Arch Sex Behav (2015) 44:1035–1045 DOI 10.1007/s10508-014-0297-z
ORIGINAL PAPER
Patterns of Client Behavior with Their Most Recent Male Escort: An Application of Latent Class Analysis Christian Grov • Tyrel J. Starks • Margaret Wolff • Michael D. Smith Juline A. Koken • Jeffrey T. Parsons
•
Received: 7 March 2013 / Revised: 3 July 2013 / Accepted: 5 January 2014 / Published online: 29 April 2014 Springer Science+Business Media New York 2014
Abstract Research examining interactions between male escorts and clients has relied heavily on data from escorts, men working on the street, and behavioral data aggregated over time. In the current study, 495 clients of male escorts answered questions about sexual behavior with their last hire. Latent class analysis identified four client sets based on these variables. The largest (n = 200, 40.4 %, labeled Typical Escort Encounter) included men endorsing behavior prior research found typical of paid encounters (e.g., oral sex and kissing). The second largest class (n = 157, 31.7 %, Typical Escort
Encounter ? Erotic Touching) included men reporting similar behaviors, but with greater variety along a spectrum of touching (e.g., mutual masturbation and body worship). Those classed BD/SM and Kink (n = 76, 15.4 %) reported activity along the kink spectrum (BD/SM and role play). Finally, men classed Erotic Massage Encounters (n = 58, 11.7 %) primarily engaged in erotic touch. Clients reporting condomless anal sex were in the minority (12.2 % overall). Escorts who engage in anal sex with clients might be appropriate to train in HIV prevention and other harm reduction practices—adopting the perspective of‘‘sex workers as sex educators.’’
C. Grov (&) Department of Health and Nutrition Sciences, Brooklyn College, City University of New York (CUNY), 2900 Bedford Ave, Brooklyn, NY 11210, USA e-mail:
[email protected]
Keywords Clients Escorts Latent class analysis Sex work Sexual behavior Gay and bisexual men Sexual orientation
C. Grov T. J. Starks J. A. Koken J. T. Parsons Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA
Introduction
C. Grov M. Wolff J. T. Parsons Doctoral Program in Public Health, The Graduate Center of CUNY, New York, NY, USA C. Grov M. Wolff J. T. Parsons CUNY School of Public Health, New York, NY, USA M. D. Smith Department of Psychology, Susquehanna University, Selinsgrove, PA, USA J. T. Parsons Health Psychology and Basic and Applied Social Psychology Doctoral Programs, Graduate Center of CUNY, New York, NY, USA J. T. Parsons Department of Psychology, Hunter College, CUNY, New York, NY, USA
Although research on male sex work dates back more than a half century, much of the available research focuses on street based sex workers (Bimbi, 2007; Weitzer, 2005) and HIV/STI transmission risks (Cunningham & Kendall, 2010; Patterson et al., 2012; Scott, 2003; Vanwesenbeeck, 2013). Meanwhile, studies addressing indoor sex workers (such as male escorts working independently or through an agency) or accounting for the wider scope of sexual and non-sexual activities occurring between clients and escorts are less common (Cunningham & Kendall, 2010; Walby, 2012; Weinberg, Shaver, & Williams, 1999). This dearth of research is striking given the tremendous impact that increased access to the Internet has had on the commercial sex industry (Minichiello, Scott, & Callander, 2013; Walby, 2012). It may be that interactions between clients and escorts are dramatically different in street-based transactions as compared to Internet-mediated transactions. Further, because the Internet has
123
1036
expanded access to sex work, men who may otherwise not have been exposed to the sex industry have greater opportunities to enter transactions as either an escort or client (Smith & Grov, 2011; Walby, 2012). The majority of research on male sex work has focused almost exclusively on the sex workers themselves, neglecting the men they serve—the clients. With few exceptions (Goldenberg et al., 2010; Patterson et al., 2009, 2012), even the larger literature on female sex workers (FSWs) has evidenced comparatively little focus on the client (Vanwesenbeeck, 2001, 2013; Weitzer, 2009) with many studies examining clients limited by low sample size (Della Giusta, Di Tommaso, Shima, & Strøm, 2009; Monto, 2000; Pitts, Smith, Grierson, O’Brien, & Misson, 2004). What data there are tend to suggest that men hire FSWs in order to engage in more varied sexual activities, enjoy noncommittal and uncomplicated access to sex, have a greater number of sexual partners, and obtain different physical characteristics than would otherwise be possible with a primary partner (McKeganey & Barnard, 1996; Pitts et al., 2004). Even though hiring FSWs appears to be somewhat uncommon across the male population (Johnson et al., 2001; Michael, Gagnon, Laumann, & Kolata, 1994), hiring MSWs may not be atypical among men having sex with other men, especially among those residing in or visiting urban areas. In a community-based survey of 660 sexually active non-monogamous gay and bisexual men in New York City, Koken, Parsons, Severino, and Bimbi (2005) found that 42.7 % of participants had either paid for sex (36.5 %), been paid for sex (36.9 %), or both (26.6 %). If this data represented wider behavioral and sub-cultural trends, it would suggest that sex work may be a more common in urban gay life than perhaps has been suggested in the literature. Investigating client-MSW interactions is critical in order to reach a more nuanced understanding of commercial sex encounters. Much of what is known about male-on-male commercial sex encounters has been determined from research on MSWs, with sex workers frequently being used as sources of ‘‘second hand data’’ on their clients, but without sampling clients themselves (Marino, Minichiello, & Disogra, 2004; Minichiello et al., 1999). Escorts have noted that men hiring them did so not only for sexual gratification, but also apparently for companionship and even emotional support. Although the large majority of encounters typically involve some type of sexual activity, usually oral sex and masturbation (Minichiello et al., 2000; Smith & Seal, 2008a), MSWs consistently report that non-sexual activities occupied a significant amount of time spent with clients (Padilla, 2007; Walby, 2012). MSWs suggest that clients often want to get to know them before engaging in sex and sometimes share experiences about their lives. Occasionally, appointments with clients involve no sexual activity at all—representing a completely
123
Arch Sex Behav (2015) 44:1035–1045
