The Loss of Boystown and Transition to Online Sex Work: Strategies and Barriers to Increase Safety Among Men Sex Workers and Clients of Men

"It's Almost Like Playing 'The Price is Right'": Factors Considered by Online Male Sex Workers When Setting the Price for Their Services

Some men who have sex with men (MSM) engage in the exchange of sexual services for money, drugs, shelter or something else of value. There has been limited research examining the factors that influence how male sex workers (MSWs) determine their fees for their services. To learn more about this, qualitative interview data were analyzed from 180 MSM from 8 US cities who had recently engaged in exchange sex with clients they had primarily met through dating/hookup websites and apps. The primary factor that affected participants' fees was the type of services provided, with a higher price generally charged for anal sex than for oral sex, mutual masturbation or massage. Condomless anal sex, in particular, commanded a higher fee. Additionally, participants required more money for special kinks or fetishes or any services that they considered to be risky, demanding or physically or emotionally uncomfortable. Other factors that affected how much participants charged for a given encounter included the duration of the meeting, the level of client appeal, the perceived wealth of the client, and the participant's current financial situation. Participants varied in their approaches to fee setting, in terms of both their degree of flexibility when negotiating a price and whether they preferred to suggest a fee or have the client first state an amount they were willing to pay. Information about MSWs' approaches to fee setting provides greater understanding of their lived experiences and the risks they may accept for higher fees.

Communicating Sex Work Online: A Content Analysis of Client and Provider Discourse in r/SexWorkers

The growth of digital technologies has enabled the creation of online platforms for sex workers to share, create, and gather information. To elucidate how this community leverages social media, the current study analyzed how sex workers and related groups (e.g. clients) communicate in a pseudonymous online space - r/SexWorkers. A content analysis of 103 posts and 967 comments submitted to r/SexWorkers between March 13, 2021, and February 22, 2022 was performed, evaluating 1) the prevalence of risk (i.e. to sex workers and clients) within the community's discourse, 2) types of information shared within the community (e.g. legal, health, and support), 3) features of information exchange (e.g. seeking and providing), and 4) the emergence and confrontation of stigma. The findings of this study indicate that users took specific interest in the risks sex workers face (as opposed to clients), providing information predominantly about economic and health concerns, discussing potential abuses, and providing support to one another. Moreover, while stigma was not commonly discussed by the community, users who did engage with stigma (especially professional stigma) sought to counteract prevailing beliefs about sex work. Accordingly, r/SexWorkers seemingly provides a beneficial online space for sex workers and clients to discuss risk, safety, and stigma.

Strategies and Interventions Used to Prevent Violence Against Sex Workers in the United States: A Scoping Review Using the Social-Ecological Model

Structural factors in the United States, such as criminalization, contribute to disproportionate rates of violence against sex workers and subsequent risk of adverse health outcomes. There is a clear need for systemic interventions and risk reduction strategies to reduce violence in this population. To inform next steps in prevention, this scoping review provides an overview of the literature on violence prevention efforts targeting sex workers in the United States, mapped out according to the social-ecological model (SEM). A comprehensive search of peer-reviewed literature across five databases with no limit on publication date yielded 2,372 documents. Studies were eligible for inclusion if they focused on the U.S. population of sex workers and had a clearly defined aim or purpose of exploring, describing, or evaluating sex work violence prevention interventions or risk reduction strategies. Twelve studies met all eligibility criteria and were selected. Only two of the studies evaluated sexual violence prevention interventions, while the remaining 10 explored strategies sex workers use to minimize the risk of violence. Most research focused on female sex workers, violence from paying clients, and prevention at the individual level of the SEM. Our findings suggest a need for additional violence prevention interventions tailored for diverse groups of sex workers and cognizant of the overlapping forms of violence they face. This scoping review contributes to the limited body of research on the prevention of violence against sex workers in the United States by providing future directions for research and program development that span across the SEM.

