Male clients of male sex workers in West Africa: A neglected high-risk population

AbstractResearch on male clients of male sex workers (MCMSW) has been neglected for a long time globally. We aimed to characterize MCMSW and to identify factors associated with their sexual practices using data from the prospective cohort study CohMSM conducted in Burkina Faso, Côte d’Ivoire, Mali and Togo. Our study focused on HIV-negative men who have sex with other men (MSM) recruited between 06/2015 and 01/2018 by a team of trained peer educators. Scheduled study visits at 6, 12 and 18 months included medical examinations, HIV screening, risk-reduction counselling and face-to-face interviews to collect information on their sociodemographic characteristics, sexual behaviours, and HIV risk-reduction strategies (HIV-RRS). Three stigmatization sub-scores were constructed (experienced, perceived and internalized). Mixed-effects logistic regression was used for data analysis. Of the 280 participants recruited at baseline, 238, 211 and 118, respectively, had a follow-up visit at 6, 12 and 18 months. Over a total of 847 visits, 47 transactional sex (TS) encounters were reported by 38 MCMSW (13.6%). Of the latter, only one participant reported systematic TS (2.6%), 18 (47.4 %) stopped reporting TS after baseline, and 6 (15.8%) reported TS after baseline. Thirteen participants (34.2 %) reported occasional TS. After adjusting for country of study and age, the following self-reported factors were associated with a greater likelihood of being MCMSW: protected anal sex, exclusively insertive anal sex with male sexual partners, avoidance of sex after consuming psychoactive products and experiencing stigmatization (all during the previous 6 months). The majority of MCMSW in this study employed HIV-RRS with male sexual partners, including engaging in protected anal sex, avoidance of sex when consuming psychoactive products, and practising exclusively insertive anal sex.

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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

AIDS Care ◽

10.1080/09540121.2011.592813 ◽

2011 ◽

Vol 24 (1) ◽

pp. 59-70 ◽

Cited By ~ 20

Author(s):

Joseph T.F. Lau ◽

Wende Cai ◽

Hi Yi Tsui ◽

Lin Chen ◽

Jinquan Cheng ◽

...

Keyword(s):

Hong Kong ◽

Sex Workers ◽

Associated Factors ◽

Anal Intercourse ◽

Unprotected Anal Intercourse ◽

Male Sex Workers ◽

Male Clients ◽

Male Sex

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Intimate Partner Violence in Transgender Populations: Systematic Review and Meta-analysis of Prevalence and Correlates

American Journal of Public Health ◽

10.2105/ajph.2020.305774 ◽

2020 ◽

Vol 110 (9) ◽

pp. e1-e14

Author(s):

Sarah M. Peitzmeier ◽

Mannat Malik ◽

Shanna K. Kattari ◽

Elliot Marrow ◽

Rob Stephenson ◽

...

Keyword(s):

Intimate Partner Violence ◽

High Risk ◽

Partner Violence ◽

Meta Analysis ◽

Intimate Partner ◽

High Risk Population ◽

Risk Population ◽

Female Sex ◽

Significant Difference ◽

Male Sex

Background: Transgender individuals experience unique vulnerabilities to intimate partner violence (IPV) and may experience a disproportionate IPV burden compared with cisgender (nontransgender) individuals. Objectives: To systematically review the quantitative literature on prevalence and correlates of IPV in transgender populations. Search Methods: Authors searched research databases (PubMed, CINAHL), gray literature (Google), journal tables of contents, and conference abstracts, and consulted experts in the field. Authors were contacted with data requests in cases in which transgender participants were enrolled in a study, but no disaggregated statistics were provided for this population. Selection Criteria: We included all quantitative literature published before July 2019 on prevalence and correlates of IPV victimization, perpetration, or service utilization in transgender populations. There were no restrictions by sample size, year, or location. Data Collection and Analysis: Two independent reviewers conducted screening. One reviewer conducted extraction by using a structured database, and a second reviewer checked for mistakes or omissions. We used random-effects meta-analyses to calculate relative risks (RRs) comparing the prevalence of IPV in transgender individuals and cisgender individuals in studies in which both transgender and cisgender individuals were enrolled. We also used meta-analysis to compare IPV prevalence in assigned-female-sex-at-birth and assigned-male-sex-at-birth transgender individuals and to compare physical IPV prevalence between nonbinary and binary transgender individuals in studies that enrolled both groups. Main Results: We identified 85 articles from 74 unique data sets (ntotal = 49 966 transgender participants). Across studies reporting it, the median lifetime prevalence of physical IPV was 37.5%, lifetime sexual IPV was 25.0%, past-year physical IPV was 16.7%, and past-year sexual IPV was 10.8% among transgender individuals. Compared with cisgender individuals, transgender individuals were 1.7 times more likely to experience any IPV (RR = 1.66; 95% confidence interval [CI] = 1.36, 2.03), 2.2 times more likely to experience physical IPV (RR = 2.19; 95% CI = 1.66, 2.88), and 2.5 times more likely to experience sexual IPV (RR = 2.46; 95% CI = 1.64, 3.69). Disparities persisted when comparing to cisgender women specifically. There was no significant difference in any IPV, physical IPV, or sexual IPV prevalence between assigned-female-sex-at-birth and assigned-male-sex-at-birth individuals, nor in physical IPV prevalence between binary- and nonbinary-identified transgender individuals. IPV victimization was associated with sexual risk, substance use, and mental health burden in transgender populations. Authors’ Conclusions: Transgender individuals experience a dramatically higher prevalence of IPV victimization compared with cisgender individuals, regardless of sex assigned at birth. IPV prevalence estimates are comparably high for assigned-male-sex-at-birth and assigned-female-sex-at-birth transgender individuals, and for binary and nonbinary transgender individuals, though more research is needed. Public Health Implications: Evidence-based interventions are urgently needed to prevent and address IPV in this high-risk population with unique needs. Lack of legal protections against discrimination in employment, housing, and social services likely foster vulnerability to IPV. Transgender individuals should be explicitly included in US Preventive Services Task Force recommendations promoting IPV screening in primary care settings. Interventions at the policy level as well as the interpersonal and individual level are urgently needed to address epidemic levels of IPV in this marginalized, high-risk population.

