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Follow-up on: Fujimoto K, Wang P, Ross MW, Williams ML. Venue-mediated weak ties in multiplex HIV transmission risk networks among drug-using male sex workers and associates. Am J Public Health. 2015;105(6):1128–1135.
Men who have sex with men (MSM) who engage in sex work (i.e., offer sex in exchange for money, drugs, shelter, or goods) are at high risk for HIV and other sexually transmitted infections (STIs). In a 20-city study of MSM, the Centers for Disease Control and Prevention found that those who had sold sex in the past 12 months were more likely to be HIV-positive and, when positive, were more likely to be unaware of their status.
However, the risk for HIV and other STIs is not equally distributed across all MSM who engage in sex work. In an AJPH article published in 2015, Fujimoto et al. highlighted the role of the venues in which male sex workers meet clients in understanding the condom use and HIV status of MSM engaging in sex work. Specifically, they found that individuals within specific bars and street corners were more similar with respect to HIV status and condom use than those in other venues. These findings suggest the critical need to understand the role of venues (and the social networks formed within them) in transmission of HIV and other STIs among male sex workers and their clients.
Although Fujimoto et al. made an important contribution in this field of research, they focused exclusively on bars and street corners as the venues where these men meet their sexual partners. Since they collected their data, sex work has experienced a technology-driven transformation that has dramatically changed how sex workers meet and negotiate with potential clients. With the emergence of the Internet, male sex workers began to make use of online profiles and advertisements (e.g., on the now-shuttered Rentboy.com) to solicit potential clients. More recently, the growth of mobile applications (apps) and Web sites that facilitate quick sexual hookups among MSM have further changed male sex work, creating a need for new research.
Gradually migrating from the streets or escort agencies to new online venues, sex work has become more anonymous and safer.3 Instead of seeking clients in streets, bars, or other venues where they may face violence, arrest, and stigma, sex workers can now meet, vet, and negotiate with potential clients through apps and Web sites. Online technologies allow sex workers to work independently without splitting fees, and make it easier and safer for clients to hire them. Thus, the buying and selling of sex has likely become more attractive to more people. Male escorts who advertise on escorting Web sites have been well-studied; however, research has suggested the existence of a distinct, potentially large, but understudied population of men who find opportunities for sex work on gay hookup apps and Web sites that were not designed for sex work.3
NEW PATHWAY INTO SEX WORK
Scholars have recently suggested that gay hookup apps and Web sites have become a common venue for—and possibly even a pathway into—sex work. For example, MacPhail et al. have noted, “research suggests that many men are introduced to sex work via the Internet,”(p484) and hookup apps and Web sites may be becoming the new pathway into sex work. On hookup apps and Web sites, men sometimes “casually proposition other users of the site,”3(p889) leading many to experience sex work without advertising themselves as sex workers. McLean observed that there could be a sizeable population of young men “engaging in online sex work on an informal basis” on hookup Web sites without identifying as sex workers or escorts.3(p900) Once initiated, men may remain involved in sex work because they come to value the financial and psychological rewards (e.g., empowerment, enhanced self-esteem) that being paid for sex provides.
GROWING DIVERSITY AMONG MALE SEX WORKERS
New technologies have made male sex work more visible, accessible, and “an everyday commodity in the marketplace.”(p483) As sex work has become much more normalized within the gay community, it has also been reconceptualized from being a form of deviance, psychopathology, and a vector for disease to a reasonable source of money or other needed goods. Earlier studies described male sex workers as delinquent youths selling sex on the streets, but a more recent study of male online escorts presented them as professionals who work independently and well past the age of 30 years. By making sex work safer, easier to engage in, less stigmatized, and more anonymous, new technologies may have increased the willingness of many MSM to hire sex workers, thereby resulting in increased demand. The migration of much sex work to hookup apps and Web sites is thus also likely expanding and diversifying the pool of people participating in sex work.
RISKS AND THEIR MANAGEMENT
Unlike street workers who are often socialized by more experienced people in their network, MSM who enter sex work through hookup apps or Web sites without such socialization may be ill-equipped to effectively vet potential clients, negotiate safer sex, or otherwise manage the risks for HIV and other STIs their clients pose. Furthermore, they may not think of themselves as sex workers, which could cause them to underestimate the sexual risks associated with their sex work and to fail to take adequate precautions. In addition, hookup apps and Web sites are not designed to support the transparent negotiation of sex work as they forbid offering or soliciting prostitution. Users therefore resort to a series of codes, symbols, or euphemisms to communicate their interest in sex work (e.g., inserting the dollar sign in their profile’s text or saying that one is or is looking for “generous”). They also must be careful when proposing sex work with other users to avoid being reported to Web site moderators or caught by law enforcement. These obstacles to transparent communication could lead to encounters in which the expectations and boundaries have not been clearly established and in which safety has not been discussed.
Finally, another important development is the availability of pre- and postexposure prophylaxis for HIV. Male sex workers are regularly offered more money for condomless sex, which may become more frequent with the growing availability of effective biomedical prevention strategies. Yet, because their engagement in sex work may only be occasional, MSM who casually find clients on hookup apps and Web sites may not be on preexposure prophylaxis or perceive themselves as needing it.
DIRECTIONS FOR FUTURE RESEARCH
At the current time, little is known about this new population of MSM sex workers, making it difficult to tailor sexual health promotion activities for them. There is a pressing need for more research on several fronts. For example, it is important to understand what features of sex work through hookup apps and Web sites may lead to unprotected sex and what strategies MSM are employing to mitigate risk. The barriers to HIV testing and use of preexposure prophylaxis are also especially important to investigate in this population to try to prevent infections or ensure their early detection. The ways in which race/ethnicity shapes the interactions between clients and sex workers has received scant attention in the existing literature on male sex workers. Sex workers of various races/ethnicities might appraise their own worth in the sexual marketplace differently, which in the case of sex work might lead to differences in their perceptions of the power they have in their negotiations with clients. Similarly, as noted previously, the migration of sex work to apps and Web sites has allowed MSM who are sex workers to continue working later in life, but many studies of male sex work have neglected potential age differences.
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