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Condomless Anal Sex Between Male Sex Workers and Clients in the Age of Hookup Apps

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Abstract

Among men who have sex with men (MSM), those who also engage in the exchange of sex for money, drugs, shelter or other material goods (i.e., male sex workers-MSWs) have been found to have higher rates of condomless anal sex (CAS), HIV, and STIs than MSM who do not engage in exchange sex. To gain a better understanding of the factors that influence MSWs’ engagement in CAS with male clients, we analyzed qualitative interview data from a diverse sample of 141 MSWs from 8 U.S. cities who met clients primarily through hookup or dating apps/websites and who reported having condomless anal sex with at least one of their exchange sex partners in the prior three months. While high client demand and financial incentives were the most frequently mentioned reasons for engaging in CAS with clients, other factors including drug and alcohol use, attraction to the client, the heat of the moment, concerns about sexual performance, and reliance on pre-exposure prophylaxis (PrEP) were also important. Participants who engaged in CAS generally felt that due to client characteristics or mitigating steps they had taken themselves, their chance of acquiring HIV/STIs was acceptably low. Hookup or dating apps/websites have provided an additional and increasingly popular venue for exchange sex to be arranged. These platforms also offer an opportunity for HIV/STI prevention through interventions and tailored messages delivered through these venues that address the motivations, misconceptions and/or situational factors that may lead to CAS.

Resumen

Entre los hombres que tienen relaciones sexuales con hombres (HSH), se ha encontrado que aquellos que también participan en el intercambio de sexo por dinero, drogas, vivienda u otros bienes materiales (es decir, hombres trabajadores sexuales-HTS) tienen tasas más altas de sexo anal sin condón (SASC), VIH y ETS que los HSH que no participan en relaciones sexuales de intercambio. Para obtener una mejor comprensión de los factores que influyen en la participación de los HTS en SASC con clientes masculinos, analizamos los datos de entrevistas cualitativas de una muestra diversa de 141 HTS de 8 ciudades de EE. UU. que conocieron a los clientes principalmente a través de aplicaciones/sitios web de conexión o citas y que informaron haber tenido sexo anal sin condón con al menos una de sus parejas sexuales de intercambio en los tres meses anteriores. Mientras la alta demanda de los clientes y los incentivos financieros fueron las razones mencionadas con mayor frecuencia para participar en SASC con los clientes, otros factores como el uso de drogas y alcohol, la atracción hacia el cliente, la seducción del momento, las preocupaciones sobre el desempeño sexual y la dependencia de la profilaxis preexposición (PrEP) también fueron importantes. Los participantes que tomaron parte en SASC generalmente sintieron que debido a las características del cliente o a los pasos de mitigación que habían tomado ellos mismos, su probabilidad de contraer VIH / ETS era aceptablemente baja. Las aplicaciones/sitios web de conexión o citas han proporcionado un lugar adicional y cada vez más popular para organizar el intercambio de sexo. Estas plataformas también ofrecen una oportunidad para la prevención del VIH/ETS a través de intervenciones y mensajes personalizados que se transmiten a través de estos lugares y que abordan las motivaciones, los conceptos erróneos y/o los factores situacionales que pueden conducir a SASC.

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Acknowledgements

The authors wish to thank Katharine E. Peglow, MPH for her assistance in the preparation of this manuscript for submission.

Funding

This work was supported by the National Institute on Minority Health and Health Disparities under Grant R01MD011587, ‘‘Exchange Sex and HIV Risk Among MSM Online’’ (PIs: Siegel/Schrimshaw).

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Authors and Affiliations

  1. Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA

    Karolynn Siegel & María Cabán

  2. Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA

    Courtney J. Brown-Bradley

  3. Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL, USA

    Eric W. Schrimshaw

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  1. Karolynn Siegel
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Contributions

KS and EWS contributed to the study conception and design. Data analysis was carried out by all the authors. The first draft of the manuscript was written by KS, CJB-B, and MC and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Karolynn Siegel.

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Siegel, K., Cabán, M., Brown-Bradley, C.J. et al. Condomless Anal Sex Between Male Sex Workers and Clients in the Age of Hookup Apps. AIDS Behav 28, 1077–1092 (2024). https://doi.org/10.1007/s10461-023-04216-8

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