Of all the populations that Canadian researchers have looked at in relation to male sex work, street youth and younger sex workers are the two that have been most frequently studied.

Sexual behaviour and condom use of younger male sex workers

Health Canada's 1998 Epi Update Series reported that recent studies of street youth indicated that 85-98% have had sexual intercourse, with over 60% indicating that their first sexual intercourse was before age 13. Between 52% and 78% reported six or more sexual partners in their lifetimes.117

The Badgley Committee (1984) reported that the sexual activities most frequently requested of young male sex workers were active fellatio (64%), passive fellatio (12%), anal sex (5%) and vaginal sex (12%).118 The Committee reported that only 14% of males indicated that they used condoms. Almost 18% of males said that when they fellated clients they required the men to wear condoms, and 46% did not require clients to wear condoms during intercourse.119 The Committee commented that

it is relevant in this context to recall that these findings were obtained during 1982-83 when there was a growing public awareness of the sharp increase in the reported incidence of Acquired Immune Deficiency Syndrome (AIDS). Despite this shift in the recognition of the hazards of this condition, it is evident that the juvenile male prostitutes had not as yet sought to afford themselves better protection by contraceptive means.120

A 1989 research project studied the HIV and AIDS knowledge, attitudes and behaviours of 137 street-involved people in Vancouver. Of the small proportion of this study that identified as younger male sex workers, all reported using condoms with clients.121

A second paper on this sample, presented in 1989, reported on results of 69 street-involved people who provided information on condom use, 40 of whom were male. Of the 69 people in the sample, 70% had supported themselves by sex work. Overall, "77% felt that AIDS was not as serious as the media said, 46% would use condoms with a new but not a steady partner, 45% felt their chances of catching an STD were low ... 85% always used condoms with Śdates' (i.e., customers) but only 26% always used condoms with Ślovers' (i.e., steady partners)."122

An Edmonton street sex work research project published in 1993 collected data on sex workers and reported on a subgroup of 20 males. Three of the 67 respondents were HIV antibody-positive, but it is unclear what proportion of these were male.123

A 1993 Toronto-area study of 695 street youth, 71% of whom were male, found that 12% reported ever having been paid for sex and 69% had sold sex in the previous six months. The younger male sex workers were more likely to always use condoms with female clients (68%) than with male clients (54%) and, although 38% of males involved in sex work reported participating in anal sex with clients, only 10% reported having unprotected anal sex at least occasionally with clients.124

And a study of 75 youth (49% male) conducted in Victoria in 1997 reported that 73% of its sample always used condoms with clients, 9% usually did, 3% occasionally did and 7% never did. "There were no statistically significant differences between males and females concerning condom usage; however the data indicate that older youth [18 or older] were more likely to use condoms."125

STDs in younger male sex workers

The risk of disease or health-related problems does not frighten young men enough to keep them off the street or to stop them from selling sex. One Toronto study (1986) found that "most kids reported that they were aware that there would be some risks involved in working on the street. Even though they soon learned that the risks could be far greater than they had originally anticipated, this, too, was not enough to deter them."126

For example, 52% of male sex workers told the Badgley Committee that they had contracted an STD, a sex-related disease or another condition since they began to actively participate in sex work. Of these, 84% had sought treatment. Overall, 66% said they regularly accessed health care, regardless of suspected STD infection.

