Background HIV pre-exposure prophylaxis (PrEP) has reshaped condom use practices in many contexts, but little is known about its impact on commercial sex encounters between men. This study investigated condom use in Australian male sex work.

Methods During 2017–2018, we undertook a mixed-method ethnographic study of male sex work in Australia, working with male sex workers (n=32) and clients of sex work (n=3) to collect online sex work profile data and conduct individual and group interviews. These data were analyzed topically with a focus on condom use.

Results In November 2018, online data were scraped from 236 male sex work profiles: 2.1% expressed an explicit requirement for condom use, down from 14.2% in June 2017 (p<0.001). In the interim, PrEP was widely implemented across Australia. Using interview data, we generated two themes describing condom use. Some sex workers and all of the clients we interviewed strictly refused to engage in condomless commercial sex. This strictness, however, extended only to anal sex (several participants laughed at using condoms for oral sex) and commercial encounters (many men were willing to forgo condoms for personal sex). Most male sex workers, however, were highly pragmatic about condoms. They described assessing the commercial risks-benefits of condoms, and while men were aware that condomless sex put them at risk for STIs other than HIV, they balanced that risk against increased earning potential: sex workers consistently reported charging more for condomless sex. This approach was characterized as a ‘cash buffer’ to compensate for the risk of being unable to work following a STI diagnosis.

Conclusion Although condom use has shifted dramatically among male sex work communities in Australia, to some they remain an important safer sex strategy. HIV PrEP and market forces have increased STI risk among male sex workers, making them ideal candidates for STI antibiotic prophylaxis.

Disclosure No significant relationships.