Interest in Sex Work-Related Resources Among Gay, Bisexual, and Other Men Who Have Sex with Men Engaged in Sex Work

Abstract

Introduction:

Practicing sex work can present considerable risks to an individual’s sexual health and overall well-being. Though resources tailored for sex workers can help mitigate such risks, little is known about male sex workers’ interest in them.

Methods:

From 2018 to 2020, we conducted in-depth telephone interviews with 180 U.S. men who engaged in sex work with clients met online. We inquired about what sex work-related resources they were aware of or had used, the specific content of resources they would want, and whether they would use such resources or not.

Results:

Few participants had used sex work-related resources, but many had found material related to sex work through organizations and online media. While some participants expressed interest in resources to help make their engagement in sex work safer and more profitable, others were interested in resources that would help them address the conditions that had led them to sex work in the first place. Participants also discussed some barriers to resource utilization such as low perceived need, privacy concerns, and low credibility of the material.

Conclusions & Policy Implications:

Results show that there is substantial interest in sex work-related resources among men engaged in the practice. However, programs should carefully consider potential barriers to utilization when developing these resources.

Introduction

In a survey conducted by the U.S. Centers for Disease Control (CDC) in 2017, 9.3% of gay, bisexual, and other men who have sex with men (MSM) reported having given or received money or drugs in exchange for sex with a man in the prior year (Centers for Disease Control and Prevention, 2019). Having sex in exchange for money, drugs, or other goods (i.e., sex work) is a practice that can present risks and rewards for MSM. For instance, male sex workers have reported finding the practice rewarding both financially and psychologically, as it can develop self-esteem and self-confidence (Mimiaga et al., 2009; Parsons et al., 2007; Ridder-Wiskerke & Aggleton, 2014; Uy et al., 2004). However, some studies have found male sex work to be associated with elevated risk for HIV and other sexually transmitted infections (STIs), primarily because those who engage in the practice report higher numbers of condomless sex partners than those who do not (Meunier et al., 2021; Mgbako et al., 2019; Nerlander et al., 2017; Prestage et al., 2014; Weber et al., 2001). Although HIV/STI risks might be more elevated among MSM who engage in sex work because of dire financial or substance-use needs (Bimbi & Koken, 2014; Salhaney, Biello, et al., 2021), male sex workers in general can benefit from resources to help them maintain sexual health.

Sex work can also involve an array of psychosocial risks. Male sex workers are at high risk for experiencing violence in the form of physical assault, rape, or theft (Mimiaga et al., 2021; Raine, 2021), and studies comparing MSM who engage in sex work to those who do not have found the former to be more likely to report experiences of harassment, assault, or intimate partner violence (Balaji et al., 2017; Walters et al., 2021). Sex work is illegal in most U.S. jurisdictions, and men who sell sex are more likely than those who do not sell sex to have ever been incarcerated (Nerlander et al., 2017; Philbin et al., 2018). Further, male sex workers are more likely than other MSM to experience socioeconomic or psychosocial challenges such as financial insecurity, housing instability, mental health issues, and substance use (Bauermeister et al., 2016; Biello et al., 2017; Chandler et al., 2021; Nerlander et al., 2017; Salhaney, Mimiaga, et al., 2021; Voisin et al., 2017; Walters et al., 2020). Such psychosocial hardships are associated with increased sexual risk-taking among MSM in general (Halkitis et al., 2013; Tapia et al., 2021) and could thus exacerbate male sex workers’ vulnerability to HIV and STIs.

Male sex workers could benefit from resources to help improve the conditions of their lives and work and minimize the various risks associated with selling sex. Though few of them exist, resources for male or female sex workers often take a harm-reduction approach and have included HIV/STI prevention, negotiation skills development, and personal empowerment strategies, often delivered by peers (Rekart, 2005). Recently, researchers have begun to frame the importance of sex work-related resources as an issue of occupational health and safety, emphasizing the importance of providing sex workers with adequately safe work conditions (Bernier et al., 2021; Jiao et al., 2021). Nevertheless, although some harm-reduction initiatives targeted to male sex workers have been documented (Bimbi & Koken, 2014; Grov et al., 2014; Laing & Gaffney, 2014), at present, there seem to be no formal resources tailored to this population in the US.

While there is limited information regarding male sex workers’ utilization of sex work-related resources, a few U.S. studies have documented male sex workers’ interest in such resources. In two qualitative studies, male sex workers expressed interest in HIV and STI prevention and treatment services, particularly if they are easily accessible and offered by providers comfortable discussing sex work (Parsons et al., 2007; Reisner et al., 2008). Participants in these studies were also interested in resources to improve their practice of sex work (e.g., negotiation and communication with clients, financial management), information about the laws surrounding sex work, and services to help cope with the emotional and psychological challenges of sex work (Parsons et al., 2007; Reisner et al., 2008). A survey of 418 U.S. male sex workers recruited from an escorting website invited participants to rank their interest in different types of workshops and found that the most endorsed topics were related to improving sex work business (e.g., marketing oneself, attracting the right clients, or financial management) and learning about the law (Grov et al., 2014). This small body of literature shows that male sex workers are interested in a variety of resources and that further inquiry into their interests is necessary to develop resources for this population.

The circumstances within which MSM engage in sex work vary greatly and could inform the types of resources they are interested in. For instance, some male sex workers (often online escorts) engage in this work as a professional choice, while others (often street-based workers) do so to obtain drugs or to meet basic needs (Minichiello et al., 2002; Parsons et al., 2004; Ryan, 2019; Uy et al., 2004). Accordingly, some male sex workers might be interested in resources that would help them improve their business while others might favor resources that would allow them to stop relying on sex work. Researchers have recently drawn attention to MSM’s use of dating and hookup websites and apps (not intended for sex work) as a means to find sex work (Brennan, 2017; McLean, 2015; Morris, 2021; Ryan, 2016). Because little is known about these MSM’s motivations for engaging in sex work and the specific risks to which they are vulnerable (Schrimshaw et al., 2017), we also do not know the types of resources from which they would benefit.

In the current study, we sought to investigate what types of resources men engaged in sex work were aware of, had used, or would be interested in. To do so, we examined qualitative data collected from a sample of 180 MSM who engaged in sex work via dating/hookup apps/websites.

