The Lived Experiences of Male Sex Workers: A Global Qualitative Meta-Synthesis

Abstract

The sex industry literature predominantly focuses on the lived experiences of cisgender female sex workers, their customers, and work dynamics. Recently, there has been a shift in the discourse regarding sex work as the sex industry has been openly represented within art, fashion, and film. As such, there has been a growing number of qualitative studies dedicated to investigating cisgender men’s experiences of the sex industry. This article seeks to identify and synthesize these emergent findings to identify possible gaps in the literature, aid in defining new research opportunities, and guide public health policy development. Using qualitative meta-synthesis, 66 original studies were identified and analyzed. Nine meta-themes emerged. Findings demonstrated that male sex workers (MSWs) encounter many of the same experiences that have been previously documented by female sex workers, such as work-related discrimination and the influence of economics on their interest and involvement in the industry. However, MSWs also experience areas of privilege and discrimination unique to their lived experiences. This was particularly salient for men who sold sex in countries where sexual minorities are criminalized or decriminalized but not legalized. These findings highlight the need for responsive sex worker resources tailored to address the unique issues faced by MSWs.

1. Introduction

Sex work refers to the process by which individuals or businesses directly or indirectly provide goods or services related to sexuality. Much of the current literature regarding the selling of sex heavily focuses on female sellers’ experiences, customers, work dynamics, and understanding of the why, how, where, when, and how much for their labor [1,2,3]. Often considered a “feminine” job, cisgender men involved in the sex trade have long been overlooked and understudied [4,5]. The sex industry’s most often cited feminist critiques rest within a heteronormative ideology that insists that sex work reifies patriarchal ideals where cisgender men exert their institutional power to sexually exploit cisgender women [6]. These narrow notions about the buyers and sellers of sex have contributed to the invisibility of male sellers in sex work literature [7]. Recently, cross-disciplinary qualitative studies have begun to critically examine the lives of male sex workers (MSWs).

1.1. Male Sex Work Visibility

Frequently, female sex work is positioned as more of a public concern than male sex work due to gender norms surrounding sexuality and the selling of sexual services [6]. Because of this positioning, male sex work remains largely unacknowledged even though it is present in most societies [2]. Logan [8] asserts that MSWs are positioned in a state of invisibility by providing services to a gender-diverse clientele. Since MSWs and their clientele are more likely to be cisgender men, current theorizing and conceptualization built upon the experiences of female sex workers cannot necessarily be applied to them [9]. The involvement of cisgender men as sex workers challenges some of the heteronormative assumptions of women’s bodies as commodified objects [2].

Historically, male sex work has been conflated with notions of sodomy and/or same-gender desire and considered problematic for reasons different from female sex work [3]. Male sex work was associated with effeminate behavior and an emerging discourse around same-gender desire, whereas literature on female sex work centered upon female sexuality and social power [10]. As the literature expanded, the understanding of male sex work evolved.

Between the 1940s and 1990s, literature on MSWs’ experiences centered around deviancy and pathology [1]. As such, research on MSWs diverged in two directions: (1) sociological and (2) clinical. Sociological research was primarily concerned with understanding deviant subcultures (e.g., same-gender desire and same-gender sexual activity) [11]. Clinical research centered on male sex work in terms of pathology [12]. Male sex work became a public health crisis during the 1980s HIV epidemic [2]. During this period, MSWs were storied as transmitters of infection within epidemiological literature because they were seen as a risk group or vector of disease transmission [13]. In addition to being labeled a risk group, researchers began to examine the prevalence of alcohol and drug use among MSWs and their clients [13]. Few qualitative accounts of MSWs’ lived experiences exist from this period. The focus of these studies surrounded MSWs’ relationship with clients and sexual behaviors [14,15].

Although some researchers question the notion of MSWs as transmitters of infection, contemporary research continues to examine HIV positivity among MSWs [16]. As such, most of the current literature focuses on drug use and HIV awareness and prevention among MSWs. Positioning male sex work as either deviancy or a public health concern impacts the research done on this population. Therefore, scholars’ understanding of MSWs’ experiences remains partial tellings, limiting our ability to effectively support MSWs’ health and wellbeing.

1.2. Global Prevalence

Contemporary literature on MSWs has highlighted how global transformations have affected scholars’ understanding of the lived experiences of MSWs [17]. These transformations are linked to globalization, which leads to changes in culture, society, economics, and politics [18]. Although there has been a turn toward understanding the lives of MSWs globally, Western countries still dominate the literature, leaving regions like sub-Saharan Africa, East, and Southern Asia, and the Middle East largely ignored [5]. For example, in Dennis’ [5] systemic review of the prevalence of MSWs within the sex work literature, only 7% of articles on MSWs appeared in non-Western countries. With scholars sampling primarily from Western countries, the experiences of MSWs are presented as a Western phenomenon [2]. Even when researching MSWs in Eastern cultures the focus is predominately on HIV prevention, mimicking much of the MSW literature in Western science [19]. There are a few exceptions to this contemporary trend.

The work of Alcano [20] and Mitchell [21] provide contemporary accounts of male sex work markets in Indonesia and Brazil. Alcano [20] details how masculinity is uniquely constructed and performed in Southeast Asian settings. Similarly, Mitchell [21] examines how the interplay between masculinity and same-gender sexual acts influence encounters among Brazilian rent boys. These studies highlight the significance of how culturally specific ideals of masculinity construct male sex work and MSWs’ experiences [2]. In addition to cultural constructs shaping MSWs’ lives, the current COVID-19 pandemic has caused significant economic strain for MSWs as they have shifted from in-person services to piloting virtual services [22]. With researchers continuing to explore male sex work globally, it is likely to increase our understanding of MSWs’ experiences in ways to help bolster social and economic support for these individuals. However, the emerging trend towards amplifying the voices and the lived experiences of MSWs remains dispersed throughout various social science disciplines.

1.3. Research Aims

Prior evidence indicates that MSWs experience social circumstances, vulnerabilities, and sexual hazards uniquely different from their female counterparts due to the compounding effects of social stigma associated with prostitution and queerness [3]. Yet, literature in this area remains largely diffused. As a result, this study aimed to synthesize contemporary qualitative research on MSWs’ lived experiences. The findings of this study contribute to scholars’, interventionists’, and policymakers’ understanding of MSWs to develop future scholarship and targeted interventions aimed at identifying and addressing the needs of MSWs.

2. Materials and Methods

2.1. Meta-Synthesis

Meta-synthesis is a qualitative methodology concerned with understanding and describing key points and themes for a research phenomenon [23]. Unlike quantitative synthesis (i.e., meta-analysis), qualitative meta-synthesis is not concerned with reducing findings to a standardized metric (e.g., mean or effect size). Instead, the purpose is to integrate themes and insights gained from studies into a higher-order synthesis to promote a broader understanding of the entire body of research while respecting the integrity of each study [23]. The current study utilizes Noblit and Hare’s [24] line-of-argument approach of meta-synthesis, which focuses on translating study findings into one another resulting in a more parsimonious but encompassing understanding of the phenomenon. In accordance with this approach, we treated each identified research study as an individual “informant” and created a meta-synthesis across all individual research reports. In this way, each study was allowed to present original data and conclusions based on these data. This information was then integrated with the findings of other researchers in much the same way a qualitative researcher might use data from multiple informants to draw conclusions.

