The economy of risk and respect: Accounts by Puerto Rican sex workers of HIV risk taking

Three‐hundred eleven female drug‐using sex workers in urban Puerto Rico were asked to describe their last negotiation with a client. They described efforts to protect themselves from many hazards of sex work, including violence, illness, and drug withdrawal. They also described efforts to minimize the stigma and marginalization of sex work by cultivating relationships with clients, distinguishing between types of clients, and prioritizing their role as mothers. Sex workers adopted alternating gender roles to leverage autonomy and respect from clients. Their narratives suggest that sex workers negotiate a world in which HIV is relative to other risks, and in which sexual practices which are incomprehensible from an HIV‐prevention perspective are actually rooted in a local cultural logic. Future HIV prevention efforts should frame condom use and other self‐protective acts in terms that build upon sex workers' own strategies for understanding their options and modifying their risks.     

Entertainment Venue Visiting and Commercial Sex in China

ABSTRACT

Entertainment venues in China play an important role in the sexually transmitted disease (STD)/HIV epidemic. Most previous studies have focused on sex workers working in entertainment venues, but little is known about their clients. This study investigated the perceptions and behavior of the patrons visiting entertainment venues. Qualitative in-depth interviews were conducted with 30 male market vendors who visited entertainment venues at least once in the past 3 months in an eastern city in China. Information about their risky behavior, attitude toward commercial sex, and STD/HIV prevention approaches was collected. Saunas, karaoke bars, and massage centers are the most frequently visited entertainment venues. Seventy-three percent of study participants reported purchasing commercial sex at these entertainment venues. Participants expressed a very liberal attitude toward commercial sex. Seeking commercial sex was perceived as a characteristic of a male's nature. The perceived risks of STD/HIV infection do not deter participants from engaging in commercial sex. Commercial sex clients reported irregular condom use and a number of other misperceptions and improper practices toward preventing STD/HIV infection. Venue-based intervention is urgently needed to target the population. The sex workers themselves could potentially serve as “health educators” to communicate prevention information to their clients and encourage safer sex behavior.     

Sexual Risk,Behavior, and HIV Testing and Status Among Male and Transgender Women Sex Workers and Their Clients in Lima,Peru

Objectives: To determine the socio-demographics, sexual practices, and HIV prevalence of male sex workers (MSWs), transwomen sex workers (TSWs), and their male clients in Lima, Peru. Methods: Following ethnographic mapping of sex work venues, the authors revisited randomly selected venues to survey MSWs, TSWs and their clients. Results: MSWs and TSW clients are more educated than MSW clients and TSWs. Only 50% of TSW clients have received HIV testing. Self-reported HIV positivity is highest among MSW clients and TSWs. Conclusion: Notable differences exist between MSWs and TSWs and their clients that can affect the health of these groups and warrant intervention.     

How Does a “Risk Group” Perceive Risk?

Abstract

Throughout the HIV/AIDS epidemic, female sex workers have been identified as a “risk group” and interventions developed to reduce their behavioral risk-taking. Both individual and structural level programs continue to target “risks” such as multiple partners and lack of condom use. Sex workers themselves, however, are likely to view their experiences more holistically, perceiving a range of risks within their work. This paper presents qualitative data from a participatory study conducted with brothel-based migrant Vietnamese sex workers in Cambodia, illuminating one community's perceptions of the sex industry. It argues that design and implementation of effective HIV prevention activities must be based on sex workers' own interpretations and responses to risk, using them as a realistic entry point for effecting change. Actively engaging with sex workers through participatory research and projects offers the first step in shifting the current epidemiological focus toward identifying feasible, context-specific risk-reduction strategies.     

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 harm-reduction 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.     

HIV Risk Behaviors Among Three Classes of Female Sex Workers in Vietnam

Increases in the rate of HIV infection in Vietnam among female sex workers and their clients require more effective preventive interventions based on a better understanding of this population and important subgroups within it. Because little was known about women in the hospitality sex industry, this study compared demographic and work characteristics, history of sexually transmitted infections (STIs), and condom use among a sample of 310 female sex workers in low-, middle-, and high-class hospitality businesses in Ho Chi Minh City (mean age = 26.77 years, SD = 6.17). Data were collected through individual, face-to-face, semistructured interviews. Logistic regression models were used to identify demographic predictors of the incidence of STIs and reported condom use. Low occupational status was most strongly associated with a history of STIs, and use of condoms with new and regular clients also differed by occupational class. Implications are discussed.     

