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Male Sex Workers in ThreeAustralian CitiesVictor Minichiello PhD a , Rodrigo Marino PhD a ,Jan Browne PhD b , Maggie Jamieson PhD a , KirkPeterson MA c , Brad Reuter d & Kenn Robinson ea School of Health at the University of New England ,USAb School of Nursing at Deakin University , USAc Prostitutes Collective of Victoria , USAd Self-Health Queensland Workers in the SexIndustry , USAe Sex Workers Outreach Project , SydneyPublished online: 12 Oct 2008.

To cite this article: Victor Minichiello PhD , Rodrigo Marino PhD , Jan Browne PhD ,Maggie Jamieson PhD , Kirk Peterson MA , Brad Reuter & Kenn Robinson (2002) MaleSex Workers in Three Australian Cities, Journal of Homosexuality, 42:1, 29-51, DOI:10.1300/J082v42n01_02

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Male Sex Workersin Three Australian Cities:

Socio-Demographicand Sex Work Characteristics

Victor Minichiello, PhD

University of New England

Rodrigo Mariño, PhD

Deakin University

Jan Browne, PhD

Deakin University

Maggie Jamieson, PhD

University of New England

Kirk Peterson, MA

Prostitutes Collective of Victoria

Brad Reuter

Self-Health Queensland Workers in the Sex Industry

Kenn Robinson

Sex Workers Outreach Project, Sydney

Victor Minichiello is Head and Associate Professor in the School of Health at theUniversity of New England. Rodrigo Mariño is Senior Lecturer in Public Health andEpidemology in the School of Health at the University of New England. Jan Browne isSenior Research Fellow in the School of Nursing at Deakin University. Maggie Jamie-son is a Lecturer in the School of Health at the University of New England. Kirk Peter-son is Project Manager of the male outreach project at the Prostitutes Collective ofVictoria. Brad Reuter is Project Manager of the outreach project at the Self-HealthQueensland Workers in the Sex Industry, and Kenn Robinson is Project Manager of themale outreach project at Sex Workers Outreach Project, Sydney.

Correspondence may be addressed to: Dr Victor Minichiello, School of Health,University of New England, Armidale, New South Wales 2351 Australia.

Journal of Homosexuality, Vol. 42(1) 2001 2001 by The Haworth Press, Inc. All rights reserved. 29

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ABSTRACT. This article describes the socio-demographic and sex

work characteristics of sex workers in Sydney, Melbourne, and Bris-

bane. A total of 185 male sex workers completed the questionnaire com-

ponent of the study. The results of this study serve to debunk many of the

myths surrounding the popular view of the male sex worker (MSW). The

respondents in this study were on average 27 years old, and the majority

had completed secondary education, with 30% having gained some form

of tertiary qualification. Interestingly, those MSWs who had not com-

pleted secondary education were mostly street workers and were gener-

ally aged under 25 years. The majority of sex workers lived in rented

accommodation, with only 6% reporting to be homeless. Half of all re-

spondents identified as being “gay,” 31% as “bisexual” and 5.5% as

“straight.” More than half of the respondents were in a permanent rela-

tionship. Only 7.3% of this group reported using heroin daily, although

the majority consumed alcohol, tobacco, marijuana, and ecstasy. The

majority of sex workers had been in the profession for less than six

months, although some had been working in the industry for more than

ten years. Most of the sex workers reported having taken an HIV test and

a preference to offer safer sex. The article highlights ways in which the

work context of MSW can be better understood and supported by educa-

tion and public policy programs. [Article copies available for a fee from The

Haworth Document Delivery Service: 1-800-342-9678. E-mail address:

<getinfo@haworthpressinc.com> Website: <http://www.HaworthPress.com>

© 2001 by The Haworth Press, Inc. All rights reserved.]

KEYWORDS. Male sex workers, sex work industry, street sex workers,

escort sex workers, independent sex workers, safe sex, drug use

INTRODUCTION

Since the discovery of HIV/AIDS, governments have been recognising the

importance of understanding the sex work industry and collecting reliable and

systematic data about the work and sexual sale contexts of commercial sex.

While research on female sex workers is extensive, less information on male

sex work (MSW) exists, particularly in Australia (Minichiello et al., 1998).

Yet we cannot simply assume that the pattern and characteristics of the female

sex industry will be the same as that of the male sex work industry. Nor can we

presume that the safe sex behaviours emerging from studies on inner city gay

men can be generalised to MSWs, who constitute a heterogeneous group of

30 JOURNAL OF HOMOSEXUALITY

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gay, straight, and bisexual men (DeGraaf et al., 1994; Simon et al., 1994) and

where IV drug use and other social factors vary considerably among the group

(Estep et al., 1992).

Sex work is an occupation where a sex worker is hired to provide sexual ser-

vices for monetary considerations (Visano, 1988). A male sex worker (MSW)

has been defined as any male who engages repeatedly in sexual activities with

persons with whom he would not otherwise stand in any special relationship

and for which he receives currency and/or the provision of one or more of the

necessities of living (food, clothing, and protection) (Coleman, 1989). This

also may include drugs (Coleman, 1989; Sullivan, 1996) and other items of

monetary value (Morse et al., 1991). Davies and Simpson (1990) described

three main types of male sex worker: the “escort,” “independent,” and “street”

sex worker, and these categories are not mutually exclusive. Sex workers often

move between types of work, depending on factors such as age, sexual orienta-

tion, and education (Pleak & Meyer-Bahlbury, 1990; Morse et al., 1992;

DeGraaf et al., 1994).

