Gay and bisexual male escorts who advertise on the Internet: understanding reasons for and effects of involvement in commercial sex.

The growing research on male commercial sex work has primarily concentrated on adolescent hustlers and street-based workers. Few studies have addressed the specific characteristics of adult male gay or bisexually identified escorts who work independently. We explored qualitatively reasons for and effects of sex work among 46 gay and bisexual male escorts in New York City who use the Internet to advertise their services. Participants completed quantitative measures and a semi-structured qualitative interview. A manual search of themes in the transcribed interviews identified three main reasons for participation in sex work--monetary benefits, positive impact on the self, and sexual pleasure. Participants also reported various changes to their personality and sexuality because of their involvement in commercial sex work. Internet-based male escorts represent a unique population of commercial sex workers, different from male sex workers who work on the streets, and have their own specific health needs.

Keywords: male commercial sex work, gay and bisexual, Internet-based male escorts, health needs

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The growing research on male commercial sex work has approached this topic in various ways. Social scientists have drawn a number of distinctions among this population of sex workers with regard to nomenclature, research perspective and orientation, and research foci. For instance, there exist a number of terms to denote sex work among males, such as "hustler," "kept boy," "body worker," or "escort." While each term refers to a profession in which an exchange of some form of sexual activity occurs for some sort of payment or compensation, differences in nomenclature often also denote more subtle differences, such as in type of clientele, specific sexual acts that take place, method used in attracting clients, and the nature of the relationship between the sex worker and his client. Therefore, differences in terminology often indicate differences in typology. Researchers have consistently noted differences among these varied categories of male sex workers (Allen, 1980; Browne & Minichiello, 1996; Estep, Waldorf, & Marotta, 1992; Minichiello et al., 2000; Parsons, Bimbi, & Halkitis, 2001; Price, Scanlon, & Janus, 1984; Vanwesenbeeck, 2001; West & de Villiers, 1993).

Earlier studies from a sociological perspective focused on the deviance aspect of male commercial sex work (Klein, 1989; Luckenbill, 1984; 1986; Sagarin & Jolly, 1997; Salamon, 1989), asserting the negative aspects of an illegal and thus stigmatized profession. However, recent efforts have examined male sex work in a less negative manner, emphasizing the business aspects of a rational vocational choice and thereby viewing male sex work in a less criminal fashion by focusing on the legal and sociopolitical aspects of the industry (Browne & Minichiello, 1996; Minichello, Marino, Browne, & Jamieson, 1998; Vanwesenbeeck, 2001).

While there are a number of studies on male sex work that have originated from a sociological perspective, much of the research on this topic is psychologically oriented. Earlier studies have sought to examine the reasons for entry into such a profession, most often by citing some form of psychopathology or negative upbringing (Price et al., 1984; Sagarin & Jolly, 1997; Simon, Morse, Osofsky, Balso, & Gaumer, 1992; West & de Villiers, 1993). Some of these studies examined personality and social characteristics of male sex workers using various standardized measures (Cates & Markley, 1992; Earls & David, 1989) while others theorized on this subject using a clinical focus (Caukins & Coombs, 1976; Ginsburg, 1967). Many of these efforts focused on adolescent hustlers, men not of legal age who usually solicit sex on the streets. These young men tend to come from impoverished, dysfunctional, or chaotic families where parental fighting, drug abuse, and other forms of familial pathology are present (Caukins & Coombs, 1976; Sagarin & Jolly, 1997). It is this difficult family background that is often cited as the reason why some young male adolescents run away from home and turn to sex work as a way to support themselves, and overall these street-based male sex workers have been documented to suffer from problems with their physical and psychological health (Coleman, 1989; West & de Viliers, 1993; Price et al., 1984).

Other researchers have asserted the importance of intrapsychic variables regarding entry into and continuance of male sex work. For instance, research has found that some men enjoy the work (West & de Villiers, 1993) and view it as exciting (Cates & Markley, 1992). In one study of male hustlers, while nearly half stated that a benefit of their work was sexual pleasure, some viewed hustling as addictive or otherwise psychologically damaging (Calhoun, 1988). It has also been suggested that a reason for entering a sex work profession is the need for some psychological fulfillment such as affection or to fill some emotional void (Cates, 1989; Cates & Markley, 1992; Caulkins & Coombs, 1976). This literature also implies that the transient sexual encounter between the hustler and his client serves as a surrogate for an intimate relational understanding not otherwise achieved. This work, however, has focused almost exclusively on street-based hustlers, and thus such a characterization may not be appropriate for male sex workers who solicit their clients in other ways.

