Masculinities, vulnerability and negotiated identity: Understanding the reporting behaviours of men who experience violence or otherwise harmful behaviour, within a sex work context

Context The focus of sex work related discussions most commonly falls on female providers of sexual services, and male purchasers. As a result, the often victim-oriented policy response in England and Wales falls short of truly addressing the needs of men who are involved in the sale of sex, with there being limited support available for them and a systemic approach which does not fully recognise the potential for men to face harm within this context. Methods The aim of this study is to explore experiences of and reactions to violence, and otherwise harmful behaviours, faced by men in the context of their sex working, by understanding the lived realities of a sample of men who engage in this type of work. The study takes a phased approach which combines an initial informative quantitative survey, with three subsequent phases of semi-structured interviews with male sex workers, sex work-focused practitioners and police officers. The method is guided by feminist research principles which suggest that reality is situated within those with lived experience, and also by an element of co-creation which has grounded this study within the perspectives of male sex workers from its conception. Findings The findings of this research suggest that all of the men involved in the study had faced at least one of the violent or otherwise harmful behaviours outlined, though reporting of these behaviours was not at all common. Discussions with the male sex working participants, practitioners and the police highlighted the issues related to the structural influences of authority, such as the police, and the social environment, and the internalisation of these wider factors, which create barriers to reporting for groups such as male sex workers and others who face similar social marginalisation. Conclusions This study challenges existing gendered understandings of violence and otherwise harmful behaviour within a sex work context, by highlighting the harmful experiences of men. By exploring these experiences and the reporting behaviours of those involved, the study also proposes a new framework for understanding barriers to reporting, which suggests that these are formed through the influences of formal and informal measures of social control, and the internalisation of these outside influences by the individual. By better understanding the experiences of men, and the barriers to their reporting, this study attempts to nuance a gendered discussion. Within, I propose that in order to better support male sex workers, responses must begin by appreciating the heterogeneity of those involved in sex work and the influence of their individual circumstances and the social environment on their willingness to seek support.

Barriers and facilitators to pre-exposure prophylaxis uptake among male sex workers in Mexico: an application of the RE-AIM framework

Background The ImPrEP México demonstration project is the first to distribute free HIV pre-exposure prophylaxis (PrEP) to men who have sex with men (MSM) and transgender women living in Mexico. In Mexico City, MSM who are also male sex workers (MSWs) face a disproportionately high risk of HIV infection. PrEP is highly effective for HIV prevention, yet “real-life” implementation among MSWs is a challenge due to the unique adherence barriers faced by this population. Methods This study uses the RE-AIM implementation science framework to characterize the unique barriers to and facilitators of PrEP uptake among MSWs in Mexico City. We conducted 9 in-depth key informant interviews and 2 focus group discussions with MSWs across 5 clinic and community sites. Qualitative data were analyzed using inductive, open coding approaches from grounded theory. We supplemented findings from the primary qualitative analysis with quantitative indicators derived from ImPrEP program records to describe the current Reach of the ImPrEP program among MSWs in Mexico City and the potential for wider PrEP Adoption among other high-risk populations in Mexico. Results The Reach of the ImPrEP program was 10% of known HIV-negative MSWs in Mexico City. Program Reach was lowest among MSWs who were street-based sex workers, of lower socioeconomic status, migrants from other states and self-identified as heterosexual. Barriers to program Reach included limited PrEP knowledge, HIV-related stigma, and structural barriers; facilitators included in-person program recruitment, patient-centered care, and spread of information through word of mouth among MSWs. Two out of the four eligible institutions had adopted the ImPrEP protocol. Barriers to wider program Adoption included HIV- and sexual identity– related stigma, protocol limitations, and lack of a national policy for PrEP distribution; facilitators of Adoption included existing healthcare infrastructure, sensitized providers, and community support from non-governmental organizations. Conclusions Increasing the ImPrEP program’s Reach among MSWs will depend on improving PrEP education and addressing HIV-related stigma and access barriers. Future Adoption of the ImPrEP program should build on existing clinical infrastructure and community support. Creation of a national policy for PrEP distribution may improve the Reach and Adoption of PrEP among highest-risk populations in Mexico.

A reflective review on gay and bisexual men in China

Pre-Exposure Prophylaxis (PrEP), Treatment as Prevention (TasP), and undetectability affect the experience of gay and bisexual men living with HIV. They also link ‘risk’ and ‘safety’ to raw sex and the use of recreational drugs as they relate to sexual practices among gay and bisexual men. From these insights, we can think about the complex connections between biomedical innovations in the field of HIV, sexual practices, subjectivity, pleasure, spaces, and technologies. This commentary offers a sociocultural perspective based on a study with 28 male sex workers (hereafter MSWs) on gay and bisexual men—mainly male sex workers— and their wives (Tongqi) in China.

Male Sex Workers Selling Physical Sex during the COVID-19 Pandemic in Portugal: Motives, Safer Sex Practices, and Social Vulnerabilities

The purpose of this research was to assess the motives, safer sex practices, and vulnerabilities of male sex workers who sold physical sex during the COVID-19 pandemic. This study used a mixed strategy, utilizing purposive sampling techniques to conduct 13 online surveys with male sex workers working in Portugal during the COVID-19 pandemic. Participants were aged between 23 and 47 years old and mostly provided their services to other men. Additionally, half of the participants were immigrants. Participants mentioned paying for essential expenses (rent, food, phone, etc.), having money for day-to-day expenses, wanting to, and enjoying it, as their main motives for engaging in sex work. Regarding sexual practices, 3 to 11 participants did not always or did not consistently use condoms during penetrative sex with their clients. Thematic analysis was used to identify the following repeated patterns of meaning regarding COVID-19-related vulnerabilities, encompassing a loss of clients and income, increased work availability, price reductions and negotiation difficulties, emotional functioning, health care access, safer sex negotiations, age, and immigration status. The findings serve as a basis for recommendations regarding social policies aimed at male sex workers who sell physical sex in Portugal.

When the law is silent: stigma and challenges faced by male sex workers in Japan

This study considers how invisibility under the law can lead to stigmatisation. It examines how legal silence affects the stigmatisation process and the identity of male sex workers in Japan. Since male sex work is currently not recognised under Japanese law, male sex workers are not subject to control, regulation, punishment or protection. However, the number of male sex workers in Japan is increasing. Many studies have noted that male sex workers may experience double stigmatisation – referring to the stigma associated with homosexuality and the stigma associated with commercial sex. Male sex workers in Japan, however, may face an additional stigma caused by the fact that the law essentially ignores their existence. This paper draws on fieldwork interviews to show how the silence of the law can exacerbate the marginalisation and disempowerment of a vulnerable social group.