The escort works in association with an agency, which advertises the ser-

vices and establishes contact between the worker and clients. Agencies take a

proportion of the worker’s earnings, and the sex transaction usually takes place

either at the client’s residence or hotel. According to Davies and Simpson

(1990), most clients of the escort MSWs are single visits, although some report

maintaining regular customers. The independent sex workers are self-em-

ployed, and they manage their own business (e.g., advertising). Independent

workers provide their services at either the client’s or their own home and at

hotels. Negotiations about the encounter usually take place over the phone

(Davies & Simpson, 1990). Street sex workers offer their services in a public

setting (i.e., streets, parks, bars, etc.), are more likely to consider this work as a

casual occupation, and their work does not require advertisement, phones, or

premises to contact clients. The public setting is more likely to expose these

workers to certain dangers, such as police detention and physical violence,

which are more easily avoided in the other two forms of sex work (Davies &

Simpson, 1990).

A growing literature on the socio-demographic characteristics and work ex-

perience of MSWs has been reported over the past decade (Minichiello et al.,

1998). Large scale surveys of male sex workers in Canada (Earls & David,

1989); the United States in New York City (Pleak et al., 1990), New Orleans

(Morse et al., 1991; Simon et al., 1994), Atlanta (Elifson et al., 1993), and San

Francisco (Estep et al., 1992); the United Kingdom (McKeganey et al., 1990;

Bloor et al., 1992, 1993); Thailand (Kunawararak et al., 1995); the Nether-

lands (Amsterdam) (DeGraaf, 1994, 1995); and Indonesia (Bali) (Ford et al.,

1993, 1995) have been conducted. In Australia, with the exception of Browne

Minichiello et al. 31

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and Minichiello (1995), who conducted a qualitative study on MSWs in Mel-

bourne, there currently exists limited information about MSWs. While this

knowledge has been useful in informing the development of public health pro-

grams and our knowledge about the sex worker, some methodological limita-

tions have been noted (Minichiello et al., 1998). For example, most of the

studies have concentrated on one particular type of sex work, the street worker,

and, given the increasing diversity of the composition of this population (e.g.,

street, escorts and brothels), generalisations made beyond the sample group

must be questioned. Less is known about the similarities and differences in the

biographical and work context of sex workers across the different modalities

of sex work (Minichiello et al., 1998). This study will sample across a wide

range of male sex work categories to address this shortcoming. Caution must

also be taken when using data on MSWs from other countries to make compar-

ison with the Australian situation, as Australia has some particular social con-

ditions, such as welfare state programs and laws which decriminalise sex

work, which may create a different context for the sex work industry.

The purpose of this study is to offer descriptive Australian data on male sex

workers as a necessary first step which may inform policy makers in the design

and implementation of health promotion/disease prevention programs. Spe-

cifically, the article will provide information on a range of characteristics of

Australian male sex worker by location and type of sex worker. This will allow

us to test the veracity of several popular beliefs about male sex workers, such

as the assumptions that male sex workers are uneducated, mainly street work-

ers, drug or alcohol abusers, and HIV positive. It is expected that an improved

knowledge of these characteristics will provide a base to better contextualise

the male sex worker in Australia.

METHODS

Instrument

Data reported here was collected using a self-completion questionnaire, as

part of a larger study which included diaries completed by each sex worker

over a two week period. The questionnaire examined a variety of topics, in-

cluding the personal characteristics of the sex worker, their work back-

ground in the industry, attitudes towards being a sex worker, engagement in

various sex practices, substance use, and health status. The final research in-

strument was revised after three workshops were conducted by the research

team with representatives of the local sex work support organisations, which in-

cluded the Sex Workers Outreach Project (SWOP) in Sydney, the Self-Health

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Queensland Workers in the Sex Industry (SQWISI) in Brisbane, and the Pros-

titutes Collective Victoria (PCV) in Melbourne. The questions were worded in

a non-threatening style, using MSWs language and were acceptable to the sex

work organisations.

Procedures

The field research assistants (FRA) were outreach workers from sex work-

ers organisations in the three cities, who already had established rapport with a

large number of male sex workers and escort agencies. A brief letter explain-

ing the details of the project, along with names and contact details of the FRA,

was distributed to sex workers. During their first contact with potential partici-

pants, the field workers introduced themselves, and explained the aims and the

fieldwork protocols of the study. After a candidate expressed interest in partic-

ipating, they were invited to sign a consent form, which was read to them by

the field research assistants. After a sex worker consented to participate in the

project, he was asked to complete and return the questionnaire and to contact

the FRA to arrange a convenient time to discuss the diary component of the

larger study.

Code numbers were used to ensure the participants’ confidentiality on the

instrument, but names and contact details of MSWs were kept on a separate

sheet for administrative purposes by the sex work organisations and for con-

tacting the sex workers during the diary stage of the study. Questionnaires

were completed by participants in their own time, with the exception of some

street workers who used the office of the sex work organisations to complete

the instrument. Data were collected from mid-April 1998 to mid-July 1998.

Sample

Given the nature and legal complexities of sex work, representative sam-

pling is difficult to achieve due to the absence of epidemiological data on this

population and because MSWs remain a largely hidden and stigmatized popula-

tion (Pleak et al., 1990; Elifson et al, 1991; Minichiello et al., 1998). In the con-

text of these constraining factors, the sampling strategy for recruiting the

different types of MSWs was developed in consultation with three local sex

workers organisations.

The inclusion criteria was men aged 18 years and older currently working as

a male sex worker. For the independent male sex worker category (IMSW)

identification of potential participants was identified by reviewing the popular

gay press where male sex workers advertise. These included: Brother/Sister

Brisbane, Melbourne Star Observer, and Capital Q and Sydney Star Observer

Minichiello et al. 33

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from Sydney. A count of the advertisements which appeared in these publica-

tions before the commencement of the fieldwork revealed a potential number

of 67 IMSWs. For male sex workers who work in or through licensed escort

agencies (EMSW), the field research assistants contacted the escort agencies

through the owner/administrator. Contact was established with all five male

escort agencies: two in Sydney and three in Melbourne, but none in Brisbane

because of their legal status. Street male sex workers (SMSW) were recruited

using convenience sampling according to where male sex workers are known

to be working and visible and where they can be conveniently reached by the

field research assistants. The SMSW sample consists of people working in the

suburbs of St. Kilda in Melbourne, “The Wall” in Sydney, and Albert Park in

Brisbane.