social interaction where the two men watch a movie, exchange a massage, or eat dinner together (Smith & Grov, 2011). In their qualitative interviews with MSWs, Smith and Grov (2011) noted that escorts often described clients in terms of discrete behaviors in which they would engage during an encounter or in terms of a client’s age. Escorts in this study also discussed men who hired them in terms of the time frame clients desired. The most common encounter was described as the ‘‘one hour call,’’ meaning that all interactions with the client took place within an hour. With regard to behaviors requested by a client, some escorts described primarily social/companionate encounters (the‘‘talking call’’) whereby they spent most or even all of the appointment engaging in non-sexual social behaviors (conversation, watching a movie, massage). A second type of client encounter (the ‘‘business deal’’) was characterized by an almost exclusive focus on having sex with minimal personal interaction. Last, there was the‘‘kinky client.’’These encounters were characterized by a range of less common sexual behaviors such as bondage and domination, sadism and masochism (BD/SM), watersports (urine play), and sexual role play. In all, Smith and Grov’s (2011) qualitative study suggested that there may be common sets of behaviors and social scripts guiding client-escort encounters. Current Study In order to reach a more comprehensive understanding of commercial sex encounters between men, research is needed that directly samples clients of MSW. As few studies have sampled this population, a quantitative approach is ideal in order to begin to characterize the client population demographically and understand what kinds of behaviors are most common during commercial sex encounters. Thus, the present study had two goals: (1) using latent class analysis, to identify groups of clients based on common sets of sexual behaviors with the most recent escort hired; and (2) to statistically compare these groups on demographic characteristics (e.g., age, HIV status, race, employment status) as well as on contextualizing elements of the most recent encounter with a male escort. Statistical analysis to identify client subgroups has not been reported in the MSW literature given that research with MSW clients has been almost exclusively qualitative in nature. By employing an empirical approach to identify client groupings with a larger sample of participants, this study will begin to examine the validity of client grouping identified by earlier studies and will be able to compare these groups with men hiring FSWs. Co-occurring elements include non-sexual behaviors between the client and escort, substance use during the appointment, condomless anal sex, prior hiring history with the escort, amount of payment, age of the escort, and the client’s satisfaction with his hire and their time together during the call. We hypothesized that
Arch Sex Behav (2015) 44:1035–1045
the best-fitting model could identify more than one latent class of individual based on common sexual behaviors. Given the novel and exploratory nature of our analysis, we did not hypothesize a specific number of classes or anticipate a priori differences across classes, except that clients interested in more atypical sexual behaviors might form a separate grouping. In so doing, this study informs research on the clients of male sex workers, and, through its quantitative approach, builds off prior qualitative work that has suggested encounters could be typologized.
Method Participants and Procedure Data for this study were taken from an Internet-based survey of clients of male escorts. For a 3 week period in spring 2012, DaddysReviews.com posted an invitation to participate in the research study on its main welcome page. DaddysReviews.com is an escort review website where clients read and post reviews of MSWs they have hired. It is free to use and content is available to the public; no membership is required. Although it is based in the U.S. and content is in English, the website draws an international audience. At the time of the study, there were reviews for more than 2,800 escorts and any individual escort could have multiple reviews. The site attracted between 9,000 and 14,000 unique visitors each month (source: compete.com, May 2011–May 2012). It represents one of the largest and most utilized resources of its kind. Interested participants clicked a link that routed them to a separate secure website to complete the survey. To be eligible, participants had to identify themselves as over the age of 18 years. The survey was anonymous and no information about participants’ computers, Internet browsers, or IP addresses was collected. Participants were allowed to skip questions. At the end of the survey, participants were invited to provide their email address if they wanted to be informed of study results. The survey took approximately 10 min to complete and there was no compensation for participating. The Human Research Protection Program at Brooklyn College approved all study procedures. This study received no external funding and the research team has no financial ties to daddysreviews.com. Although we do not have data on the number of times the invitation was viewed, 741 clicked the link and 543 (73.3 %) reviewed informed consent and started the survey. Two cases reported being under the age of 18 and thus automatically skipped to the end. For analytic purposes, we excluded responses from three females, one man who indicated he had never had sex of any kind with a man, and two cases who completed the survey twice (i.e., the same email address was provided at the end of the survey). Of the remaining 535 men who began the survey, 495 (92.5 %) completed it successfully. The 40 men who did not complete the questionnaire closed
1037
their browser window at some point during the response process. For those completing the survey, response rates to individual questions were high. The question with the lowest response rate was that of income (93.9 %, n = 465 of 495). Responses were recorded for participants in 24 countries; however, the majority (85.7 %, n = 424) resided in the United States, followed by the United Kingdom (3.2 %, n = 16) and Canada (3.2 %, n = 16). Participants from outside the U.S. were similar to U.S. men across a variety of variables including age, HIV status, income, and satisfaction with their most recent escort hire (all ps[.05). Among those from the U.S., participants resided in 40 of the 50 states. The distribution of participants closely patterned the population distribution of U.S. residents, with a greater number of participants from more densely-populated regions such as the Atlantic and the Pacific coasts. Table 1 shows demographic characteristics. The sample was mostlyWhite/Caucasian, HIV-negative, employed full time, and single. Theirmean agewas54.Three-quartersofclients weregay identified, 18 % bisexual, and 4 % heterosexual. More than onethird lived with a spouse, partner, or family member. Among those currently in a relationship, divorced, or widowed, 41 % of participants indicated their partner is/was female. A majority (62 %, 305/495) said they met their last hire via the Internet. A quarter (124/495) said it was someone they hired previously. Measures Demographic Characteristics Participants were asked to complete standard demographic questions including age, race or ethnicity, sexual identity, relationship status, income, employment status, and HIV status. Items and response choices are shown in Table 1. Sexual Behavior During Most Recent Hire Participants reflected on the most recent male escort they hired and were presented with 22 questions about different types of sexual behavior in which they may have engaged during that encounter (‘‘yes,’’‘‘no,’’‘‘refuse to answer’’). Behaviors ranged fromkissingandoralsextoroleplayandwatersports(urineplay). The full list is shown in Table 3. Although not exhaustive, these items were generated, in part, from existing research on the sexual behaviors of MSM (Nordling, Sandnabba, Santtila, & Alison, 2006; Rosenberger et al., 2011; Smith & Grov, 2011) and in consultation with a group of experts in male sex work (both academic and community-based). Social Behaviors During Most Recent Hire Participants were similarly asked to reflect on nine different social (non-sexual) behaviors in which they may have engaged
123
1038
Arch Sex Behav (2015) 44:1035–1045
Table 1 Demographic characteristics, clients of male escorts, 2012 (n = 495) n
%
video (non-erotic),’’ and ‘‘went shopping.’’ Response choices included ‘‘yes,’’ ‘‘no,’’ or ‘‘refuse to answer.’’ Although not exhaustive, these items were selected from available literature (Smith & Grov, 2011; Walby, 2012).