A 1994 analysis reported on data from the Canadian Youth and AIDS Study (1989), which questioned 656 street youth, a little more than half of whom were male (54% male, 46% female), and 14% of whom were sex workers. The study found that 69% of male sex workers reported worrying about AIDS.127 Reported concerns about AIDS were higher for sex workers than for other groups of street youth. Sixty percent reported having engaged in anal intercourse, but only 55% of these had always used condoms. Sex workers were more likely than other subgroups to talk to prospective partners about using condoms (83%). However, sex workers also reported the highest rates of STDs (45% in males and 68% in females). "Among the male sex industry workers, 63% of whom had engaged in anal intercourse, regular condom use was associated with a lower reported STD history (36%) than for those who inconsistently used condoms (61%)."128 In their conclusions, the authors stated:

the large difference in reported STD rates among male sex industry workers who consistently used condoms vs those who did not (36% vs 61%) suggests that programs that facilitate and encourage all street youth to use condoms regularly have the potential to reduce their STD rates.129

In his book This Idle Trade (1987), sociologist Livy Visano used the research technique of participant observation, spending months observing and interviewing young male sex workers in Toronto. He found that the men he interviewed in pre-HIV 1982 were not highly concerned about the dangers of acquiring or transmitting these diseases:

So I got the dose. Big deal. I'll just give it to the trick. Even the score. I really don't give a sweet shit. Who cares.

Penicillin, that's it. It'll hurt. That's cool. I'm here for a good time. Don't plan to be a hermit.

Everybody's got some kind of disease. So what! Just like getting crabs, the clap is no different.130

Eleven years later, in a very different Toronto, Tremble (1993) found that

the rules of the hustling game are simple. No kissing. Money up front. No free second helpings. The point is to make it safe, impersonal and quick as possible. No one wants to be hurt, busted or embarrassed. Business is business. These rules are sometimes broken, and if drugs or a place to stay are badly needed, anything can -- and sometimes does -- happen. ... AIDS is a low-level concern for them. Getting by one day at a time means not living for tomorrow, and, in their adolescent fashion, they all think AIDS happens to someone else. In fact if these young men combine the dual threat of unprotected sex and sharing needles for injection drug use, they become a potential next wave in the AIDS epidemic.131

In a study conducted in Victoria in 1997, 75 "sexually exploited youth" were interviewed about a variety of issues related to their experiences in sex work. Of these, 49% were male. Though the report does not differentiate between male and female sex workers, the findings are illustrative. Three-quarters of the youth reported that they had been tested for an STD at some point in their lifetimes, approximately 65% in the previous year.132

Brannigan (1994) surmised that from the point of view of the client, youthfulness may have a particular appeal in terms of STDs because the client may view younger sex workers as less likely to have STDs.133

HIV and AIDS and younger male sex workers

A Toronto-area study of 700 street youth conducted in the early 1990s found that 16, or 2.29% of the sample, were HIV antibody-positive. Of these, 15 (94%) were male. More than half (eight) of the 15 youths had known and reported that they were HIV antibody-positive before testing for the study. Ten who tested HIV antibody-positive reported that they had sold sex to a male client in the previous six months. Seven of the 10 reported that they never had anal sex with clients. Those who reported having had anal sex with clients all reported always having used condoms with their clients, though with their regular partners they sometimes had unprotected anal sex. Interestingly, of the HIV antibody-positive youth interviewed, 60% had migrated or immigrated to Toronto from elsewhere in Canada or from another country.134

The same study reported that "street youth in Toronto have a high knowledge that HIV is transmitted sexually and through IV drug use. The youth are unsure whether oral sex is a low-risk or no-risk activity."135 Overall, 64% of male street youth reported that AIDS was their biggest health concern.136

A study conducted in Ottawa in 1994 asked 26 street youth, 12 of whom were male, what medical services were most needed on the street. Nine percent of respondents indicated that the service most needed was AIDS/STD testing.137

When the same question was asked of 61 street youth in Saskatoon (1994), 31 of whom were male, AIDS/STD testing was indicated by 37% of respondents.138

A 1996 analysis of 641 street youth in Montreal found that 8% of the sample reported having had male sex workers as sex partners. The study also found sex work to be associated with HIV infection in male street youth. It reported that 12 of 13 HIV antibody-positive respondents were male. The authors reported that further analysis was necessary "to determine the role of prostitution in HIV infection among street youth." Interestingly, having sex with men outside of sex work was not associated with HIV infection. Among the 122 men having sex with men, six were HIV antibody-positive.139 All six reported having engaged in sex work.140

