Male Clients Research Articles

Data on the sexual health of providers and clients of sexual services for men who have sex with men in Germany

Little is known about the sexual health of male providers and clients of transactional sex. The data of participants of the European MSM Internet Survey (EMIS-DE; N= 50,086) who live in Germany were analysed. The outcomes were testing for and diagnoses of HIV and other sexually transmitted infections (STIs), partner numbers, illicit drug use, and sexual happiness in two populations: (1)men who offered and (2)men who paid for transactional sex in the past 12months.In the age group of under 30years (n= 19,138), providers of sexual services (escorts) were compared with non-providers; in the age group of30 years and above (n= 30,948), we compared men who paid for sexual services with those who did not. We applied univariable and multinomial, multivariable logistic regression analyses in both age groups.Of those under the age of 30, 8% (n= 1529) had been paid for sex in the last 12months, of which 49% were only paid once or twice. Escorts had lower educational achievements, lived more commonly in large cities, were more often born abroad, self-defined less frequently as gay, and were more frequently single. They reported higher numbers of sex partners, more drug use, and more sexual happiness. Escorts were more frequently tested for HIV and STIs, and among the tested, more diagnoses of HIV and STIs were reported, but those with HIV were less likely to be treated.Among those over 30 years, 11% (n= 3334) had paid for sex, the majority (58%) only once or twice. Payers were older, lived more commonly in large cities, and were more likely to be single, bisexual, or living with awoman. Clients used more illicit drugs, sexual enhancement drugs, and sedatives, but reported less sexual happiness. They were less likely to be tested for HIV and STIs.

Profile of HIV positive clients: an ICTC record based retrospective study

Background: Deaths in productive age group due to HIV/AIDS have damaging impact on families and communities, skills are lost, workforce shrinks & children's are orphaned. Our study reports the socio-demographic characteristics of HIV/ AIDS clients from one of the Integrated Counselling & Testing Centre (ICTC) situated at Amtala, West Bengal. This will give us an insight on the distribution of various epidemiological characteristics of the HIV positive clients in this region thus help in formulating strategies for effective implementation of its prevention. The objective was to study socio-demographic profile and risk behavior pattern of HIV positive clients attending ICTC.Methods: It was an observational study cross sectional in design. Records of last eight years of HIV positive clients were accessed from ICTC centre at Amtala hospital, rural training centre, Department of community medicine, ESI PGIMSR medical college, Joka, Kolkata. Data was entered in SPSS for Windows version 20 software. Data was presented in percentages, mean with standard deviation etc.Results: Retrospective record of 62 HIV positive clients was studied, of them 37 were males (5 pediatric cases) and 25 females (7 ANC).Excluding pediatric clients, mean age of clients was 32 years. It was observed that majority of clients were illiterate and were on daily wages. Except one male client who was homosexual rest were heterosexual. Majority of clients 71.9% males and 92% females were married, of them 45.3% males and 34.7% females were sero concordant with their spouse. Seventeen subjects were co infected with TB.Conclusions: HIV sero prevalence rate has inverse relation with literacy level. Majority of male clients were daily wagers who act as link between high risk populations to general population i.e. their spouse, which in turn can pass on the infection to her baby. Lack of knowledge on mode of spread and preventive measures against HIV infection devastate the families making many children orphaned. There is need to carry out intense IEC activities for behavior change at grass root level.

Community Partners in Care: 6-Month Outcomes of Two Quality Improvement Depression Care Interventions in Male Participants.