2.2. Eligibility Criteria

Several inclusion criteria were imposed to identify studies that best address our research aims. First, a study must have exclusively focused on investigating or narrating the lived experiences of cisgender men engaged in the sex industry. Studies that included various perspectives on the experiences of cisgender men who sell sex, such as clients, female sex workers, and health care providers, were not included because findings specific to the experiences of MSWs could not be separated from those of other respondents. Second, studies had to have been qualitative or mixed methods as we were interested in participants’ construction of their own experiences. Third, studies must have provided detailed information regarding the construction of their findings (i.e., how researchers reduced their qualitative data in salient findings) and provided sufficient evidence (i.e., interview transcripts, direct quotes from participants, etc.) to support the original author’s interpretation of participants’ lived experiences for us to construct a comprehensive understanding of the studies’ findings. Fourth, the studies had to be written in English since interpreting ideas and concepts from a different language could be mistranslated and misinterpreted. Last, studies had to be published between January 2000 and November 2021 to best represent contemporary literature.

2.3. Search Strategy

Potential studies were identified using several strategies. First, we conducted an electronic search of various relevant online databases, including PsycINFO, SocINDEX, ScienceDirect, PsycARTICLES, ProQuest Psychological Journals, ProQuest Dissertations and Theses, GenderWatch, LGBTQ + Source, EBSOhost, Sociological Abstract, Web of Knowledge, Sociological Collection, Social Services Abstracts, and Social Work Abstracts. Keywords (such as male sex work, male escort, male prostitution, male prostitute, male sex seller, and men who sell sex), along with the Boolean operators AND/OR, were used to narrow the search. Second, we hand-searched for gray literature produced by organizations across global regions that served or conducted research on MSWs. For example, such organizations included the Caribbean Sex Workers Coalition (CSWC), the U.S. Department of Health and Human Services, the Global Network of Sex Work Projects, and the Red Umbrella Fund (see Supplementary Material).

The total sample without screening included 8761 products. The retrieved titles were managed in the electronic reference-program Endnote X7, where duplicates were removed. A total of 978 works were removed due to being duplicates. We then manually reviewed the remaining articles’ titles, keywords, and abstracts to identify their relevance to the aims of this meta-synthesis resulting in the removal of 7334 products (n = 449). Articles were screened twice: first by MGC and second by JB. An additional 273 products were removed because they did not include a qualitative component (n = 176). The next step was a full-text screening of each article. We then obtained electronic copies of the 176 remaining articles and examined the degree to which the lived experiences of MSWs were examined. Each article was read and assessed for inclusion based on our criteria at least twice.

Upon review, an additional 125 products were removed because they either (a) presented various perspectives on the experiences of cisgender men who sell sex, such as clients, female sex workers, and health care providers, or (b) did not provide sufficient information to be synthesized. This resulted in an initial analytic sample of 51 works. Last, we conducted both backward citation searching (i.e., searching the reference lists of included articles for additional articles that met criteria) and forward citation searching (i.e., examining works that referenced included articles for additional articles that met criteria) by hand to identify additional literature [25]. This process identified an additional 15 studies that met inclusion criteria, leading to a total of 66 papers and reports identified for the review (see Figure 1). Potential conflicts at all stages of this process were resolved, and agreement was obtained through weekly discussions among both authors.

2.4. Data Extraction and Synthesis

The two authors completed data extraction independently using NVivo [26] The following information was extracted: (a) authors of the study, (b) year of data publication, (c) study location, (d) sample size, (e) participants’ age range, (f) to whom MSWs sold sex work, (g) qualitative research findings (i.e., themes and subthemes), and (h) qualitative method. Data synthesis was conducted using an inductive approach to thematic analysis. An inductive thematic analysis with little or no predetermined theory, structure, or framework was used to analyze data. Instead, the data itself is used to derive the structure of the analysis, and themes were strongly linked to the data as they emerged from it [27]. Articles were read and re-read with first- and second-order themes extracted and recorded in NVivo. First-order constructs consist of the themes emerging from participants’ understandings found in the findings section of the original studies [28]. Second-order constructs reflect the authors’ interpretations of participants’ understandings, found in the discussion and conclusion sections in the original studies [28]. Next, extracted first- and second-order themes were assimilated and evaluated recursively through the process of synthesis (i.e., a cyclical process so that where new themes were identified, each paper was searched in turn for the occurrence of the theme) [28]. During this stage, findings from individual studies were translated into third-order meta-themes (i.e., higher-order fusions of findings across studies). Discrepant and negative cases were used to further understand and refine theoretical constructs.

Throughout this process, we avoided an actuarial approach to data analysis, interpretation, and presentation. That is, rather than counting instances in which a certain theme or observed phenomena occurred and providing specific totals, means, or percentages; we evaluated studies’ findings concerning recurrence, corroboration, and presence or absence of disconfirming instances in the same or other research reports and how disconfirming instances, when observed, were explained. This approach allowed us to attend to the unique areas of strength or risk that may be influenced by contextual information, such as geographic location or cultural beliefs regarding sexuality, and to arrive at conclusions that were faithful to the diverse material realities of the participants presented in the original investigations (

Table 1. Characteristics of the Qualitative Studies Included in the Metasynthesis.

