HIV and other STDs are not the only health issues confronting male sex workers and their clients. There have been studies indicating that sex workers have great difficulty accessing physical and mental health services in general.
In 1987, the National Youth in Care Network conducted a national consultation on juvenile prostitution. As part of a panel discussion, the following question was asked of a group of young people: "Are there medical services accessible/available to you and what would be most useful to you right now?"
Two comments evoke the situation of male sex workers seeking health care in Canada:
[HIV] testing is supposed to be confidential, but there always ends up to be people knowing and talking about your medical problems.
When entering a hospital for medical care, the first thing I was asked was whether or not I was homosexual. Upon answering yes, the practitioners immediately put on face masks and rubber gloves and I felt like I was being treated like some kind of experiment.218
Others have suggested that
despite universal health care access in Canada, a high-risk population is not using the present system of health care delivery. A proposal to send health care professionals into the street to recruit high-risk youth for a complete medical examination and sexually transmitted disease screening should be contemplated. The cost for this type of health care delivery will be minimal in comparison with the human suffering and cost of the complications associated with sexually transmitted diseases.219
Today, in Canada, there is more evidence to support the argument that male sex work and HIV and AIDS are not necessarily associated. Within this context, sex work advocates believe that police and policy makers should turn their attention away from their current stance of criminalization towards another framework that would promote occupational safety and healthy sexuality.
Attitudes, laws and policies which stigmatize and discriminate against sex workers affect the "health, well being and safety of sex workers, particularly street prostitutes, and increase their vulnerability to HIV infection."220
Sex workers are often disinclined to access health and social services on account of the stigma associated with their occupation.221
Nevertheless, despite evidence which does not support the "exaggerated link" between male sex work and HIV and AIDS, "policies directed at the sanitary policing of prostitutes are still evident today."222
If there was more of a workplace structure for boys to work in, the "harm," or maybe better "risk," would be reduced dramatically. It is precisely because we have no legal place of work (especially in small cities and towns) that it is left to the street, including runaways and survival sex. And it is in this grey area of negotiation, trust and relationships that younger guys are most at risk of having regular unsafe sex and catching something.223
Forced or mandatory medical examinations and HIV antibody testing for sex workers in Canada
An important issue associated with sex workers' access to health care is the question of forced or mandatory medical examination of sex workers, including HIV antibody testing.
In 1984, 69% of Canadians agreed with the statement that "prostitution is a major cause of the spread of venereal disease," and 82% agreed that one of the roles of government in adult sex work was to "require prostitutes to have medical examinations."224
The Ontario Law Reform Commission (1992) was not convinced that mandatory testing of sex workers could deter high-risk sexual behaviour. The Commission also found it unclear "how involuntary testing could be useful in preventing HIV transmission in the sex industry."
Unless Canadians are willing to consider isolating indefinitely or otherwise restricting all infected workers -- measures that would encourage prostitutes and others at risk to avoid HIV-related testing and other help-seeking alternatives -- little could be done with the information. In short, for both the client and the sex worker the Commission believes the risk of transmission is best addressed by targeted education efforts and programs designed to encourage risk-reducing behaviour, including information about the use of condoms and clean needles. No exception to a general rule requiring voluntary, specific, and informed consent for all HIV-related testing is justified with respect to male or female sex workers.225
In 1943, in an article focusing on syphilis published in The Canadian Journal of Public Health, Nelson wrote that if the forced medical examination of sex workers
could prevent the spread of infection, those who support prostitution and derive profit from it would have cleaned it up long ago, at their own expense. It would be worth millions of dollars to prostitution to have it freed from infection, for it is the prolific spread of disease by prostitutes which subjects it to really serious public attack.226
In 1989, The National Advisory Committee on AIDS found that "mandatory or compulsory HIV testing is unwarranted for persons working in the sex industry because harms from such testing would outweigh any benefits for them."227
And a 1997 report on HIV antibody testing and discrimination concluded:
Mandatory or compulsory testing of sex workers or other coercive measures directed at them will do little to prevent the spread of HIV among sex workers and to clients. Rather than such measures, interventions are necessary that would give sex workers the means to protect themselves against HIV transmission and would empower them to use them. This will also necessitate an analysis of the impact of laws regulating and/or penalizing prostitution on efforts to prevent HIV infection.228
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