The changing meaning of "no" in Canadian sex work

With the migration of sex workers to online advertising in Canada, a substantial body of research has emerged on how they communicate with prospective clients. However, given the enormous quantity of archival material available, finding representative ways to identify what sex workers say is a difficult task. Numerical analysis of commonly used phrases allows for the analysis of large numbers of documents potentially identifying themes that may be missed using other techniques. This study considers how Canadian sex workers communicate by examining how the word "no" was used by online advertisers over a 15-year period. Source materials consisted of three collections of online classified advertising containing over 4.2 million ads collected between 2007 and 2022 representing 214456 advertisers. Advertisers and demographic variables were extracted from ad metadata. Common terms surrounding the word "no" were used to identify themes. The word "no" was used by 115127 advertisers. Five major themes were identified: client reassurance (54084 advertisers), communication (47130 advertisers), client race (32612 advertisers), client behavior (23863 advertisers), and service restrictions (8545 advertisers). The probability of there being an association between an advertiser and a major theme was found to vary in response to several variables, including: time period, region, advertiser gender, and advertiser ethnicity. Results are compared with previous work on race and risk messaging in sex work advertising and factors influencing client race restrictions are considered. Over time, the restriction related themes of client behavior, service restrictions, and client race became more prominent. Collectives, multi-regional, cis-female, and Black or Mixed ancestry advertisers were more likely to use restrictions.

Experiences of interpersonal violence among a diverse sample of male sex workers

A notable portion of men who have sex with men engage in exchange sex-i.e. the trading of sex for money, drugs, shelter or other material goods. Despite the risks for physical and sexual violence, threatening behaviour and robbery that male sex workers confront, very little is known about their experiences of such actions by clients. To gain more insight into male sex workers' experiences of interpersonal violence, we analysed qualitative interview data from 180 men who have sex with men from 8 US cities who engaged in sex work with clients they had met primarily through dating/hookup websites and apps. Participants discussed their experiences of a range of untoward behaviours by clients including physical violence, sexual violence, threats and robbery. Healthcare and social services providers can play a significant role in violence prevention among male sex workers. The decriminalisation of sex work could also potentially reduce the risks many sex workers face by facilitating their reporting of harms suffered.

"I Want to Be Really Clear": What Male Sex Workers Want to Clarify With Prospective Clients Before Agreeing to Meet for Sex

Men who have sex with men (MSM) and engage in sex work (MSW) frequently meet clients through dating/hookup apps. This provides an opportunity to discuss the parameters of the exchange prior to meeting and to learn things about the prospective client and the risks he might pose. Limited research has examined the specific issues or topics MSWs discuss with clients before agreeing to meet. We analyzed interview data from a sample of 180 MSWs from eight U.S. cities who engaged in exchange sex with clients they had primarily met through dating/hookup apps and websites. Participants typically asked about clients' sexual interests and expectations regarding what will transpire when they meet to make sure they were compatible with their own boundaries and limitations. Most participants inquired about clients' sexual health and often discussed condom use. Assertiveness and communication skills training might help MSWs negotiate encounters with clients that promote health and safety.

Male Sex Workers' Strategies to Manage Client-Related Risks of Violence

A substantial minority of men who have sex with men (MSM) engage in the exchange of sex for money, drugs, shelter, or material goods. This work carries risks for violence, sexual assault, and other kinds of harm such as robbery and threatening behavior by clients. Yet limited research has focused on the strategies that male sex workers (MSWs) use to prevent or manage these risks. To gain more insights into this matter, we analyzed qualitative interview data from 180 MSM recruited from eight U.S. cities who engaged in sex work with clients they had primarily met through dating/hookup websites and apps. Participants described the strategies they used to manage risks of interpersonal violence, both prior to meeting their clients and at the time of their encounters. Many of the strategies used ahead of the encounter relied upon information and communication technologies, such as negotiating the parameters of the exchange encounter, screening clients, sharing information about the client and meeting place with others, identifying safe meeting locations, and gathering information from social networks about problematic clients. Strategies employed during the encounter included: receiving payment up front; being prepared to protect oneself with a weapon or self-defense techniques; staying alert and sober; and planning an exit route from the location. Technology-based interventions through dating/hookup apps could play an important role in providing resources and skill building for MSWs to help them protect themselves during sex work.

History of Sex Work Is Associated with Increased Risk of Adverse Mental Health and Substance Use Outcomes in Transgender Adults

Understanding factors influencing mental health and substance use in transgender and gender diverse people is critical to reducing disparities in this population. We sought to investigate whether a history of sex work was associated with increased prevalence of poor mental health, substance use, and a negative experience within drug and alcohol treatment facilities. We conducted a secondary analysis of the data of 25,204 transgender respondents of the 2015 United States Transgender Survey. We estimated multiple logistic regressions to assess the association between a history of sex work and adverse mental health and substance use outcomes. We then estimated mean prevalence of adverse outcomes by type of sex work. Finally, we performed chi-square analysis to explore differences in mistreatment at drug and alcohol treatment facilities. Respondents with a history of sex work were significantly more likely to have poorer psychological health, suicidality, and substance use after adjusting for covariates. Among those who visited drug and alcohol treatment facilities, those with a history of sex work were significantly more likely to report adverse experiences (26.34% vs. 11.63%). Our findings highlight the increased risk of adverse outcomes in transgender sex workers and emphasize the need for interventions targeting this subgroup of transgender people.