Lead Author (Date)	Region	Sample Size	Age Range	Clientele Served (Man/Woman/Both)	Qualitative Method	Themes
McCamish (2000) [29]	Southeast Asia	100	19–29	NS	NS	Findings not presented as themes
McCamish (2002) [30]	Southeast Asia	100	19–29	NS	In-Depth Interviews	(1) Economic motivation for sex work; (2) Adherence to general family values; (3) Support for the elderly; (4) The family home; (5) Support in emergencies; (6) Support for younger siblings; (7) Festival time; (8) Reasons for non-support and parental differentiation
Koken (2004) [31]	North America	46	NS	NS	Semi-Structured Interviews	(1) The experience of stigma; (2) Positive feelings about escorting; (3) Negative or ambivalent feelings about escorting; (4) Information-management techniques; (5) Passing; (6) Covering; (7) New emerging strategies; (8) Entrepreneurial framework; (9) “The money makes it worth it”; (10) Sex work as normative within the gay community
Parsons (2004) [32]	North America	46	22–47 (M = 31.76)	NS	Semi-Structured Interviews	(1) The Role of The Internet for Sex Work; (2) Sexual Risk and Sexual Safety with Clients; (3) Sex Workers as Sex Educators
Uy (2004) [33]	North America	46	22–47 (M = 31.76)	NS	Open-Ended Interviews	(1) Money; (2) Sex; (3) A Long Day at The Office: Changes to Sexual Energy.; (4) Learning the Tools of The Trade: Changes in Specific Sexual Practices; (5) Taking the Work Home with You: How the Work Affects Sex for Pleasure; (6) The Downside of The Work
Bimbi (2005) [34]	North America	50	NS	Both	Semi-Structured Interview	(1) Quantitative Insights into Barebacking; (2) Qualitative Insights Regarding Barebacking
Hodge (2005) [35]	North America	NS	NS	NS	Dialectical Analysis	Findings not presented as themes
Lankenau (2005) [36]	North America	10	19–27 (M = 21.9)	Men	Semi-Structured Interview	(1) Early Exposures to Street Capital: Low SES, Caretaker Fluidity, And Consecutive Housing; (2) Troubled Teens in Public Institutions: Translating Street Capital into Street Competencies; (3) Full Speed into Street Careers: The Coalescence of Street Capital and Street Competencies; (4) Disruptions in Street Careers: Stigma, Hospitalization, Incarceration, Addiction, And Injury
Leichtentritt (2005) [37]	Middle East	9	16–21	NS	Life Course History	(1) Life-Long Path to Prostitution; (2) Entering Prostitution; (3) Interpersonal Encounters While Engaging in Prostitution; (4) Consequences of Working in Prostitution
McCabe (2005) [38]	North America and Europe	23 (11: North America; 12: Europe)	North America: 20–35 (M = 25.36) Europe: 22–39 (M = 29.42)	NS	Semi-Structured Interview	(1) Family Backgrounds; (2) Homelessness; (3) Entry into Prostitution and Experiences
Morrison (2005) [39]	North America	9	20–42 (M = 31.9)	NS	Semi-Structured Interview	(1) Escorting Is Volitional (i.e., One Isn’t Forced to Work as An Escort, Rather It Is a Choice One Makes); (2) Escorting Is a Profession (i.e., The Client Is a Customer and The Escort A Service Provider); (3) The Escort Is in Control During Client/Escort Interchanges; And (4) Escorting Is Distinct From And Better Than, Street Prostitution
Parker (2006) [40]	Europe	1	24	NS	Case Study	Findings not presented as themes
Kaye (2007) [41]	North America	6	16–41	NS	In-Depth Interview	(1) Space And the Material Underpinning of Street Life; (2) Street Families and Emotional Instrumentality; (3) Violence and The Self-Management of Identity
Klein (2007) [42]	North America	12	NS	NS	NS	(1) An Economic Strategy; (2) Drifting into Hustling; (3) Narcissism and Bodybuilding Subculture; (4) Narcissism and Bodybuilding; (5) Gender Narcissism; (6) Homophobia; (7) Hypermasculinity; (8) Authoritarian Personality Traits; (9) Hustling as Personal Conflict
Leary (2007) [43]	Oceania	27	M = 23; Range = NS	NS	Unstructured Interview	(1) Precursor Relationships And SMSW; (2) Engaging the Scene: A Relational Perspective; (3) Relating Within the SMSW Scene; (4) Remain or Go: Pathways Out Of SMSW
Morrison (2007) [44]	North America	21	20–57	NS	Interview	(1) Stigma Awareness; (2) Putative Effects of Working in A Stigmatized Industry
Padilla (2007) [45]	Caribbean	200	NS	Men	Ethnography	Findings not presented as themes
Parsons (2007) [46]	North America	46	22–47	NS	Semi-Structured Interview	(1) Getting Started as An Escort; (2) The Basics of Business; (3) Staying Healthy, Staying Safe, And Staying Out of Jail; (4) Got Personality? (5) Taking Care Of Yourself; (6) Proceed With Caution
Fernández-Dávila (2008) [47]	South America	30	18–30	Men	Interviews and focus group	(1) The Context of The Interactions; (2) Sexual Interactions and Compensated Sex; (3) Meeting Places; (4) Sexual Risk
Kong (2008) [48]	East Asia	30	19–31 (M = 23.3)	NS	Semi-Structured Interview	(1) Reported Condom Use, AIDS Knowledge, Perceived Risk, and HIV Testing; (2) Risk Factors Affecting Condom Use
Padilla (2008) [49]	Caribbean	72	Santo Domingo: M = 24.8 Boca Chica: M = 26.1	Men	Ethnography	(1) Experiences Of Stigma and Social Inequality Related to Sex Work and Homosexual Behavior; (2) Strategies to Manage Stigma Related to Sex Work or Homosexual Behaviors; (3) Men’s Predictions Regarding Social Stigma Upon Real or Imagined Disclosure of Sex Work And/Or Homosexual Behavior; (4) The Effects of Stigma and Social Inequality on Men’s Decisions to Employ Risk Reduction Techniques with Female Partners
Smith (2008) [50]	North America	30	18–35 (M = 22.4)	NS	Semi-Structured Interview	(1) Health Concerns; (2) Emotional Intimacy; (3) Client Attractiveness; (4) Relationships; (5) Structural Work Factors
Wilcox (2008) [51]	Europe	9	19–45	Both	Interview	(1) Motivations; (2) Involvement in Sex Work; (3) Leaving Sex Work; (4) Risks and Precautions; (5) Victims or Businessmen?
Jones (2009) [52]	North America	4	NS	NS	Structured Interview	Findings not presented as themes
Kong (2009) [4]	East Asia	15	17–39 (M = 27)	NS	In-Depth Interview	(1) Perceived Stigma; (2) Coping Strategies: Reducing Stigma and Accomplishing Masculinity
Lorway (2009) [53]	South Asia	70	21–23 (M = 22)	NS	Interview	Findings not presented as themes
Okal (2009) [54]	East Africa	36	17–45	Both	Structured Interview and Focus Group	(1) Context Of First Sexual Encounter and Entry into Sex Work; (2) Sexual Geography; (3) Stigma, Discrimination, and Violence; (4) Condom Use and Perceptions of HIV Risk
Ings (2010) [55]	Oceania	30	NS	NS	NS	Findings not presented as themes
Jamel (2011) [56]	Europe	50	20–57	NS	Web-based survey; tick-box questionnaire; interviews	(1) Sexual Violence; (2) Drug and Alcohol Consumption and Condom Use; (3) Young Escorts at Risk; (4) Perceived Vulnerability of Female Sex Workers; (5) Absence of Client-Perpetrated Sexual Violence; (6) Gay Men Are Non-Confrontational; (7) The Secretive Nature of Clients; (8) Lucky; (9) No Formalized Warning System
Nurena (2011) [57]	South America	42	18–45 (M = 27)	NS	Ethnography	(1) Patterns Of Male Sex Work; (2) Social Vulnerabilities; (3) HIV/STI-Risk Perception and Behaviours; (4) Alcohol and Other Substance Use
Kong (2012) [58]	East Asia	3	25–28	Men	Ethnography	Findings not presented as themes