Methods

This cross-sectional study examined the sexual health of men who engaged in sex work using online social and sexual networking technologies. Recruitment and data collection occurred online between October 2018 and April 2020. Paid advertisements on social media and dating/hookup applications stated that researchers at Columbia University were looking for men who found partners online to participate in a sexual-health study. The focus on exchange sex work was not stated but was alluded to in the advertisement pictures. Potential participants were invited to click on advertisements to be redirected to a short questionnaire to determine their eligibility for the study. They were also informed that eligible participants who completed the study would earn a $100 electronic gift card.

Advertisements redirected to the screener survey hosted on Qualtrics. The first page displayed the study’s information sheet. Participants who agreed to take the screener questionnaire were then asked a series of questions eliciting information about their demographic characteristics, sexual health, and sexual behaviors. At the end of the questionnaire, participants were notified of their eligibility. Those who were eligible were invited to provide their contact information so a study staff member could contact them to schedule the study procedures.

To be eligible, participants had to: a) have been assigned male sex at birth and currently identify as men, genderqueer, or non-binary; b) be 18–45 years old; c) self-report having never tested positive for HIV; d) self-identify as Black/African-American, White/Caucasian, or Hispanic/Latino of any race; e) report being fluent in English; f) reside in the areas of Atlanta, Baltimore, Boston, Chicago, Detroit, New York City, Philadelphia, or Washington, D.C.; g) report having received money, drugs, shelter, or other goods in exchange for any kind of sex with at least two different male partners (exchange partners) in the prior three months; h) report anal sex with at least one of their exchange partners from the prior three months; and i) report having initially met at least one of their exchange partners from the prior three months on a hookup/dating app or website. To ensure the racial/ethnic diversity of the sample, we used quota sampling to recruit approximately equal numbers of participants across racial/ethnic groups (Black non-Hispanic, White non-Hispanic, and Hispanic/Latino). To maximize the variability of perspectives on the topic of the study, quotas were also imposed to recruit similar numbers of participants between ages 18–29 and 30–45, and of different sexual risk-taking categories (i.e., participants who consistently used pre-exposure prophylaxis (PrEP) and/or condoms with their exchange sex clients in the past three months and those who did not).

Participation involved three study procedures that participants could complete at their own pace, which on average was over one week. First, participants completed a questionnaire administered on the phone by an interviewer which lasted between 20 and 30 minutes. At the beginning of the call, the interviewer took the participant through the informed consent process. The questionnaire then confirmed eligibility and elicited further information about participants’ sexual behaviors. Second, participants were sent a link to complete an online self-administered questionnaire that included further items about engagement in sex work and mental health. Finally, participants completed an in-depth qualitative interview over the phone during which they were asked to further discuss their engagement in sex work and their strategies to maintain sexual health. The current analysis reports on a series of questions in the qualitative interview asking if participants had ever heard of or used sex work-related resources and what types of resources they would be interested in.

Interviews were transcribed and then coded using the qualitative data analysis software ATLAS.ti. First, two study members did a structural coding of the entire interview transcripts, labeling all sections according to the broad topics of inquiry of the study. For this article, sections of transcripts labeled under the broad topic of sex work-related resources were further analyzed. We coded these sections using a qualitative content analysis strategy (Morgan, 1993), aiming to present an exhaustive account of the data organized into categories best containing participants’ responses. The sections and subsections presented in the results represent the categorization of participants’ responses. Quotations were selected to represent these categories and subcategories in an effort to include excerpts from as many different participants as possible.

Results

Participant characteristics

As a result of the quota sampling strategy, the sample was diverse, with 25.6% identifying as non-Hispanic Black, 37.8% as non-Hispanic White, and 36.7% as Hispanic/Latino of any race (Table 1). In accordance with the inclusion criteria, participants were between 18 and 45 years old (median: 28). Education level was relatively high as only 17.2% of participants did not have at least some college education. However, income in the prior year was relatively low as 40.7% reported having made less than $20,000 from all sources, including sex work. Most participants reported currently having employment unrelated to sex work, with 27.7% working part-time and 43.3% working full-time.

Table 1.

Participant characteristics (n = 180).

	Total
	n	%
Total	180	100%
Age (mean; median)	28.65	28
Age group
18 to 29	103	57.2%
30 to 45	77	42.8%
Race/ethnicity
White, not Hispanic	68	37.8%
Latino, any race	66	36.7%
Black, not Hispanic	46	25.6%
Education
Less than High School	4	2.2%
High School	27	15.0%
Some college	48	26.7%
Associate's	11	6.1%
Bachelor's	56	31.1%
Graduate	34	18.9%
Student
Yes	48	26.7%
No	132	73.3%
Employment
Not employed	41	29.1%
Part time	39	27.7%
Full time	61	43.3%
Income
Under $20,000	72	40.7%
$20,000 to $59,999	72	40.7%
$60,000 more	33	18.6%
Birthplace
United States	155	86.1%
Outside the US	25	13.9%
Sexual identity
Gay	152	84.4%
Bisexual	21	11.7%
Queer	2	1.1%
Pansexual	1	0.6%
Heterosexual	1	0.6%
“No label”	1	0.6%
“Other”	2	1.1%

In the qualitative interviews, participants further discussed their awareness, experiences, and perceptions of sex work-related resources. We categorized their responses into three broad categories: a) the resources participants were aware of or had used; b) the content that participants looked for in such resources; and c) their considerations about using such resources. These categories are outlined in a table included as supplemental material.

Awareness and use of existing resources

Participants mentioned several resources that could be helpful to sex workers, regardless of whether they were intended for this population. These included: 1) community-based organizations; 2) sexual-health clinics; 3) sex-worker organizations; 4) online resources; and 5) personal networks. Relevant quotes are displayed in Table 2.

Table 2.

Participant quotes related to awareness and use of existing sex work-related resources.

