Abstract
BackgroundMale sex work in the western countries has changed, including now a subculture of male sex workers who have paid sex with men arranged for via the internet. The men involved in this subculture do not easily identify themselves as sex workers nor as homosexual, and are therefore missed by regular health care and public health interventions. These male sex workers may form a hidden key population for sexually transmitted infections (STIs) and HIV, bridging towards other persons outside this context.MethodsThis clinic-based observational study included consultations by male sex workers (n = 212), female sex workers (n = 801) and in men having sex with men who did not report being paid for sexual contacts (MSM, n = 2703) who received STI and HIV testing and counselling at our clinic during the study period. In this study we compare the consultations in male sex workers to those in in female sex workers and MSM.Demographic characteristics and sexual behaviour of the male sex workers, female sex workers and MSM were compared using chi-square tests and non-parametric tests. Using univariate and multivariate regression analyses, determinants for STI positivity in male sex workers were evaluated.ResultsMale sex workers tested positive for STI (including HIV) in 40 % of the consultations; female sex workers and MSM respectively in 9 and 14 % of the consultations. A new HIV infection was found in 8 % of the consultations of male sex workers. Male sex workers were a young population of migrant sex workers from Eastern Europe. They reported more often to also have sex contacts with women and other sex workers. Male sex workers are at a higher risk for one or more new STI than female sex workers and other MSM, even after correction for age, ethnicity, known HIV positivity and behavioural variables.ConclusionsMale sex workers form a hidden key population that impacts the transmission of STI and HIV within the MSM population and, possibly, to the heterosexual population. They require specific targeted interventions. Although targeting male sex workers is labour intensive it is feasible and important to reduce STI transmission.
Highlights
Male sex work in the western countries has changed, including a subculture of male sex workers who have paid sex with men arranged for via the internet
Outreach activities targeted at female sex workers took place at known sex venues, while outreach activities towards men who have sex with men (MSM) were at gay parties and gay sex venues
Characteristics of the study population In total, 3716 consultations were included in analyses; 212 consultations among male sex workers, 801 among female sex workers and 2703 among MSM
Summary
Male sex work in the western countries has changed, including a subculture of male sex workers who have paid sex with men arranged for via the internet. The men involved in this subculture do not identify themselves as sex workers nor as homosexual, and are missed by regular health care and public health interventions These male sex workers may form a hidden key population for sexually transmitted infections (STIs) and HIV, bridging towards other persons outside this context. In recent years the setting of male sex work in western countries has shifted towards a subculture of men having paid sexual contacts with men who they encounter via the internet [2] These male sex workers are often home-based internet escorts who do not self-identify as homosexual nor refer to themselves as sex workers [3]. The male sex workers visiting our sexually transmitted infection (STI) clinic often don’t refer to their own activities as sex work, but as being involved in “escort” Their sexual behaviour includes paid sexual contacts with men, often without using a condom. The male sex workers often do not refer to themselves as homosexual [4,5,6,7,8,9], nor do they refer to their activities as sex work. and, even though contacts are made online - these male sex workers tend to keep their activities hidden from public attention
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