McLean (2012) [59]	Oceania	23	NS	NS	Semi-Structured Interview	(1) Experiences Of Stigma; (2) Identity Management; (3) Impact on Sex Life; (4) Lack of Engagement with Existing Services; (5) Lack of Engagement with Other Workers
Muessig (2012) [60]	East Asia	40	16–33 (M = 21)	Men	In-Depth Interviews	Findings not presented as themes
Mendoza (2013) [61]	North America	12	18–37	Men	Semi-Structured Interviews	(1) Space And Sex in Puerto Vallarta; (2) Motivations for Involvement: Keeping in Business; (3) The Body and Sexualities
Niccolai (2013) [62]	Eastern Europe	12	18–31 (M = 23.75)	Men	In-Depth Interviews	(1) Patterns Of Male Sex Work; (2) Social Vulnerabilities; (3) HIV/STI-Risk Perception and Behaviours; (4) Alcohol and Other Substance Use
Okanlawon (2013) [63]	West Africa	6	M = 23	Men	In-Depth Interviews	(1) Reasons For Entering Male Sex Work; (2) Risky Sexual Behaviour and Condom Use with Clients; (3) Other Risks and Human Rights Violations; (4) The Need for Social Protection; (5) Male Sex Workers and Money-Making Rituals; (6) Relationships with Female Sex Workers; (7) Ways Forward
Scull (2013) [64]	North America	22	22–44 (M = 32.5)	Women	Ethnography	(1) Embodied Aspects of Exotic Dance; (2) Gender and Stripping; (3) Dancer’s Relationships; (4) The Self-Concept
Smith (2013) [65]	North America	38	18–35	NS	Semi-Structured Interview	(1) Environment And Behavior: Interactions Between Situation and Action; (2) Environment and Cognition: Interactions Between Situation and Expectation; (3) Behavior and Cognition: Interactions Between Action and Expectation
Bayer (2014) [66]	South America	40	17–23	NS	Semi-Structured Interview	(1) Entry Into Sex Work: Establishing the Link Between Economy and Affection; (2) Permanence in Sex Work: Cementing the Tie Between Economy and Affection; (3) Perceived Risk of And Vulnerability to HIV And Other STIs and Related Prevention Practices: The Continued Domination of Economics and Affections
Corriveau (2014) [67]	North America	19	19–41	NS	Semi-Structured Interview	(1) (Mis)Understanding the Law and Its Enforcement; (2) Strategies to Minimize the Risk Of…;
Aunon (2015) [68]	Middle East	16	19–31	NS	In-Depth Semi-Structured Interviews	(1) Disclosure Of Homosexuality and Engagement in Sex Work; (2) Condom Use with Clients and Non-Client Partners; (3) HIV And STI Testing
Closson (2015) [69]	Southeast Asia	23	M = 24 (SD = 3.9) *	Both	In-Depth Interviews	(1) Economic Need as A Main Reason to Engage in Sex Work; (2) Experiences of Stigma; (3) Stigma Management Techniques: Non-Disclosure and Emphasizing Economic Imperatives; (4) Stigma Management as A Challenge to Sexual Communication
McLean (2015) [70]	Oceania	23	NS	NS	Interviews	(1) The Declining Street Trade; (2) The Decline of The Brothel and Agency; (3) Private Escorts and Print Media; (4) Ease, Convenience, and Accessibility of Internet-Based Work; (5) Anonymity, Autonomy, and Safety; (6) Economic Gain; (7) Informal Engagement in Internet-Based Male Sex Work (IMSW)
Smith (2015) [71]	North America	40	18–35	NS	Ethnography	(1) Customer Service; (2) Stress Related to Sexual Activity; (3) Stigma and Social Challenges
Hall (2016) [72]	Europe	60 (Czech Republic = 14; Prague = 46)	NS	Men	Case Study	Findings not presented as themes
Kong (2016) [73]	East Asia	30	NS	NS	Ethnography	(1) The City as The Site for Becoming a Money Boy; (2) Strategies for Handling Triple Stigmatisation; (3) The Temporary Urban Citizen and The Hukou System; (4) Illegal Labourer and The Male Sex Industry; (5) ‘Improper’ Gay Man and The Cosmopolitan Gay Community; (6) Exit or Moneyboyisation?
Oselin (2016) [74]	North America	19	25–51	NS	Ethnography	(1) Male Sex Workers’ Repudiation of Violence; (2) Clashes Impede Business Opportunities; (3) Engagement in Fights Amplifies Risk; (4) Sex Work Facilitates Pacifist Masculinity
Ryan (2016) [75]	Europe	18	19–27	NS	In-Depth Interviews	(1) The (Re)Construction of The Male Sex Worker; (2) Building and Displaying Bodies; (3) Watchers And ‘Meeters’: Generating Social Media ‘Fans’;
Ellison (2017) [76]	Europe	15	18–22 (M = 19)	NS	Ethnography	Findings not presented as themes
Kumar (2018) [77]	Oceania	20	20–30	Men	Semi-Structured Interviews	Findings not presented as themes
Lasco (2017) [78]	Southeast Asia	10	18–25	NS	Ethnography	(1) The Context: An Informal Economy; (2) Sex Work: “Easy Money”; (3) Pampagilas: Drugs as Performance Enhancers; (4) The “Local Moral World” Of the Port Community; (5) Masculinity and Sex Work; (6) Masculinity and Drug Use; (7) Risk and Masculinity
Oselin (2018) [79]	North America	18	25–51	NS	Ethnography	(1) Identity Talk: A Tactic to Lessen Stigma; (2) Organizational Alignment: An Identity Tied to Recovery; (3) Rejecting Recovery: Crafting and Claiming Alternative Identities
Kuhar (2018) [80]	Southeastern Europe	9	24–40	Men	Semi-Structured Interviews	(1) Entrance Into Sex Work; (2) Clients; (3) The Use of Technology
Oselin (2019) [81]	North America	17	25–51 (M = 42)	NS	In-Depth Interviews and Conversational Interviews	(1) Financial Need: Entering the Street Trade; (2) Choosing Clients, Reimagining Themselves; (3) Status Symbols, Markers, and Associations; (4) Sociopsychological Effects and Bodily Capital
Peters (2019) [82]	South Africa	23	NS	NS	Narrative Interviews	(1) Narratives Of Violence; (2) “Real Men” Are Heterosexual; (3) Being A Black Man in Cape Town: The Challenges and Benefits; (4) Constructing the Dignified Sex Worker
Qiao (2019) [83]	Africa	15	19–38	NS	Interviews	Findings not presented as themes
Srivastava (2019) [84]	Southeast Asia	10	20–17 (M = 23.8)	NS	Case Study	(1) Entering Transactional Sex; (2) Soliciting Practices; (3) Role of Pimps; (4) Clients
Tsang (2019) [85]	Africa	15	NS	Men	In-Depth Interviews	(1) Drivers Of Stigma; (2) Multilayered Stigma and Vulnerabilities for HIV Infection
Tsang (2019) [86]	East Asia	16	19–38	Men	In-Depth Interviews	(1) Money Boys’ Negotiations of Home and Spatial Environment in The City; (2) Spatial Exclusion and Necropolitics of Substance Abuse
Edeza (2020) [87]	North America	23	M = 30.8 (SD = 8.3) *	NS	In-Depth Interviews	(1) Drivers Of Inconsistent Condom Use; (2) Interest in Prep to Reduce Worry About HIV Infection; (3) Interest in Prep Relating to Protecting Intimate Sexual Partners; (4) Expected Changes in Sexual Behavior
Henriksen (2020) [88]	Europe	21	22–52	NS	Semi-Structured Interviews	(1) Men’s Experiences of Selling Sex; (2) Care and Support
Legg (2020) [89]	North America	76	22–62 (M = 39)	NS	Narrative Interview	Findings not reported as themes
Phua (2020) [90]	South America	45	NS	NS	In-Depth Interviews	(1) Playing Defensive; (2) Visual Verification; (3) Governing Gossip
Lennes (2021) [91]	Europe	1	29	Men	Case Study	Findings not reported as themes
Ruiz-Burga (2021) [92]	Europe	25	24–44 (M = 33)	NS	In-Depth Interviews	(1) Leaving The Country of Origin; (2) Migration Toward The UK; (3) Sex Work in London; (4) The Use of Health Services in The UK And Sexual Health Issues Reported; (5) Sexual Health Issues Reported
Trudeau (2021) [93]	North America	14	>25	NS	Focus Groups	(1) The Hustle of Sex Work; (2) Sex Work as Survival; (3) Entrepreneurs Despite the Circumstances