Limited data exist on approaches to improve depression services for men in under-resourced communities. This article explores this issue using a sub-analysis of male participants in Community Partners in Care (CPIC). Community partnered, cluster, randomized trial. Hollywood-Metropolitan and South Los Angeles, California. 423 adult male clients with modified depression (PHQ-8 score≥10). Depression collaborative care implementation using community engagement and planning (CEP) across programs compared with the more-traditional individual program, technical assistance (Resources for Services, RS). Depressive symptoms (PHQ-8 score), mental health-related quality of life (MHRQL), mental wellness, services utilization and settings. At screening, levels of probable depression were moderate to high (17.5%-47.1%) among men across services sectors. Intervention effects on primary outcomes (PHQ-8 score and MHRQL) did not differ. Men in CEP compared with RS had improved mental wellness (OR 1.85, 95% CI 1.00-3.42) and reduced hospitalizations (OR .40, 95% CI .16-.98), with fewer mental health specialty medication visits (IRR 0.33, 95% CI .15-.69), and a trend toward greater faith-based depression visits (IRR 2.89, 95% CI .99-8.45). Exploratory sub-analyses suggest that high rates of mainly minority men in under-resourced communities have high prevalence of depression. A multi-sector coalition approach may hold promise for improving community-prioritized outcomes, such as mental wellness and reduced hospitalizations for men, meriting further development of this approach for future research and program design.

Individuals with Mild Intellectual Disability or Borderline Intellectual Functioning in a Forensic Addiction Treatment Center: Prevalence and Clinical Characteristics

Knowledge regarding substance-related problems and offending behavior in individuals with mild intellectual disability or borderline intellectual functioning (MBID; IQ 50-85) has increased over the last years, but is still limited. The present study examined differences in prevalence and clinical characteristics of individuals with and without MBID in a forensic addiction treatment center. Participants were 190 court mandated male clients of a low to high security forensic addiction treatment center in the Netherlands (aged between 21 and 59 years old, 82% of Dutch origin). Of the total sample 39% could be identified with MBID which is much higher than the estimated 12% to 15% of the general population. Results showed that clients with MBID reported significantly lower scores on desire for help, compared to clients without MBID (F (1, 73) = 5.12, p = .027). Against expectations, no significant group differences were found for aggression during treatment while controlling for impulsivity, treatment duration and type of substance use and offense. As results of the present study showed that clients with MBID are overrepresented in the forensic addiction treatment center, future research should further explore characteristics and responses to treatment of these clients. More knowledge about the characteristics of clients with MBID will not only help to better identify these clients, but will also to improve treatment for this group

Trends in PIEDs use among male clients of needle–syringe programs in Queensland, Australia; 2007–2015

Abstract Background Increased utilisation of needle–syringe programs (NSP) by men who inject performance and image-enhancing drugs (PIEDs) has been reported. While fewer in number, people who inject PIEDs possess distinct service and knowledge needs compared to other NSP clients. Methods Using standardised data from 26 NSP outlets through the Queensland NSP Minimum Data Set (QNSPMDS), trends in occasions of services among males intending to inject PIEDs were assessed using multilevel mixed-effects negative binomial regression, adjusting for month, year, and age, and clustering by site. Results Compared to 2007, PIEDs-related occasions of service increased from 2008 until 2013 (3% and 13% of all occasions of service involving males in 2007 and 2015, respectively). While accounting for the fewest occasions of service, the Northern region experienced the greatest rate of occasion of service increase (2015 IRR 7.46, 95%CI: 6.11, 9.12). Similarly higher rates were seen among males aged Conclusion NSP settings provide an opportunity to engage with this unique population, providing important education on injection-related injuries and diseases, including blood-borne viruses, and greater linkage to primary care.

Masculinity and the Occupational Experience of Male Independent Escorts Who Seek Male Clients

While male sex work (MSW) is a highly gendered practice involving the commodification of the male body, masculinity has rarely been examined to understand this new occupational environment. Semi-structured interviews were conducted with twenty male independent internet-based escorts in Brisbane, Australia. Masculinity was used as a conceptual tool to understand the nuances of the escorting experience, resulting in two themes: Endurance and Technical Skill. These themes were aligned with hegemonic expressions of masculinity, a system that orders masculinity into a hierarchy and potentially marginalises escorts. Participants thus used features of a system that subordinated them to attain primacy in the same framework, avoiding stigma. These themes described were far removed from dialogues of deviance oft-repeated by past sex work research, and instead bolster the view that male escorting is moving toward a paradigm of normalisation. We thus argue that masculinity is a critical conceptual tool in understanding the contemporary dynamics of the male escorting experience as it becomes increasingly normalised.

