This document has compiled and considered many kinds of information on male sex work in Canada.

Across the country, studies have examined the experiences of sex workers with STDs; health care utilization; injection drug use; HIV testing; HIV and AIDS knowledge, attitudes and beliefs; sexual behaviours with clients and with partners; and, in some instances, HIV antibody status. There has been virtually no consistency of measurements used or of populations sampled.

In the absence of consistent science, any synthesis of this data will have to look for the commonalities that do exist.

One commonality found in many of these studies is that of reported condom use. This is largely because questions concerning the use or non-use of condoms are central to HIV prevention studies. This commonality is not ideal, as there is great variation in how questions regarding condom use have been conceptualized, as well as variation in how results pertaining to condom use have been reported and analyzed.270 Yet it is these data which allow for the most valid and least biased synthesis of what is known in Canada about the risks of HIV infection and transmission for male sex workers, their clients and their partners (see Table p. 70).

• The Badgley Committee (1984) reported that 18% of younger male sex workers used condoms for oral sex and 19% for anal sex.

• Rekart and Manzon (1989) reported that 88% of the men in their sample of street-involved people always used condoms and 100% of those who had engaged in sex work always used condoms.

• Rekart et al. (1989) reported that 85% of the sample who self-identified as male sex workers always used condoms.

• Millson et al. (1991, 1994) reported that 61% of male injection drug users who had engaged in sex work always used condoms with male clients, and 34% with female clients. Condoms were always used for anal sex with male clients 40%, 67% and 77% of the time in 1991-92, 1992-93 and 1993-94, respectively. For vaginal sex with female clients, condoms were reportedly used all the time by approximately 50% of respondents in each of the three time periods.

• DeMatteo et al. (1993) reported that 100% of the HIV antibody-positive male sex workers they studied used condoms for anal sex with clients.

• Lamothe et al. (1993) reported that male injection drug users who had also sold sex indicated that they used condoms at least occasionally: 51% of the time with clients, 35% of the time with occasional (casual) partners and 10% of the time with regular partners.

• Read et al. (1993) reported that 54% of their sample always used condoms with male clients and 68% with female clients.

• Baskerville et al. (1994) reported that 72% of their sample of injection drug users who had sold sex always used condoms for anal sex with clients.

• MacDonald et al. (1994) reported that 55% of street-involved younger male sex workers always used condoms.

• Romanowski et al. (1994) reported that 64% of men who reported trading sex for money always used condoms, 55% of men who reported trading sex for drugs always used condoms and 61% of men who self-identified as male sex workers always used condoms.

• Shaver and Newmeyer (1996) reported that 55% of male sex workers always used condoms for oral sex, 90% for anal sex and 75% for vaginal sex. In terms of partner type, 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 Capital Regional District (1997) reported that 73% of younger male sex workers studied always used condoms with clients.

• Parent et al. (1997) reported that of male injection drug users who had also sold sex, 36% always used condoms with clients, 27% always used condoms with regular partners and 25% always used condoms with casual partners.

• The Village Clinic (1997) reported that 35% of male sex workers sampled always used condoms with both clients and partners, 50% always used condoms with clients and 55% always used condoms with partners.

• Calzavara et al. (1998) reported that 100% of the men in their sample of prison inmates who had sold sex did not report unprotected anal intercourse.

• Dufour et al. (1998) reported that 96% of their sample of male sex workers did not report unprotected anal sex with clients, nor did 91% of the relevant men in the Vanguard Study (cited in Dufour et al., 1998).

In 1985, Sansfaçon, in a research review of sex work in Canada, concluded that among male sex workers, the number of men who used condoms was between 30 and 40%. It would appear from the research undertaken for this document that this figure is no longer valid. Though drawing definitive conclusions from the data contained in the present document is problematic, the findings on reported condom use do suggest a trend:

Viewed holistically, the evidence does much to refute the label of male sex workers as AIDS vectors.

Instead, it suggests that increasingly, male sex workers in Canada are protecting themselves, their clients and their sexual partners from STD and HIV infection and transmission.

Although prostitutes do contract STDs, the public's strongly held belief that prostitutes are a major cause of the spread of such diseases is not substantiated. Epidemiological studies indicate that prostitutes are not a prime factor in the spreading of STDs. This occurs as a consequence of sexual mores changing throughout society and cannot be seen as the result of the behaviour of one relatively small group of people. As indicated, prostitutes, of all people in society, have a real interest in seeing that they are not infected.271

While the summary of Canadian data gathered for this document does much to verify the hypothesis that male sex workers have incorporated safer practices into their occupational and sexual repertoires, there are three areas, in particular, which may require further analysis.

First are data which indicate that men who inject drugs and also sell sex may engage in less safe sex than men who sell sex and do not inject drugs. Second are data which indicate that men who sell sex may practise safer sex with their clients and casual or occasional partners than with their regular partners or lovers. Third are the limited data which suggest that men who sell sex may use condoms more with female clients than with male clients.

It is not the intent of this document to suggest that these unanswered questions are anything other than hypotheses. Differences in how researchers have conceived and defined sex work, the time periods researchers consider reliable in terms of recall, the manner in which questions are worded, the means by which data are collected, the strategies for recruitment, the techniques of data analysis and the lack of standardization -- all, to date, have functioned to impede any methodologically sound synthesis of research on male sex work and AIDS in Canada.

In 1985, the Fraser Committee issued the statement that "prostitutes are very aware of the dangers of sexually transmitted diseases (STDs) and the reputation prostitutes have for the spread of such diseases," but then qualified this statement by noting that research had yet to substantiate this.272

It is hoped that this document has gone some distance in rectifying this problem.

Footnotes

270. See Crosby, R. A., "Condom Use as a Dependent Variable: Measurement Issues Relevant to HIV Prevention Programs," AIDS Education and Prevention, 1998, 10, 6, pp. 548-57. [back]