Another hypothesis regarding entry into sex work, posited by Boyer (1989), presents a relationship between male sex work, homosexual identity, and sexual abuse. According to Boyer, the realization and acceptance of one's homosexuality places that individual in the public territories of homosexuality the street corner in the gay community. She reviews literature that states that homosexuality and sex work are inextricably bound, augmented by homosexual promiscuity and notions of "cruising," and further states that sexual abuse affords the prospective sex workers an awareness of the existence of a sexual market and that sex work may be a way in which they can reclaim and gain control of their sexuality. Again, there is essentially no evidence supporting that this conceptualization is appropriate or accurate when describing male sex workers who do not work on the streets, and one recent study failed to find a strong association between childhood sexual abuse and working as an independent male escort (Parsons, Bimbi, Koken, & Halkitis, in press).

To date, few systematic investigations have been made regarding the consequences and effects of sex work on the individual, and of those that have, most have relied almost exclusively on samples of street-based male sex workers. Studies examining the psychological health and well-being of street-based male sex workers have found such individuals to be more depressed and more neurotic compared to a comparable non-sex worker cohort (Earls & David, 1989). According to a study conducted by Simon et al. (1992), male street hustlers scored significantly higher on all nine symptom dimensions and also on the three global indices of distress of the SCL-90-R, a measure that gauges the extent of psychiatric symptomology, when compared to normed population means. It is unclear, however, whether these findings are a result of being in sex work or if such problems with psychological health existed prior to entry into this line of work. It is clear from other empirical work that such psychopathology is not as routinely identified among more independent male sex workers who do not work on the streets (e.g., bar-based sex workers, escorts, masseurs) (Bimbi & Parsons, in press; Browne & Minichiello, 1996; Joffe & Dockrell, 1995; Koken, Bimbi, Parsons, & Halkitis, in press).

With recent increases in the rates of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) among gay and bisexual men (Catania et al., 2001; Koblin et al., 2000), specific studies are needed to examine how occupational behaviors could affect the physical health of male sex workers. These men, due to the very nature of their work, are at greater risk for STIs and HIV, even if condoms are used consistently, due to the potential for condom breakage and the potential for transmission of some STIs despite condom use. Aside from such physical health concerns, male sex workers may be in need of mental health resources or social support to reduce feelings of isolation and aspects of stigma (Koken et al., in press; Parsons, Koken, Bimbi, & Halkitis, in press). However, an investigation of the needs of male sex workers should be careful not to collapse all men who are paid for sex into one generic category, due to the evidence that different issues face different types of male sex workers, particularly street-based workers as compared to those who solicit clients in other ways.

With the advent of the Internet, a new venue for male sex work has emerged. The ease, availability, and relatively low cost of advertising for commercial male-to-male sex work has led to the increased use of this venue by male sex workers (Parsons, Bimbi, & Halkitis, 2001; Gaffney, 2003). The dearth of research on this diverse population of Internet-based workers has resulted in a body of literature that has been inappropriately generalized to all men who are paid for sex as a group. For these reasons, we sought to focus on an understudied population--gay and bisexual male sex workers who advertise on the Internet. More specifically, we focus on "escorts"--a broad category that includes male sex workers that other studies have labeled "call men," "masseurs," and "bodyworkers." The term escort is commonly used on the Internet in gay-oriented chatrooms and websites to refer to gay or bisexually identified men over the age of 18 who provide a range of sexual services via in-calls (at the home of the escort) or out-calls (at the home or hotel of the client). As such, this category of male sex worker does not include adolescent hustlers or runaways, heterosexually identified men, or those engaged in "survival sex."

Examining the perceptions of these Internet-based male escorts regarding their reasons for and consequences of sex work offer researchers, health-care providers, and other professionals the opportunity to shed light on a social phenomenon that occurs surreptitiously as well as to identify the potential unique health issues (physical or psychological) that these men may face. This exploratory investigation of factors related to sex work was thought to be best addressed using qualitative methods since descriptive data serve various purposes: they assist in better understanding this relatively new and scarcely researched phenomenon of male Internet-based sex work and can serve to generate hypotheses and relationships that can be subsequently tested using different study designs. Descriptive data will be presented regarding sex work, specifically reasons for sex work and effects of sex work on the individual.