Note. NS = not specified, M = mean, SD = standard deviation, * studies that included SD.

).

2.5. Trustworthiness

Trustworthiness was established utilizing Guba and Lincoln’s [94] principles of credibility and transferability. Credibility refers to the confidence that can be placed in the truth of the research findings [94]. We employed several different methods to establish credibility: (a) analyst triangulation, and (b) memo writing. Analyst triangulation seeks to establish credibility by using multiple methods and investigators to understand the same phenomenon [95]. Collaborative analysis meetings between the authors were used to establish data triangulation. During these meetings, the authors discussed emerging themes, improved the analysis protocol, and deepened their understanding of the relationship between codes and essential themes. At the end of the coding process, a list of essential meta-themes and subthemes was revised, reorganized, and discussed in additional meetings. Secondly, memo writing (i.e., the act of recording reflective notes regarding the research process and how researchers interrupt participants’ information) was used to document the detailed exploration of processes involved in data analysis by tracking emerging theorizing regarding (a) the construction of concepts, categories, properties, and themes, (b) the rationale used to operationalize analytic constructions, and (c) the relationships between these analytic constructions [96]. Through memo writing, qualitative researchers can engage with their research more by cultivating an intense relationship with their data [96]. This relationship enables researchers to establish a heightened sensitivity to the meanings contained within their data [97]. These memos were recorded and stored within NVivo.

Transferability refers to the degree to which qualitative research results can be generalized or transferred to other contexts or settings [94]. Unlike the concept of generalizability commonly adopted in quantitative research, transferability is primarily the responsibility of the person doing the generalizing. The person who wishes to “transfer” the findings of this study to a different context is then responsible for judging how sensible the transfer is. The transferability of this study’s results was demonstrated with the presentation of thick descriptions via providing detailed quotes from included studies, and participants, when possible, in the findings section to illustrate experiences in detail [98].

3. Results

The meta-themes included in this section represent essential experiences, narratives, and meaningful attributions shared across studies by participants. While rigorous reflexive processes were used to support the centering of participants’ perceptions, inevitably, the meta-themes shared in this study are also informed by our subjective experiences. Each theme is represented by our description of the meta-theme and its respective subthemes. This section incorporates direct exemplar quotes to support our summative conclusions.

3.1. Theme 1: Participants Lives’ before Becoming a Sex Worker

Articles provided little detail regarding participants’ pre-sex work lives. When provided, information regarding men’s pre-sex work lives was inconsistent. Participants included in the McLean [59] (p. 76) study reported coming from “stable, middle-class upbringings” but provided little additional detail. In contrast, other participants recounted narratives of early-life familial instability and abuse [80,88]. Participants’ early life experiences were linked to their introduction to sex work in one of two ways: (1) serendipity and (2) relationships with individuals who were already sex workers. MSWs in Smith et al.’s [65] analysis initially became aware of sex work through various mechanisms, including a chance encounter with the agency’s website or advertising, by interacting with agency staff in an online chat room chanced across the agency either, through talking to a stranger, or by coming across one of the agency’s business cards. Participants in Okanlawon et al.’s [63] (p. S25) study were “influenced by peers to join the trade as an option to avoid poverty”.

Regardless of pre-sex work-life and introduction to the sex industry, cisgender men reference economics as their chief motivation behind engaging in the sex industry [69]. Bayer et al. [66] (p. 377) discussed the implications of “critical moments”:

Critical moments arose due to separation from family, the death of a close family member who was often a parent and usually the main breadwinner, abuse, and violence in the family, loss of a job, and separation from a romantic partner, the latter in only two cases. Some participants directly linked these critical moments to their entry to sex work, while others described how these moments led to intermediate events that later steered them into sex work.

3.2. Theme 2: Client Relations

Many MSWs drew clear distinctions between clients and their causal and relationship partners when discussing their relationship with clients. For many MSWS, their relationships were merely transactional. In drawing this distinction, some MSWs constructed boundaries between personal and professional sexual behaviors. For example, escorts may avoid kissing and anal intercourse in their professional relationships because of how intimate they feel those acts are [71]. Moreover, some MSWs clients were single acts in which clients did not provide their contact information for future transactions [83]. Some MSWs allow themselves to create emotional connections with their clients. Such relationships turned into caring relationships or even friendships [80]. The development of these emotional attachments may partly be explained by the financial incentivizing of emotional intimacy:

However, these relationships are nevertheless based on financial rewards: clients might financially support the sex worker without being offered sex or might engage them in some other activities (like physical work in the garden, cleaning up the apartment, etc.), but the relationship itself—despite being described by our participants as a friendship or caring relationship—is most often a dependent one (p. 233) [80].

