Advertising Patterns of internet-Based Male Sex Workers Who Have Sex With Men (MSMSW): The Association Between LGBTQIA+ Events and Advertising for Work During the 2022 Pride Season

Abstract

Research into populations of male sex workers who have sex with men (MSMSW) has historically been stymied given the illegal, stigmatized nature of the profession. The internet has shaped how many sex workers advertise their services to clients. Few studies, however, have leveraged internet advertising data to inform MSMSW-specific public health programming and/or outreach efforts. The primary aim of this study was to describe the association between MSMSW advertising during LGBTQIA+ events in U.S. cities during the 2022 pride season. Data were web-scraped at weekly intervals from an internet platform popular among MSMSW in 16 U.S. cities with scheduled LGBTQIA+ events over 18 weeks June to October 2022. For each city, a Poisson regression was fitted for the outcome of number MSMSW advertisements/week and the association with LGBTQIA+ pride events (binary, no/yes), adjusted for month. Cities with the greatest number of MSMSW advertisements were New York City, San Francisco, and Chicago, with 848.2 (SD = 48.0), 293.3 (SD = 34.7), and 252.3 (SD = 22.8) mean weekly advertisements, respectively. LGBTQIA+ events were significantly (p < .05) associated with an increased number of MSMSW advertisements in San Francisco (incidence rate ratios (IRRs) = 1.16, 95% confidence interval (CI) = 1.07–1.25, p < .001), New York City (IRR = 1.15, 95% CI = 1.05–1.26, p < .005), and Chicago (IRR = 1.25, 95% CI = 1.12–1.39, p < .001). In these jurisdictions, LGBTQIA+ events could represent opportunities to overcome barriers to reaching MSMSW; findings from this study may assist in identifying priority cities for MSMSW-specific sexual health initiatives.

Background

Sex work is colloquially touted as the “world’s oldest profession.” Sex work is an umbrella term to describe the act of “exchanging sex for money or nonmonetary items” (Centers for Disease Control [CDC], 2022b, para. 1). Sex work, however, takes on many forms. Not all sex workers perform sex acts for money; sex workers also exchange services for drugs, food, medicine, and/or housing (CDC, 2022b). Another important distinction among sex workers is the difference between “indoor” (e.g., internet-based sex work and escort services) and “outdoor” sex work (e.g street-based sex work), as well as the inherent risks associated with both practices (Preble et al., 2019). The internet has undeniably changed how many sex workers approach advertising services to prospective clients (Kumar et al., 2017); many sex workers attribute improvements in working conditions and quality of their working life to the internet (Sanders et al., 2021).

Male sex workers, specifically male sex workers who have sex with men (MSMSW), remain a largely under-researched population despite accounting for approximately 20% of the 40 to 42 million sex workers globally (Fondation Scelles, 2019). Some researchers speculate that the underrepresentation of MSMSW in contemporary research is due to the fact MSM sex work lies at the intersection of two socially taboo and stigmatized behaviors: sex work and homosexuality (see e.g., Dennis, 2008). Contemporary research into this largely hidden, stigmatized population is challenging as not all individuals who practice MSM sex work self-identify as MSM and/or as a sex worker, presumably due to the societal stigma associated with both identities. While challenging, research into this vulnerable population is a public health priority, given the disproportionate health risks borne by this community (Verhaegh-Haasnoot et al., 2015).

Some intrepid researchers have leveraged the internet as an opportunity to gain insight into the world of MSM sex work (see e.g., Callander et al., 2021; Grov et al., 2017; Scott et al., 2023). Historically, internet-based MSM sex worker research was drawn from classified ad websites (e.g., Craigslist, Backpage) or other advertising platforms that are now defunct (e.g., RentBoy) as a result of The Stop Enabling Sex Traffickers Act (SESTA) and the Fight Online Sex Trafficking Act (FOSTA) signed into law by President Donald Trump in 2018. Despite attempts to stymie sex work advertising in the United States, sex work advertising remains ever-present on a variety of internet platforms—often operated by businesses headquartered in international jurisdictions where sex work is not criminalized.