Sample Size

The sample was determined using a 3 3 3 sampling design (3 cities, 3 sex

work modalities). Using this model, and after consultation with the sex work

organisations in each of the cities, it was anticipated that the expected sample

would be 190 MSWs: 80 from Sydney, 70 from Melbourne, and 40 from Bris-

bane. These three cities were chosen because they were regarded as the areas

of greatest concentration of male sex workers, and they have a distinctive pat-

tern of sex work due to, among other things, the different legal status of sex

work on each location (Neave, 1994). By modality of work, it was decided that

40 participants would be from the IMSWs group, 45 from the EMSWs group,

and 105 from the SMSWs group. Outreach workers, who as part of their work

monitor this population, estimated that these figures would capture between

50% and 70% of the total MSW population working in Brisbane, Melbourne,

and Sydney. The total number of sex workers who actually returned the ques-

tionnaire was 185, five short of the predicted sample size. Of the 185 respon-

dents, 92 were from Sydney, 55 from Melbourne, and 38 from Brisbane. The

socio-demographic characteristics of the sample obtained in the three cities are

summarized in Table 1. In some cases the total figures may be lower due to

missing answers to specific items.

A relatively high response rate was achieved for this population. Different

modalities of MSW yielded different response rates, based on estimations pro-

vided by the outreach workers. For example, among the SMSWs between 70%

and 95% of the MSWs who were approached, depending on the location,

agreed to participate and complete the questionnaire and the diary stage of the

project. Among both the IMSWs and EMSWs groups, 50% of the workers ap-

proached participated in the study. The exception was Sydney, where 95% of

the IMSWs approached agreed to participate. Reasons for non-participation

34 JOURNAL OF HOMOSEXUALITY

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included: agency did not allow outreach workers to contact MSW, lack of

time, or lack of trust. MSWs who were under 18 years of age were excluded

from this study due to legal and ethical reasons. While the researchers were ini-

tially concerned that compliance to completing the research instruments could

be problematic and that the quality of data might be influenced by this factor,

the results indicate that the overall quality of the data was high as measured by

the proportion of missing values on key variables being generally less than 5%

of the cases.

Data Analysis

The instrument included socio-demographic and sex work experience vari-ables. The socio-demographic variables were age, ethnic background, sexualorientation, comfort with sexual orientation, relationship status, living ar-rangement, level of education, economic need status, HIV serostatus, and alco-hol and substance use. Ethnic background was recorded using the categories ofnon-English speaking background (NESB) and English speaking background(ESB) described by the Australian Bureau of Statistics (Commonwealth ofAustralia, 1988). Participants were classified as belonging to either an Englishspeaking background (ESB), that is, parents who were from Australia or immi-grated from Ireland, United Kingdom, New Zealand, Canada, South Africa orthe United States, and those who had a non-English speaking background(NESB), that is, those whose parents were born from a non-English country.When one parent was from ESB and the other from NESB, the participant wasclassified as NESB. Following the advice of Simon et al. (1994), sexual orienta-tion was defined in terms of the individual’s definition of self, and respondentswere asked to identify themselves as either “straight,” “bisexual,” “gay,” or“other.” Living arrangement was classified into four groups: “renting sharedhome with flatmate”; “rented place”; “own my place,” and “others,” which in-cluded living with parents, with friends, and being homeless. Participants wereclassified according to their educational level using the following categories:incomplete secondary education; secondary education; and tertiary education.While the questionnaire did not include a specific item on income, economicneed was assessed by asking participants the following question: “Money-wise,do you usually feel that you: ‘cannot make ends meet’; ‘can manage to get by’;‘can manage, plus save’; or ‘do not have money problems.’ ” Participants wereasked to report on their general alcohol and type of substance consumption, us-ing a list which included tobacco, marijuana, heroin, speed, ecstasy, pain kill-ers, benzodiazepines, and were also asked to note the frequency of use utilisinga 5-point scale ranging from never to daily. Individuals were asked whetherthey had been tested for HIV. Those who answered positively were furtherasked to state the period (less than one week, 1-4 weeks, between 1 to 6months, 7 to 12 months, or over a year since the study) since the last test and to

Minichiello et al. 35

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36 JOURNAL OF HOMOSEXUALITY

TABLE 1. Distribution of Demographic Characteristics (Percentages) of MaleSex Workers in Sydney, Melbourne, and Brisbane

Sydney(n = 92)

Melbourne(n = 55)

Brisbane(n = 38)

Total(n = 185)

Mean age (s.d.) 26.80 (6.39) 26.78 (6.92) 27.71 (8.26) 26.98 (6.95)Age Group21 and younger22 to 25 years old26 to 30 years old31 to 35 years old36 to 40 years oldOlder than 40 years old

19.1%28.1%30.3%14.6%4.5%3.4%

23.6%27.3%27.3%10.9%3.6%7.3%

18.4%21.1%44.7%5.3%5.3%5.3%

20.3%26.4%32.4%11.5%4.4%4.9%

EducationIncomplete secondary educationSecondary educationTertiary education

22.0%34.1%44.0%

43.6%29.1%27.3%

34.2%23.7%42.1%

31.0%30.4%38.6%

Economic Need StatusCannot make ends meetCan manage to get byCan manage, plus saveDo not have money problems

18.7%42.9%19.8%18.7%

14.5%49.1%16.4%20.0%

10.5%52.6%21.1%15.8%

15.8%46.7%19.0%18.5%

Living ArrangementRenting shared home with flatmateRenting placeOwn my placeOthers

