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Understanding the experiences of male sex workers and their risk perceptions and behaviors in Cape Town, South Africa

Meade, John W. (2017)
Master's Thesis (61 pages)
Committee Chair / Thesis Adviser: Andes, Karen
Committee Members: Rochat, Roger
Research Fields: Public health
Partnering Agencies: Community-based non-profit organization (e.g., AID Atlanta) ; Emory University schools, faculty or affiliated programs
Keywords: sex work; risk perception; South Africa; Sexual health; HIV
Program: Rollins School of Public Health, Hubert Department of Global Health
Permanent url: http://pid.emory.edu/ark:/25593/s0rzx

Abstract

Background: In South Africa, male sex workers are a particularly vulnerable population because they encounter verbal, physical and sexual violence and have a very high burden of diseases. Most of the statistics on sex work that public health professional has obtained are from female sex workers. There is a vital need to understand the unique experiences of male sex workers and to explore the kinds of risk encountered in a society that criminalizes sex work in South Africa.

Methods: In the summer of 2016, 22 in-depth life history interviews were conducted with male sex workers, who receive services from Sex Worker Education and Advocacy Taskforce (SWEAT). Two primary research questions were asked: what types of risk do male sex workers encounter in a society that criminalizes sex work and what strategies do male sex workers take advantage of to manage these risks? Thematic analysis was used to identify key patterns in the data.

Results: Participants discussed reasons for entering sex work and were categorized into three main trajectories: Migrating to South Africa, drug addiction and unstable family/origin. Participants discussed that the reasons for entering sex work would have an impact on the types of risk that they encountered while working as sex workers in Cape Town. All participants had some form of experience with law enforcement officials but the majority explained that these interactions were negative and abusive. All participants mentioned that they have used drugs/alcohol during the interaction with clients and inhibits the ability to make safe decisions such as using condoms. Participants mentioned some interesting elements of their sex work including that they work for themselves (no pimps), feel comfortable negotiating condom use with clients and get paid before interaction with clients.

Discussion: These findings shed light on the HIV risk perceptions of male sex workers in Cape Town, South Africa. One key finding is that there are the proximal and distal factors for entering sex work. The proximal factors include drug addiction while distal factors include migration and an unstable family/origin. Secondly, the results provide insight on factors that may lead to higher or lower risk of HIV among male sex workers. The frequency of ‘regular clients' and the fact that male sex workers generally serve as their own bosses may serve as a protective effect and lower HIV risk among male sex workers. While violence perpetrated by law enforcement and drug/alcohol use serve as factors that may increase the risk of HIV among male sex workers. More tailored multidisciplinary interventions that address homelessness and drug addiction need to be implemented. This research has helped to shed light and pressure public health and human rights organizations to put the needs of male sex workers at the top of their agendas.

Table of Contents

I. Introduction- Pg. 1

II. Background- Pg. 3

III. Methods- Pg. 9

IV. Results- Pg. 16

V. Discussion- Pg. 29

VI. Future Directions/Public Health Implications- Pg. 33

VII. References- Pg. 37

VIII. Appendices- Pg. 40

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