MSM Sexual Health: A Rapidly Changing Landscape

In addition to the fact that many of the foundational studies of internet-based MSM worker behavior and patterns of advertising are based on data extracted from websites that no longer exist, further research into the contemporary practices of internet-based MSM sex workers is essential, given the rapidly evolving landscape of sexual health among MSM community members. For example, several early studies of internet-based MSM sex worker behavior address condomless intercourse as a health behavior of interest (see e.g., Bimbi & Parsons, 2005; Mimiaga et al., 2008). These studies predate the—now three—medications approved by the U.S. Food and Drug Administration (FDA) for use as HIV chemoprophylaxis, more commonly known as pre-exposure prophylaxis or “PrEP” (CDC, 2022a) and the growing momentum behind the “undetectable = untransmissable” or “U=U” movement. “U=U” refers to “treatment as prevention” (TASP), reflecting the inability of a person living with HIV (PLWH) to transmit the virus to an uninfected partner if the PLWH is virally suppressed or has an undetectable HIV viral load. PrEP, TASP, and the growing traction behind the “U=U” movement have largely influenced how MSM community members conceptualize risk and approach their sexual health (Bernays et al., 2021).

HIV prevention is not the only aspect of MSM sexual health that is rapidly evolving. Studies of doxycycline administration for the prevention of sexually transmitted infections (STIs) such as C. trachomatis, N. gonorrhoeae, and T. Palladium in the form of pre-exposure prophylaxis (DoxyPrEP) and/or post-exposure prophylaxis (DoxyPEP) appear promising (see e.g., Luetkemeyer et al., 2023; Molina et al., 2018) and additional studies are ongoing. The opportunity for MSMSW to engage in sex work with a considerably mitigated HIV and STI risk is a significant development in terms of MSM sexual health and HIV prevention in the United States. Given these relatively novel breakthroughs in HIV and STI prevention, it is conceivable MSMSW may change how they approach client encounters and perceive the risks associated with client encounters. As such, ongoing research is necessary to ensure that MSMSW have both knowledge of and access to these valuable sexual health services.

LGBTQIA+ Pride: Activism, Economics, and Public Health Research

Each year, the LGBTQIA+ pride season begins in June, coinciding with the anniversary of the Stonewall uprising—an event heralded as the beginning of the gay rights movement in the United States. The precursor of contemporary, large-scale LGBTQIA+ pride parades and festivals in the United States began in June 1970—a commemoration of the 1-year anniversary of the Stonewall uprising. These events took place not only in New York City, but also Chicago, Los Angeles, and San Francisco (Tandon & Rao, 2021). These celebrations now take place annually in communities large and small across the United States and around the world; Pride festivals have been cited as a mechanism for signaling to LGBTQIA+ community members that a given host city is “gay friendly” (Ram et al., 2019).

Beyond the LGBTQIA+ visibility generated by these events, large-scale pride festivals have historically served as venues for public health research, community needs assessments, and HIV testing (see e.g., Cafferty et al., 2020; J. L. Martin et al., 1989; Mdodo et al., 2014). Notable, however, is that no studies have explored the relationship between contemporary LGBTQIA+ pride festivals and MSM sex work. Drawing on economic theories of migration (see e.g., Greenwood, 1997; Sjasstad, 1962), it is conceivable a sex worker may elect to travel to one or more LGBTQIA+ pride festivals given the increased MSM presence in such markets during these events.

Several recent studies have suggested large-scale sporting events (e.g., World Cup, Super Bowl) may result in transient increases in female sex worker advertising in the cities hosting such events (Boecking et al., 2018; L. Martin & Hill, 2019). Given the transient increased concentration of MSM in a given city during LGBTQIA+ pride festivals, it is conceivable that MSMSW may travel to and/or transiently enter the MSM sex work market recognizing that the increased concentration of MSM in a given city during LGBTQIA+ events may represent a remunerative opportunity.

The primary aim of this exploratory study was to determine if large-scale LGBTQIA+ pride events were associated with increased MSMSW advertising. Communities with increased MSMSW advertising during large-scale LGBTQIA+ pride festivals may represent opportunities for research, education, and/or the provision of sexual health services to an oft-overlooked, vulnerable population.

Methods

Study Design

This is an exploratory, longitudinal ecological study of profile-based MSMSW advertising data conducted between June 19 2022 and October 15 2022. This timeline was selected, given that it captures the majority of large-scale LGBTQIA+ pride festivals during the 2022 “pride season.”

Setting and Participants

Parsehub (2023), a subscription web-scraping tool was used to extract advertising data from a well-known, high-volume MSMSW internet advertising website. ¹ The selected website contains profile-based MSMW advertisements (as opposed to anonymous classified advertisement-style advertisements [e.g., Craigslist, Backpage]), allowing for a more precise measurement of the number of unique MSMSW advertisers at any point in time because each sex worker’s profile is associated with a unique unified resource locator (URL). Prospective clients are able to search and filter the website for MSMSW-based sex workers’ demographic characteristics, physical attributes, sexual interests, and location. At weekly intervals, count data from each of the study cities were extracted from this website. Data collection continued for a total of 18 weeks (June 19th 2022 to October 15th 2022). No identifiable profile information (e.g., contact information, photos, etc.) was collected during the data collection process.