Being the Only One: Finding Connection through the Shared Experience of “Otherness”

ABSTRACTThere is a noticeable paucity of clinical resources that help clinicians of color to name and navigate the multitude of challenges in working through racial, cultural, and power differences in psychotherapy with White clients. African American therapists rarely receive adequate preparation for clinical practice in identifying, addressing, and working through transference and countertransference reactions in racially mixed dyads. The author highlights the challenges she faced early in her career with addressing racial and sociopolitical differences as an African American female clinical social worker providing individual psychotherapy to her older White male client whose traumatic experience focused on racial issues.

P117 A review of sexual health provision at coastline homeless day centre

IntroductionHomelessness goes beyond rooflessness It is isolating and destructive. The government recognises the homeless are more vulnerable to sexual health risks and need targeted interventions. Cornwall’s sexual health outreach is...

AGE AND GENDER SENSITIVITIES TO CONTINGENCY MANAGEMENT AND TOKEN REINFOREMENT STRATEGIES ON SELF CONTROL LEVELS OF REMAND HOME INMATES IN NIGERIA.

The study examined Age and Gender Sensitivities to Contingency Management and Token Reinforcement strategies on Self Control levels of Remand home inmates in Nigeria.The study adopted the quasi-experimental non-organized pre-test, post-test and control group involving 3x2 factorial designs. The participants were randomly assigned to three groups. Seventy two (72) clients formed the sample for the study. Three remand homes- Akure (Ondo state), Osgbo (Osun state) and Ibadan (Oyo state) were purposively sampled for the study. The clients were randomly assigned to two treatment groups and a control group. The first group was treated with Contingency Management while the second with Token reinforcement and the third served as control. Self Control Scale (SCS) was employed in gathering data and descriptive statistics, ANCOVA, and scheffe posthoc analysis were used to analyze the data. The result revealed that both Contingency Management and token reinforcement strategies were adequately effective therapies in enhancing self control levels of the clients. However no significant difference on the self-control levels of male and female was found as well as that of old and young clients, this implies that both male and females as well as old and young clients are sensitive to Contingency Management and Token Reinforcement strategies. On the basis of these findings, it was highly recommended that government at various levels should employ well trained counseling psychologies who are competent in the use of various behavior modification techniques in solving different maladjustment problems among our youths and clients should avail the opportunity of the training exposed to at various homes and realized that both male and female clients deserve the treatment while the old and the young clients need treatment equally. Though the level of their involvement on delinquent behavior differ from one another, however, both need adequate and qualified counseling psychologies in behavior modification techniques

Should I stay or should I go? The impact of a sense of control on young men's therapeutic engagement

AbstractBackgroundDespite the fact that young men are difficult to engage in counselling, there is a paucity of research that examines the factors that may influence their decision making to enter, remain in or exit from therapy. One area that has remained particularly unrepresented in the literature is the role that a sense of control plays in this process.Aim/MethodologyUsing a narrative approach, this study aimed to explore the stories of young men aged 18–25 and in doing so illuminated the impact of control on their counselling experiences.FindingsThe study suggests that control impacts on young men's therapy‐related decision‐making in three distinct ways: making the decision to engage in therapy; controlling the process of therapy; and choosing who knows about the therapy.ImplicationsThese emergent domains suggest that incorporating and discussing control with young male clients may provide the therapist with a means of increasing a young male's therapeutic engagement.

