Navigating queer digital sex work: motivations, challenges, and platform practices of gay, bisexual, and transgender sex workers

Sex workers are often perceived as possessing ‘deviant’ identities, contributing to their exclusion from health services. The literature on sex worker identities in relation to health has focused primarily on cisgender female sex workers as the ‘carriers of disease’, obscuring the experiences of cisgender male and transgender sex workers and the complexities their gender identities bring to understandings of stigma and exclusion. To address this gap, this study draws on 21 interviews with cisgender male and transgender female sex workers receiving services from the Sex Workers Education and Advocacy Taskforce in Cape Town, South Africa. Our findings suggest that the social identities imposed upon sex workers contribute to their exclusion from public, private, discursive and geographic spaces. While many transgender female sex workers described their identities using positive and empowered language, cisgender male sex workers frequently expressed shame and internalised stigma related to identities, which could be described as ‘less than masculine’. While many of those interviewed felt empowered by positive identities as transgender women, sex workers and sex worker-advocates, disempowerment and vulnerability were also linked to inappropriately masculinised and feminised identities. Understanding the links between gender identities and social exclusion is crucial to creating effective health interventions for both cisgender men and transgender women in sex work.

Objectives: To establish the prevalence of HIV, syphilis, and sexual risk behaviour among three groups of men who have sex with men in Jakarta, Indonesia, and to investigate sexual links...

In 2002-2005, a cross-sectional study to assess the potential for HIV transmission was carried out among 557 female and male-to-female transgender commercial sex workers (CSW) in three cities in the Netherlands. Female CSW (F-CSW), drug-using female CSW (DU), and transgender sex workers were recruited in street-based and establishment-based sites. An anonymous questionnaire was administrated by interviewers and a saliva sample was collected for HIV antibody testing. The overall HIV prevalence was 5.7% (31/547; 10 samples were excluded because of "intermediate" test results). HIV was more prevalent among transgender (18.8%, 13/69) and DU (13.6%, 12/88) sex workers than among F-CSW (1.5%, 6/390). Of the HIV positive CSW, 74% were unaware of their infection. Consistent condom use with clients was 81%. Regular condom failure with clients was reported by 39%. In multivariate analyses, transgender sex workers (OR = 22.9), drug-using CSW who ever injected drugs (OR = 31.1), African (OR = 19.0), and South European ethnicity (OR = 7.2) were independently associated with HIV. Condom failure (PRR = 2.0), anal sex (PRR = 2.1), and drug use (PRR = 3.8) were associated with inconsistent condom use with clients. There is a potential risk for further spread of HIV, through clients and (private) partners of sex workers, to the general population. Targeted health promotion activities are indicated for transgender sex workers and drug-using female CSW; active HIV testing must be continued.

Sex workers in east and southern Africa are exposed to multiple occupational health and safety risks. Detailed understanding of barriers to accessing care would optimise design of improved services for this population. In this study, trained sex workers conducted 55 in-depth interviews and 12 focus group discussions with 106 female, 26 male and 4 transgender sex workers across 6 urban sites in Kenya, Zimbabwe, Uganda and South Africa. Data were analysed thematically, following an interpretive framework. Participants cited numerous unmet health needs, including diagnosis and treatment for sexually transmitted infections and insufficient access to condoms and lubricant. Denial of treatment for injuries following physical assault or rape and general hostility from public-sector providers was common. Resources permitting, many sex workers attended private services, citing higher quality and respect for dignity and confidentiality. Sex workers in southern Africa accessed specialised sex worker clinics, reporting mostly positive experiences. Across sites, participants called for additional targeted services, but also sensitisation and training of public-sector providers. Criminalisation of sex workers and associated stigmatisation, particularly of transgender and male sex workers, hinder HIV-prevention efforts and render access to mainstream healthcare precarious. Alongside law reform, sex worker-led peer outreach work should be strengthened and calls by sex workers for additional targeted services heeded.