Twenty U.S. cities were originally selected for inclusion in this study based on the large-scale LGBTQIA+ pride or “special interest” festivals (hereafter referred to as LGBTQIA+ events) scheduled to take place in each city on/after the beginning of the data collection period. Unfortunately, one or more web-scraping “runs” for four cities produced corrupt or incomplete data during the study period and as a result, these four cities (Key West, New Orleans, Palm Springs, and Phoenix) were excluded from the final analysis. Table 1 contains the final list of study cities, as well the information about each city’s LGBTQIA+ event(s) during the study period. Notably, 14 of the study cities are jurisdictions designated by the CDC as “Ending the HIV Epidemic” (E.H.E.) priority cities, a designation assigned to 50 U.S. jurisdictions accounting for more than 50% of new HIV infections in the United States (CDC, 2022a).

Table 1.

LGBTQIA+ Events, Dates, and Corresponding Study Weeks

City	Event(s)	Event date(s)	Study week
Atlanta, TX a	Atlanta Pride	October 8 and 9, 2022	Week #17
Austin, TX a	Austin Pride	August 20, 2022	Week #10
Charlotte, NC a	Charlotte Pride	August 20 and 21, 2022	Week #10
Chicago, IL a	Chicago Pride	June 26, 2022	Week #2
	Market Days	August 6 and 7, 2022	Week #8
Columbus, OH a	Columbus Pride	June 18, 2022	Week #1
Denver, CO	Denver Pride	June 25 and 26, 2022	Week #2
Ft. Lauderdale, FL a	Wilton Manors Stonewall Pride Parade and Street Festival	June 18, 2022	Week #1
Houston, TX a	Houston Pride	June 25, 2022	Week #2
Las Vegas, NV a	Las Vegas Pride	October 8, 2022	Week #17
Minneapolis, MN a	Twin Cities Pride Festival	June 25 and 26, 2022	Week #2
New York City, NY a	NYC Pride	June 25 and 26, 2022	Week #2
Orlando, FL a	Orlando Pride	October 15, 2022	Week #18
Portland, OR	Portland Pride Parade & Festival	June 19, 2022	Week #1
San Francisco, CA a	San Francisco Pride	June 25 and 26, 2022	Week #2
	Dore Alley	July 31, 2022	Week #7
	Folsom Street Fair	September 25, 2022	Week #15
San Diego, CA a	San Diego Pride	July 16 and 17, 2022	Week #5
Seattle a	Seattle Pride	June 26, 2022	Week #2

^aU.S. CDC “Ending the HIV Epidemic” (EHE) priority community.

Variables

For each of the 16 study cities, a data set was created containing the number of advertisements associated with each of the 18 weekly observations. A dichotomous, categorical (0/1) dummy variable was created to indicate whether each week was associated with an LGBTQIA+ event or not. An additional categorical variable was created representing the month associated with each weekly observation (e.g., June, July, August, September, or October) for each of the 16 study cities.

Analyses

Changes in the number of MSMSW advertising profiles during the study period were assessed using a Poisson regression model for each of the 16 study cities. Poisson regression is a standard model commonly used to model count data (Tutz, 2011). In each model, the month variable and the dichotomous dummy variable representing LGBTQIA+ event were fitted as predictor variables. The outcome variable in each of the forthcoming models is the number of active MSMSW profiles. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were calculated for both the LGBTQIA+ event and month predictors. STATA (v. 16) was used for data management and all statistical analyses.

Results

During the 16-week study period, a total of 54,134 observations were made representing a total of 6,371 unique user profiles. The weekly observations and advertising totals are listed in Table 2. The cities with the greatest number of MSMSW profiles during the study period were: New York City, San Francisco, and Chicago, with 848.2 (SD = 48.0), 293.3 (SD = 34.7), and 252.3 (SD = 22.8) mean weekly advertisements, respectively. Examining the data more closely, it is notable that Chicago, New York City and San Francisco are not the cities with the greatest density of MSMSWs during the study period. As presented in Table 3, Fort Lauderdale (population 182,760), Atlanta (population 498,715), and Orlando (population 307,573) are comparatively much smaller cities with a far greater observed density of MSMSW during the 2022 LGBT pride season.

Table 2.