Sustaining an intimate and sexually fulfilled marriage or partnership in older adulthood with a disability: Perspectives of social workers

ABSTRACT

The American portrayal of sex is often left for only the young, attractive, and able-bodied. In contrast many studies have found that older adults with disabilities in marriages and intimate partnerships have sexual desire and sexually active lives. Social workers are often burdened with balancing the sexual intimacy desires of their older adult clients with disabilities, alongside the need to protect them from sexual abuse and exploitation, particularly among those who may lack the capacity to consent due to cognitive impairment. This phenomenological study aimed to understand the lived professional experience of social workers (N = 5) in supporting married and intimately partnered couples in which at least one person was an older adult with a disability to understand the clients’ needs and common social work practice methods used to address their needs. Inductive coding was used to identify themes and subthemes. Their role included helping their clients to learn about their ability to have sex, consenting to sex, negotiating accommodations for intimacy and sex with their spouses, and counseling those who took on caregiver roles for their spouses. Social workers reported that individual diagnosis, such as dementia, should not alone determine one’s ability to consent to sex.     

The Friends Thou Hast

Abstract

Most studies of male commercial sex workers (CSWs) in Thailand have been framed within a context of HIV risk and have investigated sexual behaviours and HIV knowledge. However, Mann et al. (1992) have identified health and social services and a supportive social environment as equally essential partners in an HIV-preventive triumvirate. This paper is based on extended observation and a series of in-depth interviews with forty-three male CSWs who are both organised (bar workers) and freelance as well as a number of clients (farang and Thai) and bar management. This paper examines the social environment in which male CSWs operate. It considers workplace conditions and support, the personal relationships workers have with parents, friends, clients, other bar workers and management, and how these are influenced by workers' cultural norms. A number of recommendations designed to reduce HIV-infection rates are made.     

Women's health and HIV: experience from a sex workers' project in Calcutta

This article narrates an inspiring discovery for development professionals who are searching for ways to empower women to protect themselves, their partners and families from HIV infection. This was based on the experience of the author as she came across a movement of sex workers who successfully negotiated safe sex in the heart of Calcutta, India. Employing focus group discussions, informal interviews and home visits during 1999, the author discovered that a Sexually Transmitted Disease/HIV Intervention Project has been set up to promote disease control and condom distribution among these sex workers. Operating on three principles for its work--respect, recognition, and reliance, the program aims to create an impact on the sex workers themselves and their peers. Likewise, the need to build alliances with clients, training the police and forming the Durbar Mahila Samanvaya Committee were deemed as necessary. Several lessons were learned during the course of the research: use of stories and history to rally the community; retaining flexibility, meeting changing needs; using drama to promote communication; and negotiating with men and opposing patriarchy.     

Where The Trans Men and Enbies At?: Cissexism,Sexual Threat,and the Study of Sex Work

In this article, I examine the existing research on transgender sex workers and explore how cissexism and sexism overlap and shape this work. Overall, researchers assume that all trans sex workers are women, and all male sex workers are assumed to be cisgender. Transmasculine and other gender non‐conforming sex workers are absent from studies of sex work. Researchers in public health and criminology dominate the literature and this research is limited because it focuses only on trans women and because it focuses primarily on disease and trauma, and almost exclusively on HIV. The literature I examined treats transgender women as a public health “problem” to be solved, rather than addressing their experiences and needs as workers and as people in our society. I argue that in order to have useful applied and policy implications aimed at harm reduction, researchers must use a sociological lens to document what structural conditions push and pull people of various genders into sex markets in the first place. Finally, I advocate for the use of queer, intersectional, and transnational frameworks in future lines of inquiries as a way to push the sociological and public health literature on sex work forward in a way that will benefit all sex workers, their advocates, and service providers.     

