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While the risks and vulnerabilities of women engaging in prostitution have been well documented, little is known about this group of men in Scotland. In order to try and improve our services, we undertook a retrospective case note review of men attending NHS Greater Glasgow and Clyde (NHS GGC) sexual health services who reported giving sexual acts for payment with the aim of gathering information on the social backgrounds and STI prevalence of these men.
All patient notes are stored electronically in National Sexual Health Systems (NASH). This study did not require ethical review as it was a service evaluation and needs assessment using routine data. The system was interrogated to identify all men attending Sandyford between 1 January 2009 and 31 July 2011 (31 months) who had been recorded as having given sexual acts for payment.
Thirty-four men were identified as having had a history of involvement in prostitution. The average age was 29, and the majority were of white ethnicity (85%). Two-thirds of the sample lived in the most deprived areas of NHS GGC. Twenty-six (76%) of the men had exchanged sexual acts for payment to other men, two to women (6%) and three to both (9%). Nine cases had specific reasons for engaging in prostitution recorded. These were to fund alcohol or drug addictions or to support them when they were homeless or on a low income. Six patients gave a history of non-consensual sexual intercourse.
Condom use was reported as ‘sometimes’ in 26 (76%) clients, ‘always’ in 5 (15%) and ‘never’ in 2 (6%). Thirteen out of thirty-four had one or more acute STI. There was one new HIV diagnosis (3% incidence). Three patients had evidence of previous infection with hepatitis B, but none had active hepatitis B infection. Four patients with a history of injecting drug use were hepatitis C PCR-positive (12%). There was no new syphilis diagnosis. There were two new diagnosis of anogenital herpes simplex virus (6%). Four patients tested positive for rectal chlamydia (12%) (no lymphogranuloma venereum). There were three positive urethral gonorrhoea (9%) tests; one positive rectal gonorrhoea (3%) and one positive pharyngeal gonorrhoea test (3%).
This case note review highlights the vulnerabilities of men engaging in prostitution in Glasgow and that the risk of sexual assault is high. The inconsistent use of condoms and the presence of rectal STIs illustrate ongoing risk behaviour for HIV acquisition. More research is needed to fully understand the scale of male prostitution and how current clinical service could best support these men and reduce risk-taking behaviour.
Dr Rak Nandwani contributed to editing one of the preliminary drafts of this report.
Contributors GF, RM and JH worked together on the original concept and design of the work. GF performed the data analysis and wrote the subsequent drafts with the other authors advising on the structure of the analysis, interpretation of results and edited drafts of the paper.
Competing interests None.
Provenance and peer review Not commissioned; internally peer reviewed.
Data sharing statement There are more data, but this has not been published and there is no plan to publish it. It will be available to anyone with an interest in knowing more.
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