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

Journal of Interpersonal Violence ◽

10.1177/0886260520922361 ◽

2020 ◽

pp. 088626052092236

Author(s):

Pablo K. Valente ◽

Alberto Edeza, BS ◽

Tsitsi B. Masvawure ◽

Theo G. M. Sandfort ◽

Peter B. Gichangi ◽

...

Keyword(s):

Sex Work ◽

Sex Workers ◽

Peer Networks ◽

Same Sex ◽

Male Sex Workers ◽

Male Clients ◽

Sexual Exchange ◽

Male Sex ◽

Depth Interviews ◽

Sex Practices

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.

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Satisfaction with health services for STIs, HIV, AIDS among a high-risk population in West Africa

AIDS Care ◽

10.1080/09540120701583761 ◽

2008 ◽

Vol 20 (3) ◽

pp. 388-394 ◽

Cited By ~ 5

Author(s):

D. Morin ◽

G. Godin ◽

M. Alary ◽

M.-R. Sawadogo ◽

M. Bernier ◽

...

Keyword(s):

High Risk ◽

Health Services ◽

West Africa ◽

High Risk Population ◽

Risk Population ◽

Hiv Aids

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Differences in Socio-demographics Status, Risk Behaviours, Healthcare Uptake and HIV/STIs Between Brothel-based and Street-based Female Sex Workers in Yunnan, China

10.21203/rs.3.rs-529460/v1 ◽

2021 ◽

Author(s):

Guoxi Cai ◽

Yufen Liu ◽

Jinman Zhuang ◽

Yixiao Lu ◽

Jiwen Wu ◽

...

Keyword(s):

High Risk ◽

Sex Workers ◽

Healthcare Services ◽

Consistent Condom ◽

High Risk Population ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Risk Population ◽

Sti Prevention ◽

Female Sex

Abstract Background Heterosexual contact is the primary mode of HIV transmission in China and commercial sex is thought to play a crucial role in China’s epidemic. Female sex works (FSWs) in China tend to be either brothel-based (BSWs) or street-based (SSWs), but few studies have investigated the differences between these important segments of this difficult-to-reach, high-risk population. Our aim was to explore these differences. Methods A cross-sectional survey was conducted in Yunnan Province of China in partnership with a local FSW-friendly non-governmental organization. Face-to-face interviews using a structured questionnaire were conducted to collect data on socio-demographic characteristics, sex work history, sexual behaviours, HIV/STI-related knowledge, HIV testing history, and healthcare services uptake. Blood samples were taken for HIV and syphilis testing, and urine samples for gonorrhea and chlamydia testing. Descriptive statistics were used to evaluate differences between SSWs and BSWs. Results A total of 185 BSWs and 129 SSWs were included in the study. SSWs were older and less educated, had more dependents and more clients, accessed fewer healthcare services, and had higher prevalence of HIV/STIs. SSWs also had similar but higher rates of consistent condom use with clients.Conclusions Our study provides evidence that confirms the disproportionately high vulnerability of SSWs to HIV and other STIs, underscoring the urgent need for the Chinese health and public health sectors to prioritize outreach to SSWs. Awareness and educational programs, condom distribution, testing and health check-ups should be included in a comprehensive strategy for HIV/STI prevention in this high-risk population.

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The Economics of Male Sex Work

10.1093/oxfordhb/9780199915248.013.10 ◽

2016 ◽

Author(s):

Trevon D. Logan

Keyword(s):

Sex Work ◽

Sex Workers ◽

The United States ◽

Male Sex Workers ◽

Male Prostitution ◽

Male Clients ◽

Male Sex Work ◽

Ex Post ◽

Male Sex ◽

Basic Features

This chapter examines the economics of male prostitution as practiced in the United States. It begins with an overview of some basic features and organization of the online market for male sex work. It then considers the unique social circumstances that occur in male prostitution and how they inform the economic analysis. It also reviews two empirical economic issues that have been analyzed in the literature: the role of asymmetric information and the geographic distribution of male-sex-worker services. The results show that male sex workers typically attempt to signal their reliability to potential male customers by providing detailed information about their identity ex ante so as to credibly implicate themselves if there is any ex post negative outcome. Furthermore, male sex workers appear to have a nontrivial number of heterosexually identified male clients, which can help explain why credible signals by male sex workers are so important in this market.

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