Advertising Totals for Each of the 16 Study Cities During Study Period Measured at Weekly Intervals

	June		July					August				September				October
City	Week 1	Week 2	Week 3	Week 4	Week 5	Week 6	Week 7	Week 8	Week 9	Week 10	Week 11	Week 12	Week 13	Week 14	Week 15	Week 16	Week 17	Week 18
New York	869	1,003	844	860	828	837	816	802	828	819	788	807	840	827	852	871	882	895
San Francisco	285	308	265	281	292	286	302	248	252	278	297	302	309	319	410	273	286	287
Chicago	245	257	256	246	269	274	279	323	246	231	228	239	235	251	240	249	234	239
Atlanta	200	190	210	223	247	222	209	209	195	194	201	255	220	235	233	231	261	230
Fort Lauderdale	155	142	155	173	154	165	185	161	169	181	182	185	190	187	195	193	195	193
Las Vegas	171	167	185	185	187	173	177	188	192	185	167	172	170	150	173	156	164	170
Houston	146	151	133	145	146	134	147	136	139	138	140	121	133	148	136	148	150	153
San Diego	128	123	140	139	161	128	123	119	131	129	127	127	136	139	120	130	134	133
Orlando	105	100	92	110	108	121	123	99	98	118	114	115	112	116	103	107	110	121
Seattle	82	94	83	95	97	90	83	93	96	104	105	99	96	97	103	106	106	107
Denver	71	72	63	64	66	65	78	68	67	67	69	76	74	68	68	82	74	75
Portland	63	54	56	52	53	44	47	52	52	62	57	65	60	57	62	64	63	66
Charlotte	40	39	44	41	52	48	36	38	41	50	43	54	54	47	46	52	45	53
Austin	44	45	45	41	44	42	38	33	43	41	36	38	37	47	46	45	42	39
Minneapolis	44	45	45	41	44	42	38	33	43	41	36	38	37	47	46	45	42	39
Columbus	37	29	40	38	45	42	38	46	56	42	41	36	39	36	35	38	41	38

Note. Gray cell indicates total corresponding to week with scheduled LGBTQIA+ festival or event.

Table 3.

MSMSW Profile Advertising Density for Study Period Expressed per 100,000 City Population

City	Population a	M Profiles	SD	Profiles/10,000 population
Fort Lauderdale	182,760	175.6	16.7	9.6
Atlanta	498,715	220.3	21.1	4.4
Orlando	307,573	109.6	8.8	3.6
San Francisco	873,965	293.3	34.7	3.4
Las Vegas	641,903	174.6	11.5	2.7
Seattle	737,015	96.4	8.1	1.3
Denver	715,522	70.4	5.2	1.0
New York City	8,804,190	848.2	48.0	1.0
Minneapolis	429,954	41.4	3.9	1.0
Chicago	2,746,388	252.3	22.8	0.9
Portland	652,503	57.2	6.4	0.9
Houston	2,304,580	141.3	8.3	0.6
Charlotte	874,579	45.7	5.8	0.5
Columbus	905,748	39.8	5.6	0.4
Austin	961,855	41.4	3.9	0.4
San Diego	3,298,634	131.5	9.7	0.4

^aPopulation data based on U.S. Census Bureau (2020) estimates.

LGBTQIA+ events were significantly (p < .05) associated with an increased number of MSMSW advertisements in only three of the regression models performed for each of the study cities (n = 16). As shown in Table 4, LGBTQIA+ events were significantly associated with increased MSMSW advertising in San Francisco (IRR = 1.16, 95% CI = 1.07, 1.25, p < .001), New York City (IRR = 1.15, 95% CI = 1.05, 1.26, p < .005), and Chicago (IRR = 1.25, 95% CI = 1.12, 1.39, p < .001). These are the estimated rate ratios comparing the study weeks coded as LGBTQIA+ event weeks versus non-event LGBTQIA+ event weeks, holding all other factors constant. Furthermore, this value suggests that LGBTQIA+ event weeks in, for example, San Francisco, are expected to have an MSMSW advertising rate 1.16 times greater than non-LGBTQIA+ event weeks.

Table 4.