Race or ethnicity White/Caucasian
434 87.7
Black/African American
7
Hispanic/Latino
10
2.0
Asian/Pacific Islander
22
4.4
Multiracial/other
19
3.8
Relationship status Single
290 58.6
In a relationship
74
14.9
Divorced
21
4.2
Widowed
11
2.2
Married, had a commitment ceremony, domestic partner
97
19.6
Gender of partner (for those currently in a relationship, divorced, widowed, or married) Male
119 58.6
Female
83
40.9
B$59,999
96
19.4
$60 K-$99,999 $100 K-$149,999
138 27.9 141 28.5
$150 K?
90
Income last year
18.2
HIV Status Negative
443 89.5
Positive
34
6.9
I don’t know, I am unsure
15
3.0
Employment Status Full-time (greater than 35 h/week)
352 71.1
Part-time (n = 25) or semi-retired (n = 39)
64
12.9
Retired (n = 64), unemployed (n = 8), or disability (n = 1) 73
14.7
Type of area where client resides Suburban or Rural
224 45.3
Urban
269 54.3
Current living situation Alone
287 58.0
Roommates Spouse/partner/family
32 6.5 169 34.1
Sexual identity Straight, heterosexual
20
4.0
Bi, Bisexual
90
18.2
Gay
378 76.4 M
Age (range 21–80, IQR 47–62)
SD
54.2 10.7
during their most recent hire: ‘‘massage,’’‘‘talking,’’‘‘cuddling (non-sexual),’’ ‘‘shared a meal (e.g., dinner, dessert),’’ ‘‘drank alcohol (wine, beer, liquor),’’‘‘watched a movie or went to see a show,’’‘‘went for a scenic walk or drive/ride,’’‘‘took pictures or
123
Contextualizing the Most Recent Hire
1.4
Participants were asked a series of questions to further contextualize their encounter with their most recent escort hire. These included using drugs prior to/during the encounter; being drunk or ‘‘buzzed’’ on alcohol prior to/during the encounter; taking prescription erectile drugs or other erectile supplements for the encounter; and having previously hired the escort. Participants also reported the amount of money paid to the escort; the escort’s age; if they engaged in condomless anal sex; and their overall satisfaction with the encounter (1 = very dissatisfied to 7 = very satisfied). Analytic Plan Research involving a large number of discrete behaviors poses a conceptual and analytic challenge. Aggregating data across behaviors may result in substantial loss of information about the pattern of responding across items assessing meaningfully distinct behaviors. At the same time, the use of individual behaviors as predictors can result in multicollinearity, higher-order interactions, and/or inadequate power. One alternative to addressing this challenge involves identifying patterns of responses among the indicator variables assessed. A researcher could attempt to identify groups of people who engage in a particular subset of behavior at a similar level of probability—participants are statistically divided into groups based upon the likelihood that they will engage in a given set of behaviors. Mixture modeling refers to set of analytic techniques that can be used to divide a heterogeneous population into a set of homogeneous subgroups (Reid, 2010). Latent class analysis (LCA) (Clogg, 1995; McCutcheon, 1987) represents one type of mixture modeling procedure. The assumption of LCA is that an unobserved (latent) categorical characteristic underlies responses on the set of observed indicator variables (Pedrana, Hellard, Guy, Wilson, & Stoove, 2012; Reid, 2010). Conducting an exploratory LCA involves comparing the fit of a series of models. The initial model assumes only one latent class is present and all participants belong to it. Subsequent models increase the number of classes by one at each step. The goal is to arrive at a model which maximizes fit while maintaining parsimony—one which identifies the smallest number of classes necessary to accurately reproduce the observed responses (Pedrana et al., 2012; Reid, 2010). This procedure has the benefit of consolidating data across a large number of indicators while avoiding the loss of information inherent in aggregation; however, it should be noted
Arch Sex Behav (2015) 44:1035–1045
that assignment to a specific class is not perfect. In the most commonly applied methods of class assignment, the probability of membership in each class is calculated for each individual based upon indicator item responses. The participant is then assigned to the class to class associated with the highest probability (Pedrana et al., 2012). Thus, some heterogeneity in individual item endorsement is present within classes and error in classification is possible. Analyses were conducted in two phases. In the first phase, latent classes were identified based on sexual behaviors with the most recent male escort hired. The second phase compared latent classes on variables including social behaviors with the most recent hire, substance use, and overall satisfaction with the encounter.
1039
Phase 2 The second series of analyses categorized clients according to their latent class and examined correlates of class membership. Potential interclass differences in demographic characteristics (e.g., age, HIV status, race, employment status) and contextualizing elements of the most recent encounter with a male escort were examined. Possible contextual elements included non-sexual behaviors, substance use (drugs, alcohol, or erectile dysfunction prescription/supplements), condomless anal sex, prior hiring history with the escort, payment, age of escort, and client satisfaction with the encounter. v2 or one-way ANOVA were deployed as appropriate with Bonferroni tests (for significant ANOVA tests) and partial v2 (for significant omnibus v2 tests) used as post hoc analyses if needed.
Phase 1 Latent class models, from one to five classes, were estimated and the fit of each model was compared to the others using MPlus, version 6.1 (Muthe`n & Muthe`n, 1998–2006). LCA tests whether a latent variable, specified as mutually exclusive classes, accounts for co-variation among observed variables (Laumann, Paik, & Rosen, 1999). Following steps outlined by (Ramo, Grov, Delucchi, Kelly, and Parsons, 2010) and (Grov, Starks, Rendina, and Parsons, 2014), model fit was evaluated using three sets of criteria: (1) The adjusted Lo-Mendel-Ruben Likelihood Ratio Test (LMR-LRT) provides a test of whether a model with k categories represents a statistically significant improvement in fit over a model with k-1 categories. A significant p value for the LMR-LRT is support for rejecting a given model in favor of a model with one additional class. (2) The Bayesian information criterion (BIC) (Raferty, 1995) and Akaike’s information criterion (AIC) (Akaike, 1973) represent the amount of information lost by imposing a model on the observed data. Low BIC and AIC values imply better model fit because they indicate that less information is lost. (Muthe`n & Muthe`n, 2000). (3) The entropy value is a measure of the clarity of classification. Entropy values range from 0 to 1, with 0 corresponding to random assignment to category and 1 representing perfect classification (Muthe`n & Muthe`n, 2000; Ramaswamy, DeSarbo, Reibstein, & Robinson, 1993). The present study fit a series of latent class models using the variables regarding sexual behavior with the most recent escort hired (presence/absence of each behavior) and evaluated the best fitting model using the criteria outlined above (LMRLRT, AIC, BIC, and entropy). In the context of these indicators, class size and predictive utility were considered when making final model selections. Classes with extremely small n’s possess limited utility; classes representing key theoretical implications or high predictive value may be considered in the presence of ambivalent indicators of fit. Based on the patterns of sexual behaviors endorsed within each class, meaningful labels or definitions of the latent classes can be made.
