Masquerading as "community research," the Vanguard Project is really just sloppy science in a quest for personal gain and social status that is alienating the clients of public health services. The Vanguard Project is a classic example of how research can exploit the people it claims it will help to establish profitable academic careers. All of this paid for out of the public purse.

At the end of February, 1995 I received a phone call from Steve Martindale of the Vanguard Project, in response to an article on the Sex Workers Alliance of Vancouver in The West Ender, a local weekly, a week earlier. I was asked to join the community advisory committee for the project. At the next committee meeting following that phone call, late April, Martindale, the project coordinator, announced that the questionnaire was finished, it had been printed and distributed to the testing sites. He joked that if anyone did have any concerns, they could keep them to themselves -- see him after the meeting.

Upon reading the questionnaire, I did have concerns, and I tried to raise them, wanting the whole advisory committee to hear them. The questionnaire contained a section on "paid sex." Martindale asked me to see him after the meeting. The entire meeting was spent talking about what images to put on the posters and praising the logo. After the meeting, I approached Martindale and tried again to raise my concerns about the questions specific to sex work. He dismissed me with "I'll make a note of it, maybe the data from those questions won't be analysed anyway."

My main problem with the questionnaire had to do with the broad definition of "paid sex." Any results of HIV incidence with regards to male sex workers, will reflect on those who are visible and identify as sex workers. But, the "data" will have really been drawn from the much broader experience of any form of compensation in exchange for sex.

"For the purposes of this study, we are defining 'paid sex' in the following way "Paid sex includes sex exchanged for money, drugs, goods, clothing, shelter or protection..."

This loose definition of "paid sex" allows the category of people responding to be very broad. Research that suggests that this group of people were not having safe sex and were contracting HIV could have an ill-effect on how visible male sex workers are perceived by the public and by law enforcement, public health and government policy-makers. It has not even been ten years since prostitute advocates and activists protested possible quarantine legislation for HIV-positive prostitutes in BC and Ontario.

Case law also shows forced HIV testing of people charged and convicted of prostitution offences. On August 21, 1987, BC Provincial Court judge Collings sentenced a male sex worker to six month probation. One of the conditions of his probation was to have monthly HIV tests and report that he had done so (but not the results) to his probation officer. The condition was appealed in County court (now the Supreme Court of BC) and was upheld by Judge Ryan, but the number of tests was reduced to one during the six-month probation. There was also a similar case involving a female prostitute in Ontario in 1987 (July 13, 1987 judgement by W.P. Ross, Ontario Provincial Court).

As recently as March of 1994, police in London, Ontario forced hustlers they were interrogating (in relation to the "kiddie" porn investigation) to take HIV tests. To quote a hustler from the CBC Radio Ideas program The Trials of London (aired May 11, 1995), "The cops told me if I didn't come down to the station they would send an officer to my house and they would hold me down..."

Adding insult to injury, the questionnaire then asks, "Have you every been paid more to have unsafe sex?" This question assumes that the responsibility belongs entirely on the prostitute. It doesn't ask, for instance, "Has anyone ever offered you more money to have unsafe sex?" There is no comparable question aimed at clients such as, "Have you ever offered someone more money to have unsafe sex?" As well, safe sex is not clearly defined, making it impossible to distinguish what sex acts were happening without protection. From this I can only conclude that the "Paid sex" section of the questionnaire is based on the assumption that people who have sex for money do so only out of desperation -- desperation for money that overrides their personal concerns for their health. This is offensive.

On May 15, (which I honestly was unaware was the day of the Vanguard launch!) I made my exit from the Vanguard Project by faxing a letter outlining my concerns to the community advisory committee, the project directors, government funders and the gay press, as well as sex workers' rights groups, national and international. An obviously very upset Steve Martindale left a long message on my voice mail in which he said that the community shouldn't attack each other, and that I "will never make any friends in this town." He concluded, "You were invited to the launch party, but I certainly don't want to see you there now."

Two years later, on Thursday, May 22, at the 1997 Canadian AIDS/HIV Research (CAHR) conference in Ottawa, Steve Martindale and Mary Lou Miller, R.N. of the Vanguard Project presented two abstracts: "Characteristics of Male Sex-Trade Workers Enrolled in a Prospective Study of HIV Incidence" and "Evidence of Psychologic Distress in a Cohort of Young Gay and Bisexual Men."

In May 1997, I went up to the provincial STD Control clinic for a regular check up. While I was there I filled out a form (which I got from the nurse) for community groups who wanted to receive bulk condoms. I asked for four gross (144) to start. A woman phoned me back and we played telephone tag a bit. Finally I got a hold of her. She told me that she had asked around about my group. I informed her that I wasn't from the Social Workers Alliance of Vancouver, it was the Sex Workers Alliance.

