There has never been a clear picture of what proportion of individuals may either have sold or bought sex in Canada. On a national level, sex work is not a factor recorded either in terms of possible exposure to HIV or in terms of reported AIDS cases. One of the problems in trying to sort through the data on male sex work and HIV and AIDS is that much of the information is based on samples of street youth and injection drug users, two populations identified early on as being at risk for HIV infection. Very few studies exist which include male sex workers from a broader range of lifestyles.

AIDS case reporting and male sex work in Canada

The AIDS Case Reporting and Surveillance System was created by the Department of National Health and Welfare96 in February 1982, when the first AIDS case in Canada was reported.97 As of December 31, 1997, 15,528 AIDS cases had been diagnosed and reported. "Adjusting for report delays, the total number of AIDS cases in Canada was estimated to be approximately 20,000."98 Of these, 11,175 (71.9%) involved adult males who have sex with men. An additional 681 (4.4%) involved adult males who have sex with men and also inject drugs. "Adjusting for reporting delays, the number of AIDS cases among men who have sex with men was estimated at 13,046 by the end of 1997."99

HIV antibody testing first became widely available in Canada in 1985.100 By the end of December 1997, an estimated 41,681 people had tested positive for HIV antibodies in Canada, 2,598 of them in 1997 alone.101 A national survey conducted in January 1997 found that 18.6%102 of men 15 years of age or older had been tested for HIV.103

It is estimated that in the early years of the epidemic (as early as 1982-84) as many as 36% of men who had sex with men in Vancouver104 and 25% of those in Montreal105 were HIV antibody-positive.106 The National Men's Survey (1993) reported that 65% of men who had sex with men across Canada had been tested for HIV antibodies. Self-reported HIV antibody status showed that over 18.2% of respondents who had taken an HIV antibody test were HIV antibody-positive, with figures ranging from 10.2% to 27.2%, depending on the city or town.107

More recently, the number of men who are becoming infected with HIV appears to be declining. One estimate based on Canadian studies of men who have sex with men (1994-97) indicates that between 4% and 11% of men who have sex with men may be infected with HIV.108 However, the Laboratory Centre for Disease Control, Health Canada, currently estimates that HIV prevalence among men who have sex with men is approximately 20%.109

HIV prevention research and male sex work in Canada

There is very little data that examines male sex workers in Canada from more than a single geographic, social or economic context.

An Eastern Canada study published in 1989 reported data on 55 male sex workers. Ninety-six percent were aware of the existence of AIDS and 58% had changed their sexual practices as a result of AIDS. Forty-two percent reported having had a venereal disease and 92% sought medical checkups on a regular basis. "However, of those subjects who stated that they had not changed their sexual practices, it was generally the case that they had always refrained from those behaviours associated with the risk of contracting AIDS."110

An Alberta study published in 1994 studied 505 men who had sex with men, recruited from STD clinics in Calgary and Edmonton. Of these men, 6% had received money for sex in the previous year, and of those, 64% always used condoms and 7% never used condoms. Fewer than 3% of the sample had exchanged sex for drugs, and of these, 55% reported always using condoms. The remainder reported sometimes using condoms. Of the men who self-identified as sex workers (4%), 61% always used condoms when working, 33% sometimes did and fewer than 6% never did.111

Shaver and Newmeyer (1996) compared Montreal-area male sex work data with Montreal data from two studies of gay and bisexual men: The National Men's Survey (1993),112 conducted throughout Canada, and Entre Hommes (1993),113 a simultaneous study conducted throughout Quebec.

The 40 male sex workers recruited for Shaver and Newmeyer's ana-lysis were drawn from a subsample of the Sex Work Survey, a series of field work interviews conducted in Montreal in 1991. Thirty of the respondents were men and 10 were transgendered sex workers. The transgendered people were defined as "men who dress as women when working and who identified themselves as gay." The authors note that these transgendered people "were not strongly committed to transvestism. They work in women's clothing and may do the occasional show in drag, but otherwise present themselves as men."114

Compared to gay and bisexual men from the National Men's Survey and Entre Hommes, the male sex workers were younger and less educated. As well, more were heterosexually self-identified: only half identified as homosexual or gay. Male sex workers were also much more likely to have had at least one female partner than were the other men.115