METHOD

PARTICIPANTS AND PROCEDURE

Data from 46 participants from the New York City metropolitan area were collected. The e-mail addresses of 535 potential participants were identified through advertisements in local gay publications, user profiles on a popular online service, and escort websites. An e-mail describing the project was sent to these e-mail addresses, and men were invited to call to be screened for the study. The e-mails assured potential participants of the confidential nature of the research study. A total of 165 e-mails either bounced back or were not read (e-mails sent to America OnLine can be verified to see if the e-mail was opened), so we can assume that as many as 370 men received and may have read the e-mail invitation. Snowball sampling was also used in that the description of the project was posted on escort listservs by men who had completed the study.

A total of 60 phone calls were received, and 57 of these respondents were scheduled for in-person appointments. Seven men failed to show for their appointment. Although 50 interviews were conducted, complete qualitative and quantitative data were obtained for only 46 participants due to equipment failure during the audiotaping of four interviews. Men were screened by telephone to determine eligibility (self-identified as a gay or bisexual male, self-reported sex work at least once in the past 90 days, age greater than 18, and use of the Internet to advertise sexual services and solicit clients). Individuals who were interested and eligible were then scheduled for data collection. Participants provided informed consent and then completed a qualitative interview.

The qualitative interview took from 45 to 75 minutes to complete and covered a variety of areas such as sexual debut, initiation into sex work, reasons for being a sex worker, and how the work impacts other aspects of one's life. The open-ended questions in the interview encouraged participants to elaborate on their thoughts, feelings, and experiences. Two trained male interviewers conducted all interviews in a private room in a New York City social research facility, following a common interview protocol. Interviews were audio-recorded, then sent to an independent firm for transcription. A member of the research team reviewed the transcripts, checking for accuracy and correcting errors (the majority of errors by the transcription service involved misinterpreted slang terms specific to the gay/bisexual community). All identifying details were removed from transcripts to protect participants' privacy. Using a grounded theory approach (Strauss & Corbin, 1990), emerging themes and patterns were noted as they arose from the transcripts. Manual coding was performed and applied to the data.

Following the interview, participants completed a self-administered quantitative survey, which collected demographic data, information regarding HIV/STI status, work-related variables, and attitudes regarding health-care providers. Prior to the participant leaving, completed surveys were reviewed for missing data as well as improbable or conflicting responses. Participants were asked to provide missing data or clarify responses as needed. Each participant received $75 for participating in the qualitative interview and the quantitative survey.

RESULTS

PARTICIPANT CHARACTERISTICS

The mean age of the 46 participants was 31.76 (SD = 6.50) with a range of 22 to 47. The majority of participants identified as Caucasian (n = 31, 67.4%), gay-identified (n = 38, 82.6%), and well educated (n = 44, 95.6% reported at least some college). The majority of participants reported being HIV seronegative (n = 38, 82.6%); six participants (13.0%) reported being HIV seropositive, and two participants (4.4%) reported never having been tested for HIV due to their belief that it was unnecessary because they had never engaged in receptive anal intercourse. Twenty-one participants (45.6%) reported a history of STIs other than HIV. More than a third of the sample (n = 17, 36.9%) reported currently having a male primary partner while none of the men reported having female primary partners. Fourteen of the 17 men in relationships reported having disclosed their sex work to their partners. In the past three months, the men reported engaging in sexual activity with an average of 44.80 (SD = 40.69) work-related and 25.04 (SD = 51.78) non-work related sexual partners.

The average length of time men reported working as escorts was 2.66 years (SD = 5.03) with a range from three weeks to 25 years. Half of the men (n = 23) reported spending at least 12 hours a week escorting or performing escorting-related activities (such as answering phone calls or communicating with potential clients online); 26% (n = 12) reported spending more than 20 hours a week escorting and could be considered "full time" or nearly full-time sex workers. Eleven men (24%) were involved with escort-related work less than 12 hours per week. Most men (70%, n = 32) charged $200 an hour with a range from $75 for "body work" (typically a massage performed by a nude escort, including genital massage) to $250 for "full service" (typically direct sexual contact, including masturbation, fellatio, and/or anal intercourse). The median annual income range reported from sources other than sex work was $10,000 to $19,999. The median annual income range reported from sex work was $20,000 to $29,999. Although the majority (72%) felt comfortable discussing their sexual orientation with health-care providers, only 46% felt comfortable discussing sex work with their providers. About a quarter (24%) reported never having discussed their occupation as a sex worker with their health-care providers.

