Social Environment and Male Sex Work in the United States

In little over a decade, medical science has advanced significantly in its ability to detect, treat, and in many cases sustain the lives of persons infected with human immunodeficiency virus (HIV). Similarly, public health educational efforts in Europe and North America have significantly increased public awareness and knowledge regarding infection and transmission. With the introduction of protease inhibitors, medical science cautiously embraces combination drug therapy, which is likely to result in positive treatment gains and increased survival for HIV infected individuals, some of whom will now have the opportunity to return to their previous lifestyles. Simultaneously, however, these same medical advances may have a latent negative consequence of restoring health to various HIV infected marginalized populations, who have not historically participated in HIV prevention and intervention efforts. Many of these individuals, left within their current uncompromising social environments, may continue to engage in health threatening HIV-related high risk sexual and drug use behaviour patterns in order to survive. In the United States, male street sex workers ¹ are one such population. Studies of HIV seroprevalence among male sex workers in the United States report rates ranging from 17.5 per cent (Morse et al., 1991) to 29.4 per cent (Elifson, Boles and Sweat, 1993), thus confirming their identity as a highly vulnerable group. With improved medical outcomes, it is now more important than ever to understand the HIV-related social risk behaviour and medical profiles of male sex workers and their customers, as well as the social contexts within which these behaviours occur. Utilizing this knowledge is critical to the design of effective prevention and intervention efforts aimed at arresting future HIV transmission.