Community-based organization
1	They [Housing Works] are working on it. Right now, my housing situation is really bad. (24, Black, NYC)
2	We have GMHC, Gay Men’s Health Crisis. It’s really great work, especially for men of color. I was dealing with an immigration issue and they helped me. (43, Black, NYC)
3	In Chicago, there is the Center on Halsted. They help out a lot of people who are LGBTQ and homeless and sex workers. I have used them for health services, for testing and for getting my prescriptions. (29, White, Chicago)
4	I know that the Philadelphia LGBT Office of Affairs, which is actually a city organization, has a woman there who works directly in outreach with sex workers in the LGBT community. I know someone personally who has gone to her after being victimized, and gotten what I would describe as superb justice. (40, Latino, Philadelphia)
5	There’s an organization here called COMHAR. I wanted to see a psychiatrist to do med management and then also someplace where I could get psychotherapy and CBT, but I wanted it all under one roof. Literally phenomenal experience! At the time, I didn’t have private insurance because I wasn’t employed, so I was on state-based medical assistance. (29, White, Philadelphia)
6	Whitman-Walker was where I ended up going from outpatient care and then, Samaritan in D.C. is where I went for my inpatient. The inpatient got me off the streets; it was a 28-day program. [Then] I was eligible to move into a sober house that they own. (42, White, D.C.)
7	The Hendrick Martin Institute has classes after the scene gets out. They offer classes and they give you compensation, just so they could teach you about HIV and other STIs and your risks. These don’t really target to escorts in general, but I feel like a lot of people that go to those classes are escorts. A lot of my friends are into the kinky scene, and they’ll tell you those classes were cool. I feel like those classes have helped me in a lot of situations. (21, Latino, NYC)
Sexual-health clinics
8	I got to a place in Atlanta called Positive Impact that has no stigma based on what I do. They offer free testing, so I go there and get tested every three months and that’s where I get my PrEP prescription filled. They’re really cool and open about everything and let me talk freely. If I have concerns about something happening, I can talk openly about clients or stuff like that. (44, White, Atlanta)
9	When I had this bad moment with a client, I looked for help and I just called. I told what had happened and immediately they told me where I should go. They were waiting for me and then the doctor was extremely open-minded. The doctor managed to make me feel safe and comfortable. Then, they gave me the prescription for free. (39, Latino, NYC)
Sex-worker organizations
10	They [HOOK workshop] talked about how to protect yourself legally. That was very early on, in the first few months after starting sex work. That was just good to know. (36, Latino, NYC)
11	People would get together and discuss these topics. Information about how to navigate seeing clients, staying safe, that sort of thing. When I was first getting started, it was useful to hear the perspective of somebody who was a little more experienced and could relay the information that they have learned. (31, White, NYC)
12	I have gone to a writing workshop for sex workers in the past. They had an every-other-week thing where you would go and they had writing prompts based on your sex work experience. It was a really fun experience. It was really great. (25, Latino, NYC)
13	I volunteered for SWOP a couple of times. I’ve gone to information sessions and helped pass out pamphlets or work the slides. that’s been nice to know that there’s a community out there, and if I ever needed it that they’re there. It’s sort of just nice to be in an environment where It’s just sex workers and we can all just be relaxed about it. (24, Latino, Chicago)
14	In Washington D.C., there’s an organization called HIPS that I know is focused around resources for people who do sex work. I was referred there several times when I was homeless. They connect you with housing, they connect you with food resources, they connect you with legal and medical resources if you need them. It’s a full-service organization. (42, White, D.C.)
15	Getting information about knowing where legal services are available if it were to come up. It’s mostly been the Urban Justice Center and their Sex Workers Project. I think there’s one called PONY. I haven’t really ever needed to reach out further. Just trying to be most up to date in terms of safety and sexual health through various journal articles and publications that are posted on those sites. (30, White, NYC)
Online resources
16	I Google the questions, that’s basically it. Like, “ways to protect my identity,” “how to feel out for fraud,” “how to protect your identity and your anonymity.” I learned about the questions to ask, the ways to keep my identity off the Internet, and how to develop that sixth sense for when something’s wrong. (24, White, NYC)
17	They have a section where escorts are reviewed. On the other side is the forum, which I enjoy. They have different sections like “general talk,” not about escorting or sex or anything. Then there’s one where It’s politics and war, religion or whatever. And they have one called “Ask an Escort.” It’s like just people asking random questions like, “Do escorts like this,” or “How should I approach so and so?” (27, Black, NYC)
18	With Reddit, the community centers on one answer because you up-vote answers that are helpful and you down-vote things that are not. Usually, the best information comes to the top. So I feel like, using Reddit, I can trust the advice I get on it. (27, Latino, NYC)
19	They have some threads where people share a lot of this stuff. I think that I found very interesting information, and also very relatable experiences that have happened to me. I could relate to it. (26, Latino, NYC)
20	I used to look at this Tumblr that told me all about how to sugar effectively. It would tell you how to negotiate, how to ask for things, how to strike up the conversation, how to meet, where you should meet, how you should handle that, what you should wear. (22, Latino, NYC)
21	I have seen videos of dominatrixes, and what they did, their techniques. I have looked at what exactly they do, what’s a red flag, those sorts of things. [I found] a good laugh, and potential techniques and skills to pick up on. I found it enlightening. (22, Latino, D.C.)
Personal network
22	My friends are really good as far as information. They’re very good with that, and I do have friends in this thing. (28, Black, NYC)
23	I will occasionally message a few people on RentMen just to see how they’re doing, and just be friendly. I’ve been very grateful about that. I think that we’re all kind of in our own little community, the gay sex workers. They’ve all been pretty responsive and they’ve been really nice. There’s been times when I needed help figuring something out or whatever. They would tell me the tips or how they go about things like that. So that’s been really nice. (24, Latino, Chicago)
24	We have an online group where you can just go in and write names, phone numbers, addresses of clients that have either stiffed the escort or not shown up or things like that. You can just go through and scan that list. What I do is I just take the phone numbers and put them in my phone and block them, so that if that person ever tries to contact me, the call won’t even go through. (31, White, NYC)

Community-based organizations

Participants talked about local organizations that were not necessarily targeted to sex workers but offered resources relevant to some of them. Organizations offering socioeconomic services could be helpful to those whose engagement in sex work was primarily motivated by economic insecurity. For example, a participant who reported that he often sold sex to secure shelter said he had turned to Housing Works to resolve his housing issue (quote 1). Another participant who had been relying on sex work because he was an immigrant unauthorized to work in the US had turned to Gay Men’s Health Crisis (GMHC) in New York City for immigration assistance (quote 2).

Some participants were aware that local LGBTQ+ organizations had services that could benefit sex workers (quote 3). For example, a participant knew a sex worker who had received legal assistance from a local LGBTQ+ organization (quote 4). Participants could also turn to community-based organizations for mental health resources, especially since many did not have access to health insurance to cover such services (quote 5). Community organizations were also important to participants whose engagement in sex work was motivated by substance use and who needed recovery resources (quote 6). Finally, some community-based organizations offered sexual-health trainings that were not necessarily targeted to sex workers but were sometimes attended by many of them. For example, a participant talked about going to classes offered to people in the Ballroom community (Arnold & Bailey, 2009), which he said were often attended by peers who were also engaged in sex work (quote 7).