Diverse contexts and social factors among young cisgender men and transgender women who sell or trade sex in Bangkok and Pattaya, Thailand: formative research for a PrEP program implementation study

HIV incidence is high and persistent among cisgender men who have sex with men (MSM) and transgender women (TGW) who have sex with men, particularly among those who sell or trade sex. In preparation for an open-label combination HIV pre-exposure prophylaxis (PrEP) program for these groups, we conducted formative research to explore the context of sex work/trade and factors that affect implementation of PrEP interventions. This study analyzed interviews with 20 young (aged 18-26 years) MSM and TGW who sell/trade sex and three sex work venue managers in Bangkok and Pattaya, Thailand. Participants described diverse contexts of sex work/trade, including in multiple informal and formal sex venues. Several participants reported mobility across provinces and out of the country, which led to intermittent sex work/trade. TGW sex workers reported challenges with access and cost of femininizing hormones and limited employment opportunities. Factors that could facilitate or challenge PrEP program implementation included HIV stigma, the role of venue management in sexual health practice, lack of PrEP knowledge, lower perceived HIV risk, and interest in personal health and wellbeing. Program implementers must consider myriad factors to successfully implement PrEP among young MSM and TGW engaged in sex work or trade in Thailand.

The Marketing of Female Escorts: A Gendered Perspective of Online Companionship Advertisements

Advancement of technology has broadened possibilities for people working in the sex industry. Specifically, sex workers' use of online classified advertisement websites to market companionship and escort services has increased in recent years, yet research has lagged behind these developments. This study addresses the gap in research by examining female companionship advertisements on one of the most popular websites: Backpage.com. The lead author qualitatively analyzed over 1,500 advertisements to identify common themes and patterns in how escort companions were described. This study explores the type of identity claims escort companions make and how they formulate advertisements to appeal to a broad client base. Research on gendered stereotypes is used to interpret escort companions' use of language, symbols, and photography, through covert and overt messaging. Study results revealed that women offering companion services promoted and reinforced traditional gendered stereotypes through their online advertisements. Findings may be used to understand the context of sex work.

Digital Exclusion and the Structural Barriers to Safety Strategies among Men and Non-Binary Sex Workers Who Solicit Clients Online

Background: Evidence shows that online solicitation facilitates sex workers’ ability to mitigate the risk of workplace violence. However, little is known about how end-demand sex work criminalization and the regulation of online sex work sites shape men and non-binary sex workers’ ability to maintain their own safety while soliciting services online. Methods: We conducted 21 semi-structured interviews with men and non-binary sex workers in British Columbia between 2020–2021 and examined their ability to enact safety strategies online in the context of end-demand criminalization. Analysis drew on a structural determinants of health framework. Results: Most participants emphasized that sex work is not inherently dangerous and described how soliciting services online facilitated their ability to enact personal safety strategies and remain in control of client interactions. However, participants also described how end-demand criminalization, sex work stigma, and restrictive website policies compromise their ability to solicit services online and to enact safety strategies. Conclusions: Alongside calls to decriminalize sex work, these findings emphasize the need to normalize sex work as a form of labour, promote access to online solicitation among men and non-binary sex workers, and develop standards for online sex work platforms in partnership with sex workers that prioritize sex worker safety.

Sex Workers’ Lived Experiences With COVID-19 on Social Media: Content Analysis of Twitter Posts

Background

The COVID-19 pandemic has drawn attention to various inequalities in global societies, highlighting discrepancies in terms of safety, accessibility, and overall health. In particular, sex workers are disproportionately at risk due to the nature of their work and the social stigma that comes alongside it.

Objective

This study examines how public social media can be used as a tool of professional and personal expression by sex workers during the COVID-19 pandemic. We aimed to explore an underresearched topic by focusing on sex workers’ experiences with the ongoing COVID-19 pandemic on the social media platform Twitter. In particular, we aimed to find the main issues that sex workers discuss on social media in relation to the COVID-19 pandemic.