Results Model Selection Model fit statistics for 1–5 class solutions are shown in Table 2. Some discrepancies among model fit statistics were evident across models. Although the LMR-LRT suggested that the introduction of a second class did not significantly improve model fit compared to a one class model, the AIC and BIC values supported the superiority of a two versus a one class solution. Examination of AIC, LMR-LRT, and entropy values for three, four, and five class models suggested that the four class model demonstrated optimal fit, with no fit indicators supporting the addition of a fifth class. Although the BIC increased with the inclusion of a fourth class, all other indicators suggested that the four-class model was superior to a model with three-classes. Based on completed responses, 491 (99.2 %) of the men who completed a survey were classified. Latent Class Probability and Class Definitions Conditional response probabilities for varying sexual behaviors between clients and the most recent escort hired are shown in Table 3. Class 1 consisted of individuals who endorsed behaviors Table 2 Latent class analysis model comparisons Classes
AIC
BIC
LMR
p
Entropy
1
10053.23
10145.59
–
–
–
2
9615.61
9804.54
480.25
.14
.72
3
9311.10
9596.59
348.07
.02
.78
4
9292.38
9674.45
229.77
\01
.83
5
9186.34
9664.97
150.99
.06
.84
AIC Aikaike’s information criterion, BIC Bayesian information criterion, LMR adjusted Lo-Mendel-Ruben, p p-value associated with the LMR
123
1040
Arch Sex Behav (2015) 44:1035–1045
Table 3 Response probabilities for a four class solution Class 1 ‘‘BD/SM and Kink’’ n = 76
Class 2 ‘‘typicala escort encounter’’ n = 200
Class 3 ‘‘typicala escort encounter ? erotic touching’’n = 157
Class 4 ‘‘erotic encounters’’ n = 58
%
%
%
%
Watched an ertoic film (porn)
23.7
5.5
11.5
5.2
Erotic talk
82.9
39.5
72.0
25.9
Erotic dancing (lap dance)
6.6
2.5
8.9
6.9
Cuddling (sexual)
64.5
85.5
87.9
12.1
Role play (dad/son, dominant/submissive)
78.9
4.5
17.8
0.0
Gave him a blow job
76.3
83.5
93.0
39.7
Which sexual things did you do with this escort?
Received a blow job (got head)
51.3
77.5
79.0
39.7
Body worship
63.2
40.5
65.0
29.3
Sex toy play
48.7
2.5
12.1
6.9
Fetish clothing (spandex, leather, rubber)
51.3
0.0
10.2
3.4
Watched him masturbate
38.2
16.5
79.0
43.1
Watched him perform some other sexual act He watched me masturbate or perform some other sexual act
19.7 26.3
3.0 7.0
36.3 70.1
6.9 32.8
Mutual masturbation
32.9
56.0
86.0
31.0
Anal receptive sex (got fucked)
46.1
37.5
33.1
8.6
Anal insertive sex (fucked him)
21.1
34.5
38.9
1.7
Watersports (urine play)
32.9
0.0
1.9
1.7
Bondage and domination, Sadism and Masochism (BD/SM)
63.2
0.0
3.2
3.4
Kissing
67.1
96.0
87.9
6.9
Erotic massage
22.4
49.5
59.2
60.3
Took erotic pictures or video
19.7
0.5
7.0
3.4
Bareback play (anal sex intentionally without condoms)
14.5
9.5
10.8
0.0
Items in bold illustrate high endorsement relative to other classes a
This term was selected based on extant research on male escorts and what they have described as the‘‘typical’’encounter with their clients
akin to BD/SM and other kink behaviors (e.g., watersports, role play, erotic talk, fetish clothing). Accordingly, this group was labeled BD/SM and Kink. Class 2 consisted of individuals reporting sexual behaviors that have often been described in published research on escorts as ‘‘typical’’ during commercial encounters between two men. These included cuddling (sexual), oral sex, and kissing. Such encounters tended to include behaviors that would lend themselves to sexual gratification and client orgasm, and less so with behaviors that would facilitate a ‘‘romantic’’ or ‘‘intimate’’ type of experience. As such, this group was labeled Typical Escort Encounter. Class 3 consisted of individuals who indicated many of the behaviors from Class 2 with the addition of behaviors involving ‘‘erotic touching.’’ Additional behaviors that were common with this class, included body worship (i.e., physically reverencing a part of another person’s body), mutual masturbation, and erotic massage. This group was labeled Typical Escort Encounter ? Erotic Touching.