41.1%38.9%6.7%

13.3%

41.8%29.1%3.6%

25.5%

50.0%21.1%10.5%18.4%

43.2%32.2%6.6%

18.0%

Ethnic BackgroundEnglish speaking backgroundNon-English speaking background

62.9%37.1%

55.6%44.4%

84.2%15.8%

65.2%34.8%

Sexual IdentificationStraightBisexualGayOthers

4.4%26.7%58.9%10.0%

5.5%45.5%47.3%1.8%

7.9%23.7%63.2%5.2%

5.5%31.7%56.3%6.6%

Relationships StatusIn a relationship

With a male partnerWith a female partnerWith a transgender partner

Not in relationship

52.2%83.3%14.6%2.1%

47.8%

55.6%80.6%19.4%0.0%

43.6%

63.2%87.5%8.3%4.2%

36.8%

55.7%83.5%14.6%1.9%

44.3%

Had an HIV TestYes

PositiveNegativeOther a

NoOther

90.1%8.5%

84.4%6.1%6.6%3.3%

81.8%6.7%

88.9%4.4%

16.4%1.8%

94.7%2.8%

88.9%8.4%5.3%0.0%

88.6%6.7%

87.1%6.1%9.2%2.2%

Type of Sex WorkStreetEscort agency/BrothelIndependentWorks in more than one of these types

10.8%27.2%34.8%27.2%

23.6%30.9%23.6%21.9%

21.1%5.2%

57.9%15.8%

16.8%23.8%36.2%23.2%

a No results because never checked results.

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self-report their HIV sero status results as follows: “yes,” “no,” “never wentback for results,” “do not know.”

The sex work experience variables included, location recorded as Sydney,Melbourne, or Brisbane. The question about type of sex work originally in-cluded four main responses (street work, escort, independent, and brothel).These categories, however, were not mutually exclusive and some participantsreported as belonging to more than one modality of sex work. In addition thenumber of respondents who reported as working in brothels was low, as fewbrothels have MSWs working as employees. As a result of these two factors,three categories for modality of sex work were created: street sex work, inde-pendent, and escort. MSWs indicating operating under more than one typewere reclassified as belonging in the category of “two or more modalities ofsex work.” Length of time working as a MSW was classified into five catego-ries: “less than six months,” “between 6 months and one year,” “between 1year and 2 years,” “between 2 years and 5 years,” and “more than 5 years.”Participants were asked to select from a list of nine alternatives the main rea-son for doing sex work. Stress in sex work was coded as “not at all,” “a littlestressful,” and “very stressful.” Feeling good about being a sex worker wasclassified as “always,” “usually,” “sometimes,” “rarely,” and “never.” Partici-pants were also asked their feelings about having sex with men, coded as “verycomfortable,” “comfortable,” “neither comfortable nor uncomfortable,” and“uncomfortable.” And finally, participants were asked whether they worked assex workers in other places in Australia or overseas and to select from a list ofsexual activities the type of sexual acts they were willing to provide to clients.

The analysis primarily provides basic descriptive information on the distri-

bution of selected socio-demographic and sex work variables. Subsequently,

categorical and ordinal data were analysed utilising Chi square analysis (χ2) to

compare results between different location and modalities of sex work groups

and distribution of the socio-demographic and work variables. To evaluate the

relationship of location and modality of work with interval data, ANOVA’s

were conducted. Finally, in order to test if any combination of variables (edu-

cation level, age, ethnic background, length of time in sex work, reason for sex

work, etc.) provided a possible multivariate description of the MSWs’ profile

by selected outcomes (i.e., feeling of stress doing sex work) on the basis of the

previous analysis, a series of logistic regression analyses were conducted. In

these analyses, place of work was not included, as it was related with modality

of work, and, for the purpose of the logistic regression analysis, a new variable

was created combining information from location and type of sex work. Ad-

justed odds ratios provided a measure of the magnitude of the effect of each

variable in the final model. Confidence intervals for the odds ratios (CI) were

computed following Kahn and Sempos (1995) specifications. As there were

limited published studies on MSWs in Australia, the emphasis of the analysis

Minichiello et al. 37

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was in finding good predictors rather than eliminating bad ones (Menard,

1995), and, therefore, the significance criterion for inclusion was set at 0.10.

The logistic regression analysis (LRA) used a forward stepwise selection as

the method for stepwise regression. To measure the strength of the association

between the dependent variable and the independent variables, eta square (h2)

statistics was used (Menard, 1995). Cases with missing values were not in-

cluded in the logistic regression analysis. Data were examined for violation of

the assumptions underlying multivariate methods prior to the analysis

(Tabachnick & Fidell, 1989).

RESULTS

Socio-Demographic Profile of Sex Workers

Age

The overall mean age was 26.98 years (s.d. 6.95) with no significant differ-

ences found between the three cities at the 0.05 confidence level. Table 1 pre-

sents MSWs reclassified by age groups and shows that the majority of the sex

workers were between 26 and 30 years old (32.4%), and about 21% of the par-

ticipants were older than 30 years of age. While participants from Sydney and

Melbourne tended to show a similar age group distribution, 44.7% of the

MSW from Brisbane were within the 26 to 30 years age range. Those working

exclusively as street or escort sex workers appeared to be younger (mean ages

24 and 25 years old, respectively) than those working exclusively as indepen-

dent MSW (mean age 30 years old) or in more than one modality of sex work

(mean age 27 years old). The differences in age reached statistical significance

between independent workers and street or escort sex workers [F(3,176) =

8.20; p < 0.01).

Education, Economic Need Status, and Living Arrangements

With regards to education level, less than one third (31%) had not com-

pleted secondary education, a similar proportion (30.4%) had completed sec-

ondary school, and 38.6% had at least some tertiary or college level education.