Sexual-health clinics

Many participants mentioned that the HIV and STI testing and prevention services offered by local sexual-health clinics were relevant to sex workers, even if not specifically targeted to this population. In some cases, participants found providers at these clinics with whom they could discuss matters specific to their engagement in sex work (quote 8). Sexual-health clinics were also a place participants could turn to in case of potential HIV exposure, which could happen when doing sex work. For example, a participant discussed how he had utilized emergency post-exposure prophylaxis (PEP) services at one of these clinics after a client had forced himself on him without using a condom (quote 9).

Sex-worker organizations

Participants mentioned organizations formed by and/or for sex workers. For example, a few participants had attended workshops from HOOK, a now-defunct grassroots organization for male sex workers. One participant had found their legal workshop useful when he started exchanging sex (quote 10). Another participant talked about how the workshops had helped him learn from others who were more experienced with sex work (quote 11).

Though HOOK was targeted to men, participants also attended other sex-worker organizations that allowed them to share experiences with peers of all genders. For example, some participants had attended activities organized by the Red Umbrella Project (quote 12) and the Sex Workers Outreach Project (quote 13). Some sex-worker organizations also provided direct assistance to people engaged in sex work; for instance, a participant mentioned having been referred to HIPS in Washington, D.C. (quote 14). Without using their in-person services, participants could also benefit from sex-worker organizations by turning to the materials they posted online (quote 15).

Online resources

Many participants talked about looking for information related to sex work on a variety of online media, such as forums, blogs, social media, and video platforms. Finding online resources sometimes started with simple web searches (quote 16). Some participants also used online forums focused on male sex work, where they could casually converse with peers or clients (quote 17). On general discussion websites such as Reddit, participants could find user-created areas of interest (subreddits) dedicated to sex work, and the upvoting system helped discern whether the content was trustworthy (quote 18). On these online discussion sites, participants could learn from others who were sharing their experiences about sex work and with whom they could relate (quote 19). Participants also talked about blogs maintained by people engaged in exchange sex as a resource. One participant who identified as a “sugar baby” said he found blogs specifically giving advice for that practice (quote 20). Participants also could glean some advice from videos posted by sex workers of different genders on platforms such as YouTube (quote 21).

Personal network

Although not formal resources, participants also mentioned their personal network of peers as a resource (quote 22). When they did not initially have friends who were engaged in sex work, some participants reached out to people who advertised as sex workers online for advice or support (quote 23). Participants who were connected with other sex workers could then exchange information about problematic clients. For instance, a participant had a private online group with local peers (quote 24).

Content sought out in resources

Participants expressed interest in resources about a large variety of topics, including: 1) practical advice on sex work, 2) peer support, 3) mental health or substance use, 4) socioeconomic improvement, 5) physical safety, 6) sexual health, 7) legal advice, 8) sex-work advocacy, and 9) combatting sex-work stigma. Participant quotes in this category are displayed in Table 3.

Table 3.

Participant quotes related to content sought in sex work-related resources.