Methods

A literature review followed by a qualitative analysis of 1458 (re)tweets from 22 sex worker Twitter accounts was used for this study. The tweets were qualitatively coded by theme through the use of intercoder reliability. Empirical, experimental, and observational studies were included in this review to provide context and support for our findings.

Results

In total, 5 major categories were identified as a result of the content analysis used for this study: concerns (n=542, 37.2%), solicitation (n=336, 23.0%), herd mentality (n=231, 15.8%), humor (n=190, 13.0%), and blame (n=146, 10.0%). The concerns category was the most prominent category, which could be due to its multifaceted nature of including individual concerns, health issues, concerns for essential workers and businesses, as well as concerns about inequalities or intersectionality. When using gender as a control factor, the majority of the results were not noteworthy, save for the blame category, in which sexual and gender minorities (SGMs) were more likely to post content.

Conclusions

Though there has been an increase in the literature related to the experiences of sex workers, this paper recommends that future studies could benefit from further examining these 5 major categories through mixed methods research. Examining this phenomenon could recognize the challenges unique to this working community during the COVID-19 pandemic and potentially reduce the widespread stigma associated with sex work in general.

Perceived Stigma and Stigma Management Strategies Among Online Male Sex Workers

Technological advances like the Internet and Internet-enabled devices, such as smartphones, and the dating and hookup websites and apps available to the users of them, have transformed the nature, organization, and practice of sex work in fundamental ways. Some scholars have argued that these changes have contributed to a normalization of male exchange sex (i.e., providing sex in exchange for money, drugs, shelter, or goods), and in so doing, have diminished the stigma historically associated with it. However, little empirical research has focused on how male sex workers (MSWs), including those engaged in what might be called informal or incidental or casual sex work and primarily use dating/hookup websites and apps not designed for commercial to meet clients experience and manage stigma. To help fill this gap, we analyzed interview data from 180 MSWs who engaged in exchange sex and met their client on dating/hookup websites and apps. Most participants felt that sex work was still highly stigmatized in society at large, but many also felt it was generally accepted-if not completely normalized-within the gay community. Nevertheless, many struggled with the emotional impact of engaging in a stigmatized practice and most employed one or more of the following stigma management strategies: information management, distancing, discrediting the discreditors, asserting no other option existed, and challenging or reframing stereotypes and narratives. These findings indicate that MSWs, even those engaged in informal or incidental sex work, who meet clients on dating/hookup websites and apps are still strongly affected by sex work-related stigma and seek to manage it in various ways. Future research should investigate the sources of internalized stigma among this under-studied population of sex workers.

Internet solicitation linked to enhanced occupational health and safety outcomes among sex workers in Metro Vancouver, Canada 2010-2019

OBJECTIVES

Examine the independent association between online solicitation and sex workers' (SWs') occupational health and safety (OHS), particularly violence and work stress.

METHODS

Data were drawn from a cohort of women SWs (N=942, 2010-2019) in Vancouver, Canada. Analyses used descriptive statistics and bivariate and multivariable logistic and linear regression using generalised estimating equations (GEE); explanatory and confounder modelling approaches were used.

RESULTS

33.9% (n=319) of participants solicited online and 14.1% (n=133) primarily solicited online in the last 6 months in at least one study visit. In multivariable GEE analysis, factors associated with primarily soliciting online included younger age (adjusted OR (AOR) 0.95 per year older, 95% CI 0.93 to 0.97), sexual minority status (AOR 2.57, 95% CI 1.61 to 4.10), gender minority status (AOR 3.09, 95% CI 1.80 to 5.28), higher education (AOR 2.13, 95% CI 1.34 to 3.40), higher sex work income (AOR 1.03 per $100 weekly, 95% CI 1.01 to 1.06), being an im/migrant to Canada (AOR 2.40, 95% CI 1.26 to 4.58) and primarily servicing in informal indoor workspaces (AOR 3.47, 95% CI 2.32 to 5.20). In separate GEE confounder models, primarily soliciting online significantly (1) reduced odds of physical/sexual workplace violence (AOR 0.64, 95% CI 0.39 to 1.06) and (2) reduced work stress (β coefficient -0.93, 95% CI -1.59 to -0.26).

DISCUSSION/CONCLUSIONS

Younger workers, gender/sexual minorities, im/migrants and those in informal indoor spaces had higher odds of soliciting online. Confounder models indicate access to online solicitation methods may support enhanced OHS. Decriminalisation of sex work-including advertising via online platforms-remains necessary to support SWs' OHS.

