Strategies of Stigma Resistance Among Canadian Gay-Identified Sex Workers

Abstract

The purpose of the current study was to explore how sex workers (specifically, gay-identified Canadian men working primarily, though not exclusively, as independent escorts) combat the pervasive negativity that surrounds their profession. Semi-structured interviews were conducted with 9 men, a majority of whom were targeted through escort review boards. Interviews were transcribed verbatim and analysed for themes of “stigma resistance.” Four themes were identified: (1) escorting is volitional (i.e., one isn't forced to work as an escort, rather it is a choice one makes); (2) escorting is a profession (i.e., the client is a customer and the escort a service provider); (3) the escort is in control during client/escort interchanges; and (4) escorting is distinct from, and better than, street prostitution. Directions for future research and limitations of the current study are outlined.     

Prevalence and Behavioral Correlates of Depression and Anxiety Among Male Sex Workers in Vietnam

ABSTRACT. Objectives: This study assessed depression and anxiety symptoms and their association with high-risk sexual and drug behaviors among male sex workers in 3 Vietnamese cities. Methods: Male sex workers ages 16 to 35 years old completed an interview that included the Center for Epidemiological Studies Depression Scale to assess depressive symptoms and the Beck Anxiety Inventory to assess anxiety symptoms, as well as questions assessing drug and sexual risk practices. Results: A majority of participants reported depressive symptomatology, although fewer reported symptoms of anxiety. Risky sexual and drug use practices predicted both types of symptoms. Conclusions: Mental distress is associated with drug and sexual risk among male sex workers.     

Reactions to First Postpubertal Coitus and First Male Postpubertal Same-Sex Experience in The Kinsey Sample: Examining Assumptions in German Law Concerning Sexual Self-Determination and Age Cutoffs

ABSTRACT

In German law, sexual self-determination is seen as undeveloped in minors ≤13 and underdeveloped from 14 to 15. Consequently, harm from sex with adults is assumed likely in the former and possible in the latter. We tested assumed harm using the Kinsey data on first postpubertal coitus and male same-sex experience by comparing reactions across 5 groups: minors/peers; minors ≤13/adults; minors 14–15/adults; minors 16–17/adults; adults/adults. Contrary to assumptions, for example, minors ≤13 with adults reacted just as positively and no more negatively than adults with adults. Present-day relevance of these data in light of cultural changes since Kinsey's time is discussed.     

An Episodic Analysis of Substance Use and Risky Sexual Behavior in a Racially Diverse Sample of Young Men Who Have Sex with Men

Many studies have examined the relations between drug use and sexual behaviors; however, few have utilized episodic data to examine the co-occurrence of both behaviors within the same episode. This study surveyed 403 racially and ethnically diverse gay, bisexual, and other young men who have sex with men (YMSM; ages 18–29) in New York City. Men were surveyed about their sexual behavior and concurrent use of illicit substances and alcohol during their most recent sexual encounter with their main and/or casual partner(s). Logistic regression models were built to analyze predictors of unprotected oral and anal intercourse with main and casual partners. Results suggest that use of inhalant nitrates and alcohol increased the odds of men engaging in unprotected receptive anal intercourse (URAI) and men who identified as middle or high socioeconomic status (SES) were at lower odds of engaging in URAI with their main partner. Use of other illicit substances was not associated with unprotected sexual intercourse. These findings indicate a need to further consider the role of licit substances used by YMSM as a means of further reducing the incidence of HIV infection in this population. In addition, the high rates of unprotected anal intercourse among men reporting a main partner has the potential to be a significant source of HIV risk, and should be further explored among YMSM.     

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.     

Traumatic Experiences and Drug Use by LGB Adolescents: A Critical Review of Minority Stress

High rates of illicit drug use found among lesbian, gay, and bisexual (LGB) adolescents are often attributed to unique and chronic traumatic events tied to sexual minority identity. Although initiation of drug use is relatively common within adolescence, little research contributes to our understanding of the disparities found among LGB adolescents. This review synthesized existing literature to determine if the minority stress model is applicable to LGB drug use disparities and fits within a trauma framework. Findings indicate that minority stress experiences have been inconsistently related to drug use among LGB adolescents. Implications for future research and practice are described.     