A 1997 Victoria study of 75 youth involved in sex work, 49% of whom were male, found that approximately 75% of the sample stated that they had been tested for HIV at some point in their lifetimes, approximately 50% in the previous year. Of youth both male and female, 3-4% reported that they were HIV antibody-positive and an additional 9% indicated that they were unsure of their HIV antibody status.141

As of April 1997, Vancouver's Vanguard Study had reported that 24% of its sample (560 gay or bisexual men under age 30) had exchanged sex for money, drugs, goods, clothing, shelter or protection at some point in their lives and 13% had done so in the previous year.142

These men were more likely than the rest of the sample to use condoms for oral sex. And while there was little difference in the entire sample in terms of condom use for anal intercourse with regular partners, these men were less likely to use condoms when having anal intercourse with casual partners.

HIV antibody test results from the Vanguard Study indicated that 4.3% of men who had exchanged sex for money, drugs, goods, clothing, shelter or protection tested HIV antibody-positive at the beginning of the study, compared to 1.5% for the rest of the sample.

The report concluded that men who exchange sex for any of these commodities may be at higher risk for HIV infection than other men who have sex with men, due to their sexual behaviours, injection drug use and relatively unstable living conditions, as well as their deviant status in Canadian society.

As of April 1997, seven men from the Vanguard Study had seroconverted, or gone from an HIV antibody-negative test result at baseline to a positive test result at follow-up. Three of these seven reported having been paid for sex in the previous year.143 By April 1998, 10 men had seroconverted, and four of these 10 reported having exchanged sex for money, drugs, goods, clothing, shelter or protection in the previous year.144 In recent years the Vanguard Study has been criticized for grounding its reports of male sex work and HIV and AIDS on a definition of paid sex that is questionably broad.145 Nevertheless, the study continues to report that "compared to subjects who remained HIV negative, HIV seroconverters were more likely to have been paid for sex."146

Data from the Vanguard Study have been compared to data from the OMEGA Cohort (1998), a study to estimate HIV incidence and risk factors among men who have sex with men in Montreal.147 At the time of the analysis, 25% of the Vanguard Study's 631 participants had been paid for sex, compared to 21% of the 392 men in the OMEGA sample. In addition, 11% of the Vanguard sample had paid for sex, compared to 9% of the OMEGA cohort. Of the subsamples of reported sex workers, 9% of the Vanguard sample and 4% of the OMEGA sample reported having had unprotected anal sex with male clients. Of the subsample of reported clients, 5% of the Vanguard sample and 1% of the OMEGA sample reported having had unprotected anal sex with male sex workers.148

The AIDS-related attitudes of younger male sex workers

The Canadian Youth and AIDS Study (1989) asked questions about a variety of health issues, particularly in relation to HIV and AIDS. The male sex workers in the sample had the following to say:

On protecting themselves against HIV and AIDS:

You could tell if they have AIDS if they're real skinny and ugly, and you can tell fags.

Keep clean after sex -- like, shower.

I do not have anal sex.

I don't hang around with people who might have the virus. Isn't it people with scabs on their faces and don't they lose a lot of weight? I'm really careful.

On accessing information:

Actually, it's hard to know [what the risks are] 'cause you've got a bunch of people saying don't have sex at all, and another group saying do whatever you want. If you listen to the stuff on television it's so confusing.

I can get six articles [on AIDS] daily out of the newspaper and I'm finding a lot of contradictions.

On attitudes towards people with AIDS:

I don't care about it. Attitudes with my friends is that it's a faggot's disease.

It's reality; they know before they turn gay they're going to get it.