She told me that she could only give out condoms when she had "overflow" -- after giving out the allocated condoms to the already enrolled groups. She told me that she often has lots of old condoms kicking around in drawers and places, and sometimes they expire. She told me I should encourage girls who have lots of extras to share with other girls. I could also contact the head of the street nurses, Anne MacNab to try to get a few.

The Vanguard Project was launched in May of 1995 "to monitor HIV incidence rates and associated risk factors among young men who have sex with men." The research is being conducted by the B.C. Centre for Excellence in HIV/AIDS at St. Paul's Hospital and the University of British Columbia under the direction of Dr. Martin Schecter. Stephanie Strathdee is also supervising the project. Vanguard's goal was to recruit 1000 men between the ages of 18 and 30 who have sex with men into a three-year study, which includes annual HIV tests. If the young men reported having tested positive for HIV previously, they were excluded from the study.

"AIDS toll feared on rise with youths," was the title of a Vancouver Sun (August 1, 1995 p.A12) story , which featured the Vanguard Project launch. Here the study is reported to be looking for more than HIV incidence rates and associated risk factors. Vanguard will also be looking at "risk factors" such as "educational level and life experience. The study is trying to determine whether childhood sexual abuse is associated with higher HIV infection."

By June of 1996, the Vanguard Project reported the results of its first year's worth of data, based on 300 completed questionnaires (out of their original target of 1,000). Things were even worse than they had suspected. Using the media, including the local gay paper, XTRA! West ("Study finds risky sex still common," June 27, 1996 p. 13.), the Vanguard Project informed the public (and therefore the study sample) that half of the young men who have sex with men in Vancouver reported "at least one incident in the past year of unprotected anal sex." (The West Ender, June 27, 1996).

At the IX International Conference on AIDS here in Vancouver (July 7-12, 1996), the Vanguard Project presented "Risk Behaviours and HIV Prevalence Among a Cohort of Young Men Who Have Sex with Men in Vancouver," the abstract concludes that: "Sexual abuse in childhood and adolescence is clearly associated with subsequent sex trade activity; the relationship between sexual abuse and risk behaviours warrants further attention."

It's not surprising that the Vanguard Project found a correlation between "paid sex," which the questionnaire basically defines as any kind of reward for sex, and childhood sexual abuse, incest or other, which often involves some sort of bribe or guilt gift.

Linking childhood sexual abuse to AIDS and risk-taking was fashionable at the AIDS conference. There were twelve abstracts on the topic. Four of the abstracts also reported correlations between childhood sexual abuse and sex work.

The Vanguard Project also presented an abstract called, Sexual Abuse is an Independent Predictor for Sexual Risk-Taking Among Young HIV-Negative Gay Men: Results From a Prospective Study at Baseline. This abstract concludes:

"...sexual abuse was independently associated with a two-fold increased risk of sexual risk-taking, which suggests that sexual abuse counselling should be a component of HIV prevention efforts. Further study of the relationship between past sexual abuse, psychologic distress and the ability to negotiate safer sex is urgently required in an effort to reduce the risk of HIV transmission in this vulnerable population."

Vanguard's new findings after two years of collecting data is just another attempt to validate assumptions made about the correlation between class background, childhood sexual abuse and risk-taking behaviour with regard to HIV and involvement in the sex industry.

What the Vanguard study really proves, however, is that half of the young men who have sex with men who seek out an HIV test, (including at walk-in street clinics (who report not having tested HIV-positive before), reported doing something risky for catching HIV. In other words, half of the young men had a reason to go and get an HIV test. Here's why.

The Vanguard study claims to recruit subjects to participate in the study and then have a blood test done. But in these new abstracts, Vanguard boasts of its success using street nurses, who provide HIV and STD testing at walk-in clinics, to recruit young men (who are coming in for anonymous HIV tests). I personally received reports from three people, who were just wanting to get tested, and had the nurse really push the Vanguard study. (As one nurse put it, "It's giving back to the community" -- a quote from the Vanguard brochure.)

Could someone who has had this experience and participated in the study feel uncomfortable enough to not return for testing or for follow-up? Maybe not even return for his results? One person (not a sex worker) reported to me that he had thought he had seroconverted and waited months before testing because he did not want to seroconvert "in front of the Vanguard project," but he was already involved with it. He said he knew other people who felt the same way.