There was no significant association in level of education by location. How-

ever, by type of work, more than half of those working exclusively as street sex

workers (54.8%) had incomplete secondary education, and only two of the

street MSWs reported tertiary education. In contrast, 40.9% of escort MSWs

reported attending or completing tertiary studies, and the majority of inde-

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pendent MSWs (58.2%) reported some tertiary education. These differences

reached statistical significance (x2 (6) = 29.23; p < 0.01).

Data on income showed that the majority of MSWs (46.7%) could “only

manage to get by,” and another 19% reported that they “could manage plus

save some money.” A similar proportion (18.5%) indicated that they had “no

money problems,” and another 15.8% did not have enough income to cover

economic necessities. Street MSWs (35.5%) were more likely to report that

they could not manage to get by. By contrast, 47.8% of the independent sex

workers, and a similar proportion of those working as escorts (43.2%), re-

ported that they could either manage to get by plus save some money or did not

have money problems. Differences in whether the MSWs were managing or

not managing financially by type of sex work was statistically significant

(x2(9) = 22.96; p < 0.01).

The majority of MSWs (75.4%) were renting accommodation and only

6.6% owned their own place. Most of the home owners were the independent

sex workers living in Sydney. About 6% reported being “homeless,” with a

higher proportion of them being street sex workers from Melbourne.

Ethnic Background

The measure of ethnicity used in the study was parents’ country of birth. Ta-

ble 1 shows that more than 65.2% of the MSWs indicated that their father’s or

mother’s ethnicity was Anglo-Australian, and 34.8% reported an overseas

country of birth for either the father or the mother or both. A significant associ-

ation was found in the non-English speaking background (NESB)/English

speaking background (ESB) distribution by location (χ2(2) = 8.47; p < 0.02),

with sex workers from Brisbane more likely to have an ESB background than

sex workers from the other two cities (84.2%), while sex workers in Mel-

bourne had a higher NESB (44.4%), probably reflecting migration patterns in

Australia.

Self-Identifications and Relationships

When asked about their sexual identification, more than half of the partici-

pants (56.3%) self-identified as being gay, another 31.7% as being ‘bisexual,

and 5.5% self-identified as being straight. More than half of the sample

(55.7%) were currently involved in permanent sexual relationships. Of those

in a permanent relationship, 83.5% of them were in relationships with another

man, about 15% reported being in a relationship with a regular female partner,

and two MSWs were in a permanent relationship with persons with transgender

qualities.

Minichiello et al. 39

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HIV Test

About 88.6% of the MSWs reported that they have had HIV antibody test.

A logistic regression analysis was performed to explore the probability of hav-

ing an HIV test, using location and type of sex work as predictors of HIV anti-

body testing. After controlling for the other independent variables included in

the model, type of sex work by place groups were significant predictors (χ2(3) =

14.34; p < 0.01). SMSW from Melbourne were almost 10 times less likely to

have an HIV test than SMSW from the other two locations (OR = 0.09; 95% CI

0.01 to 0.37). Those working as independent sex workers in Sydney and Mel-

bourne were also less likely to have had an HIV test (OR = 0.26; 95% CI 0.08

to 0.83; OR = 0.20; 95% CI 0.04 to 0.89, respectively) than those working as

IMSW in Brisbane. Among those having an HIV test, about 44% had the test in

the last one to six month period, another 34.4% reported having the test in the

four weeks before the survey, while 13.5% had the test over six months ago. Of

those who had their results at the time of the survey (n = 167), 6.6% reported

being HIV positive.

Alcohol and Drug Consumption

Table 2 reveals that the most frequent forms of substances used were to-

bacco, marijuana, alcohol, and, to a lesser extent, heroin. About two thirds of

the MSWs (66.1%) reported daily use of tobacco, about half of the sample re-

ported use of marijuana at least once a week, and 19.6% indicated daily use of

marijuana. Regarding alcohol, 50.8% reported drinking alcohol once a week,

more than once a week, or daily, and 7.8% indicated that they drink alcohol

daily. Another drug regularly consumed was heroin, with 7.3% of the partici-

pants consuming heroin on a daily basis. Additionally, daily consumption of

methadone was reported by 4.5% of the respondents.

Except for tobacco, marijuana, alcohol, and heroin, daily use of other drugs

was low (i.e., in less than 5%). However, when we reclassify participants ac-

cording to whether they did not consume (never and less than once a week) or

did consume (all other frequency categories) alcohol or drugs, a different picture

appears: After alcohol, marijuana, and tobacco, the fourth most frequently used

drug was nitrites (13.2%), followed by pain killers (10.5%), and benzodiasepines

(10.3%). The data further reveals that over 50% of the participants reported

polysubstance use, defined as the use of more than one of the listed substances

(excluding tobacco) at least once a week.

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The Work Context

Table 3 shows that most participants always (22.3%) or usually (45.7%) felt

good about being sex workers. In contrast, only 11.4% and 3.8% reported

rarely or never feeling good about doing sex work, respectively. There were no

major differences by location. To further explore MSWs’ feelings about being

sex workers, an LRA was performed using the combination of location and

type of sex work as predictors of never or very rarely feeling good about doing

sex work. Those working as escort sex workers or street workers in Sydney

were more than three times more likely to report that they rarely or never felt

good about being a sex worker than participants in the other modalities by lo-

cation groups (OR = 3.33; 95% CI 0.77 to 14.16; OR = 3.65; 95% CI 1.37 to

9.78, respectively) [χ2(2) = 7.59; p < 0.05; h2 = 0.05]. However, the addition of