Before, I felt no remorse for people who had [AIDS], but now that I have friends who have it, it turned me right around.149

Footnotes

117. Health Canada, Sexual Risk Behaviours of Canadians, HIV/AIDS Epi Update, Bureau of HIV/AIDS and STD and TB, Laboratory Centre for Disease Control, Ottawa, Health Canada, May 1998e. [back]

119. Badgley Committee (Committee on Sexual Offences against Children and Youth), Sexual Offences against Children, Ottawa, Department of Supply and Services, 1984.

120. Ibid., p. 1023.

121. Rekart, M. L. and Manzon, L., Knowledge, Attitudes and Behaviours of Street-Involved Persons in Vancouver, Ottawa, National AIDS Clearinghouse, Canadian Public Health Association, 1989.

122. Rekart, M. L., Manzon, L. and Loftus, P., Knowledge, Attitudes and Behaviours of Street-Involved People in Vancouver, paper presented to the Vth International Conference on AIDS, Montreal, June 1989.

123. Edmonton Social Planning Council, Street Prostitution in Edmonton, Edmonton, Street Prostitution Project, 1993.

124. Read, S., DeMatteo, D., Bock, B., Coates, R., Goldberg, E., King, S., Major, C., McLaughlin, B., Millson, M. and O'Shaughnessy, M., HIV Prevalence in Toronto Street Youth, Toronto, The Hospital for Sick Children, 1993.

125. Research Subgroup of the Sexually Exploited Youth Committee of the Capital Regional District, A Consultation with 75 Youth Involved in the Sex Trade in the Capital Regional District (CRD), Victoria, Capital Regional District, 1997, p. 36.

126. Mathews, R. F., Mirror to the Night: A Psycho-Social Study of Adolescent Prostitution, unpublished PhD thesis, Department of Education, University of Toronto, 1986, pp. 146-47.

127. MacDonald, N. E., Fisher, W. A., Wells, G. A., Doherty, J. A. and Bowie, W. R., "Canadian Street Youth: Correlates of Sexual Risk-Taking Activity," Pediatric Infectious Disease Journal, 1994, 13, 8, pp. 690-97.

128. Ibid., pp. 694-95.

129. Ibid., p. 696.

130. Visano, L., This Idle Trade, Concord, Visano Books, 1987, pp. 223-24.

131. Tremble, B., "Prostitution and Survival: Interviews with Gay Street Youth," Canadian Journal of Human Sexuality, 1993, 2, 1, pp. 42-43.

132. Research Subgroup of the Sexually Exploited Youth Committee of the Capital Regional District, A Consultation with 75 Youth Involved in the Sex Trade in the Capital Regional District (CRD), Victoria, Capital Regional District, 1997.

133. Brannigan, A., Victimization of Prostitutes in Calgary and Winnipeg, Research, Statistics and Evaluation Directorate, Policy Sector, Department of Justice, Technical Report #TR1996-15e, Ottawa, Department of Justice, 1994.

134. DeMatteo, D., Read, S., Bock, B., Coates, R., Goldberg, E., King, S., Millson, P., McLaughlin, B., Major, C. and O'Shaughnessy, M., HIV Seroprevalence in Toronto Street Youth, paper presented to the VIIIth International Conference on AIDS, Amsterdam, Netherlands, July 1992; Read, S., DeMatteo, D., Bock, B., Coates, R., Goldberg, E., King, S., Major, C., McLaughlin, B., Millson, M. and O'Shaughnessy, M., HIV Prevalence in Toronto Street Youth, Toronto, The Hospital for Sick Children, 1993.

135. DeMatteo, D., Read, S., Bock, B., Coates, R., Goldberg, E., King, S., Millson, P., McLaughlin, B., Major, C. and O'Shaughnessy, M., HIV Seroprevalence in Toronto Street Youth, paper presented to the VIIIth International Conference on AIDS, Amsterdam, Netherlands, July 1992.

136. Read, S., DeMatteo, D., Bock, B., Coates, R., Goldberg, E., King, S., Major, C., McLaughlin, B., Millson, M. and O'Shaughnessy, M., HIV Prevalence in Toronto Street Youth, Toronto, The Hospital for Sick Children, 1993.