Youth workers' use of Facebook for mediated pastoralism with juvenile delinquents and youths-at-risk

Youth work seeks to rehabilitate juvenile delinquents for re-entry into mainstream society and to prevent youths-at-risk from falling into delinquency, thus necessitating that youth workers assiduously monitor their clients. With the avid use of social media by youths, youth workers must also adopt these communication platforms to reach out to their young clients. Drawing from interviews with youth workers, this study analyses how they use Facebook to communicate with their clients and monitor their activities. Surveillance forms a key thrust of youth workers' professional use of Facebook, enhancing their ability to oversee these youths' personal development for the purposes of mentoring and rehabilitation. Contrary to dystopian, power-centric conceptions of surveillance, the study finds that the youth workers' surveillance of their clients is undergirded by care and beneficence, better understood using Foucault's concept of pastoralism. Through mediated pastoralism via Facebook, these youth workers can derive a more extensive picture of their clients, including their emotional state and peer interactions. With this knowledge, the youth workers can then calibrate their interventions more strategically and only step in when their clients engage in behaviour that poses significant risks or danger. In so doing, the youth workers foster sustainable social capital with their clients that they can still leverage over time. Facebook communications also help the youth workers to bridge communication gaps with these youths. The study also examines how the youths resist the youth workers' oversight in various ways.     

Grappling with Realities: Policy and Practice in HIV Social Work

In 2012 the NSW HIV Strategy 2012–2015: A New Era was released, with a goal of eradicating Human Immunodeficiency Virus (HIV) by 2020. This new policy, prioritising biomedical treatment, has raised challenges for social work practitioners working in the HIV field. We undertook a research project exploring the implications of the Strategy on social work clients and practice. A questionnaire was sent to 57 HIV social workers and 32 (56.1%) responses were received. Thematic analysis identified five main themes affecting social workers and their clients. These were a new stigma, treatment benefits, the complexity of people's lives, the psychosocial voice, and ethical and professional tensions. We propose that a more holistic HIV strategy including the psychosocial realities that inform HIV transmission, testing and treatment options, and adherence be adopted.     

Managing Risk in Community Care of Older People: Perspectives from the Frontline

Abstract

Since the mid-1980s, Australian governments have focused on expanding community and home-based services for older people. This has led to increased levels of dependency, vulnerability, and complexity to be managed in the community. Consequently, aged care services have had to develop mechanisms for regulating and managing these increased risks, and risk management has become more central to the practices of professional workers in this field. This paper reports on some findings from a large-scale study that explores the way risk management policies have been translated into practice by community-based services in Victoria, Australia. Drawing on interviews with 18 frontline and management professionals employed in community aged care, we found that these workers were wrestling with a diverse and new range of institutional risks beyond those encountered in the actual delivery of frontline care. We found that these workers experienced “risk” in four different contexts, which often created demands for contradictory or conflicting responses. Here we examine these “contexts of risk practice”: professional workers' relationships with their clients, relationships with other service providers, the unregulated nature of the home as a work environment, and community expectations about the management of risk. Despite tensions that frequently arose, workers expressed strong professional commitments to their clients and were motivated to find positive resolutions amid competing interests. We conclude that tensions experienced by workers were embedded in the structural dimensions of institutional relationships and the systematic absence of shared understandings of “acceptable” risks in the community care of older people, rather than in the failure of professional agency.     

Female Sex Trade Workers,Condoms, and the Public-Private Divide

Abstract

This qualitative study explored the ways in which social relations within the public (work) as opposed to the private (home) contexts shape variable condom use among female sex trade workers. Semi-structured interviews were conducted with 68 female sex workers working in various settings in an urban center in Eastern Canada. The findings suggest that work-related social relations, and the meanings associated with condoms at work, create a strong confidence in condom use. Within the private setting, such confidence was also evident but most women reported either not using condoms or only using “sometimes.” Nevertheless, many women do engage in risk management within the private setting, and take active steps to decrease their risks of Human Immunodeficiency Syndrome (HIV)/Sexually Transmitted Infections (STIs).     

A Bioethics Approach to Social Work Practice With Transgender Clients

Increased advocacy for the informed consent model of transgender health care specifies that patients should be in control of access to receiving medical interventions such as hormone therapy or surgery. However, in practice, mental health clinicians, including clinical social workers, are increasingly called upon by medical providers to serve as gatekeepers for these processes. It is frequently the role of social workers to assess transgender clients’ baseline mental health and their understanding of the consequences of treatment, and to forward recommendations to medical providers regarding the readiness of patients to transition. Therefore, social workers assisting transgender clients must be aware of the ethical standards that are particularly pertinent to their work with this marginalized and oppressed population. They must also be prepared to address unique ethical dilemmas that may be especially challenging to resolve. In this article we apply the most commonly utilized bioethical framework known as Principlism to describe the ethical standards and values that are particularly important to consider when working with transgender clients, namely autonomy; beneficence; nonmaleficence; and social justice. Because clinical social workers are frequently in the position of balancing client self-determination with their role as gatekeepers, a framework for resolving resulting ethical dilemmas is described (I CARE) and applied to three case examples.     