Emotional incentivizing aside, client recruitment was a salient aspect of MSWs’ daily lives. For instance, technology was a significant component of many MSWs’ interactions with clients. There are several motivators for engaging in internet sex work (ISW). First, MSWs shared that it is easier and more convenient. For example, they did not have to travel or loiter on dark streets [70]. Second, MSWs experience greater anonymity and agency. MSWs can construct anonymous online identities, “without fear of having their personal details known” (p. 895) [70]. Furthermore, they could temporarily or permanently delete their profiles [70]. Interestingly, the use of technology enabled MSWs to screen phone calls, granting them a sense of control [80]. Although technology is a significant component in creating and maintaining client relations, some MSWs preferred distributing physical materials. Jamel [56] noted that MSWs used advertisements in gay magazines to recruit clients. However, some MSWs, “such as Kent, feel as though they have less control over their work; with the ‘tangibility’ of print advertising potentially leaving them open to identification and subsequent stigmatization” (p. 893) [70].

In countries where queer identities are criminalized and highly stigmatized, MSWs used serendipitous means to recruit clients. For example, they met potential clients at nightclubs/bars and through friends [83]. Low-paid, homeless MSWs typically waited on the street “for the ‘pick-up’ from gatekeepers or clients” (p. 3) [83]. Mendoza [61] further elaborates that within bars, people freely mingle. It is common to see younger men flirt with older foreign men and take the lead in those situations, without fear of victimization. Because of the nature of their work, MSWs conduct risk assessments for every appointment, particularly with new clients.

These assessments were often based on audio and visual information, such as assessments of clients’ physicality, vocal tone, and non-verbal cues. For instance, MSWs may evaluate potential clients through photos posted on profiles, making judgments on how well-presented the client is in those photos [70]. Escorts analyze clients’ behavior and tone of voice while attending to their gut instincts [56]. After conducting these assessments, MSWs stressed the importance of clear boundaries and expectations.

To mitigate the possible experience of violence, MSWs, who were not devoid of choice, enact strict rules [80]. In addition, some MSWs did not allow clients into their homes as a means to protect their security [70]. Such strategies were implemented after experiencing victimization and harassment from past clients. “Some clients are heartless. A trailer driver picked me up for sex one night. That was the last I remembered. He drugged me, stole my money and phone, and escaped after dropping me in toll-gate when I was feeling dizzy.” (participant, p. S27) [63]. Another participant shared that harassment becomes worse the more alcohol customers consume “ [Y]ou have people touching you, they grab your ass, your cock, they squeeze your nipples and you have to be polite” [75].

Once recruited, the process of negotiating payment with clients was highly contextually dependent. The price for services depends on the time they spend with clients, the types of services provided, and the class of the client [83]. In addition, race plays a role in negotiating payment. One participant reflected, “When it comes to pay you see some of my fellow white sex workers…they can just charge whatever amount…But for me, I charge this money where I say okay this person mustn’t look down on me because I am Black” (p. 436) [82].

Emotional intimacy, monetary compensation, and client recruitment were particularly salient when discussing the markers of success in the sex industry. Some MSWs stressed the importance of clients thinking highly of them. For them, the number of clients they service indicates their success [77]. Another participant stressed that while money can account for a percentage of success, a good indicator is maintaining client relationships, so they become a regular client—“If you keep getting different people every time, then you are not doing your job” (p. 880) [77]. Maintaining such relationships is vital because MSWs reported being able to increase prices per encounter [77].

3.3. Theme 3: Non-Vocational Intimate Relationships

Few articles discussed the types and quality of relationships MSWs had outside their working environment. Within these articles, many sex workers chose not to pursue romantic relationships while still being active in the sex industry. For some MSWs, the negative perception caused them to feel less desirable, so they avoided personal intimacy [71]. Other MSWs do not pursue relationships so as not to put a strain on the other person. For example, they do not want their romantic partner to feel jealous, especially if they were in a monogamous relationship [59]. Interestingly, when MSWs did disclose their work, their romantic relationships did not experience strain as the partner understood the financial benefits [71].

When participants did pursue a romantic relationship, their engagement in the sex industry significantly impacted the quality of these relationships. The variable work hours often disrupted social, family, and relationship activities as the escorts might receive a call from a client when they had other plans. Deciding when to take or not take a call may jeopardize the client relationship hindering their possible income [71]. An additional prohibitor for MSWs is emotional burnout. Some MSWs often felt burned out after working with clients to the point where they did not want to engage in social relationships. This is particularly demanding for MSWs who do not put boundaries into place [71]. Lastly, MSWs’ personal sex lives experienced some difficulties. For example, some MSWs chose non-disclosure of their work to avoid stigma, which created a barrier to sexual communication [69]. Moreover, some MSWs reported that they would have so much sex with clients that they were not as interested in sex with their partners [71]. In fact, for some, the professionalization of sexuality removed its ability to serve as an intimate means of connection [59]. In contrast, some MSWs discussed how their work exposed them to sexual activities that they parlayed into their causal lives. For example, esoteric sexual practices (e.g., sex toys, fisting, golden showers, etc.) that clients requested became an enjoyable experience in their casual sex life [59]. Many MSWs attempted to overcome the challenges associated with being a sex worker and maintaining a romantic relationship by dating other sex workers. Edeza et al. [87] (p. 359) highlight that “a handful of participants were in relationships with other individuals who also sold sex. These individuals noted that PrEP would benefit both themselves and their partners, by preventing transmission of HIV between them.” In addition, some couples would engage in sex work as a couple charging more depending on the service [75].

3.4. Theme 4: Coping with Work-Related Stressors

MSWs developed several coping strategies to manage work-related stresses, such as having sex with undesirable partners. Escorts would often dissociate when having sex with a client. As one escort noted, “I guess now I just put it at the back of my mind; I just don’t think about it anymore” (P5: 23 years old, Caucasian, gay; p. 1051) [71]. In doing so, an escort could separate himself from an experience he found to be unpleasant. Further, MSWs would often employ cognitive coping strategies, such as self-talk. Escorts frequently reasoned with themselves that their high pay made fewer desirable aspects of the job more bearable [65]. Some MSWs discussed using drugs as a means of coping with the realities of discrimination, rejection, and stigma in their spatial environments [86].

3.5. Theme 5: Work-Related Violence

MSWs often discussed violence as an inherent aspect of their job that they either attempted to avoid or utilized to benefit them. Experience of sexual violence and assault were not uncommon as participants in various studies discussed being sexually violated. For example, some MSWs reported that clients tried to have condomless sex with them [56]. Moreover, some participants reported being raped by their clients [56]. Sexual violence was sometimes coupled with physical violence. However, MSWs reported having a complex relationship with physical violence to gain and maintain their masculinity, monetary compensation/clients, and physical protection. In fact, some MSWs engaged in exaggerated violent talk to circumvent the idea that they were not real men because they were engaged in “women’s work” (p. 430) [82]. In addition, some used their physical dominance to generate income:

Blue unequivocally depended on physical dominance to generate income: “I would purposely start somethin’ to steal clients or wait till you get around the corner—either way, I take your money from you. That’s how it is.” (p. 217) [74]

Although some MSWs experience violence, this is not an experience for others. Some MSWs report never encountering violence from their clients. In addition, race may appear to be a protective factor against possible violence in that Black men are perceived as inherently dangerous [82].