REASONS FOR SEX WORK AND How THE WORK IMPACTS THEIR LIVES

Money. The predominant reason these men were engaged in escorting was for monetary gains and benefits. The majority of the men (n = 29, 63.0%) endorsed money-related benefits as being a reason for their participation in sex work. When asked to describe the positive aspects of being a sex worker, one participant said, "The extra money. Just this money that's not taxable, and it's instant, instant gratification. It's not hard work. Nothing else." Often, remunerations were generous and on occasion included trips abroad among other gifts, as explained by one participant:

   I can tell you I have traveled, for escorting. I have traveled to
   Oslo, to various places in Germany, to Paris. I have traveled to
   Hawaii, to California to Florida, to various places in the Midwest.
   I have traveled all over the place from escorting. And I was paid
   well for it, and I loved it. The trips were wonderful.

Occasionally, these men stated other benefits associated with wealth, such as social status, as being a positive factor in sex work. For example, one of the younger participants in the study told us:

   I really enjoy it because I get to ... see all that money, or like,
   you know, all these rich apartments in New York. And I've been taken
   to ... [the] New York Palace Hotel one night, and I've stayed at
   the Astoria. So I get to see, you know, a lot of glamorous New
   York but also just all kinds of people that I wouldn't have met if
   I'd just been filing day after day in an empty room. So it really
   has entertained me for the past year, and ... I really enjoy it.

Another participant simply described his job as "a lucrative hobby that I happen to enjoy."

Sense of self. Many participants talked about how having sexual encounters with generously paying clients bolsters their sense of self. Having clients request their services, they are made to feel empowered, desired, attractive, and important, this elevates the escort's self-esteem. For example, one participant told us:

   It's a very big ego trip. And you can get addicted to it very
   easily. You're getting paid by somebody who's giving you a lot of
   attention for an hour, and that becomes extremely addictive ... most
   of the guys that I know that do this full-time, they can't get out
   because they're addicted to the sex and the ego and some of the
   power they get.

This "ego boost," explicitly endorsed by 13 participants (28.3%), is what most men frequently reported as being a noticeable change that had occurred from sex work. However, for these escorts, the ways in which sex work has impacted aspects of their self were varied and numerous. These participants identified a number of ways sex work had influenced their own sexual and personal characteristics, and these changes ran the gamut from being perceived as extremely positive to extremely negative and included such notions as feeling empowered to feeling used to feeling as though they were living a falsehood. However, for many participants, the most salient and most frequently reported positive change occurring from sex work was increased confidence, as can be seen in the following narrative:

   What's changed? My self-confidence. Like I used to think I was
   really ugly and used to stand in bars and look at my feet and people
   wouldn't look at me or whatever, and now ... I kind of have
   more of an attitude where I can walk into a bar and basically pick
   up anybody that I want ... Men are paying a thousand a night to
   sleep with you ... it has got to boost your self-confidence. So
   that's the biggest change in my personality.

While the majority of participants did not report a positive change to their personality, 12 participants (26.1%) did, by reporting at least one positive change that was gained from sex work including increased confidence, increased outgoingness, and improved body image. One particular escort involved in sadism and masochism (S&M) explained how his growing self-assurance developed from his vocation:

   I think it's been really, really positive for me, I mean in a lot of
   ways ... especially because I do the S&M work. I, you know, tie
   up these guys and stuff. People will come over and they'll be like
   football players, like six foot five, three hundred pounds. Guys
   that I, you know, five years ago, three years ago would have been
   afraid of. And now, you know, I'm making them kiss my boots,
   lick the bottom of my shoe. You know what I mean, it's like, now
   on the street, when I see those guys, I think, "You know, whatever,
   he can kiss my boots." I'm not intimidated by people as
   much. It's been very personally empowering.