Can't Buy My Love: A Typology of Female Sex Workers' Commercial Relationships in the Mexico–U.S. Border Region

Female sex workers (FSWs) experience elevated risk for HIV and sexually transmitted infections (STIs) through unprotected sex with male clients, yet the complexity of these commercial relationships remains understudied. From 2010 to 2011, we explored FSWs' conceptualizations of various client types and related risk behavior patterns using semistructured interviews with 46 FSWs in Tijuana and Ciudad Juarez, Mexico, where FSWs' HIV/STI prevalence is increasing. Our grounded theory analysis identified four types of commercial relationships: nonregular clients, regular clients and friends, clients who “fell in love” with FSWs, and long-term financial providers who often originated from the United States. As commercial relationships developed, clients' social and emotional connections to FSWs increased, rendering condom negotiation and maintaining professional boundaries more difficult. Drug abuse and poverty also influenced behaviors, particularly in Ciudad Juárez, where lucrative U.S. clients were increasingly scarce. While struggling to cultivate dependable relationships in a setting marked by historical sex tourism from a wealthier country, some FSWs ceased negotiating condom use. We discuss the need for HIV/STI research and prevention interventions to recognize the complexity within FSWs' commercial relationships and how behaviors (e.g., condom use) evolve as relationships develop through processes that are influenced by local sociopolitical contexts and binational income inequality.     

Ethical Dilemmas of Working with Individuals Who Have HIV Disease

This article presents the results of a survey of 99 practitioners that explored their attitudes related to the conflicting priorities of maintaining the principles of confidentiality, versus exercising one's duty to warn someone of danger. Social work practitioners face this dilemma in working with individuals who have HIV disease. When clients let workers know that they are engaging in unsafe sexual practices, and have not warned their partner of their HIV+ status, Practitioners are in a bind. Results show deep ambivalence in attitudes and actions. Discussion focuses on the dilemmas involved, and presents recommendations for practice.     

Facilities and HIV prevention in bathhouse and sex club environments

This project evaluated the extent to which businesses with a primary purpose of providing opportunities for sexual encounters between men (e.g., bathhouses and sex clubs) have implemented strategies that target their customers with important HIV and STD prevention messages. Between October 1996 and February 1997, we conducted structured telephone interviews with 63 businesses throughout the United States in order to describe their facilities and their HIV education and prevention efforts. Types of facilities offered were related to what businesses called themselves and the kinds of sex space they provided. All of the businesses reported that they provided condoms and lubricant on site; 95% provided educational materials such as posters and flyers about HIV/AIDS; and 40% provided HIV testing on site, with half of these also providing some type of STD testing. Although some level of HIV prevention and educational efforts by these businesses are described, further investigation into their efficacy is required.     

Young Clients of Hotel-Based Sex Workers in Bangladesh: Vulnerability to HIV,Risk Perceptions,and Expressed Needs for Interventions

ABSTRACT

A qualitative study was conducted among key informants and 53 young clients (15 to 24 years of age) of commercial sex workers from nine hotels in Dhaka, Bangladesh. Respondents reported first sexual encounter before 18 years of age, and reasons for purchasing sex were to prove masculinity or to reduce wet dreams and masturbation, thought to be detrimental to health. Limited knowledge of HIV and sexually transmitted infections was linked to high-risk sexual practices. Condom use was related to perceptions of cleanliness, status, and trust in the sex worker.

A hotel-based, confidential intervention program promoting safe sex practices among clients of sex workers is warranted.     

Time,Trust and Hazard: Hairdressers' Symbolic Roles

Field work on five hairdressers in a small, suburban beauty shop shows that routine hazards provide an organizational justification to establish and maintain processes which create and sustain trust, both with coworkers and clients. The study analyzes data from interviews and weekly observations, and details the types of workers and clients; the hairdressers' roles as caretakers, friends and riskbearers; the necessity of establishing “professional” identities with clients by scheduling appointments; and the construction of shared futures among “regulars.” In the course of observing the symbolic and temporal processes associated with trust, hazards to hairdressers from chemicals, equipment, and procedures are examined, followed by the kinds of risks effecting clients from chemicals, equipment, and hairdressers' technical competence and moral responsibility, as framed by their “honorific” professional roles.