Poisson Regression Models: Association Between Number of Advertisements and LGBTQIA+ Events and Month ^a

City model	Poisson regression output
	B	SE B	p	IRR	95% CI	p > χ2
Atlanta						.0001 a
LGBTQIA+ event	0.12	0.08	.109	1.13	[.97, 1.32]
Month (reference = June)
July	0.13	0.06	.027 a	1.14	[1.02, 1.28]
August	0.02	0.06	.697	1.02	[.91, 1.16]
September	0.19	0.06	.002 a	1.21	[1.07- 1.36]
October	0.17	0.07	.015 a	1.18	[1.03, 1.35]
Chicago						.0003 a
LGBTQIA+ event	0.22	0.05	.000 a	1.25	[1.12, 1.39]
Month (reference = June)
July	0.17	0.06	.005	1.18	[1.05, 1.33]
August	0.08	0.06	.156	1.08	[.97, 1.21]
September	0.08	0.06	.225	1.08	[.95, 1.22]
October	0.07	0.07	.260	1.08	[.95, 1.22]
Fort Lauderdale						.0006 a
LGBTQIA+ event	0.09	0.12	.451	1.09	[.87, 1.37]
Month (reference = June)
July	0.16	0.09	.081	1.17	[.98, 1.40]
August	0.20	0.09	.031 a	1.22	[1.02, 1.40]
September	0.29	0.09	.002 a	1.33	[1.11, 1.59]
October	0.31	0.09	.001 a	1.36	[1.14, 1.64]
New York City						.0000 a
LGBTQIA+ event	0.14	0.05	.002 a	1.15	[1.05, 1.26]
Month (reference = June)
July	−0.04	0.04	.314	0.96	[.90, 1.04]
August	−0.07	0.04	.055	0.93	[.86, 1.00]
September	−0.03	0.04	.383	0.97	[.89, 1.04]
October	0.02	0.04	.690	1.02	[.94, 1.10]
San Francisco						.0000 a
LGBTQIA+ event	0.15	0.04	.000 a	1.16	[1.07, 1.25]
Month (reference = June)
July	0.01	0.05	.896	1.01	[0.92, 1.11]
August	0.00	0.05	.954	1.00	[0.90, 1.11]
September	0.18	0.06	.001	1.20	[1.08, 1.32]
October	0.03	0.06	.642	1.03	[0.92, 1.15]
Austin						.8053
LGBTQIA+ event	0.16	0.18	.376	1.17	[.82, 1.66]
Month (reference = June)
July	−0.06	0.13	.648	0.94	[.74, 1.21]
August	−0.19	0.14	.174	0.82	[.62, 1.09]
September	−0.06	0.13	.659	0.94	[.73, 1.22]
October	−0.06	0.14	.676	0.94	[.72, 1.23]
Charlotte						.2158
LGBTQIA+ event	0.21	0.17	.219	1.23	[.88, 1.71]
Month (reference = June)
July	0.11	0.13	.391	1.12	[.87, 1.45]
August	0.03	0.14	.840	1.03	[.78, 1.37]
September	0.24	0.13	.070	1.27	[.98, 1.65]
October	0.24	0.14	.090	1.27	[.96, 1.66]
Columbus						.1231
LGBTQIA+ event	0.24	0.25	.326	1.28	[.78, 2.07]
Month (reference = June)
July	0.34	0.20	.090	1.40	[.95, 2.07]
August	0.47	0.20	.019	1.59	[1.07, 2.35]
September	0.23	0.20	.258	1.26	[.84, 1.87]
October	0.30	0.21	.153	1.34	[.90, 2.02]
Denver						.6918
LGBTQIA+ event	0.01	0.17	.933	1.01	[.73, 1.41]
Month (reference = June)
July	−0.06	0.13	.674	0.95	[.73, 1.22]
August	−0.05	0.13	.725	0.95	[.73, 1.24]
September	0.01	0.13	.958	1.01	[.78, 1.31]
October	0.08	0.14	.550	1.09	[.83, 1.41]
Houston						.5349
LGBTQIA+ event	0.03	0.12	.772	1.03	[.82, 1.30]
Month (reference = June)
July	−0.03	0.09	.702	0.97	[.81, 1.15]
August	−0.05	0.09	.558	0.95	[.79, 1.14]
September	−0.08	0.09	.379	0.92	[.77, 1.11]
October	−0.03	0.10	.759	1.03	[.85, 1.24]
Las Vegas						.2147
LGBTQIA+ event	0.01	0.10	.949	1.01	[.83, 1.21]
Month (reference = June)
July	0.07	0.06	.267	1.07	[.95, 1.22]
August	0.08	0.07	.226	1.08	[.95, 1.23]
September	−0.02	0.07	.806	0.98	[.86, 1.12]
October	−0.04	0.08	.641	0.96	[.83, 1.12]
Minneapolis						.9071
LGBTQIA+ event	0.02	0.21	.916	1.02	[.67, 1.55]
Month (reference = June)
July	−0.05	0.17	.779	0.95	[.69, 1.32]
August	−0.14	0.17	.413	0.87	[.62, 1.22]
September	−0.05	0.17	.784	0.95	[.68, 1.33]
October	−0.05	0.18	.791	0.95	[.68, 1.35]
Orlando						.7752
LGBTQIA+ event	0.11	0.11	.337	1.12	[.89, 1.39]
Month (reference = June)
July	0.08	0.08	.341	1.08	[.92, 1.27]
August	0.05	0.08	.594	1.05	[.89, 1.24]
September	0.08	0.08	.319	1.09	[.92, 1.28]
October	0.06	0.10	.559	1.06	[.87, 1.28]
Portland						.1232
LGBTQIA+ event	0.15	0.19	.406	1.17	[0.81, 1.68]
Month (reference = June)
July	−0.07	0.15	.645	0.93	[.70, 1.25]
August	0.03	0.15	.833	1.03	[.77, 1.39]
September	0.12	0.15	.418	1.13	[.84, 1.52]
October	0.18	0.15	.255	1.19	[.88, 1.61]
San Diego						.1813
LGBTQIA+ event	0.20	0.09	.030	1.22	[1.02, 1.45]
Month (reference = June)
July	0.05	0.08	.479	1.06	[.91, 1.23]
August	0.01	0.08	.918	1.01	[.87, 1.17]
September	0.04	0.08	.611	1.04	[.89, 1.21]
October	0.05	0.08	.511	1.05	[.90, 1.24]
Seattle						.1367
LGBTQIA+ event	0.14	0.15	.366	1.15	[.85, 1.54]
Month (reference = June)
July	0.09	0.12	.461	1.09	[.86, 1.38]
August	0.19	0.12	.111	1.21	[.96, 1.54]
September	0.19	0.12	.126	1.20	[.95, 1.53]
October	0.26	0.12	.036	1.30	[1.02, 1.65]