Violence and Victimization in Interactions Between Male Sex Workers and Male Clients in Mombasa, Kenya

Male sex workers (MSWs) and male clients (MCMs) who engage their services face increased vulnerability to violence in Kenya, where same-sex practices and sex work are criminalized. However, little is known about how violence might arise in negotiations between MSWs and MCMs. This study explored the types of victimization experienced by MSWs and MCMs, the contexts in which these experiences occurred, and the responses to violence among these groups. We conducted in-depth interviews with 25 MSWs and 11 MCMs recruited at bars and clubs identified by peer sex worker educators as "hotspots" for sex work in Mombasa, Kenya. Violence against MSWs frequently included physical or sexual assault and theft, whereas MCMs' experiences of victimization usually involved theft, extortion, or other forms of economic violence. Explicitly negotiating the price for the sexual exchange before having sex helped avoid conflict and violence. For many participants, guesthouses that were tolerant of same-sex encounters were perceived as safer places for engaging in sex work. MSWs and MCMs rarely reported incidents of violence to the police due to fear of discrimination and arrests by law enforcement agents. Some MSWs fought back against violence enacted by clients or tapped into peer networks to obtain information about potentially violent clients as a strategy for averting conflicts and violence. Our study contributes to the limited literature examining the perspectives of MSWs and MCMs with respect to violence and victimization, showing that both groups are vulnerable to violence and in need of interventions to mitigate violence and protect their health. Future interventions should consider including existing peer networks of MSWs in efforts to prevent violence in the context of sex work. Moreover, decriminalizing same-sex practices and sex work in Kenya may inhibit violence against MSWs and MCMs and provide individuals with safer spaces for engaging in sex work.

Behavioral Changes, Adaptation, and Supports among Indonesian Female Sex Workers Facing Dual Risk of COVID-19 and HIV in a Pandemic

The objective of this study is to explore the impacts of COVID-19 and changes taking place among the Indonesian female sex worker (FSW) community during the COVID-19 pandemic and the predictors of these changes. We conducted a cross-sectional online survey and selected the participants using a purposive snowball sampling technique. Incentives were provided to participants in the form of a 5 USD e-wallet balance. Variables of interest included adaptation to online sex work, adherence to COVID-19 prevention measures during sex work, number of clients, income reduction, social support, condom access, and condom use frequency. Sociodemographic data and COVID-19 fear index values were also collected. Final analysis included 951 FSWs, of whom 36.4% of had adapted to online sex work and 48.6% had practiced COVID-19 prevention measures. Major reductions in client frequency and income were reported by 67.8% and 71.1% of respondents, respectively. However, only 36.3% of FSWs reported they had ever received any form of social support from any parties, public or private. Meanwhile, 16.7% encountered difficulties in accessing condoms and 12.5% reported less frequent condom use during the pandemic. Easy access to condoms was the main factor influencing the frequency of condom use. As expected, staying in employment protected FSWs from major income loss, while education and younger age predicted adaptive behavioral changes, such as taking up online sex work. The COVID-19 pandemic has disrupted access to socioeconomic support systems and HIV prevention services among FSWs and has further exposed them to the dual jeopardy of HIV and COVID-19 infections.

Factors associated with transactional sex among a cohort of gay, bisexual, and other men who have sex with men in Vancouver, Canada

Background Gay, bisexual, and other men who have sex with men (GBM) who engage in transactional sex (sex in exchange for drugs, money, or goods) experience increased risk of sexually transmitted infections (STI), including HIV. This study explored additional psychosocial and health-related factors associated with transactional sex among GBM. Methods Respondent-driven sampling was used to recruit GBM in Vancouver, Canada, from 2012 to 2015, with follow up every 6months until July2019. We examined factors associated with transactional sex using multivariable three-level mixed-effects modelling. Results Among 698 GBM, 22.1% reported ever receiving drugs, money, or goods for sex. Transactional sex was more likely to be reported by GBM who were younger (<30years) and who had lower incomes, less education, and insecure housing. GBM reporting transactional sex were more likely to report substance use (i.e. crystal methamphetamine, poppers, GHB, and non-steroid injection drugs) and higher risk sexual behaviours (i.e. more sex partners, sex party attendance, and condomless anal sex with serodifferent or unknown HIV status partners); however, they were no more likely to be living with HIV or to report a recent bacterial STI diagnosis. GBM who reported higher loneliness, anxiety, and cognitive escape were also more likely to report transactional sex. Conclusions More than one-fifth of GBM in Vancouver reported transactional sex and those who did were more likely to also experience psychosocial stressors, increased substance use, and higher risk sexual behaviours. Programs which consider the interconnections of personal, social, and structural challenges faced by GBM engaging in transactional sex are necessary to support improved mental, physical, and sexual health for these men.