3.6. Theme 6: Experiences of Discrimination and Social Stigma

Throughout several articles, participants discussed intense experiences of discrimination and social stigmatization that negatively impacted their intrapersonal mental health and access to health services, interpersonal relationships, and ability to engage effectively in their work. Closson et al. [69] (p. 5) noted that “almost all participants described experiences of enacted and felt social stigma in connection with being paid to have sex with other men and male–male sexual behavior.” These forms of stigma often took the form of being called slurs or being looked down upon by others [69]. Some of this stigma is associated with religious values and disproval of same-gender sexual behavior, especially in Zimbabwe [85]. In addition, MSWs experienced verbal cues of stigma (e.g., slurs) [69].

Okanlawon et al. [63] (p. S29) noted gender-related conflicts amongst various groups of sex workers. Participants in their study outlined how some FSWs took advantage of anti-LGBT national sentiments to marginalized MSWs:

One night, we had a gay party in one hotel and we dressed like girls. Female sex workers were also in that hotel looking for clients… One transgender sex worker then cracked a joke by telling the female sex workers that we owned that night and that they would not get any clients. The female sex workers who were already jealous and angry reported us to thugs who came to the hotel to beat and rape some of us.

Such encounters could be related to contextual messages of what it means to be a real man. For example, some MSWs, even those with positive experiences, experienced some stigma and discussed how the desire to be normal impacted their health [69]. However, this stigma is also associated with their internalized anti-sex work values.

As one man said, “The first appointment I did I was grossed out. I never really pictured myself doing this”. (P04: 21 years old, Caucasian, gay; p. 6) [65]. In addition to internalizing stigmatization associated with sex work, MSWs discussed the forms of enacted stigma from battling police as police tried to keep them off the streets [83]. Such encounters with the police led to MSWs never utilizing the police when encountering violence, so they began to suffer in silence [83]. These forms of enacted stigma became a significant barrier for MSWs to access reliable and effective healthcare. MSWs report doctors discriminating against them. In fact, one participant shared that “If they know we are gay sex workers, they might not attend to us since many doctors are religious” (p. S27) [63]. In addition, perceived stigma prevented some MSWs from STI-related preventative care [86].

Beyond enacted stigma from clients, other sex workers, police, and doctors, many MSWs were reluctant to disclose their work to family and friends out of fear of being ostracized or cut off. MSWs reflected that it would be upsetting for both parties if the family were to find out, as selling sex is associated with ruining people’s virtue [69]. Conversely, MSWs shared that disclosing their profession to others would help them achieve social support and ease the worries of being “discovered” doing this work [71].

MSWs also utilized various mechanisms of resistance against sex work discrimination and stigmatization. One such mechanism was justifying why sex work is lucrative work that involves two or more consenting adults [65]. In addition, some MSWs would arrange for female sex workers to pretend to be their girlfriends to be read as heterosexual by others; the women also benefit from this relationship because they do not receive the stigma associated with being single [63].

3.7. Theme 7: Sexual Health Behaviors

Sexual health behaviors can be demarcated through condom use and actions that facilitated or decreased exposure to STIs. Although MSWs recognize the role condoms use in reducing risks of infections, they do not always use a condom with clients. Economics appears to play a role in condom usage [63]. Condomless sex is associated with higher transactions for services [87]. In addition, MSWs reported that the cost of condoms does not mitigate the risk of infection [66]. Moreover, participants who are financially stable can control the interaction differently than those who are not financially stable [82]. Although finances play a role in protected sex, many participants shared that their health and wellbeing are priorities. As such, MSWs navigate ways of taking care of themselves. For example, some report starting PrEP to protect against HIV [56]. One participant reflected that they would advocate for condoms usages because they were aware of their health risks [82].

In addition to economics, several factors influenced MSWs’ inconsistent condom use and exposure to HIV. Substance use emerged as a common factor. Qiao et al. [83] note that alcohol and drugs hindered participants from protecting themselves from STIs. In addition, participants reflected that violence hindered their ability to have protected sex. For example, MSWs reported being forced to have unprotected sex by police often to avoid criminalization [63].

3.8. Theme 8: Occupational Identity, Pleasure, Community, and Invisibility

Few studies focused on MSWs’ construction of their identity as working as sex workers; this was particularly salient for heterosexual men who offered services to other men. For example, one participant distances himself from being labeled gay by stating that it is work [82]. In addition, other heterosexual MSWs draw distinctions between work and personal identity. In particular, one shared that being with men sexually is something he does not find enjoyable [61]. Unsurprisingly, this distinction was not present for gay or bisexual men as they had already engaged in same-gender sexual behavior prior to starting sex work [63,80]. Despite sexual orientation, MSWs across groups reported difficulties engaging in sexual activities with people they didn’t find attractive.

New escorts also had difficulty having sex with clients due to a lack of attraction and arousal. Most clients were not individuals to whom escorts would typically be physically attracted in their personal lives. However, some participants reflected that they did not care as the client symbolized money [59]. Other participants shared they were unaware of how lower attraction would cause a significant problem in their work. For example, some reported they could not have sex with certain clients because of their weight and hygiene practices [71].

MSWs also discussed their connection to the broader sex working community. For example, many MSWs are friends with other sex workers and share housing [68,88]. These attachments sometimes offered mentorship, especially for early career sex workers, and warning systems for dangerous clients. Having this community can serve as a protective factor within a system that can espouse sexual and physical violence [56]. Moreover, escorts rely on social support and their agency manager to manage work-related discomfort. MSWs frequently talked with each other about clients and their experiences with them. They shared stories, exchanged ideas for managing stresses and dislikes, and learned how to provide better customer service while engaging in less sexual behavior. The manager also attempted to match escorts with clients who shared the escort’s sexual boundaries [65]. In contrast, some MSWs chose not to engage with the broader sex work community to avoid identification as a sex worker and stigmatization [59].

This connection to the community may buffer how MSWs’ occupation is invisible to law enforcement and nonprofit organizations. For example, one participant shared that they assumed escorting was illegal and became paranoid about legal ramifications [67].This paranoia is warranted as there exists an intersection of gender, sexuality, and sex work. Some MSWs felt there were disparities between men and women who sell sex because of the different laws and policies [85]. For example, while escorting may not be considered illegal or police may not enforce that law, in places that criminalize same-gender sexual behavior. Moreover, participants reflected that they did not seem to be a population that some nonprofit organizations served [85]. This lack of service from nonprofits may reflect how some MSWs feel they are not considered “real prostitutes” because of the difference between how men and women sell sex on the streets (p. 443) [88]. This invisibility is also related to other social locations. One participant shared, “If you’re rich, and you’re white, and you’re well educated, and you can hide behind houses, computers, and wealth… then you don’t have much to fear. (Steve; p. 354) [67].