One report I received from a "street hustler" (working his way to finish highschool) went in for an HIV test. Smartly, he used a birthdate that made him 18 years old. He was, in fact, 16 at the time. I asked him why he initially joined the Vanguard study. He told me, "I just wanted to feel like I was part of something gay, I wanted my name somewhere as a gay person." Having his name registered somewhere as a gay person, in fact put him at some risk. If someone is working as a prostitute underage, agency workers are required legally to report them to child welfare authorities.

While the study might be confidential, it is not anonymous, because the study requires contact information in order to solicit and track annual questionnaires and HIV tests. Those questionnaires can hold very sensitive information about your sexual behaviour and they are linked to your HIV status.

Recently, provincial supreme courts have ruled that medical records, such as those held by therapists, and mental health institutions can be subpoenaed as evidence in sexual assault cases. There is no reason to believe that Vanguard information couldn't also be obtained through subpoena in a court case alleging intentional HIV infection, just because the information is blinded by keeping database records and contact information separated but then linking the information using numbers.

When someone consents to an HIV test and decides to fill out a questionnaire, just how informed are they of all the possible repercussions? Vanguard's male sex trade worker abstract then goes on to describe recruitment methods that are particularly dubious:

"Recruitment of the street-involved sex-trade workers occurred primarily at the outreach clinic specializing in street youth. ... The majority of sex trade workers heard about the study either through the street youth clinic or from their friends." "Over half (57%) of the sex trade workers were tested at the walk-in clinic for street youth." "For example, pizza parties were held at attract street youth and food vouchers were offered on completion of the questionnaire and the HIV antibody test."

Bear in mind that these are young men who already need and use the services of street clinics which provide things like STD testing, needle exchange, help with welfare cheques, maybe transit tickets, referral to other services like housing, food banks etc.

The Vanguard brochure also offers, as extra incentive, physician referrals for gay-positive doctors, and the B.C. Centre for Excellence which "distributes drugs for people with HIV/AIDS," and "participates in clinical trials."

So what's my problem with using street-based services like walk-in clinics to recruit a research sample? There are two. One is just sloppy science. The other is possibility that research could be driving needy people away from health and other services.

A sociologist at Concordia University has something to say about research that draws its data from social agency samples. According to Fran Shaver (in presentation at the When Sex Works: International Conference on Prostitution in Montreal last fall, "Traditional Data Distort Our View of Prostitution,") "Over-reliance on official crime statistics, police reports, as well as clinical and social agency samples provides an incomplete and misleading portrait of prostitution."

"The data from police and court samples, as well as clinical and agency data, also portray prostitutes as young, single, addicted, under-educated, and from backgrounds with a history of poverty and abuse."

Shaver says that field study is the only way to gather a fair sample. That's how she conducts the Sex Work Research Project at Concordia, Field work conducted over four summers in San Francisco, Montreal and Toronto. According to Shaver, "this research has provided information which is empirically grounded, strictly sampled, and more representative of street prostitution."

"When the results from the official and anecdotal data are compared to these field studies, it becomes clear that the former distort the picture by grossly over-estimating women's involvement, misrepresenting the conditions of work, and exaggerating or overstating the disadvantaged backgrounds of sex workers."

Shaver has been researching issues related to prostitution since 1983. Her published research includes "Men have sex with men: A comparison of the sexual practices and risk-taking behaviour of gay and bisexual men and male prostitutes," in May, 1996.

In one of her papers, "On the stroll: Ethical Concerns When Conducting Research Among Street Prostitutes," published in the CASH (Coalition Advocating Safer Hustling) newsletter, August 1994, Shaver states:

"Deciding who to interview raises special concerns...In order to preserve [the integrity of the data], we only interview people we have seen working on several occasions and who are not under the influence of alcohol or drugs at the time of the asking. It is also important to ensure that the distinguishing characteristics of those interviewed reflect as much as possible the characteristics of the stroll population in question. These guidelines are much more difficult to follow with respect to male hustlers: there is a higher turn-over rate, they are more willing than the women to self-select, and more likely to bring along a buddy who also wants to be interviewed. In Toronto and Montreal, we also found they were more likely to have a substance abuse problem and to want to do the interview simply for the $20 honorarium. We learned to say "NO.""

By May 1997 (two years), the Vanguard Project was able to find 74 men under 30-years-old, (although the median age was 24) who reported that they hadn't tested positive previously and that, at least once in the last year, they had traded sex for "money, drugs, goods, clothing, shelter or protection," the definition of "paid sex" in the questionnaire. (The only thing the Vanguard project left off the list is affection.) The questionnaire does not distinguish between men who identify as sex workers and those who have had only casual commercial sexual encounters, perhaps only when they were most desperate.

