Sexual Behavior, Mental Health, Substance Use, and HIV Risk Among Agency-Based Male Escorts in a Small U.S. City

Abstract

Relatively little research has examined the personal sex lives of indoor male sex workers (MSWs) or possible connections in this group between sexual behavior and factors related to HIV risk. As part of a larger project, this study collected data from 30 agency-based indoor MSWs (mean = 22.4 years) about their sexual behavior, mental health, and substance use. Few HIV risk behaviors with clients occurred. Drug use and mental health problems were relatively frequent, but not related to increased risk behavior. Instead, MSWs appeared to employ rational decision-making and harmreduction strategies. Conceptualization of MSW sexual behavior may be required where HIV risk is not attributed to sex work per se, but to other influences such as economic and relational factors. KeywordsSex work; prostitution; male sex worker; HIV risk behavior; HIV; mental health; substance use; sexual behavior During the past 20 years, much of the literature on the sexual behavior of male sex workers (MSWs) has focused on HIV risk behavior with clients. This line of study likely grew from concerns that MSWs may have been introducing HIV into the sexual networks of people who hired them (Bimbi, 2007). Thus, some researchers postulated that MSWs could be a transmission vector into less vulnerable populations (Morse, Simon, Osofsky, Balson, & Gaumer, 1991). Most of this initial research examined men working in a single type of venue, the street (Vanwesenbeeck, 2001). Street-based MSWs (i.e., hustlers) were found to exhibit relatively frequent sexual risk behaviors (Simon, Morse, Osofsky, & Balson, 1994), especially when they engaged in sex work to obtain basic needs or when they were using injection drugs (Estep, Waldorf, & Marotta, 1992). High rates of HIV risk also were found with non-clients due to unprotected sex and injection drugs (Rietmeijer, Wolitski, Fishbein, Corby, & Cohn, 1998). One study of street-based MSWs in Manhattan found that men reported the least sexual risk with paid clients, greater risk with male partners for pleasure, and the most risk with female partners for pleasure (Pleak & Meyer-Bahlburg, 1990). However, this study did not explore contextual factors accounting for the observed differences in sexual risk among these three types of partners.Address correspondence to: Michael Smith, PsyD, Psychology Department, Susquehanna University, Selinsgrove, PA 17870 (smithmichaeld@susqu.edu). NIH Public Access Author ManuscriptInt J Sex Health. Author manuscript; available in PMC 2009 September 23. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptSubsequent examination of MSWs who work in other settings has presented a more complex view. Independent and agency-based MSWs (i.e., escorts) exhibit fewer HIV risk behaviors with clients than men working on the street (Minichiello, Marino, Browne, Jamieson, Reuter, & Robinson, 2000;Simon, Morse, Osofsky, Balson, & Gaumer, 1992). Further, a growing body of research has suggested that indoor MSWs engage in less HIV risk behavior with clients than the...

Sexual behaviors in male sex workers in Spain: Modulating factors

“…Perhaps this situation is related to the high level of illegal immigration associated with the sex trade. On the other hand, economic factors play an important role in determining sexual behaviors with clients (Smith & Seal, 2007), so illegal immigration and economical difficulties among MSWs could facilitate more sexual risk behaviors when clients offer more money if they perform unsafe sex acts. In our study, MSWs told the authors that this amount of money is independent from the amount negotiated by the manager and the client previously and the MSW never talks about this amount of money received.…”

Motivational Influences on the Safer Sex Behavior of Agency-based Male Sex Workers

“…However, allowances were made for the MSWs to flexibly present their stories without interruption, as long as coverage of all required topics was accomplished (Hutchinson & Wilson, 1994). Data on sexual behavior with both clients and non-paying partners also was collected via a structured questionnaire, results which has been published elsewhere (Smith & Seal, 2007).…”

“…As noted, data on the sexual behavior of study participants has been reported elsewhere (Smith & Seal, 2007). However, to summarize as a way of providing context for the current data regarding safer sex behavior with clients, 90% (n = 27) of MSWs reported that they engaged in oral or anal sex with a paying sexual partner in the prior 30 days (median = 3.0 partners).…”

Unprotected anal intercourse behavior and intention among male sex workers in Shenzhen serving cross-boundary male clients coming from Hong Kong, China – prevalence and associated factors

“…Client characteristics (e.g., familiarity with clients) affect condom use among FSW (Choi & Holroyd, 2007) but it is less certain whether such associations are significant among MSW (Mimiaga, Reisner, Tinsley, Mayer, & Safren, 2009). A study showed that substance use was associated with UAI during commercial sex among MSW, but the timing of substance use was not aligned with that of commercial sex (Smith & Seal, 2008b). Other contextual factors associated with UAI among MSW include availability of condoms, keepers', and peers' influences (Smith & Seal, 2008a, 2008b.…”