The Use of Information and Communication Technologies by Sex Workers to Manage Occupational Health and Safety: Scoping Review

BACKGROUND

In many countries, sex work is criminalized, driving sex work underground and leaving sex workers vulnerable to a number of occupational health and safety risks, including violence, assault, and robbery. With the advent of widely accessible information and communication technologies (ICTs), sex workers have begun to use electronic occupational health and safety tools to mitigate these risks.

OBJECTIVE

This study aims to explore the use of ICTs by sex workers for managing occupational health and safety risks and strategies for reducing these risks. This paper aims to answer the following question: what is known about sex workers' use of ICTs in the delivery of occupational health and safety strategies?

METHODS

A literature review following the methodological framework for scoping reviews was conducted to analyze studies describing the use of ICTs by sex workers to mitigate occupational health and safety risks. Experimental, observational, and descriptive studies, as well as protocol papers, were included in this scoping review.

RESULTS

Of the 2477 articles initially identified, 41 (1.66%) met the inclusion criteria. Of these studies, 71% (29/41) were published between 2015 and 2019. In these studies, the internet was the predominant ICT (24/41, 58%), followed by text messaging (10/41, 24%) and assorted communication technologies associated with mobile phones without internet access (7/41, 17%; eg, voice mail). In 56% (23/41) of the studies, sex workers located in high-income countries created occupational health and safety strategies (eg, bad date lists) and shared them through the internet. In 24% (10/41) of the studies, mostly in low- and middle-income countries, organizations external to sex work developed and sent (through text messages) occupational health and safety strategies focused on HIV. In 20% (8/41) of the studies, external organizations collaborated with the sex worker community in the development of occupational health and safety strategies communicated through ICTs; through this collaboration, concerns other than HIV (eg, mental health) emerged.

CONCLUSIONS

Although there has been an increase in the number of studies on the use of ICTs by sex workers for managing occupational health and safety over the past 5 years, knowledge of how to optimally leverage ICTs for this purpose remains scarce. Recommendations for expanding the use of ICTs by sex workers for occupational health and safety include external organizations collaborating with sex workers in the design of ICT interventions to mitigate occupational health and safety risks; to examine whether ICTs used in low- and middle-income countries would have applications in high-income countries as a substitute to the internet for sharing occupational health and safety strategies; and to explore the creation of innovative, secure, web-based communities that use existing or alternative digital technologies that could be used by sex workers to manage their occupational health and safety.

Violence Against Male Sex Workers: A Systematic Scoping Review of Quantitative Data

Sex workers are recognized to be potentially vulnerable to violence and abuse. However, the extent and nature of violence committed against male sex workers remains under reported. The aim of this evidence scoping review was to identify the prevalence of violence against male sex workers globally. A systematic search was conducted of 8 databases from 1990 to the end of December 2016. In total, quantitative data from 27 studies conducted in 18 countries were included in the review. Evidence indicates that some male sex workers, especially those in non-Western countries, do experience high levels of violence. The largest proportion of studies reported data on sexual violence, whilst the most common type of violence experienced overall by male sex workers was that of 'verbal or emotional abuse or threats'. The views and experiences of male sex workers should be integrated fully into sex work debates, policy and service provision.

Information and Communication Technologies in Commercial Sex Work: A Double-Edged Sword for Occupational Health and Safety

Over the previous decade, there has been a notable shift within sex work marketplaces, with many aspects of the work now facilitated via the internet. Many providers and clients are also no longer engaging in in-person negotiations, opting instead for communications via technological means, such as through mobile phones, email, and the internet. By analysing the qualitative interviews of indoor-based providers, clients, and agency managers, this paper addresses the occupational health and safety concerns that indoor sex workers experience in the digital age, as well as how technology use can both support and hinder their capacity to promote their health and safety. Using thematic analysis, we arrived at three salient and nuanced themes that pertain to the intersection of sex work, technology use, and occupational health and safety: screening; confidentiality, privacy, and disclosure; and malice. As socio-political context can affect the occupational health and safety concerns that providers experience, as well as their capacity to prevent or mitigate these concerns, we highlight our findings in light of prevailing societal stigma and a lack of legal recognition and protections for sex work in Canada.