BackgroundTransgender community large association with sex work has put them at a greater risk of contracting sexually transmitted infections (STIs).The aim of this study was to investigate the prevalence of Epstein–Barr Virus (EBV) genotypes in transgender sex workers (TSWs) of twin-cities of Pakistan. The high prevalence of EBV-2 genotype in sex workers has been previously reported. EBV genotypes were investigated in transgender sex workers to find out EBV-2 occurrence in Pakistani population.MethodsA total of 86 transgender (Hijras) sex workers were randomly included in this study. Demographics, including age, the number of sex partners, sexual habits, and awareness about protective methods were obtained. Blood was collected from all subjects and The presence of Human Immunodeficiency Virus, Hepatitis B and C virus were determined by antibody strip testing. EBV detection and genotyping were performed by extracting genomic DNA from all whole blood samples. Β-globin and EBNA-1 were amplified to assess the quality and presence of EBV DNA. Analysis of EBNA-2 genotyping was done by nested PCR.ResultsHIV was the most prevalent infection in 40 transgender sex workers (46.51%) followed by HCV in 15 (17.44%). Among HIV-seropositive TSW’s, EBV genotype determination was only achievable in 60% of cases, where 62.5% were EBV-1, 29.16% of EBV-2 and co-infection was found in 8% samples. Among HIV-negative individuals, 78% were EBV-1, whereas EBV-2 genotype and co-infections were absent. All non-typable samples were amplifiable for the EBNA-1 gene in both populations, confirming EBV genome in the samples.ConclusionEBV-1 was the most common genotype of EBV in HIV seropositive and seronegative TSW’s but the high occurrence of EBV-2 and co-infection of both types was observed only in HIV seropositive individuals. This is the first report of frequency of EBV infections in the HIV-positive transgender community of Pakistan.DisclosuresAll authors: No reported disclosures.

ObjectivesThe burden of HIV and other sexually transmitted infections (STIs) remains high in sex workers globally, calling for strengthening targeted prevention strategies, including HIV pre-exposure prophylaxis (PrEP). The study’s objective...

This study examined sociodemographic variables, personality characteristics, and alcohol and drug misuse among male sex workers in the city of Santo André, São Paulo, Brazil. A total of 45 male-to-female transgender sex workers and 41 male hustlers were evaluated in face-to-face interviews at their place of work from 2008 to 2010. A "snowball" sampling procedure was used to access this hard-to-reach population. Male-to-female transgender sex workers reported fewer conventional job opportunities, fewer school problems, and higher harm avoidance and depression levels than male hustlers. Also, transgender sex workers reported earning more money through sex work and more frequently living in hostels with peers than their counterparts. As biological male sex workers are a heterogeneous population, attempts to classify them into distinctive groups should be further carried out as a way to better understand and identify their behavior, design effective health interventions, and consequently minimize the likelihood of unintended adverse outcomes. Our study showed that gender performance can be an important variable to be considered by researchers and policy makers when working with sex workers and developing HIV/AIDS prevention and public health programs, given that transgender and male sex workers not only display distinctive behavior and physical appearance but also reveal differences on specific psychological measures, such as personality traits and depression levels. We recommend that counselors working with this population strike a balance between facilitating self-disclosure and establishing more evidence-based directive interventions.

Human Papilloma virus genotype diversity of anal infection among trans (male to female transvestites, transsexuals or transgender) sex workers in Argentina

ABSTRACTThe risk of HIV infection is higher among transgender women and cisgender men who have sex with men (MSM) compared to the general population due in part to social and contextual factors. This study aimed to determine the prevalence and association of alcohol and drug abuse, discrimination and violence among transgender sex workers compared to cisgender male sex workers and cisgender men who had not received money for sex in Guatemala City. In 2010, transgender women and cisgender men who had had sex with men or transgender women were recruited into a cross-sectional behavioural survey. Among transgender women, 86% received money for sex in the past year. Transgender sex workers were more likely to use drugs and binge drink, three times as likely to be discriminated against and eight times as likely to be forced to have sex compared to non-sex worker men. Male sex workers were twice as likely to use illicit drugs or experience physical violence and six times as likely to experience forced sex compared to non-sex worker men. Transgender and male sex workers would benefit from harm reduction for substance use, violence prevention, response and strategies to mitigate discrimination.