123
Compared to other latent classes, Class 4 contained individuals who reported fewer overtly sexual behaviors than the other three classes with the exception of erotic massage. Although some of these men reported oral sex and masturbation with their hire, erotic massage appeared to be the dominant behavior of this client group. Accordingly, this class was labeled Erotic Massage Encounter. Differing Characteristics Across Latent Classes Exploratory ANOVA and v2 tests were used to examine differences across latent classes. With regard to demographic characteristics, latent class membership was not significantly related to sexual identity (gay vs. not-gay), v2(3) = 1.79, relationship status (single vs. not-single), v2(3) = 4.02, HIV status (HIV-positive vs. not HIV-positive), v2(3) = 3.62, M age (F\1), or city size (urban vs. suburban or rural), v2(3) = 6.53. In contrast, latent class membership was related to employment status—86.0 % of Erotic Massage Encounter
Arch Sex Behav (2015) 44:1035–1045
1041
Table 4 Differences across four latent classes Class 1 ‘‘BD/SM and Kink’’ n = 76
Class 2 ‘‘typicala escort encounter’’ n = 200
Class 3 ‘‘typicala escort encounter ? erotic touching’’n = 157
Class 4 Statistical ‘‘erotic test massage encounters’’ n = 58
n
n
n
%
n
%
%
%
x2
Post hoc
p
Which non-sexual things did you do with this escort? 1, 2 = 3, 4
Massage
28
38.9 101
51.8 84
56.8
40
69.0
12.61 .01
Talking
74
97.4 196
99.0 152
98.7
54
93.1
b
Cuddling (non-sexual)
49
67.1 149
77.2 121
82.3
8
14.0
99.84 \001 1, 2, 3 = 4; 1 = 3
Shared a meal (e.g., dinner, dessert)
33
45.2 65
33.9 49
36.6
0
0.0
34.63 \001 1, 2, 3 = 4
Drank alcohol (wine, beer, liquor)
32
44.4 62
32.0 60
43.5
5
8.8
25.33 \001 1, 2, 3 = 4; 2 = 3
Watched a movie or went to see a show
12
16.9 17
8.9
20
15.6
0
0.0
13.42 .004
1, 2, 3 = 4
Went for a scenic walk or drive/ride
13
18.3 27
14.2 19
15.1
1
1.7
8.65
.03
1, 2, 3 = 4
Took pictures or video (non-erotic) Went shopping
10 10
13.9 6 14.1 14
3.1 7.3
13 12
10.3 9.4
1 0
1.8 0.0
–
13
17.1 22
11.0 25
15.9
0
0.0
12.05 .01
1, 2, 3 = 4
15
19.7 17
8.5
16.6
6
10.3
8.73
1, 3 = 2
8.3
4
7.1
15.66 .001
29.3
19
31.0
0.07
.995 .39
b
Client had unprotected anal sex with the escort Yes Client used drugs prior to/during this encounterc Yes
26
.03
Client drank enough alcohol to feel‘‘buzzed’’or drunk prior to/during encounter Yes
17
22.7 15
7.5
13
1 = 2, 3, 4
The escort was drinking or drunk prior to/during this encounter Yes
23
30.3 59
29.6 46
Client used an erectile dysfunction prescription drug or supplement for this encounter Yes
18
23.7 49
24.6 47
29.9
11
19.3
2.99
27
35.5 51
25.5 40
25.5
6
10.3
11.09 .01
B$199 $200 to $249
13 15
18.3 49 21.1 50
24.6 33 25.1 35
21.0 22.3
29 15
51.8 25.0
35.72 \001 1, 2, 3 = 4
$250 to $399
13
18.3 48
24.1 42
26.8
9
16.1
$400?
30
42.3 52
26.1 47
29.9
4
7.1
48
63.2 140
70.0 114
74.0
49
86.0
9.19
.03
1, 2 = 4
Non-white
4
5.3
8.5
18.5
8
14.0
12.17 .01
1, 2 = 3
White
72
94.7 183
91.5 128
81.5
49
86.0
M
SD
SD
M
SD
M
SD
F
p
Post hoc 3 = 1, 4
Client has hired this escort before Yes
1, 2, 3 = 4
How much did the client pay the escort?
Client is working full-time Yes Client’s race
Age of escort
17
M
29
32.3 8.7
30.4 7.8
29.4
6.8
32.0
7.8
3.15
.03
Overall satisfaction with the encounter (range 1–7) 6.22 1.4
5.91 1.5
6.2
1.4
5.24
1.9
6.46
\001 4 = 1, 2, 3
Post hoc for ANOVA tests using Bonferroni. Post hoc for v2 using partial v2 a
This term was selected based on extant research on male escorts and what they have described as the‘‘typical’’encounter with their clients
b
v2 cannot be calculated, expected counts fall below 5 in one or more cells
c
Drugs include anything that was not prescribed or illicit drugs
123
1042
clients worked full time compared with 63.2 % of clients in the BD/SM and Kink group. However, latent class membership was also related to race—18.5 % of men in the group Typical Escort Encounter ? Erotic Touching were nonWhite compared with only 5.3 % of clients in the group BD/ SM and Kink (see Table 4). With regard to non-sexual social behavior that occurred during encounters, clients classified as Erotic Massage Encounter appeared to engage in the fewest behaviors overall, with the exception of non-sexual massage. Those classified as the Typical Escort Encounter appeared similar to those classified Typical Escort Encounter ? Erotic Touching. There were significant differences across classes in the proportion reporting condomless anal sex and substance use with their most recent escort. None of the men classified as Erotic Massage Encounters engaged in condomless anal sex, compared to 17.1 % of those classified BD/SM and Kink, 15.9 % of Typical Escort Encounter ? Erotic Touching, and 11.0 % of those classified Typical Escort Encounter. Compared to the other classes, a significantly greater proportion of men classified BD/SM & Kink (22.7 %) reported having consumed enough alcohol to feel ‘‘buzzed’’ or drunk. Furthermore, compared to men classified Typical Escort Encounter (8.5 %), a significantly larger proportions of men classified BD/SM and Kink (19.7 %) and Typical Escort Encounter ? Erotic Touching (16.6 %) reported drug use prior to or during their last encounter with an escort. There were no significant differences across groups in use of erectile dysfunction drugs/supplements, or belief that the escort hired had been drinking or was drunk prior to/during the encounter. Participants classified BD/SM and Kink tended to pay their escorts more on average than other groups (e.g., 42.3 % had paid $400 or greater). Those classified Typical Escort Encounter and Typical Escort Encounter ? Erotic Touching tended to have paid their most recent hire similarly. Meanwhile, more than half (51.8 %) of those labeled Erotic Massage Encounter paid their escort $199 or less. Those participants grouped into Typical Escort Encounter ? Erotic Touching reported that the men they hired were significantly younger on average than those labeled BD/SM and Kink and Typical Escort Encounter. Compared to others, the smallest proportion of those classified Erotic Massage Encounters (10.3 %) reported their most recent encounter was with someone they had hired previously. Finally, men grouped into Erotic Massage Encounters reported significantly lower mean scores on satisfaction than all other groups. All values are shown in Table 4.