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.     

A Comparison of Sexual Behaviors and Attitudes,Self-Esteem,Quality of Life,and Drug Use Among Pornography Actors and a Matched Sample

ABSTRACT

The present study compared the self-reports of 105 porn actors to a sample of men matched on age, ethnicity, and marital status. Comparisons were conducted on sexual behaviors and attitudes, self-esteem, quality of life, and drug use. Porn actors’ first sex was at an earlier age, they had more sexual partners and a higher enjoyment of sex, they were more concerned about catching a sexually transmitted disease, and they were less likely to use a condom during a first-time sexual encounter compared with the matched sample, although there were no differences in incidence of childhood sexual abuse. In terms of psychological characteristics, porn actors had higher levels of self-esteem and quality-of-life indicators. Lastly, male performers were more likely to have used five different types of drugs compared with the comparison group during their lifetime and were more likely to have used marijuana during the past 6 months. These findings provide mixed support for stereotypes concerning male porn actors.     

A three-city comparison of drug use and drug use before sex among young men who have sex with men in the United States

High rates of drug use have been documented among young men who have sex with men (YMSM). However, updated prevalence data are needed to understand current trends, especially for drug use before sex. We used baseline data from an HIV prevention trial to examine demographic differences in drug use and drug use before sex among YMSM in Atlanta, Chicago, and New York City. Marijuana was the most commonly used drug, but alkyl nitrites (“poppers”), cocaine, and Ecstasy were also commonly used. Drug use was more prevalent among older and White YMSM, and it was similar across cities, although use of poppers and polydrug use were more common in New York City. Our data generally support national prevention efforts.     

Age at Entry into Prostitution: Relationship to Drug Use,Race, Suicide,Education Level,Childhood Abuse,and Family Experiences

This study seeks to explore factors related to age at entry into prostitution. Participants were 389 women arrested for prostitution who had attended a diversion program. Women who entered prostitution as minors were found to be more likely to be African-American; report having a family member with a substance use problem; have a history of attempted suicide; and not have completed middle or high school. The age at first drug use was found to significantly impact the reported age at entry. Key areas for intervention should include improving school connectedness and preventing adolescent substance abuse, specifically for African-Americans.     

Substance Use and Abuse and the Role of Social Workers in Germany

SUMMARY

The paper outlines major trends in consumption patterns of alcohol and other drugs in Germany with special focus on the use of cannabis among young people. It discusses primary prevention efforts and describes the current treatment system with its two branches: one for people with alcohol problems and the other for those with drug problems. It highlights the developing role of social work and identifies the research topics that are influenced by social workers and that will influence the debate regarding the future role of the profession.     

The Extent and Nature of Practitioners,Encounters with Alcohol and Other Drug Use in Social Work and Social Care Practice

This article considers the extent and nature of social work and social care practitioners' experience of working with service users whose lives are affected by the problematic use of alcohol or other drugs (AOD). It draws on the findings of a national study of ‘working with alcohol and drug use’ which was conducted in England in 2010–2011. The study reported here comprised an online survey of front-line practitioners (n = 597), complemented by 12 practitioner focus groups and interviews with 21 key informants from participating local authorities and substance use treatment services. This paper focuses primarily on data from one element of the survey. Findings indicate that the great majority of staff encountered service users who are affected by AOD problems at some level, although there were differences between groups of practitioners in the extent and nature of AOD problems for different groups of service users. The differential experiences of staff according to their client groups underlines the need for education and professional development not only to provide training on working with AOD but to ensure that training is contextualised and relevant to practitioners across the range of social work and social care services.     

Prostitution Ideology and Trafficking Policy: The Impact of Political Approaches to Domestic Sex Work on Human Trafficking Policy in Australia and the United States

Debates over the legitimacy and legality of prostitution have characterized human trafficking discourse for the last two decades. This article identifies the extent to which competing perspectives concerning the legitimacy of prostitution have influenced anti-trafficking policy in Australia and the United States and argues that each nation-state’s approach to domestic sex work has influenced trafficking legislation. The legal status of prostitution in each country and feminist influences on prostitution law reform have had a significant impact on the nature of the legislation adopted.     