Global dynamics of an HIV model incorporating senior male clients

In this paper, a compartmental model for the human immunodeficiency virus (HIV) infection among female sex workers and senior male clients is formulated. The qualitative analyses are carried out in terms of the basic reproduction number R0. The global analytical results are then obtained by employing novel techniques and methods: the disease-free equilibrium is of global asymptotic stability when a threshold R0 ≤ 1 is satisfied; otherwise, a unique endemic equilibrium exists and it is globally asymptotically stable. Numerical simulations are performed to illustrate and extend analytical results. It is shown that diagnosis, treatment and education have positive effect on the control of HIV transmission, but senior male clients can burden the HIV epidemic and prolong the duration of the disease outbreak.

Neither “Bad” nor “Dirty”: High-end Sex Work and Intimate Relationships in Urban China

AbstractThe relationship between sex workers and their clients is generally characterized as being based entirely on the direct exchange of sexual favours for money. However, this received wisdom cannot account for a nation such as China which attaches significant value to “face,” social status and interpersonal dignity. This paper draws parallels with high-end sex workers elsewhere in Asia as well as globally. With a focus on the high-end sector, I examine how workers and their clients engage not only in pecuniary transactions but also in genuinely intimate and non-remunerative relationships. High-end sex workers make use of their earned economic capital to acquire cultural capital, and use online apps as marketing tools to target local elites and expats to forge longer-term intimate relationships. Male clients in more commercialized, post-industrial cities in China continue to seek diverse types of sexual experiences, with some clients seeking genuine intimacy. Furthermore, I explore how Chinese and foreign clients overcome social barriers to develop such relationships with sex workers. Building on this sociocultural perspective, this paper analyses ethnographically both sides of the female sex worker–client relationship in high-end karaoke lounges and bars in Dongguan, southern China.

Interventions to Increase Male Attendance and Testing for Sexually Transmitted Infections at Publicly-Funded Family Planning Clinics

PurposeWe assessed the impact of staff, clinic, and community interventions on male and female family planning client visit volume and sexually transmitted infection testing at a multisite community-based health care agency. MethodsStaff training, clinic environmental changes, in-reach/outreach, and efficiency assessments were implemented in two Family Health Center (San Diego, CA) family planning clinics during 2010–2012; five Family Health Center family planning programs were identified as comparison clinics. Client visit records were compared between preintervention (2007–2009) and postintervention (2010–2012) for both sets of clinics. ResultsOf 7,826 male client visits during the time before intervention, most were for clients who were aged <30 years (50%), Hispanic (64%), and uninsured (81%). From preintervention to postintervention, intervention clinics significantly increased the number of male visits (4,004 to 8,385; Δ = +109%); for comparison clinics, male visits increased modestly (3,822 to 4,500; Δ = +18%). The proportion of male clinic visits where chlamydia testing was performed increased in intervention clinics (35% to 42%; p < .001) but decreased in comparison clinics (37% to 33%; p < .001). Subgroup analyses conducted among adolescent and young adult males yielded similar findings for male client volume and chlamydia testing. The number of female visits declined nearly 40% in both comparison (21,800 to 13,202; −39%) and intervention clinics (30,830 to 19,971; −35%) between preintervention and postintervention periods. ConclusionsMultilevel interventions designed to increase male client volume and sexually transmitted infection testing services in family planning clinics succeeded without affecting female client volume or services.

Penile implantation and risky sexual behaviour among male clients of female sex workers, Myanmar

Introduction: Male clients of female sex workers are at risk for sexually transmitted infections worldwide, yet their behaviours are seldom described in community-based samples. In addition, physical modifications to the penis, such as injections and implantations of objects to enhance sensation, have been noted in diverse cultures. The objective of the present study was to examine risk behaviours of male clients of female sex workers in Myanmar and assess associations between penile modifications and risk for sexually transmitted infections. Methods: A cross-sectional survey was conducted in 2010 in seven cities of Myanmar. The design used probability proportionate to size sampling of male clients at sex work venues (e.g., brothels, entertainment centres, streets) to approximate a representative sample. Results: Of 2,945 male clients at sex work venues, 2,740 (93.0%) enrolled. Overall, 9.9% reported penile injections and 10.7% reported implantations. Compared to male clients without penile modifications, those with penile injection or implantation had higher numbers of partners and more episodes of unprotected sex with casual and commercialpartners. Condom breakage and history of sexually transmitted disease symptoms were also higher among male clients with penile modifications. Conclusions: Modifications of the penis mark a constellation of risky behaviours among male clients of female sex workers in Myanmar and may also be causally related to sexually transmitted infections through condom breakage or physical effects on the penis. Health education and counselling on the potential increased risk should be considered for men with penile modifications.