two socio-demographic variables (living arrangement and financial status) to

the model indicated that those working as escort sex workers in Sydney were

more than five times more likely to report that they rarely or never felt good

about being a sex worker (OR = 5.33; 95% CI 1.72 to 16.44). Those sharing a

Minichiello et al. 41

TABLE 2. Frequency (%) of Consumption of Substancea by Male Sex Workers

Type ofSubstance

Number Never Lessthan

once aweek

Once aweek

Morethan

once aweek

Daily

Cocaine 174 59.8% 36.8% 1.1% 1.7% 0.6%

Ecstasy 175 50.3% 45.7% 4.0% 0.0% 0.0%

Methadone 176 93.2% 2.3% 0.0% 0.0% 4.5%

Speed 176 54.5% 38.6% 4.0% 2.3% 0.6%

Benzodiazepines 174 69.5% 20.1% 2.9% 3.4% 4.0%

Pain killer 172 57.0% 32.6% 4.1% 5.2% 1.2%

Nitrites 174 61.5% 25.3% 4.0% 7.5% 1.7%

Heroin 178 77.5% 8.4% 1.1% 5.6% 7.3%

Alcohol 179 17.3% 31.8% 21.8% 21.2% 7.8%

Marijuana 179 24.6% 24.0% 10.6% 21.2% 19.6%

Tobacco 183 25.7% 4.4% 0.5% 3.3% 66.1%

aOrdered in terms of substance consumed never or less than once a week.

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rented place were less likely to feel bad about being a sex worker (OR = 0.34;

95% CI 0.12 to 0.91). By financial status, those who could not make ends meet

or those who could just manage were more likely to report feeling bad about

being a sex worker (OR = 12.99; 95% CI 2.32 to 71.88; OR = 11.66; 95% CI

2.45 to 55.60), respectively) [χ2 (4) = 26.66; p < 0.001]. The power of the re-

sulting model in predicting the observed value also improved to h2 = 0.15

when using the full model.

Most participants reported sex work as a little stressful (60.9%) followed by

not at all stressful (22.3%), and only 16.8% found sex work stressful or very

stressful. By location, MSWs from Melbourne were more likely (30.9%) to

find sex work not stressful at all. By modality of work, those working in more

than one modality or as street workers tended to find sex work usually stressful

or very stressful (29.3% and 22.6%, respectively). However, these differences

did not reach statistical significance at the 0.05 level of confidence. The partic-

ipants were also asked about their degree of comfort with having sex with

males. The majority (62%) reported feeling very comfortable with having sex

with men. Only 4.9% felt uncomfortable or very uncomfortable with having

sex with men.

Type of Sex Work

Table 1 shows that 36.2% of the participants reported working as indepen-

dent sex workers, 23.8% as working as escort agency/brothel sex workers, and

16.8% as street workers. The remainder (23.2%) reported working in more

than one of these categories. The most frequently nominated type of sex

worker in Sydney and Brisbane was the independent sex worker, while in Mel-

bourne, the most common modality of sex work was escort, followed by inde-

pendent sex work and street sex work. Street work was the least mentioned

modality of work in Sydney, while in Brisbane it was the second most men-

tioned modality of sex work. Differences by place were significant at the 0.01

level of significance (χ2(6) = 20.52; p < 0.01).

Reason for Doing Sex Work

The most commonly mentioned reason for doing sex work was money

(48.4%)–as the main reason or in combination with other–followed by “cho-

sen profession” (7.6%) and financing addictions (5.4%). For the Brisbane

MSWs, the second and third most mentioned reasons for doing sex work were

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friends or acquaintances in the industry (13.2%) and to pay for drugs (7.9%).

For the Sydney MSWs, the second and third most mentioned reasons were sex

work as a chosen profession” (8.8%) and to pay for drugs (5.5%), respectively,

while for MSWs in Melbourne, the second and third most mentioned reasons

were lack of employment opportunities (9.1%) and chosen profession (7.3%),

respectively.

Minichiello et al. 43

TABLE 3. Distribution of Sex Work Experience and Characteristics (Percent-ages) of Male Sex Workers In Sydney, Melbourne, and Brisbane

Sydney(n = 92)

Melbourne(n = 55)

Brisbane(n = 38)

Total(n =185)

Good About Being an MSWAlwaysUsuallySometimesRarelyNever

23.1%44.0%12.1%16.5%4.4%

23.6%45.5%21.8%7.3%1.8%

18.4%50.0%21.1%5.3%5.3%

22.3%45.7%16.8%11.4%3.8%

Stress at WorkNot at allA littleStressfulVery stressful

20.9%61.5%14.3%3.3%

30.9%50.9%10.9%7.3%

13.2%73.7%13.2%0.0%

22.3%60.9%13.0%3.8%

Comfort with Having Sex with MenVery comfortableComfortableNeither comfortable nor uncomfortableUncomfortable/Very uncomfortableDo not know/Unsure

61.5%23.1%9.9%3.3%2.2%

52.7%25.5%18.2%3.6%0.0%

76.3%5.3%5.3%

10.6%2.6%

61.6%20.1%11.3%5.4%1.6%

Reason for Doing Sex WorkChosen professionMoneyPay for drugsLack of employment opportunitiesMultiple reasons (including money)Acquaintances or friends MSWOther reasons

8.8%47.3%5.5%2.2%

24.2%3.3%8.8%

7.3%47.3%3.6%9.1%

14.5%0.0%

18.2%

5.3%52.6%7.9%2.6%

10.5%13.2%7.9%

7.6%48.4%5.4%4.3%

18.5%4.3%

11.4%

Length of Time as MSWLess than six monthsBetween 6 months and one yearBetween 1 year and 2 yearsBetween 2 years and 5 yearsMore than 5 years

27.5%15.4%16.5%17.6%23.1%

23.6%16.4%12.7%29.1%18.2%

31.6%21.1%10.5%15.8%21.1%

27.2%16.8%14.1%20.7%21.2%

Type of Clients Willing to Servea

MaleFemaleCouplesTransgender

100.0%9.9%

12.1%4.4%

100.0%16.4%18.2%5.5%

100.0%10.5%23.7%5.3%

100.0%12.0%16.3%4.9%

aMore than one answer

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Length of Time in Sex Work

The most frequent length of time working as a sex worker was less than six

months (27.2%) followed by a two to five year period (20.7%). The latter was

the most mentioned length of time by participants from Melbourne (29.1%),

while the former was the most mentioned category from Sydney and Brisbane.