Practical advice
25	Ways to suss out clients. How to build a base? What you should look for when you’re talking to someone or when you’re meeting? When you’re coming to meet them, where you should meet them? How to negotiate pricing? What to do if something goes wrong? (27, White, NYC)
26	I learned from experience—like a trial-and-error thing—how much I can charge or a way to spot a waste-of-time client, because you might not really get it at the time. Someone who could teach someone, “Avoid this!” It would save a lot of time. (27, Black, NYC)
27	It was interesting to read about what other people did. It put things in perspective for me. It initially helped me rationalize what my prices were, how much should I be expecting. (20, Latino, NYC)
28	I looked for tips in terms of what standard rates are. I felt like I was low-balling myself originally. I was like, “What are other people getting paid for this? Am I charging people way less than I should be?” I found some [tips] online. (23, White, Chicago)
29	You always have to be pretty explicit with expectations. You have to get at least half the money upfront. I think that there are certain tips that you wouldn’t know until you’ve encountered it that would be nice to know ahead of time. (29, White, Baltimore)
Peer support
30	I think that a more open communication network for us might be helpful. I think the ability to speak to each other more openly only will promote good things. (25, White, NYC)
31	I could say that I feel very lonely. All of the other guys who do the same—but the top ones, I think not the ones who are published in a regular webpage—I would say that we don’t have... We cannot talk about it. (39, Latino, NYC)
32	I think it would just make me, at the very least, just feel better and less of an outlier. Because I feel like It’s not something that the majority of people do. I think knowing more people would make me feel better, specifically more people like me, who also don’t necessarily do it because they need the money but just because a little extra money never hurt. (28, White, Baltimore)
33	For emotional support stuff it would be good, actually. Stuff like that because a lot of people don’t… it’s hard to talk about it. Just talking about a thing that you’re not the only one, even though it’s stuff that you should know, until you’re with other people talking about it, crying about it or whatever, you’re not really seeing that. (21, Latino, NYC)
Mental health and substance use
34	The resource that I feel I could use is psychological help. Not only because of this work that I do, but also because of my personality. Emotionally, sometimes I deal with stuff that is not easy to deal with. that’s one thing that I could find useful. (32, Latino, NYC)
35	I think there could be [services], yes. I think that a lot of people that do exchange sex feel trapped by it and I think that’s why the drug culture is so big and depression and suicidal ideations and attempts are so high in this population. It’s really hard to get out of it because you make such good money. I think when you start realizing your body is changing or people aren’t finding you as attractive, it’s really depressing and discouraging. (44, White, Atlanta)
36	I’ve never really felt like I needed to go to some kind of therapy other than rehab. Maybe if there’s something that can provide some kind of drug counseling services. Escorting and drugs go very much hand in hand for a lot of people. I think that might be something that would be good, and I’m not really familiar with any kind of addiction support groups that are specifically for sex workers. (33, Latino, NYC)
37	In terms of people’s access to recovery issues related to opioids and heroin, and stuff like that, It’s really something we crucially need. For me, the two [exchange sex and substance use] have been kind of related. (30, Black, D.C.)
Getting out of sex work
38	Teach us how not to do it, how to get a proper job. (31, Black, NYC)
39	I would love to see sort of a program for people who have become too involved in exchange sex, for finding employment, maybe providing support. (24, Latino, NYC)
40	Before where I live now, I was definitely hopping around, and I would never go into a homeless shelter. I’ve stayed in Penn Station before rather than going to a homeless shelter. So, I just feel like there could be possibly safer places for people who don’t have a place to stay. (31, Latino, NYC)
41	I did Google how to get out of it. There’s a Reddit forum actually all about it. I was reading how some of the guys, they literally quit cold turkey. Some of them, it took them a while to really get out of it. A lot of them stayed in because the money was great. I was like, “I don’t want to do that. I don’t want that to be me.” So quitting cold turkey is the one thing that I have done or I am doing. (37, Black, NYC)
Safety
42	What would be helpful? I guess the main priority... Your safety’s more important than whoever you think you’re trying to be with at that time. If things are uncomfortable, no gift is worth more than a black eye. How to stay away from that. (24, Latino, NYC)
43	I wish there was a message board. I wish there was a localized directory of people to avoid. (18, Latino, D.C.)
44	If there’s like an actively dangerous person out and about, people will share, but It’s never publicly. It’s sort of like the whisper network, and all of you and your sex work friends will communicate about certain people. I’ll be like, “I’m going to meet this guy,” and so-and-so will be like, “Oh, I’ve met him. It’s all cool.” Or like, “Oh, I’ve met him. He’s kind of weird. Just keep your head on straight.” (19, White, D.C.)
45	Safety would be number one. Keep yourself safe, keep the client safe. Confidentiality. Keeping your private stuff private, not putting out your personal information. And then maybe information on how to meet somebody, where to meet somebody, when you should get out of the situation. Stuff like that could definitely be helpful. Everything: physical safety, mental and emotional health. That would definitely fall under the safety category. (27, White, Philadelphia)
Sexual health
46	Anything about STIs, HIV, PrEP, all of that… I should have been more on top of that. I think I should have paid more attention to that. More information about this “undetectable” and medications like PrEP, what it covers versus what it doesn’t like STIs and stuff. Just information about STIs… (28, Latino, D.C.)
47	How to safely practice safe sex, being healthy and not getting gonorrhea and syphilis and HIV and… Whether someone’s on PrEP or not, because PrEP doesn’t protect you against herpes and things like that. (33, Latino, NYC)
48	People who don’t have a primary care provider or people who don’t have health insurance and stuff like that—people do need to be able to get tested easily. These type of free testing nights and stuff like that at these clinics that they have, It’s not that easy to get there. It can take hours and hours of your time, and It’s only one day a week during like a two-hour window. It’s not the easiest thing to do, to get tested. Perhaps something making it easier to get tested and know your status. that’s the most important thing. (30, Black, D.C.)
Legal advice
49	That would be good if there were some pro bono lawyers giving out advice or maybe even sex workers that have a law degree or something. (33, Black, NYC)
50	I wish there was legal help, like, affordable legal help. Maybe even an app, an application on a phone. Legal information or somebody I could chat with in a web chat or something. (41, White, Chicago)
51	I think the other resource that would be particularly helpful would be some legal and accounting advice. This is not a cash-based business anymore, this is done through Venmo and credit cards and stuff like that, so there are records of these transactions, which I’m sure people are not paying taxes on. It would be good to advise them on their tax obligations and what they should be doing and that sort of thing. (35, White, D.C.)
Advocacy and activism
52	The biggest thing that would be helpful is full decriminalization of sex work, which isn’t really a service, but that sort of thing that would make my life easier, I guess. (19, White, D.C.)
53	Sex work just needs to be decriminalized, because It’s absurd that it isn’t. Really, all the problems that I see all come down to… It’s just kind of stupid that It’s illegal and you can get arrested for it. All the resources that I see kind of stem from that. (21, White, Chicago)
54	Short of decriminalization, which I do think is necessary, having some kind of social work, like non criminalizing social work for people who engage in sex work, whether It’s to get them benefits or ensure their safety in a way that advice on the Internet can’t do. Then also I think in terms of the Internet, people are going to talk and there are message boards. Especially with SESTA and FOSTA, I think more protections for speech about sex work on the Internet because a lot of it is censored. (25, White, NYC)
Reducing stigma
55	Really just further activism and challenging the stigma against sex workers. (30, White, NYC)
56	I think we can always use more information to destigmatize it. (24, Latino, Chicago)
57	I feel like there needs to be more communication. People need to admit that this is a thing that happens and stop shaming people for it. that’s the first step because obviously, if you keep shaming people over it, It’s not healthy for anyone. (24, Black, Chicago)
58	I think the biggest thing that’s needed is training for people who will encounter sex workers, like in hospitals or therapists or stuff like that. Because a lot of sex workers I know don’t tell their doctors or don’t tell their therapists they do sex work. People I know have had bad experiences with doctors and therapists, and so that really limits not only their willingness to reach out for help, but also their willingness to talk about it in general and get help and resource that they need. (21, White, Chicago)

Practical advice

Participants were interested in advice on how to improve their business as sex workers. They thought guidance on how to find and retain good clients (quote 25) and on how to avoid clients who might waste their time (quote 26) could be helpful. Participants also sought advice on how much they could charge for their services and how to handle payments. For instance, some participants had researched or discussed with peers how to set the right price (quotes 27 and 28). Others felt that advice on when to demand payment could be useful (quote 29).

Peer support

Participants were interested in the fact that resources could bring sex workers together and foster a network of peers (quote 30). Some participants mentioned feeling isolated and wished they could connect with other sex workers to discuss their experiences (quotes 31, 32, and 33). These participants expressed that it could be hard to share their sex-work experiences with people who did not engage in it. They thought that sex work-related resources could help them get emotional support by bringing sex workers together.

Mental health and substance use

Some participants felt that there should be more mental health services available for sex workers. They expressed that sex work could take an emotional and psychological toll that could potentially be addressed in psychotherapy or counseling (quotes 34 and 35). Other participants remarked that sex work was often connected to substance use issues. They felt like substance use treatment resources targeted to sex workers could be relevant (quotes 36 and 37).

Getting out of sex work

Some participants were interested in resources that would help them improve the socioeconomic conditions that led them to engage in sex work. These participants often expressed wanting to end their engagement in sex work and hoped resources could help them do so (quote 38). Some felt that employment resources and housing assistance would be helpful in that goal (quotes 39 and 40). Participants who had been relying on sex work for a while also expressed that getting out of it could be a difficult transition. A participant mentioned having consulted an online forum dedicated to the topic of getting out of sex work (quote 41).