For others, confidence is described as part and parcel of the financial stability and monetary benefits this line of work affords them. One participant asserted, "I feel more in control of my life than I ever have. I'm more solvent. I feel more attractive.... My standard for my dress and grooming have all gone up." Another stated:

   On some level, it has given me a lot of confidence. It's made me
   feel very accomplished. I never thought I could do something like
   that, that I would have bravery to say that I could do this and make
   money this way and have it go on, have it continue, to build on it.
   It's made me feel very independent and entrepreneurial. It's made
   me feel like I have a lot more control over my capacity to make
   money and to deserve that money.

Sex. Clearly, sexual activity is an integral part of an escort's profession, with 18 participants (39.1%) in this study citing their enjoyment of sex as a reason for being in this particular line of work. Most participants were able to recall pleasurable sexual interactions with clients, and some deemed them as a critical reason for involvement in escorting. For example:

   Well, I like having sex. I also tend to like being in control.... I
   kind of enjoy the adventure involved. You know meeting new
   people, going to new places. You know all over. And to be real
   honest, it' s kind of exciting getting paid to do something like
   this. It kind of boosts your ego.

The ways sex work affects sexuality and the meanings associated with it differed phenomenologically between participants. There were, however, a number of recurrent themes that were voiced by participants regarding their sexual drive (libido), sexual repertoire and preferences, the fusion of sex and work and the division of self to accommodate sex work, and the growing mechanization and banality of sex.

A long day at the office: Changes to sexual energy. The most frequently reported effect of sex work on participants' sexuality concerns libidinal energy. A number of participants found that, since having begun this line of work, they no longer cruised for sex or were less likely to actively seek out sex for pleasure. One escort stated, "Well, because I spend so much of my sexual energy in my work, in the past year and a half, I haven't really pursued sex that much." Another participant maintained, "In my free time I don't feel as much of a need to go find someone to have sex with. I guess I feel like I'm getting satisfied through work on occasion."

What is indicated in these and other statements is that the decrease in libido is, to a certain extent, due to sex work satiating their sex drive, so much so that, for some, libidinal energy is to be conserved lest the escort is unable to perform with clients. Nine participants (19.6%) voiced such concerns. One participant stated, "I've decided if this is going to be my breadwinner, [then] I might as well save it." The reservation of one's sexual drive is seen in the following narrative:

   Even if I don't work for a day or two, I know I will. So I usually
   pretty much save my sex drive for clients. I'm getting older and
   I'm not.... I can't get off twenty times a day. So, I have to be
   sort of ready just in case. So I don't jerk off anymore really.
   Because you never know. I've sat in my apartment and jerked off to a
   video, and then the phone rings. So what are you going to do?

Learning the tools of the trade: Changes in specific sexual practices. Another way in which sexuality is affected by sex work is by escorts' expanding their sexual repertoires to accommodate clients' requests. Escorts are often times requested by clients to perform sexually in ways that may not be in keeping with the escort's own preferred forms of sexual activity. When asked about limits regarding sex work, one escort said, "I can't think of anything I haven't done. It has gone to that point." For some, participating in sexual activity with clients not only expands one's sexual repertoire, but also influences and perhaps changes what sexual activities the escort himself prefers to engage in. Changes regarding sexual repertoire and preferred sexual activities were explicitly reported by four participants (8.7%). This can be seen in the following testimonial where one participant discusses his growing proclivity for "fisting" (i.e., the insertion of a hand or fist into the anus of a partner):

   Now I have done things sexually, since I started doing this business,
   that I have never done before--like a whole lot of fisting. I
   had never done a lot of fisting before. I had done it a couple of
   times, but if I have one or two clients who really like that, well,
   like okay. And then I sort of think about that. And now it's sort of
   on my top five play things that I do. And it's made me really want
   to experience getting that done to me as a bottom [the receptive
   role in fisting].

Taking the work home with you: How the work affects sex for pleasure. Given that an escort's profession requires sexual activity to take place, non-work sexual activity that occurs of the escorts' own volition is logically associated with work sex, such that when one participant was asked if he was able to achieve orgasm with clients, he remarked:

   That's actually caused a bit of a problem for me. Because you
   know doing this alone, sometime, you don't get off, so even when
   you have sex for your own enjoyment, you have a hard time separating
   fun sex from work sex. And for me, it's just caused a problem
   to where it takes a long time to come.... And I think that's
   because for so long I've been geared to get the other person off.
   And even when I'm having sex with someone, that's always the
   first thought in my head is what's turning him on, "Am I turning
   him on?" I have a hard time focusing on me and having them
  focus on me.

