How Canadian research has defined and measured the HIV risk of male sex work, or Why we need methodologically sound and morally unbiased research on sex work
At the forefront of the current discourse into research on male sex work and HIV and AIDS in Canada is the concern about how data, and especially HIV prevalence and risk-behaviour data concerning sex workers and their clients, might be used.
The repercussions of research that suggests that hustlers are taking risks with their clients (putting their clients at risk), combined with the criminal status of sex work, can create an environment that promotes harassment by police and social services, and could even lead to legislation that violates the rights of sex workers (court orders, quarantine), driving them further underground, making them less reachable by education programs and therefore more vulnerable to infection.273
The complexity of undertaking research on sex workers means that those who design and implement such research must be vigilant:
Overall, the research on prostitution is plagued by a number of conceptual and methodological problems. First, proposed taxonomies based on age (juveniles versus adults), sex (males versus females) or type of activity (street walker, call girl, etc.) have not contributed appreciably toward our understanding of the general phenomenon. Second, although many studies have attempted to describe the demographic characteristics of prostitutes, faulty subject selection and a failure to include appropriate comparison groups undermine a meaningful interpretation of the results. Finally, there has been an almost complete separation of theory and research according to the sex (male versus female) of the prostitutes studied.274
Not all sex workers are alike and not all sex workers think or act in the same way:
There is considerable variation in the practices of sex workers and the conditions affecting their health and safety. Studies of HIV infection among sex workers often draw on samples that are not necessarily representative of all types of sex workers. As a result it is difficult to generalize about the risks to the health of sex workers, including the risk of HIV infection, from one locale to another.275
For many, sex work is just another job. All sex workers have work lives and personal lives, even if those outside the field cannot differentiate between the two.
Research on sex workers has focused more on their working lives than their private lives, even though many sex workers may be more at risk in the latter than the former.276
These are only a few of the realities that any future investigation need begin to recognize.
One of the challenges in summarizing the data on male sex work and AIDS in Canada has been the ways in which researchers have defined and operationalized the variables they study. One common example is age:
one of the major problems in developing a profile of youth involved in prostitution in Canada is that there are no reliable estimates of the number of youth involved. One of the problems in identifying the number of these youth relates to the different ages that are used when referring to youth involved in prostitution. The Badgley Committee defined "juvenile prostitutes" as those under 20. The Fraser Committee addressed those under 18, while still others describe youth as persons under 16.277
A second example are questions which seek to understand the relations sex workers have with their clients and partners. As one study respondent indicated,
My main problem with the questionnaire was that it didn't distinguish between clients and non-clients. ... You have to classify your clients as either casual partners or regular partners, which in itself is not always that clear. In other words, if you only do hand jobs for clients but perform oral without condoms for your casual partners, there's nowhere on the questionnaire to make the distinction, and the study could use that info to conclude that sex workers aren't using condoms for oral.278
A third common example is the actual definition of sex work. The Vanguard Study, a cohort investigation of young men who have sex with men, defines sex work or paid sex as including "sex exchanged for money, drugs, goods, clothing, shelter or protection." This is essentially the same definition the Badgley Committee utilized in 1984, and one that defines sex work as sex in exchange for almost anything.
Critiquing this definition, Andrew Sorfleet of the Sex Workers Alliance of Vancouver (SWAV)279 points out,
the only thing the Vanguard project left off the list was affection. ... Any results of HIV incidence with regard 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. ... The loose definition of "paid sex" allows the category of people responding to be very broad.280
In order for research to move ahead, the expectations research funders, researchers and researched communities bring to the research enterprise must be heightened. In the realm of research on sex work, this will require cooperation. It will also require standardization of the ways in which concerns are operationalized, variables measured and concepts, such as sex work, defined.
How HIV prevention research could begin to conceptualize sex work
In the book Men Who Sell Sex: International Perspectives on Male Prostitution and HIV/AIDS,281 Allman and Myers (1999) summarized 10 research questions that could be applied to the study of male sex work in Canada. For these researchers, arriving at a more concrete understanding of male sex work and HIV and AIDS in Canada will require a more rational, scientific and methodologically sound research than Canadians have been privy to in the past.
1. Much of what is known in terms of male sex work and HIV and AIDS pre-dates current social, behavioural and epidemiological measures of sexuality and its expression.
2. With few exceptions, most samples of male sex workers have been subsamples of other larger populations, or have been small in size.
3. Rarely have the same methods and measurements for the study of male sex work been utilized in cities of different sizes across the country.
4. There are little longitudinal data on male sex work, and less multi-site data.
5. Virtually nothing is known of the manifestation of male sex work other than visible street sex work.
6. The exchange of sex for goods other than monetary currency has, to our knowledge, never been studied in Canada.282
7. At present there is little insight into the behaviours, attitudes and beliefs of either the clients or partners of male sex workers and how these relate to HIV and AIDS.
8. There is not a solid understanding of how male sex workers who are also injection drug users differ from male sex workers who are not injection drug users.
9. Very little is known of the experiences of male sex workers of different racial, ethnic or cultural identities working in Canada, particularly Aboriginal sex workers.
10. A better understanding is needed of the roles of sexual identity, social environment, and internal and external homophobia and the experiences of younger male sex workers.283
Ten additional areas of inquiry include:
11. An examination of the roles of power and risk in negotiations male sex workers have with their clients and with casual and regular partners;
12. Greater understanding of how male sex workers experience and construct their personal relationships with both male and female casual and regular partners;
13. Exploratory investigation of the differences between male and female clients, and the variations in behaviour and context that each group brings to its encounters with male sex workers;
14. Knowledge of the migration patterns of male sex workers and an understanding of the broader social, economic and seasonal influences that may impact the stability and/or transience of the industry, both geographically and across time;
15. Investigation of how patterns of male sex work vary across regions of the country, particularly understudied regions such as the Maritimes and the Prairies;
16. An understanding of how the knowledge and experience mature male sex workers bring to their activities may cause these to differ from the activities of younger sex workers;
17. Insight into how various recruitment strategies allow access to different populations of male sex workers, particularly those who do not work in a street environment;
18. Deeper insights into how the Criminal Code interferes with HIV prevention and education services for male sex workers, and constructive steps to begin to remedy this;
19. A process by which the moral frameworks that underlie much of the Canadian research on sex work are identified and analyzed to determine where they come from, how they function, and what steps could best be taken to overcome them;
and, perhaps most importantly,
20. A process that allows male sex workers to come together to discuss what it is they need from HIV and AIDS research, and how this research should approach them, their workplaces and their daily lives.
The achievement of a truer understanding of male sex work and HIV and AIDS in Canada, free of ignorance, stigma and discrimination, will entail a continuing reconsideration of how research approaches modern male prostitution.
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