Note. IRR = incidence rate ratios; CI = confidence interval.

^aN = 18 for each of the above regression models for each study city, corresponding to the number of study weeks.

Two Poisson statistically significant regression models were based on data collected from study cities where LGBTQIA+ events were not associated with increase in MSMSW advertising during the study period: Atlanta and Fort Lauderdale. In these two cities, as presented in Table 4, study month emerged as a significant predictor. In Atlanta, several of the IRR estimates for study months compared to the June reference category were significant: July (IRR = 1.14, 95% CI = 1.02–1.28, p < .05), September (IRR = 1.21, 95% CI = 1.07, 1.36, p < .005), and October (IRR = 1.18, 95% CI = 1.03, 1.35, p < .05). In Fort Lauderdale, three of the IRR estimates for study months compared to the June reference category were significant: August (IRR = 1.22, 95% CI = 1.02–1.40, p < .05), September (IRR= 1.33, 95% CI = 1.11–1.59, p < .005), and October (IRR = 1.36, 95% CI = 1.14–1.64, p < .005).

Discussion

This study is among the first to explore patterns of MSMSW advertising during large-scale LGBTQIA+ events. In this study, we observed that LGBTQIA+ events were significantly associated with transient increases in MSMSW advertising in Chicago, New York City, and San Francisco—cities known for being LGBT-friendly and hosting some of the largest LGBTQIA+ events in the United States during the study period. In his work, Logan (2017) describes patterns of MSMSW advertising and travel; asserting that sex workers who reside in cities more densely populated with MSM are less likely to travel than those who live in less “MSM-dense” regions. Thus, cities with more MSM may seem attractive to MSMSW residing in less MSM-dense regions where there may be fewer opportunities for sex work. Findings from this study suggest this effect may be magnified during LGBTQIA+ events when there may be an increased demand for such services.

As noted previously, communities with increased MSMSW advertising during large-scale LGBTQIA+ pride festivals may represent valuable opportunities for research, education, and/or the provision of sexual health services to MSMSW community members. The notion that LGBTQIA+ events are attractive markets for MSMSW in cities typically thought of as “LGBTQIA+ friendly” is not a surprising finding. Notable, however, is that these are cities that likely have existing infrastructure and a social climate to support targeted research, education, and/or the provision of sexual health services to MSMSW community members.