However, no significant differences were found by location.

By modality of work, it is interesting to note that more street workers have

been in the industry for either less than six months (25.8%) or more than five

years (about 35.5%). Most escort workers (43.2%) have been working for less

than six months. Independent workers were in the industry for less than six

months (25.4%) or between 2 and 5 years (22.4%). These differences were

non-significant at the 0.05 level of confidence.

Places of Work

About half the sex workers (n = 89) indicated working in places within Aus-

tralia other than the location of the one they were working at the time of the

study. Most had worked in Sydney. Brisbane was the second most mentioned

place, Melbourne the third, followed by other places in Queensland.

Twenty-three participants indicated that they had also worked overseas, with

England being the most frequent destination followed by the United States. By

modality of work, more than half of street workers (58.1%) and those who

nominated more than one form of sex work (53.7%) indicated having worked

in a different location than the location of the survey.

Type of Clients

When the respondents were asked what type of clients they would accept,

all indicated male clients, 16.3% indicated that they would accept couples as

clients, and another 12% indicated that they would accept female clients.

Transgender people were the least mentioned types of clients (4.9%). MSWs

from Brisbane were more likely to state that they accept couples as clients

(23.7%). Escort MSWs and those working in more than two modalities were

more likely to agree to accepting females as clients. Also those working in

more than two modalities and independent MSWs were more likely to agree to

accept couples.

Sexual Practices

Male sex workers reported a variety of sex practices that they were willing

to engage in as part of their sex work, which range from highly unsafe sexual

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acts to activities which do not involve intimate contact, such as watching vid-

eos, talking, etc. (Pleak et al., 1990). Table 4 shows the distribution of the most

and the least frequently reported sexual practices. Most MSWs were willing to

practice mutual masturbation (95.7%) and both active and receptive masturba-

tion (96.2% and 92.9%, respectively), insertive and receptive oral sex with a

condom was also frequently mentioned (87.0%). Although not shown in Table

4, other sexual acts frequently mentioned were erotic massage (93.5%) and

body rubbing (92.4%). The least mentioned sexual acts were both insertive

and receptive anal sex without a condom (4.9% and 3.3%, respectively). A

small number of MSWs reported receptive fisting (6.5%) and receptive oral

sex to the point of orgasm without condom (6.5%).

DISCUSSION

Consistent with other research on male sex workers, this study found that

MSWs are an accessible and cooperative research population, depending upon

appropriate collaborative research protocols being developed and imple-

mented (Minichiello et al., 1998). However, as with any other studies, due to

the lack of a sampling frame (Pleak et al., 1991; Elifson, 1993), it was not pos-

sible to enumerate all the male sex workers in Sydney, Melbourne, or Bris-

bane, and, therefore, a random sample cannot be assumed in this study. It is

possible that the sampling strategies used in this study might have had an artifi-

cial effect on the recruitment process. This poses some methodological prob-

lems in terms of possible sampling bias and representativity which are difficult

to evaluate when studying populations such as sex workers (Minichiello et al.,

1998). While acknowledging this limitation, the outreach workers of sex

worker organisations in the three cities estimate that the present sample distri-

bution captures between 50% to 70% of the total MSW population at the time

of the study. But while it is true that we cannot know with confidence whether

the present sample truly reflects the demographic profile of MSWs in these

three cities, if sample representativeness is assessed by the high rate of partici-

pation (estimated response rates ranged between 50% and 95% depending on

the location and the modality of sex work), the chances of selection bias is rela-

tively low. The low refusal rate was due, in part, to reimbursing the male sex

workers for travel expenses and time lost at work as a result of participating in

the study, and the trust and rapport achieved by the field researchers who were

seen to identify with sex workers because of their affiliation with sex workers

organisations. Future efforts should focus on developing innovative recruit-

ment protocols which may have more success in recruiting males who do sex

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work on a less regular basis and may include underage workers and those who

advertise as massage therapists but also provide a sex work service.

Another issue associated with the reliability of the information presented

here centres around studies which rely on surveys when asking questions

about sexual issues and other sensitive social issues. It has been argued that

self-reported data on such sensitive topics always carries the risk of obtaining

socially desirable answers (Angel & Gronfein, 1988; Leigh, 1993). For exam-

ple, high levels of drug and alcohol consumption were reported by few partici-

pants, and this may well be due to underreporting by participants. However,

alcohol and drug consumption were also reported as low in observational stud-

ies conducted on male sex workers in the United Kingdom (Bloor et al., 1992).

Alcohol use patterns reported in this study are not dissimilar to those found

among males in these age groups in Australia (Commonwealth Department of

Health and Family Services, 1996). Although illicit drug consumption ap-

peared to follow a similar pattern, the proportion of those who have ever tried

was higher. The self-reported HIV seroprevalence was found not to be differ-

ent from those reported by STD clinics and surveillance data on the male sex

worker populations in Australia (6.0%) (Griggs et al., 1990). The consistency

of these results offer some reassurance about the reliability of the data. How-

ever, future studies need to examine the congruence or divergence between

46 JOURNAL OF HOMOSEXUALITY

TABLE 4. Sexual Practices Sex Workers Are Willing to Provide to Clients

Sydney Melbourne Brisbane Total(N = 92) (N = 54) (N = 38) (N = 184)

Sexual Practices(more than one answer)

Active masturbation 96.7% 94.4% 97.4% 96.2%Mutual masturbation 96.7% 92.6% 97.4% 95.7%Passive masturbation 93.4% 92.6% 92.1% 92.9%

Oral sex with condom 89.0% 85.2% 84.2% 87.0%Oral sex without 38.5% 37.0% 42.1% 38.8%

condom

Receptive anal sex 74.7% 53.7% 68.4% 67.2%with condom

Receptive anal sex 3.3% 1.9% 5.3% 3.3%without condom

Insertive anal sex 87.9% 74.1% 76.3% 81.4%with condom

Insertive anal sex 4.4% 5.6% 5.3% 4.9%without condom

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self-reported sexual behaviour, and actual sexual behaviour given that sex

workers operate within the context of having to negotiate between what they

are prepared to do and what clients what them to do, which may include doing

something more sexually.