In South Africa, information on sex workers' characteristics, sexual behaviour and health needs is limited. Current social, legal and institutional factors impede a safe working environment for sex workers and their clients. To describe characteristics and sexual behaviour of female, male and transgender sex workers, and assess their risk factors for unprotected sex. Repeat cross-sectional surveys among sex workers were conducted in Hillbrow, Sandton, Rustenburg and Cape Town in 2010. Sex workers were interviewed once; any re-interviews were excluded from analysis. Unprotected sex was defined as any unprotected penetrative vaginal or anal sex with last two clients. Trained sex workers interviewed 1 799 sex workers. Sex work was a full-time profession for most participants. About 8% (126/1 594) of women, 33% (22/75) of men, and 25% (12/50) of transgender people had unprotected sex. A quarter of anal sex was unprotected. Unprotected sex was 2.1 times (adjusted odds ratio (AOR), 95% CI 1.2 - 3.7; p=0.011) more likely in participants reporting daily or weekly binge drinking than non-binge drinkers. Male sex workers were 2.9 times (AOR, 95%CI 1.6 - 5.3; p<0.001) more likely, and transgender people 2.4 times (AOR, 95% CI 1.1 - 4.9; p=0.021) more likely, than females to have unprotected sex. Sex workers in Hillbrow, where the only sex work-specific clinic was operational, were less likely to have unprotected sex than those in other sites. Tailored sex work interventions should explicitly include male and transgender sex workers, sex work-specific clinics, focus on the risks of unprotected anal sex, and include interventions to reduce alcohol harm.

Sex workers in Sub-Saharan Africa are vulnerable to a range of factors that dispose them to poor health outcomes. In particular, they are at high risk of violence, injury, rape, discrimination and a spectrum of human rights abuses. Their vulnerability to HIV and other STIs are many fold greater than the non-sex worker population of the same age. Health care systems world-wide, and particularly in Africa, are not adequately responsive to the needs of sex workers. As a result, many sex workers do not receive adequate health services, education or HIV prevention tools. While the literature on female sex work in Africa is fairly robust, troubling research gaps are evident on male and transgender sex work, as well as on the intersections of migration and sex work. Mega-sport events have been associated with increased anxiety about sex work and human trafficking, with few studies tracking the impact of such events on local sex work industries over time. These fears were prominent during the 2010 FIFA Soccer World Cup. This PhD project consisted of three research projects based in South Africa and Kenya. It aimed to evaluate the impact of social and behavioural factors on the health of sex workers. To achieve this objective, it examined the effects of sex worker characteristics, migration status, and their relationships with commercial and non-commercial partners on sexual behaviour and access to services. Such information may assist in designing more effective health policies in addition to providing insights into the structural factors that affect sex work settings and heighten sex worker vulnerability to ill-health. The first research project consisted of face-to-face surveys with 1799 male, female and transgender sex workers in Johannesburg, Rustenburg and Cape Town. The second research project involved telephonic interviews in three waves with 663 female sex workers who advertised online or in newspapers in South Africa. The third component was a prospective cohort of 400 female sex workers in Mombasa, Kenya. The research findings indicate the diversity of the sex industry and the people who work in it. Sex work is an important livelihood strategy that provides an income for sex workers and their extended network of dependents. Migration is a vital component for exploring and understanding how many sex worker lives and work are structured in South Africa. Sex workers are subject to violence from their non-commercial partners as well as from police, while unprotected sex with non-commercial partners emerges as an important risk factor for HIV. The PhD research detected little significant changes in the sex industry due to the 2010 Soccer World Cup, and documents how strategic opportunities were lost to alter some of the structural conditions of sex work during a time of heightened sex work awareness, funding and scrutiny. Moreover, this thesis highlights the shortcomings of health care services in responding to the needs of sex workers. It recommends the rolling-out of specialised, sex work-specific health care services in areas of sex work concentration, and sex work-friendly services in mainstream health care facilities in areas of lower sex work concentration. Non-judgemental and empathetic health workers are a key component of responsive services. Lastly and perhaps most importantly, it underscores the importance of decriminalising sex work in order to safeguard sex worker rights and to protect individual and public health.