Urban gentrification and declining access to HIV/STI, sexual health, and outreach services amongst women sex workers between 2010-2014: Results of a community-based longitudinal cohort

Despite increasing gentrification across North American cities, little is known about impacts on work and living environments and health access for marginalized women. Drawing upon prospective cohort and external spatial data, we examined changes in land use and sex workers' work/living environments in relation to gentrification exposure in Metro Vancouver (2010-2014), and modeled independent effects of gentrification exposure on reduced utilization of HIV/STI testing, sexual health, and sex worker support services. These decreases occurred despite efforts to scale-up HIV services for marginalized populations. Planning of healthcare, housing, and other support services should be responsive to shifting urban landscapes for marginalized women.

Sexting and Gender Violence Among Young People: An Integrative Literature Review

Abstract This review aimed to systematize the studies on sexting and gender violence published between 2000 and 2016 in national and international journals. The search was performed in the databases - BVS-Psi, Psychlit, Medline, LILACS, and Oasis. We found 383 articles. After applying the exclusion criteria, 21 articles were analyzed. The results showed that sexting is not an a priori risk factor. The risk is related to variables such as the content of the messages, when it expresses violence, and age of the practitioners, indicating that the younger the age the greater the risk. It has been found that there are modalities related to gender violence, such as revenge pornography and slut-shaming, but these contents are not inherent to sexting.

Intersections of Stigma, Mental Health, and Sex Work: How Canadian Men Engaged in Sex Work Navigate and Resist Stigma to Protect Their Mental Health

Men engaged in sex work experience significant stigma that can have devastating effects for their mental health. Little is known about how male sex workers experience stigma and its effects on mental health or their strategies to prevent its effects in the Canadian context. This study examined the interrelationships between stigma and mental health among 33 Canadian indoor, male sex workers with a specific goal of understanding how stigma affected men's mental health and their protective strategies to mitigate against its effects. Men experienced significant enacted stigma that negatively affected their social supports and ability to develop and maintain noncommercial, romantic relationships. Men navigated stigma by avoidance and resisting internalization. Strategy effectiveness to promote mental health varied based on men's perspectives of sex work as a career versus a forced source of income. Programming to promote men's mental health must take into consideration men's diverse strategies and serve to build social supports.

Preventing sexually transmitted and blood borne infections (STBBIs) among sex workers: a critical review of the evidence on determinants and interventions in high-income countries

Background

Across diverse regions globally, sex workers continue to face a disproportionate burden of HIV and other sexually transmitted and blood borne infections (STBBIs). Evidence suggests that behavioural and biomedical interventions are only moderately successful in reducing STBBIs at the population level, leading to calls for increased structural and community-led interventions. Given that structural approaches to mitigating STBBI risk beyond HIV among sex workers in high-income settings remain poorly understood, this critical review aimed to provide a comprehensive synthesis of the global research and literature on determinants of HIV and other STBBIs and promising intervention practices for sex workers of all genders in high-income countries.

Methods

We searched for publications over the last decade (January 2005–March 2016) among sex workers (cis women, cis men, and trans individuals). Data obtained from quantitative peer-reviewed studies were triangulated with publicly available reports and qualitative/ethnographic research where quantitative evidence was limited.

Results

Research demonstrates consistent evidence of the direct and indirect impacts of structural factors (e.g., violence, stigma, criminalization, poor working conditions) on increasing risk for STBBIs among sex workers, further compounded by individual and interpersonal factors (e.g., mental health, substance use, unprotected sex). Sub-optimal access to health and STBBI prevention services remains concerning. Full decriminalization of sex work has been shown to have the largest potential to avert new infections in sex work, through reducing workplace violence and increasing access to safer workspaces. Promising practices and strategies that should be scaled-up and evaluated to prevent STBBIs are highlighted.

Conclusions

The high burden of STBBIs among sex workers across high-income settings is of major concern. This review uniquely contributes to our understanding of multilevel factors that potentiate and mitigate STBBI risk for sex workers of all genders. Research suggests that multipronged structural and community-led approaches are paramount to addressing STBBI burden, and are necessary to realizing health and human rights for sex workers. Given the heterogeneity of sex worker populations, and distinct vulnerabilities faced by cis men and trans sex workers, further research utilizing mixed-methods should be implemented to delineate the intersections of risk and ameliorate critical health inequalities.