The recurring work-related sexual activity requires this participant to keep his client's desires in mind. With increased frequency of sex work, the association between sex and work are commonly strengthened to the point where, even in non-work related sexual activity, escorts feel the need to please their partners at the expense of their own desires. The following narrative further illustrates this notion:

   I'm so conditioned at this point that what I want is not even ... it
   doesn't even matter. It's what the other person wants, and what
   will it take to get the other person off. But even when you ask
   "What do you like?" I mean, I almost don't know how to answer
   that, because it doesn't matter what I like, it's what the other
   person wants.

While this fusion of sex and work was specifically mentioned by three participants (6.5%), the division of the self to accommodate sex work was also found. In an attempt to preserve the integrity of the self, a dual self is developed to maintain one's work persona. One escort stated:

   It' s like complete acting. I mean, if 99 percent of these clients
   saw me like in a normal situation, they wouldn't think I was the
   same person. I mean it's like this duplicity of my personality.

While developing a work persona may not be unique to escorting, one could argue that, unlike other professions, one's identity as a sex worker has been found to be more difficult to integrate or expose due to stigma (Koken et al., in press).

Participants expressed that the sexual experiences they had, subsequent to their entry into sex work, were no longer as thrilling or as stimulating as they once were. Excessive sexual activity through work had minimized the pleasurable aspects of sex and had rendered sexual activity banal and at times tedious. One participant stated:

   You know, it's so funny, I'm just like programmed that I'm like
   fucking someone and I'm thinking of my grocery list. I mean
   sometimes--I'm just like not even paying attention to what I'm
   doing and it's just like a job. It's just so second nature now.

This concept is supported by another participant, who said:

   There's a problem with being very mechanical and robotic about
   sex after a while because you get used to it. Because in order to
   perform you really have to be that way with a client. And, in a
   way, it's very difficult to switch that off in your real life. So,
   then your real life becomes very mechanical and robotic, sexually.
   And it's difficult. What I try to do is have as much passionate fun
   sex with real people, not clients I should say, other people as I
   can-just keep things in perspective and just not getting used to
   doing it all the time for money and being very mechanical and
   robotic.

Sexual activity, once pleasurable, had over time been depleted of its gratifying qualities, and the motions of sex had become mechanized. Loss of satisfaction from sex was evident among some participants. As one participant explained, "I think a problem is [if] you do it too much, you kind of get numb to sex." Seven participants (15.2%) reported loss of sexual satisfaction.

Perhaps to counter the growing banality and mechanization of sex, three participants (6.5%) explicitly stated an emergent need to find and pursue more stimulating and pleasurable sexual activity when not on the job. One participant stated, "I'm a lot more picky.... If I have sex for pleasure, it has to be someone really, really cute, somebody I really like, or pleasing me at the moment." Another escort stated, "I think my fantasies have gotten more extreme. Like I don't like porno magazines ... When I'm fantasizing, I need more ... I mean I need more stimulation." What is inferred from this latter excerpt is that one's sexual threshold is heightened by frequent participation in sexual activity via sex work.

The downside of the work. Participants expressed negative changes also. For three participants, sex work had precipitated some form of negative affect. One escort discussed how his profession exacerbated, and made more prominent, feelings of detachment and emptiness:

   I don't like the detachment, how you see someone for that
   moment. Obviously, I'm single, so there are a lot of times when I
   don't like the periods of solitude ... like I wake up in the morning
   and I work or see a client, whoever the day may bring, and then I
   go home and there is no attachment ... I'm like alone ... and I just
   see these men for like anonymous sex and they give me money,
   and then I go on about my business. And I mean ... I don't know,
   it can be really empty sometimes. It just feels empty.

Another participant, who was unhappy with being an escort, said:

   Sometimes I feel really depressed ... because I don't like what I'm
   doing actually. I can't say that I'm enjoying my business. No. I'm
   doing this only just for money. And you know one day I will quit
   this business, hopefully. Not hopefully. Definitely.