Protecting the health of sex workers in the EU

The expansion of sex work (or harvat in Cebu) in the Philippines has surfaced transgender (TG) escorts and online-based sex workers (SWs), who are generally exposed to health risks such as sexually transmitted infections (STIs), HIV/AIDS. Recent Philippine Integrated HIV Behavioral and Serological Surveillance (IHBSS) 2011 showed Cebu City having the second highest HIV prevalence among men who have sex with men (MSM) (i.e. 4.7 percent); which TG women are included. Due to the lack of social recognition of TG women, combined with the stigmatisation of SWs, this leads to discrimination, violence and health risks among TG women SWs. Hence, it is important to look at their gender identity and self-description; context and nature of sex work involvement; and their perceived/experienced occupational risks. The method used was face-to-face in-depth interviews with fifteen (15) TG women SWs in Cebu City as identified by the researcher. Content analysis was used for qualitative analysis of transcribed interviews. The findings revealed that TG women SWs do not necessarily identify themselves as TG but see themselves as women expressed in different modalities, but commonly undergoing body modifications (i.e. hormone pills, collagen injections). Economic benefits and sexual enjoyment gained are the main motivations for TG women SWs, which is related to greater preference for foreigner clients and “versatile” sexual role. Escorting has the most economic benefits, followed by online chatting and online harvat. Lastly, there were lesser experiences of occupational risks (i.e. health, abuse, legal) than what they perceived. The study concludes that perceived/experienced risks associated with sex work are not merely occupational, but are also behavioural and gender-based. As such, sexual behaviour and not their occupation as SWs make TG women at risk to STIs, HIV/AIDS. Hence, HIV education and prevention strategies should be client-specific to address health needs of the general TG women population.

Sex workers in sub-Saharan Africa are vulnerable to a range of factors that ill-dispose them to poor health outcomes. Their vulnerability to HIV and other STIs are many fold greater than the non-sex worker population of the same age. Health care systems world-wide are not responsive to the special needs of sex workers, and many sex workers do not receive adequate health services, education or HIV prevention tools. While the literature on female sex work in Africa is fairly robust, troubling research gaps are evident on male and transgender sex work, and the intersections of migration and sex work. A cross-sectional descriptive study was conducted with female, male and transgender sex workers in four sites in South Africa. The research results point towards the diversity of the sex industry and the people who work in it. Sex work is an important livelihood strategy for many, and provides an income for sex workers and their extended network of dependents. Migration is a vital component in how sex worker lives and work are structured. Moreover, the article highlights the shortcomings of health care services to respond adequately to the needs of sex workers, and recommends the rolling-out of specialized, sex work-specific health care services in areas of sex work concentration, and sex work-friendly services in mainstream health care facilities in areas of low sex work concentration.

In Mexico, male sex workers (MSW) and travesti, transgender and transsexual (TTT) sex workers are among the groups most affected by HIV. They suffer from stigma and discrimination, yet are often absent from the design of programmes and HIV prevention campaigns. The objective of this study was to provide an account of the social context in which MSW and TTT sex workers live, by focusing on their sexual identities, sexual practices and vulnerability to HIV. Data collection took place in Mexico City and involved observational work together with 36 in‐depth interviews. Findings reveal a differentiation of vulnerability by sub‐group. In general, vulnerability is influenced by the social context, stigma related to homosexuality and sex work, as well as sex workers' access to scarce social capital and the lack of response in terms of social and health programmes. In order to diminish the vulnerability of MSW and TTT sex workers and reduce their risk of HIV infection, preventive measures are needed which take into account their specific health and social needs, promote meaningful participation and the encourage respect for human rights.