137. Caputo, T., Weller, R. and Kelly, K., Phase II of the Runaways and Street Youth Project: The Ottawa Case Study, Policing Division, Solicitor General of Canada, Final Report #1994-11, Ottawa, Ministry of Supply and Services, 1994a.

138. Caputo, T., Weller, R. and Kelly, K., Phase II of the Runaways and Street Youth Project: The Saskatoon Case Study, Policing Division, Solicitor General of Canada, Final Report #1994-12, Ottawa, Ministry of Supply and Services, 1994b.

139. Note that five of the six had also injected drugs.

140. Roy, E., Hayley, N., Boivin, J., Frappier, J., Claessens, C. and Lemire, N., Risk Factors for HIV Infection in Street Youth, paper presented to the XIth International Conference on AIDS, Vancouver, July 1996a.

141. Research Subgroup of the Sexually Exploited Youth Committee of the Capital Regional District, A Consultation with 75 Youth Involved in the Sex Trade in the Capital Regional District (CRD), Victoria, Capital Regional District, 1997.

142. Miller, M. L., Strathdee, S. A., Martindale, S. L., Cornelisse, P. G. A., Hogg, R. S., Cook, D., Montaner, J. S. G., O'Shaughnessy, M. V. and Schechter, M. T., Characteristics of Male Sex Trade Workers Enrolled in a Prospective Study of HIV Incidence, paper presented to the Sixth Annual Canadian Conference on HIV/AIDS Research, Ottawa, May 1997a.

143. Strathdee, S. A., Martindale, S. L., Hogg, R. S., Cornelisse, P. G. A., Miller, M. L., Devlin, B., Cook, D., Rekart, M. L., Montaner, J. S. G., O'Shaughnessy, M. V. and Schechter, M. T., HIV Prevalence, Incidence and Risk Behaviours among a Cohort of Young Gay/Bisexual Men, paper presented to the Sixth Annual Meeting of HIV/AIDS Surveillance and Epidemiology, Quebec City, November 1997.

144. Martindale, S. L., Strathdee, S. A., Miller, M. L., Cornelisse, P. G. A., Hogg, R. S., DeWit, J., Willoughby, B., Woodfall, B. and Schechter, M. T., Unsafe Sex and Elevated HIV Incidence Among Young Men Having Sex With Men, paper presented to the Seventh Annual Canadian Conference on HIV/AIDS Research, Quebec City, April/May 1998.

145. See the section How Canadian research has defined and measured the HIV risk of male sex work, elsewhere in this document; see also The Vanguard of Sexploitation, at http://www.walnet.org/csis/groups/swav/vanguard-3.html.

146. Martindale, S. L., Strathdee, S. A., Miller, M. L., Hogg, R. S., Woodfall, B., Sestak, P. and Schechter, M. T., Unsafe Sex and Elevated HIV Incidence Among Young Men Having Sex With Men (MSM), paper presented to the XIIth International Conference on AIDS, Geneva, Switzerland, June/July 1998.

147. Dufour, A., Parent, R., Alary, M., Otis, J., Remis, R., Masse, B., Lavoie, R., Le Clerc, R., Turmel, B., Vincelette, J. and the OMEGA Study Group, Characteristics of Young and Older Men Who Have Affective and Sexual Relations with Men (MSM) in Montreal, paper presented to the Seventh Annual Canadian Conference on HIV/AIDS Research, Quebec City, May 1998.

148. In contrast to the Vanguard Study the question asked of OMEGA respondents was "Have you ever received money in exchange for sex?"

149. King, A. J. C., Beazley, R. P., Warren, W. K., Hankins, C. A., Robertson, A. S. and Radford, J. L., Canada Youth & AIDS Study, Kingston, Queen's University at Kingston, Social Program Evaluation Group, 1989.