This participant's negative affect was a response to compromising his wants by continuing in sex work. When asked how he felt about sex work, another participant described his feelings very clearly:

   Guilt. Feelings of being used. I know that the guys, all they want
   is a piece of ass. And that's fine because all I want is the money.
   And most of them ... most of them think they're grandiose and
   they have wonderful attributes, and they're really disgusting, you
   know. Some of these [clients], they are not who they say they are.
   And they want you to sit there and tell them how wonderful they
   are, and how big their dick is, and how cute they are, and they're
   not any of that. It's a game.

Guilt, in this case, was caused from the participant's sense of feeling exploited and used by clients. Illustrated in the above passage is the notion that the insincerity and deception in sex work may lead one to experience negative affect. While the falsehood that is fostered by the sexual scenario may result in the feeling of "being used," for others this falsehood lends itself to increase the sexual tension and desire between the escort and his client in the form of role play or fantasy.

DISCUSSION

As male escorts are found rather effortlessly online, they are perhaps a more accessible and a more visible group of male sex workers than the primarily researched group of adolescent hustlers and other street-based samples of male prostitutes. Without knowledge of public territories of homosexual cruising, one need only surf the Internet to encounter the sexual market. Examined in our study are attitudes of male sex workers who constituted this cyber sexual market, and elucidated in this article are their reasons for entry into sex work and how the work impacts their psychological health and sexual functioning.

Based on the interviews, three main motives were given regarding reasons for sex work. The most frequently reported reason for sex work concerns the financial benefits this job affords them. Escorts earn more money and have more financial security than street-based male sex workers (Browne & Minichiello, 1996; Gaffney, 2003). In addition to the ample earnings, participants state a proclivity for the casual sexual activity that is provided in this line of work. For some, work-related sexual encounters were deemed exciting and arousing. Last, the resulting increase in self-esteem from admiring clients is presented as another motive for partaking in sex work. The positive evaluations offered by clients reinforce the work. Although some participants reported feeling used, depressed, or guilty as a result of their sex work activities, most reported positive improvements to their psychological health in terms of increased self-esteem, self-confidence, and the ability of the work to reduce feelings of depression and isolation.

Clearly, the majority of Internet-based male escorts in our sample failed to fit the pathological and psychologically maladjusted stereotypes of male prostitutes (Caukins & Coombs, 1976; Price et al., 1984; Sagarin & Jolly, 1997; Simon et al., 1992; West & de Villiers, 1993). Their rates of HIV infection and lifetime prevalence of STIs were not significantly different from larger, broader samples of gay and bisexual men (Catania et al., 2001; Koblin et al., 2000). As such, the perception that male sex workers are inherently more likely to suffer from HIV and other STIs, and thus serve as a vector of transmission into the heterosexual community, was not supported among this unique sample of male escorts. Contrary to previous studies focused on the pathology of male sex work, none of the men in our sample reported childhood sexual abuse or a dysfunctional family as reasons for entering the business.

This study examined the perceptions of escorts in understanding their reasons for sex work, and thus presents a more cognitive approach in uncovering themes and entrance into the commercial sex profession. Other researchers have focused on factors not within the sex worker's control or awareness, such that sex work is a product of predisposing factors (e.g., sexual abuse, familial pathology, etc.) that lead or cause one to enter sex work. In this study, we found that many male escorts report enjoying their work and that they cite a number of advantages resulting from their occupation. While this does not mean that risk factors for sex work were not present or operative in our sample, our results do suggest that escorts had, for the most part, volitionally chosen to be in this particular form of sex work. However, it is important to note that this may not be (and most likely is not) so with street-based sex workers, adolescent hustlers, or those for whom prostitution is a means for survival.

Perhaps most interesting and most valuable are the findings concerning the effects of sex work on one's personality and sexuality, a topic rarely explored in the male sex worker literature. Increased confidence and greater self-esteem were reported as positive changes that had been brought about by participation in sex work. Libido issues were voiced by escorts in this study who had reported a decrease in cruising for anonymous sexual activity, perhaps so as to conserve their libidinal energy for work. Also voiced by participants was the manner by which sex work had expanded their sexual repertoires and, in some instances, changed their preferred sexual activity and behaviors. For some escorts, sexuality had become so intertwined with occupational sex that they were unable to focus on their own sexual desires, suggesting a negative impact on overall psychosexual health. For others, the repeated imposition of sex upon the escort rendered sexual activity mundane and subsequently less thrilling. It is possible that for this reason a small number of escorts had identified an emergent need to find more stimulating and more pleasurable sexual activity.

