Objectives To assess the proportion of independent indoor female sex workers (FSW) in West Yorkshire, UK who advertise unprotected sex, and to investigate any association with cost, location and provision of anal sex.
Methods Data on whether independent indoor FSW (defined as those not advertising via an escort agency or through a parlour) advertised unprotected sexual services, along with demographic data, were collected from 462 advertisement profiles of FSW in West Yorkshire from the website http://www.adultwork.com. Independent t test and χ2 statistics were used to test the association between advertised unprotected vaginal and oral sex, and FSW age, cost of services, location and whether they advertised anal sex.
Results Unprotected vaginal sex was advertised by 8% of FSW, and unprotected oral sex by 74% of FSW. FSW advertising unprotected vaginal sex were more likely to live in Wakefield and Bradford than in Leeds, had significantly lower hourly rates, and were more likely to advertise anal sex.
Conclusions Advertised condom use for vaginal and oral sex by independent indoor FSW in West Yorkshire was significantly lower than reported rates of protected sex found in previous studies based in London and the south of England. The advertisement of unprotected vaginal sex is associated with factors such as lower hourly rates and the advertisement of higher risk anal sex, which may signify greater economic need. FSW offering unprotected sex therefore represent an at-risk target group for health promotion.
- Oral Sex
- Commercial Sex
Statistics from Altmetric.com
Female sex workers (FSW) in the UK have a prevalence of bacterial sexually transmitted infections (STI) below that of other STI clinic attendees, and a stable prevalence of HIV of 1%.1 ,2 These low levels of STI are attributable to consistent use of condoms by FSW.1–3 Rates of condom use for vaginal sex are very high for indoor FSW, with some studies showing a near universal use of condoms.1–4 In comparison, street-based sex workers have much lower levels of condom use and increased prevalence of STIs.4 ,5
A number of factors have been found to influence condom use among FSW, including financial need, number of clients, drug use, condom availability and contact with sexual health services.6 ,7 This study looked at the percentage of FSW in West Yorkshire, UK, working indoors and independent of escort agencies and massage parlours, who advertised protected and unprotected oral and vaginal sex, and whether FSW age, hourly rates and location within West Yorkshire are associated with increased risk-taking in the sexual services advertised.
Data were collected in June 2012 from 462 profiles of independent FSW (defined as those not advertising via an escort agency or parlour) in West Yorkshire, from a principal website advertising escort services, http://www.adultwork.com. Duplicate advertisements, where the same FSW advertises under different pseudonyms, were checked by comparing photographs and phone numbers. The FSW's advertised age, rates for an hour's incall (services provided at the FSW accommodation) and/or outcall (services provided at the client's accommodation) and location were recorded. The sexual services advertised were recorded as: unprotected vaginal sex (‘bareback’), unprotected oral sex (‘oral without’ and/or ‘CiM—cum in mouth’) and anal sex (‘A-levels’, with no indication of condom use).
An independent t test was used to test for differences between unprotected and protected vaginal sex and age and cost (incall and outcall). χ2 was used to test for associations between unprotected services (both vaginal and oral sex) and two factors: FSW location and anal sex.
Unprotected vaginal sex was advertised by 8% (38/462) of independent FSW in West Yorkshire. There was no significant difference in the mean age of FSW advertising unprotected and protected vaginal sex (29.2 ± 8.91 years). FSW advertising unprotected vaginal sex had significantly lower hourly rates for incalls compared with FSW advertising protected vaginal sex (means £92.67, £112.04, 95% CI for the difference=(12.68 to 26.07), t=5.83, df=45.74, p<0.001, equal variances not assumed). Similarly, FSW advertising unprotected vaginal sex had significantly lower hourly rates for outcalls compared with FSW advertising protected vaginal sex (means £100.91, £136.60, 95% CI for the difference=(22.61 to 48.77), t=5.37, df=332, p<0.001, equal variances assumed).
FSW advertising unprotected vaginal sex were more likely to live in Bradford and Wakefield than Leeds (χ2=11.04, df=3, p<0.05 table 1). Approximately a third (149/462) of FSW advertised anal sex. There was a significant positive association between FSW that advertised unprotected vaginal sex and anal sex (χ2=10.03, df=1, p<0.01; OR 0.35, 95% CI 0.18 to 0.69).
Unprotected oral sex was advertised by 74% (344/462) of FSW. Of those that did not explicitly advertise unprotected oral sex, 14.5% (67/462) did not specify whether oral sex was protected, 10.6% (49/462) did not advertise oral sex as a service at all and only 0.05% (2/462) advertised protected oral sex. There was no significant difference in age, the mean cost of an incall or outcall or location between those FSW advertising protected and unprotected oral sex.
This study finds that advertised condom use for vaginal and oral sex by independent indoor FSW in West Yorkshire was lower than rates of protected sex found in previous studies based on self-reporting of condom use by FSW.1–5 The study's principal weakness is that advertisement may not accurately estimate levels of unprotected sex, as FSW often advertise unprotected sexual services at their discretion and clients may choose to use a condom anyway. It was beyond the scope of this study to contact each FSW to confirm that the advertisement was active, or to conclusively eliminate the possibility of advertisement duplication (ie, the same FSW using two pseudonyms).
Previous studies in the UK, based on reported not advertised condom use, have found the level of unprotected vaginal sex to be lower, 0–2% compared with the 8% found by this study.1–4 The discrepancy was even greater for oral sex, which 74% of FSW in West Yorkshire advertised without protection compared with 9%–45% previously.1–4 Ninety-one percent of parlour-based FSW in Bristol reported using a condom on every occasion when performing oral sex.4 In London, 79% of FSW working in saunas, massage parlours, escort agencies and flats reported using a condom the last time they performed oral sex on a client.3 In contrast, this study showed only 0.05% of FSW in West Yorkshire advertised protected oral sex.
These differences may be due to several reasons. First, it may reflect that this study looked at advertised services whereas other studies have looked at completed sexual transactions. FSW may advertise unprotected services but still use a condom due to FSW discretion or client request. Second, it may illustrate a difference in sex work culture between the North and South of England where previous studies have been carried out. Finally, this study only included independent indoor FSW (ie, those not working for an agency or parlour). Parlour and agency FSW may have a higher use of condoms due to workplace rules or increased peer support for protected intercourse.
Evidence shows that condom use by FSW is lower with greater economic need.6 ,7 There is evidence that street-based FSW are more likely to engage in risky sexual behaviour, have lower hourly rates, come from more economically deprived backgrounds and have lower levels of condom use.4 ,5 This study found that unprotected vaginal sex was associated with factors that may signify economic need: a lower hourly rate in order to attract more clients, and a positive association between FSW advertising unprotected vaginal sex and anal sex, which may indicate a more pressing requirement to attract clients despite increased risk. Independent indoor FSW who advertise unprotected intercourse represent a specific target group for sexual health services.
Independent indoor female sex workers in West Yorkshire advertise higher levels of unprotected vaginal and oral sex than previous studies based on self-reporting condom use.
Advertised unprotected vaginal intercourse is associated with lower hourly rates and anal intercourse.
Independent indoor female sex workers that advertise unprotected vaginal sex on the internet therefore represent a target group for health promotion.
Claire Eccles would like to acknowledge the School of Medicine, University of Leeds for their support. Both authors would like to thank Dr Matthew Homer, University of Leeds, for statistical advice.
Handling editor Jackie A Cassell
Contributors Both authors were involved in the conception and design of the study. CE collected and analysed the data, wrote the draft of the article and completed a literature search. JC provided feedback on drafts and read and approved the final manuscript.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
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