Discussion This study used LCA to categorize the clients of male escorts based upon reported sexual behaviors with their most recent
123
Arch Sex Behav (2015) 44:1035–1045
MSW hire. Prior studies have suggested sex work encounters could be typologized; however, to our knowledge, this has never been done with quantitative data from clients using LCA. Interestingly, although a four-class solution appeared to fit the data best, two of the classes comprised 72 % of the sample and seemed to be characteristically similar to each other (Typical Escort Encounter and Typical Escort Encounter ? Erotic Touching). The behavioral features of these two groups converge upon what researchers have described as behaviors in a ‘‘typical’’ encounter with a male escort (Minichiello et al., 2000; Smith & Grov, 2011; Smith, Grov, & Seal, 2008; Smith & Seal, 2008a), with the exception that one group appeared to engage in more erotic touching. The other two classes, BD/SM and Kink and Erotic Massage Encounter, have also been described in the escort literature (with both male and female escorts) (Seib, Dunne, Fischer, & Najman, 2010; Smith & Grov, 2011). We recognize that the categories identified in this study did not map perfectly onto the typologies noted by Smith and Grov; however, these differences may be due to different study populations (Smith and Grov reported on escorts, not clients) and methodology (Smith and Grov used qualitative procedures with fewer participants). Taken together, our findings from clients converge with what is known from previous research on escorts. Although there is some research on HIV transmission risks in non-street-based male escorts (Bimbi & Parsons, 2005; Parsons, Koken, & Bimbi, 2004; Smith & Seal, 2008b), and even more on street based samples (Cunningham & Kendall, 2010; Scott, 2003; Vanwesenbeeck, 2013), this was one of the first studies to contextualize risks among clients of male sex workers through an investigation of common sets of sexual behaviors. Although clients who reported condomless anal sex were in the minority, concerning rates of condomless anal sex, drug use,and alcohol use to the point of intoxication were noted for three of the four classes. Those classed as Erotic Massage Only represented the sole exception. Prior work has suggested male escorts may be ideally positioned to deliver HIV education to their clients and help clients to better establish safer-sex norms when hiring an MSW (i.e.,‘‘sex workers as sex educators’’) (Parsons et al., 2004). Perhaps escorts who cater to encounters other than Erotic Massage Only could be trained in condom negotiation skills, boundary setting, sexual communication, and other harm reduction practices that would also dovetail into an MSW’s need to build positive relationships with customers and maintain personal empowerment in his work situation. Grassroots efforts to do just this have been developed (see www.Rent-U.com), but research is necessary to evaluate the effectiveness of such programs. That being said, and aside from oral sex, the most common sexual behaviors reported by clients presented little opportunity for HIV or STI transmission—cuddling (sexual), kissing, mutual masturbation, erotic talk, and body worship. These behaviors were similar to those reported in a national study of
Arch Sex Behav (2015) 44:1035–1045
nearly 25,000 gay and bisexual men (Rosenberger et al., 2011), suggesting that sexual activity between clients and escorts may be no different from gay and bisexual men more generally. Relatively low levels of HIV risk behavior in this sample also contrasts with prior research suggesting that sex workers act as bridge populations to transmit HIV (Morse, Simon, Osofsky, Balson, & Gaumer, 1991) and may be indicative of shifts in the sex work marketplace to online environments (Cunningham & Kendall, 2010). The range of behavior reported in the current study reflected a diverse sexual repertoire between clients and the escorts they hire and strongly suggests a pressing need to study sex work through a lens other than the likelihood of HIV infection and other negative outcomes (Cunningham & Kendall, 2010; Parsons et al., 2004; Scott, 2003; Vanwesenbeeck, 2013; Walby, 2012).
Limitations Because our study employed an anonymous online survey, we cannot be fully certain as to whom the participants actually were. In addition, there is also a chance that some participants may have completed the survey more than once. Such concerns are inherent to anonymous online surveys. However, given that no compensation was offered for taking part in the survey, there would have been little incentive for creating multiple submissions. We further wish to note that common methods researchers use to thwart duplicate responses (e.g., recording IP address and placing a cookie on a computer’s browser) (Bauermeister et al., 2012) can be circumvented easily by a technologically savvy user (i.e., resetting one’s modem, deleting one’s cache, or using a different web browser). Our study collected event-level details of a client’s most recent hire. Even though such an approach allowed for contextualizing client’s experiences and focusing on the most recent event facilitates greater recall accuracy, a single event may not represent a client’s practices with sex workers more broadly. Therefore, caution must be used when seeking to expand these results beyond the most recent experiences reported by study participants. Because research has noted that escorts often report engaging in different sets of behaviors between their clients and personal partners (Bimbi & Parsons, 2005), it would be advisable to contrast clients’ behavior with the men they hire versus that with their non-commercial sex partners. For this study, we partnered with a website which hosts one of the largest communities of clients of male escorts in the world. However, participants represented those who visited this one website (targeting men who are interested in reading and posting reviews about escorts they have hired) and volunteered to take part in this survey. The sample was mostly White with high incomes, consisting of men who frequently hired MSWs (a median of five hires in the past year), the majority of whom said their last hire was from the Internet.
1043
Thus, our participants do not represent the entire community of men hiring men for sex, nor can we accurately characterize those who were not represented. For example, it may exclude men hiring MSWs from the street or in a bar. Researchers have noted that condomless anal sex may be related to familiarity, trust, and emotional intimacy; however, such findings have been drawn from non-commercial sexual encounters (Bauermeister, 2012; Golub, Starks, Payton, Weinberger, & Parsons, 2012; Hoff, Chakravarty, Beougher, Neilands, & Darbes, 2012). Measures of familiarity, trust, and emotional intimacy were not included as part of this study. Although rates of condomless anal sex were low our study it would be useful to investigate if the aformentioend factors contributed condomless anal sex between clients and escorts. Our use of a brief survey allowed for more rapid engagement with participants on a variety of topics; however, survey items were close-ended and there may be additional variables not assessed that could have further explained some of our findings. There were also some sexual behaviors that, in hindsight, should have been assessed, such as rimming (analingus) and directionality (i.e., giving and/or receiving) during behaviors like watersports, role play, and erotic massage. LCA is a useful person-centered approach to understand how individuals may cluster together around common sets of behaviors. That being said, there are other analytic approaches that may also be useful such as cluster analysis or exploratory factor analysis.