Importantly, no significant differences were found between rates of reported unprotected anal intercourse. Male sex workers were more likely to have been tested for HIV antibodies (88% compared to 61% and 68%) and less likely to report a positive result (0% compared to 11% and 21%) than other men who had sex with men. Fifty-five percent of male sex workers always used condoms for oral sex, 90% for anal sex (fewer than 25% of males provided this service to clients) and 75% for vaginal sex (provided to clients by only approximately 10% of the sample). Men indicated that condom use increased with the riskiness of sexual activity. It was also found that 71% of male sex workers used condoms most or all of the time for oral sex with clients, 45% for oral sex with partners, 92% for anal sex with clients and 71% for anal sex with partners.

The authors reported that:

With regard to both sexual practices and risk taking behaviour, male hustlers' behaviour with partners seems to be more

similar to that of gay and bisexual men than it is different. ... In addition, both groups are knowledgeable about AIDS and

the risks involved, and both have made some changes in their sexual practices.116

Footnotes

96. Now Health Canada. [back]

98. Health Canada, AIDS and HIV in Canada (1998), HIV/AIDS Epi Update, Bureau of HIV/AIDS, STD and TB, Laboratory Centre for Disease Control, Ottawa, Health Canada, May 1998a.

99. Health Canada, HIV and AIDS Among Men Who Have Sex with Men, HIV/AIDS Epi Update, Bureau of HIV/AIDS, STD and TB, Laboratory Centre for Disease Control, Ottawa, Health Canada, May 1998b.

100. Health Canada, HIV Testing Among Canadians: An Estimated 11,000-17,000 Current HIV Infections May Not Be Diagnosed, HIV/AIDS Epi Update, Bureau of HIV/AIDS and STD and TB, Laboratory Centre for Disease Control, Ottawa, Health Canada, May 1998d.

101. It is estimated that as of December 1996, there have been between 50,000 and 54,000 cumulative HIV infections in Canada. Nguyen, M., Archibald, C., Farley, J. and Sutherland, D., HIV/AIDS in Canada -- 1998, Bureau of HIV/AIDS, STD and TB, Laboratory Centre for Disease Control, Health Canada, paper presented to the Agenda Building Meeting on HIV Prevention Research, HIV/AIDS Prevention and Community Action Programs, Health Canada, Ottawa, February 1999.

102. Ibid.; These figures do not include those who were tested for blood donation or insurance purposes. When these are taken into account, it is suggested that 41% of Canadian men have been tested at least once for HIV antibodies. Houston, S., Archibald, C., Strike, C. and Sutherland, D., "Factors Associated with HIV Testing among Canadians: Results of a Population-based Survey," International Journal of STD and AIDS, 1998b, 9, pp. 341-46.

103. Houston, S., Archibald, C. and Sutherland, D., Sexual Risk Behaviours Are Associated with HIV Testing in the Canadian General Population, paper presented to the Seventh Annual Canadian Conference on HIV/AIDS Research, Quebec City, May 1998a.

104. Craib, K. and Schechter, M., "The Vancouver Lymphadenopathy AIDS

Study: An Overview of Research into HIV/AIDS," B.C. Medical Journal, 1992, 34, 3, pp. 162-64.

105. Remis, R., Najjar, M., Pass, C. and Paradis, G., Seroepidemiological Study of HIV Infection and Sexual Behaviour among Men Attending a Medical Clinic in Montreal, paper presented to the Vth International Conference on AIDS, Montreal, June 1989.

106. See also Health Canada, HIV and AIDS Among Men Who Have Sex with Men, HIV/AIDS Epi Update, Bureau of HIV/AIDS, STD and TB, Laboratory Centre for Disease Control, Ottawa, Health Canada, May 1998b.

107. 23% in Vancouver, 27.2% in Toronto, 20.1% in Montreal and between 10.2% and 20.5% in other regions of Canada. Myers, T., Godin, G., Calzavara, L., Lambert, J. and Locker, D., Canadian Survey of Gay and Bisexual Men and HIV Infection: Men's Survey, Ottawa, Canadian AIDS Society, 1993.

