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Investigating the effects of COVID-19 on global male sex work populations: a longitudinal study of digital data
  1. Denton Callander1,2,
  2. Étienne Meunier3,
  3. Ryan DeVeau4,
  4. Christian Grov5,
  5. Basil Donovan2,6,
  6. Victor Minichiello7,8,
  7. Jules Kim9,
  8. Dustin Duncan1
  1. 1 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
  2. 2 The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, New South Wales, Australia
  3. 3 Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
  4. 4 Faculty of Arts, The University of Melbourne, Melbourne, Victoria, Australia
  5. 5 CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
  6. 6 Sydney Sexual Health Centre, Sydney, New South Wales, Australia
  7. 7 University of New England, Armidale, New South Wales, Australia
  8. 8 Queensland University of Technology, Brisbane, Queensland, Australia
  9. 9 Scarlet Alliance, Australian Sex Workers Association, Sydney, New South Wales, Australia
  1. Correspondence to Dr Denton Callander, Department of Epidemiology, Columbia University, New York, NY 10027, USA; d.callander{at}


Objectives Recommendations of ‘social distancing’ and home quarantines to combat the global COVID-19 pandemic have implications for sex and intimacy, including sex work. This study examined the effects of COVID-19 on male sex work globally and investigated how men who sold sex responded to and engaged with the virus in the context of work.

Methods This study made use of an existing database of deidentified data extracted from the online profiles maintained by male sex workers on a large, international website. Website engagement metrics were calculated for the periods before (September to December 2019) and during COVID-19 (January to May 2020); Poisson regression analyses were used to assess changes over time before and after, while a content analysis was undertaken to identify modes of engagement with the virus.

Results Data were collected from 78 399 profiles representing 19 388 individuals. In the ‘before’ period, the number of active profiles was stable (inter-rate ratio (IRR)=1.01, 95% CI 0.99 to 1.01, p=0.339) but during COVID-19 decreased by 26.3% (IRR=0.90, 95% CI 0.89 to 0.91, p<0.001). Newly created profiles also decreased during COVID-19 (59.4%; IRR=0.71, 95% CI 0.69 to 0.74, p<0.001) after a period of stability. In total, 211 unique profiles explicitly referenced COVID-19; 185 (85.8%) evoked risk reduction strategies, including discontinuation of in-person services (41.2%), pivoting to virtual services (38.9%), COVID-19 status disclosure (20.9%), enhanced sanitary and screening requirements (12.3%) and restricted travel (5.2%). Some profiles, however, seemed to downplay the seriousness of COVID-19 or resist protective measures (14.7%).

Conclusions These findings support the contention that COVID-19 has dramatically impacted the sex industry; globally, male sex workers may be facing considerable economic strain. Targeted education and outreach are needed to support male sex workers grappling with COVID-19, including around the most effective risk reduction strategies. Those involved with the sex industry must have access to state-sponsored COVID-19 financial and other aid programmes to support individual and public health.

  • commercial sex
  • sexual health
  • public health
  • social science

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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  • Handling editor Tristan J Barber

  • Twitter @dentoncallander

  • Contributors DC conceived this analysis along with EM. DC, VM, BD and RD conceived the idea for the database. RD developed and oversaw the processes of data extraction. Data analysis was conducted by DC with support from EM and DD. CG, VM and BD provided topical guidance, while JK guided interpretation of the study’s implications from a policy and practice perspective. All authors contributed to the manuscript’s creation, providing numerous reviews and signing off on the final version.

  • Funding Funding for the database from which this study draws was provided by a project grant from the Australian Research Council (DP170104575).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study used publicly-available, de-identified data. As such, it was classified as non-participant research and exempt from ethical review.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.