Martindale continues: "This may be a broader definition than what is commonly understood as prostitution. A number of participants in this cohort do not fit the stereotype of street hustlers. For instance, some of the respondents are also post-secondary students." I am not sure what his stereotype of the street hustler is. I "hustled" the streets of Toronto to get myself through college and I know others who have done the same.

This group of 74 young men provided the Vanguard Project with the fodder (their "sample" -- one-time questionnaires collected over two years) on which Martindale recycles his assumptions that "male sex trade workers" are more likely to have been "institutionalized in a psychiatric ward, to be depressed, or to have been to jail." They are more likely "to be of a lower socio-economic status, as indicated by lower education and income and living in unstable housing (defined as living primarily in a hotel or transition house, on the street or in jail)."

According to Martindale, "male sex trade workers" are more likely to not be white, not to have a high school diploma, to use recreational drugs, to use needles, to smoke crack and to have been sexually abused as children. We are more likely to have sex "outside (for example in parks), which is consistent with their unstable housing." (I guess Martindale has never been at the fruit loop when the limo or the BMW or the brand new white Jeep pulled up.)

"Sex trade workers" were more likely to use condoms for blowjobs than the rest of the study, and less likely to use condoms for "insertive anal sex" with casual partners, someone you see less than once a month ("this could be due to a common misconception that insertive anal sex is a lower-risk activity"). Martindale highlighted one of the big insults to sex workers in the study when he stated that the whole cohort was more likely to have sex without condoms with a regular partner, but: "due to the wording of the questionnaire, we aren't able to differentiate between clients and non-clients. It should not be assumed that regular partners exclude clients, since many sex workers have "regular" clients or "sugar daddies" -- often married men -- who may in fact be their primary male partner." What evidence in this study did Martindale draw this cliche conclusion from?

Then Martindale states: "Finally, it should be noted that 19 per cent reported being paid more to have sex without condoms, which is a reminder that among male sex trade workers, economic need may sometimes compromise decisions surrounding safer sex."

Casting more doubt on the accuracy of this research, Martindale then displays contempt for his research subjects. According to Martindale, "completion of the questionnaire is sometimes hampered by low literacy levels and English as a second language, and also by the influence of drugs or alcohol." It seems perverse to me to use a long (13 pages) self-administered questionnaire if you have even a hint that the population you are researching might have low literacy or poor English skills.

Using bad science to reproduce tired stereotypes about prostitutes is bad enough, but it is unethical to also hamper health services in the process. Near the end of the abstract, Martindale also noted that of those 74 young men who had been "paid" for sex, only 19 have returned for follow-up. I wonder why? Even according to Martindale the young men in this "vulnerable population" are not returning. "Men who have not yet returned are significantly younger, and are more likely to have reported being paid for sex," Martindale tells us in another abstract.

Having become involved in this research, will these young men now not come back to use the services at the street clinic? When the 19 men come back for their next pizza party, follow-up and free food vouchers they can wonder which of them who didn't return (three, according to Vanguard) have seroconverted. Will any of the other 55 men who have not yet returned for a follow-up survey and HIV test not come back to the street health clinic in order to avoid the Vanguard study? Will those who have tested HIV positive while participating in the study still come back to the clinic when they are in need of services?

If you test positive for HIV you are directed to the VLAS (Vancouver Lymphadenopathy-AIDS Study), ongoing since 1982 a study for "recent seroconverters" who are gay men over 18 years old. If you have recently seroconverted you are directed to St. Paul's for anti-viral treatment research for early seroconverters. It all seems like procuring for the purposes of academic research to me. Well-paid professional jobs for at least three years to prove that people living without homes or regular sources of enough income take risks.

While disrupting health services and producing bad, cliched and dangerous research may seem bad enough, I can't help also thinking this research is also opportunist and self-serving. Why? "Because the results of this type of research directly affect public policy. For instance, an accurate picture of HIV-infection rates influences decision-making on the distribution of government funds for health care and AIDS education," according to the Vanguard brochure.

The Vanguard is finally getting those hard-to-learn answers: "Prevention efforts must: target male STWs (both gay and straight identified); emphasize condom use during anal sex; take into account cultural, socio-economic and sexual realities." Does it really require three years worth of research money to come up with something we've known since 1986?

Steve Martindale used to do AIDS prevention education (Man to Man) for AIDS Vancouver. Stephanie Strathdee used to work for Street Outreach Services in Toronto, a street-based project to help prostitutes off the streets that catered to boystown and the trannie stroll. Anyone smell a request for government funding for an AIDS prevention project for Male Sex Trade Workers?

Andrew Sorfleet, A.O.C.A.

Coordinator, Sex Workers Alliance of Vancouver
Regional Coordinator for International Network of Sex Work Projects, UK.
Male STW -- eight years