New York City’s pride festival is attended by millions of people annually during the last weekend in June (see e.g. The Advocate, 2022). Tens of thousands of individuals travel to Chicago during its annual “Market Days” festival in August (see e.g., Northalstead Business Alliance, 2023). San Francisco is a unique opportunity for MSMSW in that San Francisco pride is only one of three large-scale LGBTQIA+ events. Also home to kink and fetish events such as Dore Alley and the Folsom Street Fair, San Francisco is a unique market for sex workers to interact with clients who travel to the city for the purposes of attending these niche events. The sex- and kink-positive nature of these events may be opportune markets for sex workers inclined to offer services to clients with specific interests.

Considering the cities where LGBTQIA+ events were not associated with increases in MSMSW advertising, factors such as variation in geopolitical views on homosexuality, the magnitude/popularity of a given city’s pride festival, and/or other factors (e.g., seasonality) might affect the number of sex workers advertising in these markets at any given point in time. In this context, our findings suggest that June could be a less popular month for MSMSW advertising in Atlanta and/or Fort Lauderdale as compared to the other study months. These observations could be due to seasonality, but these estimates might also be influenced by the large-scale LGBTQIA+ festivals occurring in other MSM-dense destination cities during the month of June, potentially drawing both MSM and MSMSW to cities like Chicago, New York City, and/or San Francisco where large-scale LGBTQIA+ events were occurring during this time frame. Additional research is necessary to quantify these patterns of short-term migration and geographical linkages between cities among members of the MSMSW community. If LGBTQIA+ events are associated with short-term MSMSW work travel, LGBTQIA+ events in cities such as Chicago, New York City and/or San Francisco may be opportunities to reach geographically diverse populations of MSMSW.

Limitations

There are several limitations to this study. The most notable limitation is perhaps related to the analysis. The small number of observations (n = 18) limited the analyses feasible for the data available. While this is longitudinal time series data, it was not analyzed as such. Time series analyses and/or vector autoregressive models (VAR models) were not appropriate for these data given the small number of observations and violations of the assumptions central to these types of analyses (e.g., stationarity). Instead, each weekly observation was dichotomized using a binary (0/1) variable denoting whether each weekly observation was or was not an LGBTQIA+ festival week. As such, the order of the weeks was not considered when conducting each Poisson regression model. This point is significant when one considers the two methods of how mobile MSMSW approach advertising services:

Advertising Approach (A): MSMSW advertise availability on their advertising profile in a given city weeks or months in advance

Advertising Approach (B): MSMSW change the advertised location on their profiles when arriving in a new city.

There are likely pros and cons associated with each of these approaches to advertising for MSMSW. On one hand, MSMSW who elect to advertise availability in the future allows MSMSW to line up clients ahead of arriving in a new city, potentially ensuring business and that the endeavor to travel to a new city will be remunerative. On the other hand, some MSMSW might prefer to simply change their location when arriving in a new city because they would prefer to deal with scheduling in the present instead of weeks or months in advance. The differences in approaches to advertising are relevant to this study because the MSMSW advertising upcoming availability in each city during the study period are included in the weekly advertising totals for each city. Furthermore, it is important to consider that some MSMSW may not be traveling to a given city, but instead transiently entering the local sex work market amid a large-scale LGBTQIA+ event.

By dichotomizing each week into a binary (0/1) variable denoting whether each weekly observation was or was not an LGBTQIA+ festival week in each of the preceding Poisson regression models, the MSMSW advertising their upcoming availability in a given city increase the advertising numbers in the week(s) leading up to an LGBTQIA+ event. Given this, any gradual increases in MSMSW advertising in the weeks leading up to an LGBTQIA+ event are not captured by the regression models. The net effect is, however, likely an underestimation of the effects of the LGBTQIA+ events on MSMSW advertising as a result of focusing on the weeks during which LGBTQIA+ events were occurring. Also notable, the scale of the LGBTQIA+ events described in this study are not equivalent. For example, New York City Pride or Chicago Market Days attracts a far larger crowd than Dore Alley in San Francisco. As designed, this study does not capture differences in the magnitude of such LGBTQIA+ events.

This study was designed to analyze the relationship between LGBTQIA+ events and MSMSW advertising in geographically, politically, and socially diverse cities. As noted previously, four cities were excluded from the final analysis due to missing data. Also notable, several large-scale U.S. LGBTQIA+ pride events/cities were not included in this study because these LGBTQIA+ events occurred prior to the beginning of the data collection period. Among the events not represented in this study is Los Angeles Pride, occurring each year during the second week of June. The omission of Los Angeles from this study is quite notable; prior studies of MSMSW and short-term migration of MSMSWs previously identified Los Angeles as having both increased MSMSW prevalence (see e.g., Javanbakht et al., 2019) and as a city commonly frequented by MSMSW who travel for work (Logan, 2017). Future research is necessary to determine if the potential relationship between MSMSW advertising and LGBTQIA+ events observed in cities like Chicago, New York, and San Francisco also exists Los Angeles.