Safety

Participants were also interested in resources to avoid violence when doing sex work. Whether or not they had experienced violence from clients, some participants were interested in learning how to protect their physical safety (quote 42). To ensure safety, participants thought that online “blacklists” of clients could be useful (quote 43). As a participant mentioned, resources could facilitate existing communications about problematic clients among sex workers (quote 44). The topic of safety also extended beyond preventing violence. For instance, a participant thought that resources about safety could address issues related to mental and emotional health and provide guidance on how to protect one’s privacy when doing sex work (quote 45).

Sexual health

The topic of safety also extended to sexual safety, and participants thought that sexual-health resources and services were important for people engaged in sex work. Some participants, like the one below, felt like they lacked knowledge about HIV, other STIs, and new prevention strategies such as PrEP and treatment as prevention (or Undetectable = Untransmittable; quote 46). Even among participants who knew about biomedical HIV prevention, there was an interest in resources on safer sex. For instance, knowing that PrEP only offered protection from HIV, a participant felt like he needed more information about how to protect himself from other STIs (quote 47). Besides improving knowledge about HIV and STIs, participants mentioned the importance of facilitating access to healthcare for people engaged in sex work. For instance, a participant felt that free testing services should be made very easily accessible (quote 48).

Legal advice

Participants were interested in learning more about the legality of exchange sex and how to protect themselves from legal reprisal. They wanted to know more about the local laws surrounding the practice of exchange sex and were interested in resources that could offer them legal advice. Some participants thought it would be beneficial to have legal help that could be free or affordable, easily accessible, and perhaps even provided by people experienced with sex work (quotes 49 and 50). Interest in legal help also included wanting to know how to properly handle the income generated through sex work. A participant remarked that transactions were increasingly made through cash transfer apps, which had different implications for taxes compared to cash exchange (quote 51).

Advocacy and activism

When asked about resources that would benefit those engaged in sex work, many participants mentioned the importance of changing the broader structural factors that affected the practice, including laws against prostitution. They felt that legalization or decriminalization would make their engagement in exchange sex easier (quote 52). Participants remarked that many of the issues about which sex workers needed resources (such as the ones described above) stemmed from the legal status of sex work. As a participant expressed (quote 53), decriminalizing sex work might address many of the difficulties experienced by sex workers. Participants also noted that prostitution laws impeded the provision of and access to resources related to sex work. For instance, a participant felt that laws against prostitution could make it difficult for people to discuss their engagement in sex work with a social worker, or to talk about it on the Internet (quote 54).

Reducing stigma

Participants mentioned the need for combatting the stigma associated with sex work (quotes 55 and 56). For instance, a participant thought that there should be more open communication about the fact that sex work is happening among a lot of people, which could help improve respect towards those engaged in it (quote 57). Addressing stigma related to sex work could also help people access resources. For instance, a participant remarked that it was important to educate providers to have non-stigmatizing attitudes toward people engaged in sex work (quote 58).

Considerations about using resources

As they discussed the types of resources they might be interested in, participants expressed various considerations that could inform whether they would be willing to use such resources or not. Some of them described obstacles to their utilization of sex work-related resources, and others discussed how to make resources more appealing. Relevant quotes are presented in Table 4.

Table 4.

Participant quotes related to considerations about using sex work-related resources.

Never felt the need for resources
59	I didn’t need advice getting started. It really just comes to you so easily. It falls in your lap. (36, White, Philadelphia)
60	I’m currently feeling that I don’t see myself having a problem that I need to seek help for. I mean, It’s just sex. It’s just sex, at the end of the day, and just getting some money. (28, Black, NYC)
61	I don’t know exactly what I’d get out of them. It definitely can’t hurt, but It’s just another thing where It’s I haven’t had any real major issues. There haven’t been any serious threats to my safety that I know of. I understand why these things exist, that they're very, very good. They do a lot of good things and really help people, but I don’t know what I would go to them for. (23, White, D.C.)
62	I’m sure there are people who have had worse encounters, better encounters, and different encounters. I’m 30 and I like to think that if I were in a situation, I can defend myself. (30, White, Chicago)
63	I never have [looked for resources]. It’s not something that I think about when I’m doing it. I would never just research stuff about that. No, like I said, I’m really trying to kind of get out of that, so I can’t really say that it would [be useful]. (22, Black, Detroit)
64	In my case I was so under the influence, nothing could deter me. I just wasn’t willing to seek any of that because I was in denial about it, completely. And also I didn’t care about anything except getting high. I wasn’t thinking about getting help. (41, White, Philadelphia)
Did not relate to sex work and workers
65	It’s not something I do regularly. It’s not something that is at the forefront of my life. It’s just something I’ve done a handful of times that I’ll continue to maybe do on occasion. I understand why those resources would be important for someone that engages in this regularly, for whom It’s important for their livelihood, but I don’t think It’s necessary for me. (31, Latino, Boston)
66	I think my situation’s a little bit unique compared to a lot of people. I know a lot of people do it because they don’t have other options. Or some people do have other options, but they would just rather do that because It’s easier than certain things. But for me, It’s more, I wouldn’t say of a luxury, but It’s definitely something that I don’t need to do. (27, Black, Atlanta)
67	The only way I really meet people that pay me for sex is on Grindr, and I don’t really seek it out. It just sometimes happens. I just don’t really feel like I need to learn that much about it. It’s not something I really seek out that much. (24, White, NYC)
68	I don’t really know much [resources] that’s in the city just because I don’t associate myself with other sex workers. I mean, technically I am a sex worker because I have sex for money, but I don’t think of myself as a sex worker. So, I don’t associate with other people who do it. (27, White, Philadelphia)
69	It’s not really all that applicable to me. It mostly applies to people I guess who work in either brothels or stuff like that, who are working with agencies. Not in my field of sex work. Mostly for, lack of a better phrasing, street workers, the ones who work the corners. Obviously, they have a lot more struggle. (29, Latino, NYC)
Privacy concerns
70	They would be branding themselves. I don’t think too many people would be comfortable walking into a class with other people. They’re going to be like, “This class is for escorting, so everybody inside of here is an escort. Everybody inside of here sucks dick for money.” I wouldn’t be comfortable with walking into a class like that because I don’t like being branded. (21, Latino, NYC)
71	I feel like there could be concern there. I feel like some people could be stealing the wrong information on it or it could be law enforcement uses it to catch people. I would say, do a process of vetting these people, but that’s also really hard. (21, White, Boston)
72	I’m very comfortable being honest with not sex work, but the amount of partners I have. No not disclosing sex work, but disclosing that I do have multiple partners, sure. I just don’t think It’s any of their business and It’s illegal. So yeah, I’m not going to be talking about that. (32, Black, Atlanta)
Trust and credibility
73	Stuff like that is hard because there’s always like a mediator for example and they will have nothing to do with it and that technically will make me feel uncomfortable because you’re really just here to be here. I get it, you want to help but you’re not a part of the lifestyle. I feel like anybody who doesn’t do it, I can’t talk to them about it because I just feel like I would be judged instantly. (21, Latino, NYC)
74	I don’t think that a lot of people will be trusting of something that’s attached to a nonprofit or, worse, the government. (25, White, NYC)
75	Websites could be made by people who are currently working in the industry. They could be written at a level that other people are at, or use the same slang. I think that that would be a really good resource because it would give them more cred. (27, White, NYC)
Preferences for in-person or online
76	I think online would be best because then you’re able to access it anytime and you’re able to remain an anonymous. In extreme circumstances, person to person might be helpful, but you'd have to know that this is a person that is a professional, they know what they're doing, they’re not someone that’s law enforcement. (24, White, NYC)
77	I think It’s better online. It’s closer, It’s easier for people to get. Let’s be honest. Look at the kids at Planned Parenthood. You have people protesting outside the establishment. I can easily see something similar happening. We’d have people protesting outside, and I don’t think anyone would be comfortable coming in that situation. (24, Black, Philadelphia)
78	I feel like YouTube would be helpful. Maybe vlogs of sorts. Maybe a community center could do a vlog, that way someone who feels a little more intimidated to come out in person could have an option. (28, Latino, Chicago)
79	If It’s an app, that can be disguised as something else. Everyone carries their phone 24/7. People wake up in the middle of the night, check their phones. That is information that could pop up by SMS notification. You could ask a question any time. We’re app-oriented these days. We are conditioned to everything having an app. (45, Black, Atlanta)
80	I think the physical contact seems so much better. Online, sometimes there’s a disconnect. If there are resources, I personally like in groups and stuff like that. That would be so much better. I think online makes no sense to me at all unless you lived in a rural area. (33, Latino, Boston)
81	I guess either one’s fine. I prefer to meet with people in person, but that’s just me. It’s easier for me to talk to people in person. (21, Latino, NYC)
82	I don’t prefer online resources because I’m really bad at reading. I don’t concentrate at all so that’s why I wasn’t really into it, I had my friends to talk about it but that’s where I got the help. (21, Latino, NYC)
83	I wish there was a place that was like, “Hey, if you’re having issues sexually and you want to discuss it, come here, we’ll talk.” It could be like impotency, erectile dysfunction, it could be sex work, anything. Doing like a small group, like five or six, almost like an AA meeting kind of thing. (34, Black, D.C.)