108. See Romanowski, B., Campbell, P., Preiksaitis, J. and Fonseca, K., "Human Immunodeficiency Virus Seroprevalence and Risk Behaviours in Patients Attending Sexually Transmitted Disease Clinics in Alberta," Sexually Transmitted Diseases, 1997, September, pp. 487-94; Dufour, A., Alary, M., Poulin, C., Allard, F., Nöel, L., Trottier, G., Lepine, D. and Hankins, C., "Prevalence and Risk Behaviours for HIV Infection among Inmates of a Provincial Prison in Quebec City," AIDS, 1996, 10, 9, pp. 1009-15; Roy, E., HIV and Street-Involved People in Canada: Status Report and Recommendations for a National Action Plan for HIV Prevention, draft document submitted to the AIDS Education and Prevention Unit, Ottawa, Health Canada, 1996; Myers, T., Calzavara, L., Major, C., Marchand, R., Morrison, K. and Allman, D., Self-reported HIV Antibody Status and Laboratory Test Results in a Community Sample of Gay and Bisexual Men: Winnipeg Men's Survey, paper presented to the Fifth Annual Canadian Conference on HIV/AIDS Research, Winnipeg, June 1995; Palmer, R., Major, C., Ofner, M., Brown, D., Falli, R. and Fearon, M., Laboratory-based HIV Surveillance in Ontario, paper presented to the Fifth Annual Canadian Conference on HIV/AIDS Research, Winnipeg, June 1995.

109. Nguyen, M., Archibald, C., Farley, J. and Sutherland, D., HIV/AIDS in Canada -- 1998, Bureau of HIV/AIDS, STD and TB, Laboratory Centre for Disease Control, Health Canada, paper presented to the Agenda Building Meeting on HIV Prevention Research, HIV/AIDS Prevention and Community Action Programs, Health Canada, Ottawa, February 1999.

110. Earls, C. M. and David, H., "A Psychosocial Study of Male Prostitution," Archives of Sexual Behavior, 1989, 18, 5, pp. 411-12.

111. Romanowski, B., Campbell, P., Preiksaitis, J. and Fonseca, K., "Human Immunodeficiency Virus Seroprevalence and Risk Behaviours in Patients Attending Sexually Transmitted Disease Clinics in Alberta," Sexually Transmitted Diseases, September 1994, pp. 487-94, cited in Health Canada, HIV Risk Behaviours Among Canadians: An Inventory and Synthesis, Division of HIV Epidemiology, Bureau of HIV/AIDS, STD and TB, Laboratory Centre for Disease Control, Ottawa, Health Canada, November 1998c.

112. Myers, T., Godin, G., Calzavara, L., Lambert, J. and Locker, D., Canadian Survey of Gay and Bisexual Men and HIV Infection: Men's Survey, Ottawa, Canadian AIDS Society, 1993.

113. Godin, G., Carsley, J., Morrison, K. and Bradet, R., Entre hommes -- 91/92: Les comportements sexuels et l'environnement social des hommes ayant des relations sexuelles avec d'autres hommes, Québec, COCQ-sida, 1993.

114. Shaver, F. and Newmeyer, T., Men Who Have Sex With Men: A Comparison of the Sexual Practices and Risk-Taking Behaviour of Gay and Bisexual Men and Male Prostitutes, paper presented to Sida, jeunesse et prévention. Au-delà du discours, des actions!, at the 64th conference of ACFAS, Montreal, May 1996, p. 7, note 3.

115. For more on bisexuality in Canada, see Myers, T. and Allman, D., "Bisexuality and HIV/AIDS in Canada," in Aggleton, P., ed., Bisexualities and AIDS: International Perspectives, London, Taylor and Francis, 1996 and Doll, L., Myers, T., and Allman, D., "Bisexuality and HIV Risk: The Canadian and U.S. Experience," Annual Review of Sex Research, 1997, vol. 8, pp. 102-147.

116. Shaver, F. and Newmeyer, T., Men Who Have Sex With Men: A Comparison of the Sexual Practices and Risk-Taking Behaviour of Gay and Bisexual Men and Male Prostitutes, paper presented to Sida, jeunesse et prévention. Au-delà du discours, des actions!, at the 64^th conference of ACFAS, Montreal, May 1996, p. 13.