Book Review: Pimp State: Sex, Money, and Equality by Kat Banyard

In this strongly recommended book, Banyard effectively demolishes six myths which defenders of unregulated commercial sexual exploitation of girls and women offer: 1) “Demand for sex work is inevitable; 2) Being paid for sex is regular service work; 3) Porn is fantasy; 4) Objecting to the sex trade makes you a pearl-clutching, sexually conservative prude; 5) Decriminalizing the entire prostitution trade makes women safe; and 6) Resistance is futile.” I add to Banyard’s analysis my views on the following topics: 1) the sexual exploitation of minors as an essential part of the commercial sex industry; 2) recent Canadian experience in adopting the ‘Swedish model’ of criminalizing male clients, but not the women they seek to purchase; and 3) a perspective on the sexual exploitation of children and adolescents from recent work in Bangladesh.

Devoted, Caring, and Home loving: A Chinese Portrayal of Western Masculinity in Transnational Cyberspace Romance

Discussions of cross-border marriages between women from developing countries and men from economically advanced countries often focus on the objectification of women, while the process through which men are presented as “marriageable entities” is rarely examined. In this article, I explore the case of China, where middle-aged, divorced women are seeking second-chance marriages with Western men via international cyber-dating agencies. Contrary to the stereotypical portrayal of Western men as rich and powerful in the Chinese media, many of the Western men enrolled at the cyber-dating agencies I am studying earn a modest income. I analyze the agencies’ portrayal of their Western male clients as caring, family oriented, and worthy of marrying despite their lack of wealth. Results from this article show that masculinity is fluid, malleable, and continuously being reconstructed in accordance with the changing demographic and socioeconomic patterns of the globalizing world.

Disparities in HIV and syphilis prevalence and risk factors between older male clients with and without steady sex partners in southwestern rural China

BackgroundHeterosexual intercourse accounted for 93% of reported HIV cases in Guangxi, and Guangxi had 10% of China’s total number of reported HIV cases. Older men are particularly vulnerable to STIs, for example, 46% of Guangxi’s HIV cases were men over 50 years of age. As this is an under-studied population in China, effective prevention and control policies have yet to be developed. Thus, the aim of this study was to use a large-scale cross-sectional survey to understand the demographic and behavior factors associated with HIV and syphilis infections among older male clients of female sex workers (FSWs) in a high epidemic area of rural Guangxi, China.MethodsA large-scale cross-sectional survey was conducted in 2012 among older male clients of FSWs in low-cost commercial sex venues. Questionnaire interviews were administered to collect sociodemographic and sexual behavior information. Blood samples were collected for HIV and syphilis infection tests.ResultsOf the 3485 participants, 2509 (72.0%) clients had a steady sex partner and 976 (28.0%) clients had no steady sex partner. The overall prevalence of HIV and syphilis infection were 3.0% and 3.2%, respectively. Compared to those with a steady sex partner, clients with no steady partner had higher odds of HIV infection (AOR: 1.90, 95% CI: 1.27–2.86), syphilis infection (AOR: 1.53, 95% CI: 1.02–2.30), and having factors associated with HIV or syphilis infection, including non-commercial casual sex encounters in last month (AOR: 3.29, 95% CI: 2.42–4.46), >10 years of commercial sex history (AOR: 1.31, 95% CI: 1.12–1.53), >2 incidents of commercial sex in last month (AOR: 1.53, 95% CI: 1.19–1.96), and aphrodisiac use in last month (AOR: 1.40, 95% CI: 1.16–1.70). Clients with no steady partner had lower odds of having heterosexual intercourse (AOR: 0.66, 95% CI: 0.56–0.79), awareness and knowledge of HIV/AIDS (AOR: 0.75, 95% CI: 0.64–0.88), and having had HIV tests (AOR: 0.65, 95% CI: 0.44–0.98).ConclusionOlder male clients of low-cost commercial sex venues in rural southwestern China are at high risk for HIV and syphilis infection, especially those with no steady sex partner. Improved interventions are urgently needed for this neglected risk population.