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.     

Brief Screening and Intervention for Alcohol and Drug Use in a College Student Health Clinic: Feasibility,Implementation, and Outcomes

Abstract

Objective: Evaluation of the Brief Alcohol Screen and Intervention in College Students (BASICS) in a university primary care setting. Participants/Methods: Undergraduates (N = 449) participated in BASICS and electronic surveys assessing frequency/quantity of alcohol and drug use, psychosocial and mental health outcomes, and demographic information. Data were collected at baseline and 6-month follow-up between August 2006 and August 2008. Results: Drinking and drug use decreased between baseline and 6 months. Participants reported an increase in protective factors and in readiness to change alcohol-related behaviors, and a decrease in alcohol-related consequences and in distress symptoms. Heavy episodic drinking at baseline significantly moderated the changes in number of drinks in a typical week and in a typical weekend, and number of drinks on the occasion drank most on a weekend. Conclusions: BASICS can be implemented in a primary health care setting and university students may reduce their alcohol and/or drug use.     

Testing a New Measure of Sexual Health Knowledge and Its Connections to Students' Sex Education,Communication, Confidence,and Condom Use

ABSTRACT

This study investigates the nature of college students' sexual health knowledge, prior sex education coverage, and sexual communication and confidence. We created a new, comprehensive sexual health knowledge measure to assess 347 undergraduates' knowledge of reproductive health, contraception, condom use, sexually transmitted diseases (STDs), and HIV/AIDS. Overall, students demonstrated a fairly poor understanding of sexual health issues. Women were more knowledgeable than men, specifically on the topics of contraception and STDs. Prior exposure to sex education covering mainstream reproductive health issues or newer contraception methods was correlated with greater knowledge across all domains, particularly for men. Greater knowledge was also correlated with greater sexual assertiveness and confidence with condoms among women.     

Exploring Dimensions of Racism,Homophobia, and Social Network As Concomitant Predictors of Condom Use in a Sample of Black MSM

With a convenience sample of 148 Black men who have sex with men (MSM) who primarily resided in the Washington, District of Columbia, metropolitan Area, the purpose of this research was to concomitantly use dimensions of racism, homophobia, and social network constructs in a regression model to predict condom use. In the model, analysis indicated that condom nonusers versus consistent users experienced more conversations with friends regarding salient topics (i.e., HIV status) (odds ratio [OR] = .86, p < .01) and fewer discussions with sexual partners about salient topics (OR = .77, p = .02). Furthermore, inconsistent condom users versus consistent users experienced higher levels of internalized homophobia (OR = 1.12, p = .04) and less racism associated with physical characteristics (OR = .89, p = .04). Notably, all of the racism dimensions identified in this research were nonsignificant as positive predictors of condom use. Overall, based on the findings, internalized homophobia may need to be isolated or targeted as an HIV-risk factor when implementing individual- and group-level HIV-prevention strategies for Black MSM. Moreover, improved communication skills among Black MSM pertaining to discussing salient topics (i.e., HIV status) with their sexual partners could also be used as a possible HIV-prevention strategy.     

Self-rated Health in Relation to Rape and Mental Health Disorders in a National Sample of College Women

Abstract

Objective: The purpose of this study was to employ a multivariate approach to examine the correlates of self-rated health in a college sample of women, with particular emphasis on sexual assault history and related mental health outcomes. Participants: A national sample of 2,000 female college students participated in a structured phone interview between January and June 2006. Methods: Interview modules assessed demographics, posttraumatic stress disorder, major depressive episode, substance use, rape experiences, and physical health. Results: Logistic regression analyses showed that poor self-rated health was associated with low income (odds ratio [OR] = 2.70), lifetime posttraumatic stress disorder (OR = 2.47), lifetime major depressive episode (OR = 2.56), past year illicit drug use (OR = 2.48), and multiple rape history (OR = 2.25). Conclusions: These findings highlight the need for university mental health and medical service providers to assess for rape history, and to diagnose and treat related psychiatric problems in order to reduce physical morbidity.