Conclusion Limitations not-withstanding, this was the first study to our knowledge that performed a person-centered event-level analysis with the clients of male escorts. Certainly, some clients did engage in condomless anal sex with their most recent hire. The largest proportion of men engaging in condomless anal sex with an escort endorsed behaviors along the BD/SM and kink spectrum. Concerning rates of condomless anal sex have been observed in gay and bisexual men in leather communities (Moskowitz, Seal, Rintamaki, & Rieger, 2011). Thus, our finding may reflect sexual practices that are not exclusive or specific to commercial sex encounters, but rather reflect practices within certain sexual subcultures. Although the observed percentage of condomless anal sex among BD/SM and Kink clients was higher than those classed Typical Escort Encounter and Typical Escort Encounter ? Erotic Touching, this did not achieve statistical significance. It may be that, with a larger sample size, significance would be achieved. Escorts who engage in anal sex with clients, particularly those who cater to BD/SM and kink behaviors, might be appropriate candidates to train in HIV prevention and other harm reduction practices (Parsons et al., 2004). However, most of the clients we surveyed did not engage in condomless anal sex and, in fact, engaged in behaviors conferring minimal risk for HIV or STI transmission.
123
1044
Thus, findings from this study suggest the strong need to consider viewpoints in addition to a ‘‘risk perspective’’ when investigating sex work (Walby, 2012). Although sexual risk behaviors do occur during commercial encounters, a ‘‘risk only’’ perspective may unnecessarily limit consideration of behaviors, situations, and motivations to only a portion of those involved when men hire other men. Psychosocial needs for social connection and emotional support may be discounted in a risk perspective and normative client desires for low risk behavior (such as mutual masturbation and erotic massage) may be ignored. Thus, future research could employ a more holistic perspective regarding behaviors between clients and MSWs that accounts for situational factors (e.g., street vs. Internet), client needs and preferences (e.g., ‘‘typical’’ behaviors vs. erotic massage only), and degree of non-sexual interaction. In doing so, the broad and varied array of commercial sex could be more fully explored. Acknowledgments Special thanks to ‘‘Daddy,’’ the moderator of DaddysReviews.com, for his guidance in developing this survey as well as engaging membersof the website to participate.Also, thanks to H. Jonathon Rendina for his guidance in programming the online survey and to the participants who took part in this study.
References Akaike, H. (1973). Information theory and an extension of the maximum likelihood principle. In B. N. Petrov & F. Csaki (Eds.), Second international symposium in information theory (pp. 267–281). Budapest: Akademiai Kiado. Bauermeister, J. A. (2012). Romantic ideation, partner-seeking, and HIV risk among young gay and bisexual men. Archives of Sexual Behavior, 41, 431–440. doi:10.1007/s10508-011-9747-z. Bauermeister, J. A., Pingel, E., Zimmerman, M., Couper, M., CarballoDieguez, A., & Strecher, V. J. (2012). Data quality in HIV/AIDS web-based surveys: Handling invalid and suspicious data. Field Methods, 24, 272–291. Bimbi,D.S. (2007).Male prostitution: Pathology,paradigms and progress in research. Journal of Homosexuality, 53, 7–35. Bimbi, D. S., & Parsons, J. T. (2005). Barebacking among Internet based male sex workers. Journal of Gay and Lesbian Psychotherapy, 9, 85–105. Clogg, C. (1995). Latent class models. In G. Arminger, C. Clogg, & M. Sobel (Eds.), Handbook of statistical modeling for the social and behavioral sciences (pp. 311–359). New York: Plenum Press. Cunningham, S., & Kendall, T. D. (2010). Risk behaviours among internet-facilitated sex workers: Evidence from two new datasets. Sexually Transmitted Infections, 86(Suppl. 3), 100–105. doi:10. 1136/sti.2010.044875. Della Giusta, M., Di Tommaso, M. L., Shima, I., & Strøm, S. (2009). What money buys: Clients of street sex workers in the US. Applied Economics, 41, 2261–2277. Goldenberg, S. M., Gallardo Cruz, M., Strathdee, S. A., Nguyen, L., Semple, S. J., & Patterson, T. L. (2010). Correlates of unprotected sex with female sex workers among male clients in Tijuana, Mexico. Sexually Transmitted Diseases, 37, 319–324. doi:10. 1097/OLQ.0b013e3181c5334f. Golub, S. A., Starks, T. J., Payton, G., Weinberger, C. L., & Parsons, J. T. (2012). The critical role of intimacy in the sexual risk behaviors of gay and bisexual men. AIDS and Behavior, 16, 626–632.
123
Arch Sex Behav (2015) 44:1035–1045 Grov, C., Starks, T. J., Rendina, H. J., & Parsons, J. T. (2014). Rules about casual sex partners, relationship satisfaction, and HIV risk in partnered gay and bisexual men. Journal of Sex and Marital Therapy, 40, 105–122. doi:10.1080/0092623X.2012.691948. Hoff, C. C., Chakravarty, D., Beougher, S. C., Neilands, T. B., & Darbes, L. A. (2012). Relationship characteristics associated with sexual risk behavior among MSM in committed relationships. AIDS PatientCareandSTDs,26, 738–745. doi:10.1089/apc.2012.0198. Johnson, A. M., Mercer, C. H., Erens, B., Copas, A. J., McManus, S., Wellings, K., … Field, J. (2001). Sexual behaviour in Britain: Partnerships, practices, and HIV risk behaviours. Lancet, 358, 1835–1842. doi:10.1016/S0140-6736(01)06883-0. Koken, J. A., Parsons, J. T., Severino, J., & Bimbi, D. S. (2005). Exploring commercial sex encounters in an urban community sample of gay and bisexual men: A preliminary report. Journal of Psychology and Human Sexuality, 17, 197–213. Laumann, E. O., Paik, A., & Rosen, R. C. (1999). Sexual dysfunction in the United States: Prevalence and predictors. Journal of the American Medical Association, 281, 537–544. Marino, R., Minichiello, V., & Disogra, C. (2004). A profile of clients of male sex workers in Cordoba, Argentina. International Journal of STD and AIDS, 15, 266–272. doi:10.1258/095646204773557811. McCutcheon, A. (1987). Latent class analysis. Beverly Hills, CA: Sage Publications. McKeganey, N., & Barnard, M. (1996). Sex work on the streets: Prostitution and their clients. Maidenhead, England: Open University