Never felt the need for resources

Some participants expressed little interest in resources related to sex work because they had never felt the need for them. For instance, some felt sex work was something they could learn on their own (quote 59). They felt like sex with paid partners was not so different from sex with unpaid partners, for which they did not need resources (quote 60). Participants also thought that resources were not necessary because nothing bad had ever happened to them. They thought that resources would only be helpful for those who had experienced trouble or those who were less able to handle difficult situations, should they arise (quotes 61 and 62). Some participants said that they were not interested in resources that would help them better practice sex work because they actually were hoping to stop doing so (quote 63). Other reasons for not seeking out resources included the fact that the need for sex work outweighed risk prevention. That is, some participants thought that advice on how to engage in exchange sex safely would be ignored or feel irrelevant in situations where money, housing, or drugs were desperately needed (quote 64).

Does not relate to sex work and workers

Some participants did not feel like resources about sex work would be relevant to them because they did not see their involvement in the practice as serious enough. For instance, a participant felt that he did not need resources because he did not engage in sex work regularly (quote 65). Similarly, some participants felt like resources were not for them as they did not rely on sex work as a regular source of income. Some participants felt that having other options for income and not really seeking out sex work made resources irrelevant to them (quotes 66 and 67). Others also felt little interest in resources because they did not identify as sex workers or did not relate to the type of sex workers whom they thought needed these resources (quotes 68 and 69).

Privacy concerns

A barrier to using resources related to sex work was privacy. Participating in interactive resources, whether in person or online, could make it known that someone was a sex worker. Some participants were concerned about how this exposure could hurt their reputation or make them a target for law enforcement. For example, a participant felt he would not be comfortable using sex work-related resources in community settings (quote 70). Another concern was that resources related to sex work, provided in person or online, could be a way for law enforcement to entrap sex workers. As a participant suggested, there would need to be a vetting process to ensure that everyone using a service could be trusted, though this might not be possible (quote 71). Finally, some participants were simply not comfortable sharing their experiences with sex work. A participant, for example, did not want to tell anyone about his engagement in sex work because it was illegal (quote 72).

Trust and credibility

Participants wanted resources to be provided by people they could trust and who understood sex work. Some participants were concerned that people working in community organizations, even if they had the interest of sex workers in mind, might hold a negative perspective on sex work (quote 73). As mentioned in the previous quote, resources provided by peers who had experience with sex work would be more credible and comfortable. Another participant felt that sex workers would not typically trust material that was coming from nonprofits or government agencies (quote 74). Whether it was for in-person or online resources, participants thought that sex workers should be involved in the development of these materials (quote 75).

Preferences for in-person or online

Finally, many participants discussed whether they would be interested in resources provided in person or online. An important reason to prefer online resources was the anonymity they could provide. As mentioned above, there was a fear that in-person meetings could be attended by law enforcement (quote 76). Another participant compared accessing sex work-related resources in person to attending an abortion clinic and felt that online resources might prevent sex workers from attracting unwanted attention (quote 77). Otherwise, participants felt like online resources would be the most conveniently accessible. As some participants explained, smartphone applications and social media were ubiquitous, and resources should capitalize on their popularity (quotes 78 and 79).

Though more participants expressed preferences for online resources, many described reasons in favor of in-person resources. Online resources were more impersonal, and some participants were interested in the opportunity to meet with other sex workers in person (quotes 80 and 81). A detrimental aspect of online resources was that they were often text-based and involved a lot of reading. A participant expressed a preference for learning through conversation with peers (quote 82). Some participants had used in-person group resources unrelated to sex work in the past, and thus felt like similar meetings for sex workers could be interesting. For example, a participant had attended 12-step meetings before and thought group resources about sexual health could be interesting (quote 83).

