Male prostitutes and safe sex: different settings, different risks

AIDS Care. 1994;6(3):277-88. doi: 10.1080/09540129408258640.


Twenty-seven male prostitutes were interviewed extensively about their work and considerations relating to safe sex with clients. Important differences were found between street prostitutes and those working at home. Street-workers were more likely to be using hard drugs, to have a heterosexual preference, to have no other occupation, to have more clients, but less steady ones, and to have a more negative working attitude. Sexual techniques most often practised were manual and oral contact; however, most prostitutes also practised either insertive or receptive anal intercourse. Homosexual male prostitutes reported more receptive anal intercourse than did their heterosexual male colleagues; but no such differences were found in insertive anal intercourse. Prostitutes were most likely to have had anal intercourse with steady clients, with clients whom they trusted regarding condom use, or with clients they felt sexually attracted to; and also when in dire need of drugs. Of those who had practised anal intercourse in the previous year, a minority had not consistently used condoms. The same factors that encourage anal intercourse also appear conducive to unprotected intercourse.

PIP: 27 male prostitutes were interviewed in the Netherlands over the period July 1990 - January 1991 about their work and considerations relating to safe sex with clients. They were aged 18-40 of mean age 25 years, with 85% working in one of Holland's four largest cities, especially Amsterdam. No non-Dutch prostitutes were recruited. Sixteen worked in street prostitution, nine in home prostitution, and two in clubs or brothels. These latter prostitutes are underrepresented, however, because establishment owners were reluctant to grant permission to interview their boys. Street workers were of mean age 23 years compared to the mean age 29 years of men who worked at home. The prostitutes tended to pass back and forth between club/brothel prostitution and either street or home prostitution, with little interchange between street and home prostitution. All heterosexual street prostitutes used hard drugs, while all non-drug-using street prostitutes considered themselves to be gay or bisexual. The use of hard drugs, gambling habits, curiosity, and/or an interest in easy money prompted their entry into prostitution. Respondents began prostituting themselves at the average age 18 years. Street workers worked an average 26 hours per week with 30 clients at 67 guilders per sexual episode. Home workers, however, worked an average of 7 hours per week with 13 clients at 140 guilders per sexual episode. Street workers spend an average 42 minutes/client compared to the 79 minutes/client among home workers. Of the various types of prostitution, home prostitution corresponds closest to unpaid sex and intimate relationships. Four street workers and four home workers each participated in anal receptive sexual intercourse, while 12 street workers and 7 home workers participated in anal insertive sexual intercourse. 50% did not always use condoms during receptive intercourse, while four street workers and one home worker did not always use condoms during insertive intercourse. In the previous year, 30% of these men reported receptive intercourse and 74% insertive anal intercourse, mostly with low frequency. A reluctance to have anal receptive sex stemmed from their personal dislike of the activity and to some extent fear of HIV infection. Respondents were mainly negative about personally wearing condoms, but they still use them. There was a relatively low rate of condom use in orogenital sex because HIV transmission occurs mainly in anal sex. All were well-informed about which sex practices can definitely cause HIV transmission, although some uncertainty exists whether transmission can occur through oral intercourse or kissing. This study therefore found anal intercourse, especially the receptive form, to not be one of the sexual services which prostitutes in the Netherlands offer clients as a matter of course, and the rate of condom use in such intercourse is high.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Condoms*
  • HIV Infections / psychology
  • Health Knowledge, Attitudes, Practice
  • Homosexuality, Male / psychology*
  • Humans
  • Male
  • Motivation
  • Netherlands
  • Risk Factors
  • Sex Work / psychology*
  • Substance Abuse, Intravenous