While it may seem as though a number of inconsistent (perhaps even contradictory) themes had emerged (e.g., sex as exciting and sex as mundane), it is possible that participants who endorsed one theme did not endorse the opposing theme. Another possibility is that participants possess seemingly paradoxical ideas and that perhaps these inconsistencies are reflective of different work experiences. One's endorsement of a theme doesn't render opposing themes mutually exclusive. For example, an escort may feel empowered by sex with a client on one occasion and may later feel used on another occasion. Similarly, while the pleasurable aspects of sex may have attracted participants into sex work, it is not implausible that some of these escorts, after a period of time, deem sexual activity as less enjoyable. A systematic investigation of any relationships between and within the reasons for and consequences of sex work should be explored empirically, particularly through the use of longitudinal diary or calendar methods.

The greatest limitation in this study involves the retrospective nature of the data, as inaccuracies may have been recollected or perhaps participants may not have been forthright in their responses. Self-selection bias is another concern, as those who responded to our initial e-mail may be different from those who did not. Although it is impossible to know how our sample differs from the larger population of Internet-based male escorts, a review of the websites of those escorts who did not respond to our email invitation for participation suggests that the subsample we enrolled was somewhat representative of the diversity of Internet escorts in terms of age, ethnicity, and sexual services provided. Another limitation in this study concerns the number of respondents who endorsed a particular notion. As can be seen in the section reporting the effects of sex work, small numbers of men endorsed each particular notion. This was so because only those who had explicitly addressed a particular topic were counted as doing so, and others for whom responses were ambiguous (yet perhaps alluded to the endorsement of a particular notion) were not, as this would leave much to interpretation and would raise concerns regarding reliability. Therefore, frequencies reported in this portion of the article tend to be of a conservative number, and presumably a more systematic assessment of these effects would yield higher estimates.

The importance of this study is in the qualitative data, which had uncovered that, while the advantages of sex work are great, there are other potential negative effects regarding the sexual health of men, such as aspects of one's sexuality becoming hindered, strained, or distorted. The implication of this finding is that mental health services are needed to address these and other difficult issues that arise from sex work. Future studies could further explore these issues and other negative effects of sex work on the health of sex workers as well as identify methods to alleviate them.

The fact that many of the participants felt unable to speak to health-care providers about their sex work, and that most felt uncomfortable having such discussions, leads us to be concerned that male escorts may not be able to obtain appropriate health care, both physical and psychological. It is interesting that, due to the monetary benefits that result from sex work, these men actually have excellent access to health-care resources, but may choose not to use them as a result of internal stigma regarding their occupation and/or fear of disclosing their work-related activities to their providers.

As such, it is not to say that male escorts are without need for services to improve their physical and psychological health. Recently, Internet-based educational and referral sources have been developed that specifically target male sex workers, the most comprehensive of which is www.hookonline.com, an online resource developed by and for male sex workers. This website aims to reduce the stigma faced by male sex workers and to ensure that they have adequate information regarding HIV, STIs, and other factors that could negatively impact their health. In addition, this and other Internet-based services may help to alleviate the sense of isolation some male escorts feel by creating a cyber-community of male sex workers, capable of providing social support. Health-care providers may consider becoming more involved with such resources as a way to reach out to male sex workers and increase the likelihood that male escorts can comfortably discuss their work with their providers.

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The authors would like to thank James Kelleher and other members of the Center for HIV/AIDS Educational Studies and Training (CHEST) team for their assistance and support with this project. We would also like to thank the participants and the members of our community who encouraged us to undertake this investigation. This paper was part of a master's thesis completed by the first author under the supervision of the second author. The "Classified Project" was supported by a Faculty Development Grant awarded to the second author.

Correspondence concerning this article should be addressed to Jeffrey T. Parsons, Hunter College--CUNY, Department of Psychology, 695 Park Avenue, New York, NY 10021. Electronic mail: [e-mail].

Jude M. UY, Jeffrey T. PARSONS Hunter College of the City University of New York

David S. Bimbi, Juline A. Koken, Perry N. Halkitis Center for HIV/AIDS Educational Studies and Training