Discussion

Because engaging in sex work presents many forms of risk, male sex workers can benefit from a variety of resources to help them safely navigate the practice. However, few studies have examined male sex workers’ utilization of such resources or their interest in them. Our study with 180 men engaged in sex work found a wide range of experiences with and attitudes towards sex work-related resources. Some participants had sought resources in a variety of settings, some of them specifically targeted to sex workers, and others not. Other participants had never felt the need for sex work-related resources and expressed little interest in them. Among participants who were interested in resources, some wanted material that would improve their practice of sex work, while others wanted resources that would decrease their need to engage in sex work. As we further discuss below, this wide array of perspectives on the topic shows that resources for male sex workers cannot be one-size-fits-all and must be able to address the various considerations of this diverse population.

The few prior studies looking at male sex workers’ perceived needs also found high interest in material that could help improve the practice of sex work (Grov et al., 2014; Parsons et al., 2007; Reisner et al., 2008). Consistent with these studies, we found that many participants were interested in resources that could make their engagement in sex work safer and more profitable. Such participants were interested in practical advice on how to find and retain clients, how to operate on the right side of the law, or how to navigate or fight the stigma attached to sex work. Those who had sought such resources had often turned to sex-work organizations and a variety of online sources. Many of these participants were also interested in connecting with other sex workers to benefit from the support or guidance of peers. However, participant responses indicated that resources to help sex workers improve their engagement in the practice were scarce, especially those specific to male sex workers. Indeed, other studies have documented that sex work-related resources are more often targeted to women than men (Henriksen et al., 2020; Laing & Gaffney, 2014). Although the development of resources aimed at improving the practice of sex work might seem difficult to justify from a public health perspective, there can be harm reduction benefits to such resources. That is, empowerment strategies and skill development can help sex workers protect themselves from the multiple forms of risks involved in the practice (Rekart, 2005). Male sex workers’ desire for resources to improve their practice of sex work could thus be mobilized to motivate these individuals to participate in health interventions.

On the other hand, some participants expressed interest in resources that would help them decrease their engagement in sex work or end it completely. Some of them wanted resources to help improve their socioeconomic situations (e.g., securing other employment and affordable housing) or to address substance use issues so they would not need to rely on sex work anymore. In recent years, scholars and advocates have emphasized how sex work should be viewed as a legitimate form of work, and how resources aiming to get people out of sex work can be stigmatizing (Sawicki et al., 2019). The participants in our study who desired resources to improve their sex-work practice would probably find resources to help them stop sex work stigmatizing. However, other participants felt like they needed resources to stop their engagement in sex work and might therefore find resources aimed at improving their practice of sex work inappropriate. As such, resources targeted to male sex workers need to cater to those who want to pursue sex work and those who want to stop doing so in a manner that does not turn away either group.

Another group of participants in our study included those who were indifferent to sex work-related resources. For instance, some participants felt like nothing could be done to improve the circumstances of their lives or to decrease the risks involved in sex work, expressing a sense of fatalism similar to that expressed by male sex workers in Reisner et al.’s (2008) study. Other participants felt like they were able to get what they wanted from sex work without the need for guidance. The fact that some male sex workers exhibit such a sense of self-confidence might downplay the importance of making resources available to those who need them. For instance, a review of the literature on sex work found that many studies presented male sex workers as more agentic than female sex workers, and less in need of resources (Dennis, 2008). Although some participants in our study did not believe resources would be beneficial to them, the findings demonstrate that many men engaged in exchange sex are interested in sex work-related resources.

Another reason some participants did not feel like sex work-related resources were relevant to them was that they did not identify as sex workers. Indeed, a study found that some men who engage in sex work distinguish themselves from “real prostitutes,” decreasing their perceived need for care (Henriksen et al., 2020). This distinction could be particularly common among men who engage in sex work via dating/hookup websites and applications because these venues are not designed for sex work and can blur the line between casual unpaid sex and sex work (Morris, 2021). Future interventions related to sex work might thus need to reconceptualize how we define the practice and the needs of those who engage in it. Resources for male sex workers will have to find ways to attract the attention of those who identify as sex workers and those who do not. The way in which people identify with sex work is also likely to vary depending on the types of venues they use (e.g., online or in public spaces), which in turn is also likely to inform their interest or perceived need for resources.

Participants mentioned a few barriers that could prevent them from using sex work-related resources, most of them revolving around the fact that sex work is highly stigmatized and often illegal. They mentioned issues of trust and concerns about such resources being used by law enforcement to entrap sex workers. Some were also concerned about their privacy and felt that using sex work-related resources would identify them as sex workers. Laws against prostitution in the US can thus be a barrier to the development of sex work-related resources and their utilization. Indeed, some participants said that the one thing that would help them in their practice of sex work would be its decriminalization, and some of the sex work-related resources they had used had been developed by U.S. organizations advocating for sex-work decriminalization (e.g., Sex Workers Outreach Project). In the debate around the legal status of sex work, it is important to consider how legalizing or decriminalizing the practice could facilitate the development of resources that can minimize the risks involved in sex work.

Findings from this study should be viewed in light of some limitations. Data were collected through a convenience sample that may not be representative of the general population of male sex workers. Recruitment was conducted in a few urban centers in the US, and access to sex work-related resources might differ in other regions. The sample was also relatively homogenous in that all participants had used dating/hookup apps/websites to find clients, thus the findings might not represent other groups of sex workers (e.g., those who mainly work in public places). Social desirability bias could have affected participants’ responses. For instance, because the interviews were conducted by public health researchers, participants might have been more inclined to talk positively about sex work-related resources. Also, data were self-reported, thus some responses could be affected by recall error. For example, some participants had been engaged in sex work for a long time and might not have remembered, at the time of the interview, some of the resources they had used in the past.

Despite these limitations, this study provides data on a topic that has seldom been addressed. Although few resources targeted to male sex workers exist, we found that many participants had identified and utilized resources through various types of organizations and online media. Participants expressed interest in content on a variety of topics related to sex work, indicating that developing resources for male sex workers would be helpful to many of them. However, participants also expressed some barriers to using sex work-related resources, including low perceived need, privacy concerns, and low perceived usefulness. Results from this study thus convey both the importance of making resources available to male sex workers as well as the necessity of conducting careful assessments of needs and potential barriers before their development.