Some limitations of the study, however, need to be pointed out. First, this is

a study of the male to male commercial sex interaction, and excludes encoun-

ters with female customers. It is possible that MSWs who exclusively or

mostly provide a paid sex service to female clients may have a different pro-

file, and operate under different sex work contexts. Second, the study does not

include a random selection of MSWs, nor MSWs under the age of 18 years, a

population which may be more prone to being homeless, socially isolated, and

vulnerable to risky behaviours, such as drug addiction (Coleman, 1989; Pleak

et al., 1990; Markos et al., 1995; Johnson et al., 1996). Third, the use of single

items cases (e.g., stress and feeling about doing sex work) presents a limitation

which must be considered when interpreting the results. Clearly single items

cannot properly identify all the underlying elements of complex and multidi-

mensional constructs. While valid and reliable scales to measure these vari-

ables do exist, we relied on personal intuitive perceptions and judgements due

to space and time factors associated with the implementation of an already

large instrument. Single items can, however, play a role in the development of

knowledge or suggest new directions for research.

One of the key findings highlighted from the study is that MSWs are a

hetergeneous group. The legal status of commercial sex and its modalities var-

ies throughout Australia, and, not surprisingly, the impact of these laws are re-

flected in the industry. For example, in Brisbane where the only legal form of

commercial sex is the private sex worker, MSWs are concentrated in that mo-

dality and, to a lesser extent, in street work, with few MSWs working in escort

agencies. By contrast, in Sydney, where the three main forms of sex work are

legal or decriminalised, fewer sex workers report working exclusively as street

sex workers.

The profile of the male street sex workers was in agreement with the results

of other studies that, for example, street MSWs are less educated, higher drug

users, particularly heroin users, more likely to report financial problems, less

likely to be tested for HIV and sexually transmissible infections (STI), and

hold less positive attitudes towards being a sex worker. Non-street workers

(independent and escort sex workers) tend to be more educated, reported less

financial problems, were more likely to see sex work as a long term occupa-

tion, and felt more comfortable with sex work. However, while street sex work

is only one aspect of the sex industry, it is usually the most visible and accessi-

ble one, and is also frequently the reference group used to develop public

health programs and social services (McKeganey & Barnard, 1996).

Minichiello et al. 47

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These findings clearly show that there are some marked differences in the

male sex work population, and programs and policies need to understand this

context so that they can develop services which are more appropriate to meet

the needs of this diverse group. For example, given that there are a significant

number of non-gay identifying sex workers, the delivery of public health pro-

grams which assume a gay self-identity or which are publicized in the com-

mercial gay culture may not be reaching or seen to be relevant for some of

these workers. Or programs which are built around the theme of homelessness,

drug addiction, and a working class subculture may be rejected by some sex

workers, particularly the escort and independent MSWs, who see this work as

an occupation and who require different sorts of support, such as a better under-

standing of the legalities of the industry, education which promotes client com-

pliance with safe sex, and programs which provide communications skills to

better market their services and negotiate safe sex. In addition, there are a grow-

ing number of MSWs who chose to work in the sex work industry because they

see it as career and who adopt a hospitality attitude towards their work. Pro-

grams which are built around the themes of deviance, stigmatization, and crime

may be totally inappropriate in assisting such sex workers to further develop

communication skills which are more consistent with their view of work.

Finally, the results of this study support the efforts of a community based

public policy program on HIV/AIDS as adopted in Australia. Most of the

MSWs are regularly tested for HIV and other STIs and practice safer sex. In

addition, few of the respondents were HIV positive, and the use of hard drugs,

such as heroin, was moderate, even when including those MSWs taking meth-

adone daily as a result of a treatment program, although there were significant

differences between the different types of sex work. This suggests that pro-

grams which are aimed at preventing the spread of HIV and STIs and promot-

ing responsible self-care among this population should continue to be publicly

supported, and possibly be more specifically and appropriately targeted for

specific sub-groups within the sex work population. Such an approach not only

benefits the sex work industry, but it is also in the public health interest of the

consumers who are using a service that is quickly moving away from the

streets to a hospitality based service advertised in newspapers or purchased

through legitimate business companies.

This study also shed light on future lines of inquiry. For example, we need

to better understand the impact of structural factors, such as, the legal context

on the opportunities that inhibit or enhance the type of sex work that occurs.

For example, is a higher level of street male sex workers and homelessness in a

particular city a reflection of the economic forces at play in society, the impact

of how we socially and legally organise sex work, the attitudes of the sex

workers, or the influence of all these factors?

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ACKNOWLEDGMENTS

This study was funded by a grant received from the National Health and Medical Re-search Council. The authors would like to acknowledge the support received from theProstitutes Collective of Victoria, Sex Workers Outreach Project, and the Self-HealthQueensland Workers in the Sex Industry. In particular, we would like to acknowledgeJohn Jones from Kirketon Road Centre for assisting with the collection of the data, MariaMcMahon from Sex Workers Outreach Project for her assistance in the development ofthe questionnaire, and Leisha Host from Sex Workers Outreach Project and theSelf-Health Queensland for her assistance in the development of the diary.

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