ABSTRACT
This chapter, which focuses on how psychosocial issues affect health, confronts the double stigma faced by male sex workers, who are stigmatized by virtue of their having sex with other men and because they are sex workers. Although substantial research has examined the mental health, substance use history, and structural conditions of female sex workers, the literature on these psychosocial factors among male sex workers is much more limited. The conceptual framing of poor psychosocial health among male sex workers is usually presented from two distinct angles: as a consequence of engaging in sex work or as a negative antecedent to sex work. Unfortunately, the lack of historical or longitudinal studies makes it difficult to draw causal conclusions. Nevertheless, the authors summarize the existing research on depression and anxiety, trauma and violence, and substance use among male sex workers. In addition, they discuss how male sex workers are affected by structural conditions such as homelessness, lower socioeconomic status, and involvement with the criminal justice system. The chapter summarizes how syndemic theory—which posits that co-occurring epidemics of poor mental health, substance use, and disadvantageous social conditions interact to adversely affect health—provides an understanding of male sex workers’ experience. Indeed, their experiences of social stigma and marginalization as a sexual minority may be at the root of their psychosocial problems. The authors also discuss the treatment and structural interventions that have been devised and tested in efforts to improve the health outcomes of male sex workers. They conclude that interventions that address intertwined syndemic factors may be most effective in reducing negative mental health symptoms.