It is essential to consider geographic variation in sex worker practices and social policy, as well as other population-level events (e.g., period effects) that could translate to differences in MSMSW advertising in each of the study cities during the study period—both long term and short term. Long term, there may be regional differences in policy surrounding sex work and/or differences in law enforcement practices surrounding the provision of commercial sex work services that might affect rates of advertising in a given city (see e.g., Rosentel et al., 2021). With respect to short-term effects, this study of MSMSW advertising patterns occurred during the 2022 global Monkeypox (MPX) outbreak that disproportionately affected members of the MSM community. MPX transmission resulted—predominantly—from MSM sexual contact and resulted in painful sores in the anogenital region and oral mucosa (Philpott et al., 2022; Wise, 2022). As such, the perceived threat of MPX may have dissuaded some MSMSW from traveling to cities such as Chicago, New York, and San Francisco where MPX was most prevalent (Big Cities Health Coalition, 2022). The association between LGBTQIA+ events and MSMSW advertising observed in this study may be an underestimate of the relationship that would be observed in the absence of the MPX outbreak and may represent a source of confounding not captured by the models presented.

The findings from this study may not be generalizable to MSMSW who advertise services on internet platforms other than the platform from which these data were collected. For example, the findings of a study conducted by Siegel et al. (2023) noted that many common geosocial networking applications (e.g., Grindr, Scruff) serve as a common point of entry to the world of sex work/transactional sex among MSM. Furthermore, as presented by Grov et al. (2017), there is evidence to suggest that the characteristics and behaviors of MSMSW may vary across different internet advertising platforms. Additional research is needed to determine if the same variation(s) in advertising around LGBTQIA+ pride festivals are observed on other internet platforms, potentially among other subgroups of MSMSW.

Public Health Significance

Patterns of MSMSW advertising should be of interest to public health officials and epidemiologists. Epidemiology is not merely a study of disease occurrence; the study of epidemiology includes the study of determinants of disease. While sex work does carry occupational risks such as STI and HIV transmission, sex work also has considerable overlap with other social determinants of health including alcohol/substance abuse, food/housing insecurity, and intimate partner/sexual violence. A common criticism of many contemporary studies into contemporary MSM sex work practices and experiences of MSMSW focus on HIV and STI transmission and, as a result, perpetuate sex worker stigma (see e.g., Bungay et al., 2021). The primary aim of this study is not to further stigmatize members of the MSMSW community or classify sex workers as potential vectors of HIV and STIs. Instead, this study sheds light on a phenomenon that may be informative for MSMSW, clinicians, and public health officials. If MSMSW truly have a significant presence at large-scale LGBTQIA+ events, such events may be an invaluable entry point into this hidden, stigmatized community for the purposes of education, outreach, and research. The provision of education and outreach services amid the LGBTQIA+-friendly, sex-positive environments facilitated by most large-scale LGBTQIA+ events may represent an opportunity to provide invaluable outreach and education services to MSM who might be traveling from communities with reduced or limited access to LGBTQIA+ friendly sexual health/HIV prevention services.

As noted previously, some MSMSW may transiently enter the sex work market during large-scale LGBTQIA+ events and exit the market following the conclusion of such events. Targeted outreach services and education during large-scale LGBTQIA+ events may represent a time-limited opportunity to reach members of the MSMSW community that otherwise do not self-identify as MSM nor as a sex worker. By including this vulnerable subpopulation of the MSMSW community in education, outreach, and research initiatives in the context of large-scale LGBTQIA+ events, health care providers and researchers may be able to better care for and design more inclusive interventions tailored to the needs of the entire MSMSW community.

Future public health-oriented research into the advertised behaviors and advertising patterns of MSMSW could help inform public health practice. While the ability to identify specific patterns of short-term migration is a limitation of this study, further research into patterns of short-term MSMSW migration may help federal, state, and/or municipal public health officials and community leaders to prioritize sexual health services for the MSMSW community. If, for example, MSMSW community members travel from their home city/state/region to one or more large-scale LGBTQIA+ events for the provision of MSMSW services and return home where there may be a lack of LGBTQIA+ affirming sexual health care services, this could translate to deleterious health effects and undue stress for MSMSW. The identification of short-term migratory patterns could inform interagency partnerships or the development of innovative networks of LGBTQIA+ sexual health providers capable of providing sexual health services to MSMSW while traveling.