Online transgender Sex Work and Public Health. A Netnographic Study in Tenerife

The purpose of this study is to understand and describe the nature of internet advertisements of transgender sex workers, and how demand drives the configuration of their services. An analysis of the offer-demand contents (n = 257) was carried out on a sexual contact website. Five categories were identified: sociodemographic characteristics, supply management, sexual services, health and clients. The results include risk factors associated with public health and social exclusion within this group. The results may inform strategies for developing socio-health interventions targeted towards transgender women in the situation of prostitution.

Criminalizing Sex Work Clients and Rushed Negotiations among Sex Workers Who Use Drugs in a Canadian Setting

Previous research indicates that criminalization of sex work is associated with harms among sex workers. In 2013, the Vancouver Police Department changed their sex work policy to no longer target sex workers while continuing to target clients and third parties in an effort to increase the safety of sex workers (similar to "end-demand sex work" approaches being adopted in a number of countries globally). We sought to investigate the trends and correlates of rushing negotiations with clients due to police presence among 359 sex workers who use drugs in Vancouver before and after the guideline change. Data were derived from three prospective cohort studies of people who use drugs in Vancouver between 2008 and 2014. We used sex-stratified multivariable generalized estimating equation models. The crude percentages of sex workers who use drugs reporting rushing client negotiations changed from 8.9% before the guideline change to 14.8% after the guideline change among 259 women, and from 8.6 to 7.1% among 100 men. In multivariable analyses, there was a significant increase in reports of rushing client negotiation after the guideline change among women (p = 0.04). Other variables that were independently associated with increased odds of rushing client negotiation included experiencing client-perpetrated violence (among both men and women) and non-heterosexual orientation (among women) (all p < 0.05). These findings indicate that despite the policing guideline change, rushed client negotiation due to police presence appeared to have increased among our sample of female sex workers who use drugs. It was also associated with client-perpetrated violence and other markers of vulnerability. These findings lend further evidence that criminalizing the purchase of sexual services does not protect the health and safety of sex workers.

A Content Analysis of Health and Safety Communications Among Internet-Based Sex Work Advertisements: Important Information for Public Health

Background

The capacity to advertise via the Internet continues to contribute to the shifting dynamics in adult commercial sex work. eHealth interventions have shown promise to promote Internet-based sex workers’ health and safety internationally, yet minimal attention has been paid in Canada to developing such interventions. Understanding the information communicated in Internet-based sex work advertisements is a critical step in knowledge development to inform such interventions.

Objective

The purpose of this content analysis was to increase our understanding of the health and safety information within the Internet advertisements among women, men, and transgender sex workers and to describe how this information may be utilized to inform eHealth service development for this population.

Methods

A total of 75 Internet-based sex worker advertisements (45 women, 24 men, and 6 transgender persons) were purposefully selected from 226 advertisements collected as part of a larger study in Western Canada. Content analysis was employed to guide data extraction about demographic characteristics, sexual services provided, service restrictions, health practices and concerns, safety and security, and business practices. Frequencies for each variable were calculated and further classified by gender. Thematic analysis was then undertaken to situate the communications within the social and commercialized contexts of the sex industry.

Results

Four communications themes were identified: (1) demographic characteristics; (2) sexual services; (3) health; and (4) safety and security. White was the most common ethnicity (46/75, 61%) of advertisements. It was found that 20-29 years of age accounted for 32 of the 51 advertisements that provided age. Escort, the only legal business title, was the most common role title used (48/75, 64%). In total, 85% (64/75) of advertisements detailed lists of sexual services provided and 41% (31/75) of advertisements noted never offering uncovered services (ie, no condom). Gender and the type of Web-based platform mattered for information communicated. It was found that 35 of the 45 women’s advertisements were situated in personal websites and hosted details about nonsexual aspects of an appointment. Men and transworkers used Internet classified advertisement platforms with predetermined categories. Communications about sexually transmitted infections (STIs) occurred in only 16% (12/75) of advertisements with men accounting for 7. Women’s advertisements accounted for 26 of the 37 advertisements noting safety restrictions. Zero men or transpersons restricted alcohol or drug use. In total, 75% (56/75) of advertisements offered out-call services and the average minimal hourly rate ranged from Can $140/h to Can $200/h.

Conclusions

The study findings contribute to understandings about the diverse platforms used in commercial sex advertisements, and how sex workers frame information for potential clients. This information affords health care providers and policy makers insights to how they might assist with promoting the health of Internet-based sex workers and their clients.