Press. Michael, R. T., Gagnon, J. H., Laumann, E. O., & Kolata, G. (1994). Sex in America: A definitive survey. Boston: Little, Brown, & Company. Minichiello, V., Marino, R., Browne, J., Jamieson, M., Peterson, K., Reuter, B., et al. (1999). A profile of the clients of male sex workers in three Australian cities. Australian and New Zealand Journal of Public Health, 23, 511–518. Minichiello, V., Marino, R., Browne,J., Jamieson, M., Peterson, K., Reuter, B., et al. (2000). Commercial sex between men: A prospective diarybased study. Journal of Sex Research, 37, 151–160. Minichiello, V., Scott, J., & Callander, D. (2013). New pleasures and old dangers: reinventing male sex work. Journal of Sex Research, 50, 263–275. doi:10.1080/00224499.2012.760189. Monto, M. A. (2000). Why men seek out prostitutes. In R. Weitzer (Ed.), Sex for sale: Prostitution, pornography, and the sex industry (pp. 67–100). New York: Routledge. Morse, E. V., Simon, P. M., Osofsky, H. J., Balson, P. M., & Gaumer, H. R. (1991). The male street prostitute: A vector for transmission of HIV infection into the heterosexual world. Social Science and Medicine, 32, 535–539. Moskowitz, D. A., Seal, D. W., Rintamaki, L., & Rieger, G. (2011). HIV in the leather community: Rates and risk-related behaviors. AIDS and Behavior, 15, 557–564. doi:10.1007/s10461-009-9636-9. Muthe`n, L. K., & Muthe`n, B. (1998–2006). MPlus user’s guide (2nd edn.). Los Angeles, CA: Muthe`n & Muthe`n. Muthe`n, B. O., & Muthe`n, L. K. (2000). Integrating person-centered and variable-centered analysis: Growth mixture modeling with latent trajectory classes. Alcoholism, Clinical and Experimental Research, 24, 882–891. Nordling, N., Sandnabba, N. K., Santtila, P., & Alison, L. (2006). Differences and similarities between gay and straight individuals involved in the sadomasochistic subculture. Journal of Homosexuality, 50, 41–57. Padilla, M. B. (2007). ‘Western Union daddies’ and their quest for authenticity: An ethnographic study of the dominican gay sex tourism industry. Journal of Homosexuality, 53, 241–275. Parsons, J. T., Koken, J. A., & Bimbi, D. S. (2004). The use of the Internet by gay and bisexual male escorts: Sex workers as sex educators. AIDS Care, 16, 1021–1035.
Arch Sex Behav (2015) 44:1035–1045 Patterson, T. L., Goldenberg, S., Gallardo, M., Lozada, R., Semple, S. J., Orozovich, P., … Strathdee, S. A. (2009). Correlates of HIV, sexually transmitted infections, and associated high-risk behaviors among male clients of female sex workers in Tijuana, Mexico. AIDS, 23, 1765–1771. doi:10.1097/QAD.0b013e32832f08a1. Patterson, T. L., Volkmann, T., Gallardo, M., Goldenberg, S., Lozada, R., Semple, S. J., … Strathdee, S. A. (2012). Identifying the HIV transmission bridge: Which men are having unsafe sex with female sex workers and with their own wives or steady partners? Journal of Acquired Immune Deficiency Syndromes, 60, 414–420. doi:10. 1097/QAI.0b013e31825693f2. Pedrana, A. E., Hellard, M. E., Guy, R., Wilson, K., & Stoove, M. (2012). The difference in self-reported and biological measured HIV prevalence: Implications for HIV prevention. AIDS and Behavior, 16(6), 1454–1463. doi:10.1007/s10461-011-0116-7. Pitts, M. K., Smith, A. M. A., Grierson, J., O’Brien, M., & Misson, S. (2004). Who pays for sex and why? An analysis of social and motivational factors associated with male clients of sex workers. Archives of Sexual Behavior, 33, 353–358. Raferty, A. (1995). Bayesian model selection in social research (with discussion). In P. Marsden (Ed.), Sociological methodology (pp. 111–196). Cambridge, MA: Blackwell. Ramaswamy, V., DeSarbo, W. S., Reibstein, D. J., & Robinson, W. (1993). The empirical pooling approach for estimating marketing mix elasticities with PIMS data. Marketing Science, 12, 103–124. Ramo, D., Grov, C., Delucchi, K., Kelly, B. C., & Parsons, J. T. (2010). Typology of club drug use among young adults recruited using time-space sampling. Drug and Alcohol Dependence, 107, 119–127. doi:10.1016/j.drugalcdep.2009.09.014. Reid, R. C. (2010). Investigating executive functions in men seeking help for hypersexual behavior using neuropsychological testing. Unpublished doctoral dissertation. Provo, UT: Bringham Young University. Rosenberger, J. G., Reece, M., Schick, V., Herbenick, D., Novak, D. S., Van Der Pol, B., et al. (2011). Sexual behaviors and situational
1045 characteristics of most recent male-partnered sexual event among gay and bisexually identified men in the United States. Journal of Sexual Medicine, 8, 3040–3050. Scott, J. (2003). A prostitute’s progress: Male prostitution in scientific discourse. Social Semiotics, 13, 179–199. Seib, C., Dunne, M. P., Fischer, J., & Najman, J. M. (2010). Commercial sexual practices before and after legalization in Australia. Archives of Sexual Behavior, 39, 979–989. Smith, M. D., & Grov, C. (2011). In the company of men: Inside the lives of male prostitutes. Santa Barbara, CA: Praeger. Smith, M. D., Grov, C., & Seal, D. W. (2008). Agency-based male sex work: A descriptive focus on physical, personal, and social space. Journal of Men’s Studies, 16, 193–210. Smith, M. D., & Seal, D. (2008a). Sexual behavior, mental health, substance use, and HIV risk among agency-based male escorts in a small US city. International Journal of Sexual Health, 19, 27–39. Smith, M. D., & Seal, D. W. (2008b). Motivational influences on the safer sex behavior of agency-based male sex workers. Archives of Sexual Behavior, 37, 845–853. doi:10.1007/s10508-008-9341-1. Vanwesenbeeck, I. (2001). Another decade of social scientific work on sex work: A review of research 1990–2000. Annual Review of Sex Research, 12, 242–289. Vanwesenbeeck, I. (2013). Prostitution push and pull: male and female perspectives. Journal of Sex Research, 50, 11–16. doi:10.1080/ 00224499.2012.696285. Walby, K. (2012). Touching encounters: Sex, work, and male-for-male Internet escorting. Chicago: University of Chicago Press. Weinberg, M. S., Shaver, F. M., & Williams, C. J. (1999). Gendered sex work in the San Francisco Tenderloin. Archives of Sexual Behavior, 28, 503–521. Weitzer, R. (2005). New directions in research on prostitution. Crime, Law and Social Change, 43, 211–235. Weitzer, R. (2009). Sociology of sex work. Annual Review of Sociology, 35, 213–234.
123