Anti-Effeminacy Moderates the Relationship Between Masculinity and Internalized Heterosexism Among Gay Men

ABSTRACTInternalized heterosexism (IH) is linked to negative mental health outcomes among people who are lesbian, gay, and bisexual. This study examined whether anti-effeminacy moderates the relationship between masculinity and IH among gay men in the United States. The participants were 239 gay men who completed measures of masculinity, anti-effeminacy, and IH. Results indicated that anti-effeminacy and masculinity predicted IH and that anti-effeminacy moderated the relationship between masculinity and IH. These findings suggest that, to reduce IH and its deleterious mental health effects, counselors should work with their male clients who are gay to reduce their anti-effeminacy and sexism.

Exploring drivers for safe male circumcision: Experiences with health education and understanding of partial HIV protection among newly circumcised men in Wakiso, Uganda.

IntroductionAbout 2.5 million men have voluntarily been circumcised since Uganda started implementing the WHO recommendation to scale up safe male circumcision to reduce HIV transmission. This study sought to understand what influences men's circumcision decisions, their experiences with health education at health facilities and their knowledge of partial HIV risk reduction in Wakiso district.MethodsData were collected in May and June 2015 at five public health facilities in Wakiso District. Twenty-five in-depth interviews were held with adult safe male circumcision clients. Data were analysed using thematic network analysis.FindingsSafe male circumcision decisions were mainly influenced by sexual partners, a perceived need to reduce the risk of HIV/STIs, community pressure and other benefits like hygiene. Sexual partners directly requested men to circumcise or indirectly influenced them in varied ways. Health education at facilities mainly focused on the surgical procedure, circumcision benefits especially HIV risk reduction, wound care and time to resumption of sex, with less focus on post-circumcision sexual behaviour. Five men reported no health education. All men reported that circumcision only reduces and does not eliminate HIV risk, and could mention ways it protects, although some extended the benefit to direct protection for women and prevention of other STIs. Five men thought social marketing messages were ‘misleading’ and feared risk compensation within the community.ConclusionsParticipants reported positive community perception about safe male circumcision campaigns, influencing men to seek services and enabling female partners to impact this decision-making process. However, there seemed to be gaps in safe male circumcision health education, although all participants correctly understood that circumcision offers only partial protection from HIV. Standard health education procedures, if followed at health facilities offering safe male circumcision, would ensure all clients are well informed, especially about post-circumcision sexual behaviour that is key to prevention of risk compensation.

Male Escorts' Construction of the Boyfriend Experience: How Escorts Please Their Clients

ABSTRACTThe current study examines the ways that male escorts provide highly desired services for male clients. Building on the “girlfriend experience” identified in the female prostitution literature, the authors discuss the corollary experience of the “boyfriend experience” and identify and examine the components of the boyfriend experience that are central to the social construction of the experience. Data is drawn from 627 online reviews of male escorts written between 2015 and 2016. Following data collection, analytic induction, using a 3-step coding process, is used to identify themes. The authors argue that the boyfriend experience is constructed out of perceptions of companionship, authenticity, and passion in both social and sexual interactions. Reviews emphasize the importance of intimacy, socialization, and emotional connections experienced between customer/escort and show that such are commonly more important and valued than sexual gratification.