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To the Editor Ellen et al1 reported on a study offering a wide range of structural changes targeting a broad representation of youth at risk for human immunodeficiency virus. It was disappointing that the evaluation found no significant effect. However, it is possible that this broad approach itself contributed to the failure. In an evaluation of a potential structural effect of human immunodeficiency virus testing on premises in a gay bathhouse environment,2 we found a significant difference in the level of reported unprotected anal intercourse. When testing was offered in the bathhouse, there were significantly fewer reports of unprotected anal intercourse compared with when testing was not offered.
Woods WJ, Pollack LM, Binson D. The Broad Approach of a Structural Intervention Study and the Lack of Effect DetectionTarget Population and Sampling Issues. JAMA Pediatr. 2015;169(8):790. doi:10.1001/jamapediatrics.2015.1369