff. Finally, a special thanks to Joana Roe at
NIAID. The content is solely the responsibility of the authors and does
not necessarily represent the official views of the National Institutes of
Project Scorewas funded bythe National Institutes
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