3.9. Theme 9: Exiting the Sex Industry

Several MSWs reported that exiting the sex industry was a clear goal for them as they did not foresee being a sex worker as a long-term occupation [66]. Some participants shared, “But it’s time to make a move because this is not where I see myself. I want to get a job, study, or look for a new opening in the US or Canada. Then, I will quit doing this” (Fernando, 20, Tecomán, Colima; p. 129) [61]. Although participants expressed a desire to leave the industry, many found it hard to leave. The most common barrier was their economic situation and how it was tied to their survival. In particular, “Most Cercado MSWs spend significant amounts of time seeking clients and many also spend time socializing with clients—either as part of the process to secure a client or to achieve certain benefits such as a meal, a place to sleep for a few hours, or alcohol” (p. 379) [66].

MSWs also discussed what sort of resources would be required for them to leave the industry. Okanlawon et al. [63] articulated that “they (MSWs) articulated future needs of starting alternative businesses, getting more education to improve themselves and acquiring skills to earn a less risky livelihood”. Henriksen et al. [88] further document that there are practical needs (e.g., budget, cheaper housing, a new course of education) and mental needs (e.g., social support) to help MSWs achieve independence from the sex industry.

4. Discussion

4.1. Participants Lives’ before Becoming a Sex Worker

The current analysis found conflicting narratives regarding the pre-sex working lives of men and men’s pathways into the sex industry. Some participants describe being reared within stable family systems where they were introduced to the earning potential of the sex industry via serendipity or through pre-existing relationships with individuals who were already a part of the industry. For many of these men, the sex industry was a mechanism by which they could monetize actions they were already engaging in during their private lives or innovative avenues of untapped economic potential that they could leverage to overcome an acute critical moment of economic need. This is aligned with previous research that suggests some sex workers, particularly high-profile ones, frequently reared within suburban contexts, with academic and sports accomplishments at prestigious universities, and who decided to earn some extra money by capitalizing on their physiques [99,100].

On the other hand, some MSWs recounted a very different rearing environment that pushed and pulled them into the world of sex work through desperation via having been reared within unstable family systems where they were forced to take care of themselves from a very young age. Although these men were unlikely to be coerced by romantic partners or pimps, their “decision” to enter the sex industry could hardly be defined as a completely consensual one. Many participants cite abusive childhoods, no opportunity to acquire legitimate marketable skills, days or months of living on the street, and a choice of sex work or starvation are their primary reasons for entering the industry [101]. From their perspective, sex work provided an opportunity to find financial independence and stability.

Regardless of upbringing, for most men, sex work represented a means to an end wherein they could utilize their bodies, sometimes their only resource, to provide for themselves and their families. This finding is also consistent with many researchers citing economics as the most common reason for people entering the sex industry [102,103,104]. For many men, sex work provides them the opportunity to access certain resources that were otherwise inaccessible [105].

4.2. Client Relations

Another important finding was the complex relationships participants had with their clients. Many MSWs drew clear distinctions between clients and their relationship partners. Many participants viewed their relationships with clients as transactional arrangements where the boundaries and rules of the relationship were clear from first contact and ended once both sides of the agreement were fulfilled. At times the boundaries of these relationships included the development of care relationships or friendships; however, the development of these emotional attachments may partly be explained by the financial incentivizing of emotional intimacy. Simply put, MSWs were able to increase their value in the eyes of their clients by way of developing a form of parasocial relationships, i.e., one-sided relationships wherein one or more of the members of a relationship are exaggerating their emotional engagement and investment in said relationship [106]. Bernstein [107] refers to these relationships as having a type of “bounded authenticity,” wherein the relationships are authentic but also bounded within sex work.

Parasocial relationships are formed as people spend time together, and a sense of intimacy develops out of “shared” experiences and interactions over time as clients come to believe that they know and understand the sex worker, which can blur the boundaries of such relationships for many clients [107]. With social attraction and repeated experiences of intimacy with providers, the relational value and importance of the parasocial relationship intensify for clients [106]. Consistent with previous research on parasocial relationships, sex workers in this analysis benefited from the development of parasocial relationships as the development of these relationships increases their emotional and monetary value in the eyes of their clients [108].

4.3. Non-Vocational Intimate Relationships

While nascent, narratives regarding MSWs’ private intimate relationships were complex. MSWs often chose not to engage in or pursue romantic relationships while still being active in the sex industry as they felt like their profession would undermine these relationships before they even began. When MSWs pursued these relationships, they were forced to address and cope with significant challenges, including emotional burn-out, disruptions in private sexual relationships, and jealousy. This is consistent with previous research documenting the relational challenges couples or relational systems face where one or more partners were engaged in the sex industry [109,110]. For instance, Curtis et al. [102] found that to combat experiences of stigma and cope with some of the practicalities of the industry, many participants choose to compartmentalize their personal and professional relationships from one another. This division can be weaponized by people in sex workers’ lives to control their behavior [102]. This control mechanism is frequently employed by human traffickers and pimps [111]. However, this division can be beneficial in establishing and sustaining romantic relationships as partners frequently struggle to separate the sex-working partner from their profession [109,112,113]. In previous research, sex workers discussed the usefulness of certain techniques as a means of preserving noncommercial intimate relationships, such as living far away from where they work, taking regular breaks away from the industry, keeping to a strict schedule during client interactions, and manufacturing a work persona [114,115].

4.4. Coping with Work-Related Stressors

Several of the articles included in this analysis discussed how sex work negatively impacted the psychosocial health and wellbeing of participants and the various cognitive and social mechanisms they utilize to deal with the added stress and pressure. Men frequently discussed the cognitive conflict they experience when having sex with clients that they find unattractive. Consistent with prior research, men utilized “self-talk” to reason that the discomfort they felt regarding the less desirable aspects of their jobs was undermined by the high degrees of independence and financial stability they could actualize. For instance, Roche et al.’s [116] analysis of narratives of street-based female sex workers indicated that they often rationalized risks associated with their vocation, such as discomfort, arrest, and violence, as inevitable, occupational hazards that they must endure, yet resist against.

4.5. Work-Related Violence

Perhaps one of the most striking findings of this analysis was men’s complex relationship with work-related violence. Participants provided detailed descriptions of profound experiences of sexual and physical violence related to their profession. Unfortunately, these experiences are consistent with prior evidence suggesting that sex workers experience high levels of physical and sexual violence [117]. According to Perkins and Bennett [118], violence against sex workers is a product of society’s belief that they were offering an immoral or unethical service. Individuals who adopt this framework view sex workers as having a bad reputation or a spoiled identity, thus placing them outside of the protection of the law [118]. Sex workers are frequently attacked for this very reason; perpetrators believe that their acts of violence will not be met with consequences because they are socially sanctioned to do so [118]. However, Peters et al. [82] indicate that men’s perceived manliness may be a protective factor against violence as they may be less likely to be viewed as vulnerable. In particular, Black men reported low levels of violence attributed to the stereotyping of Black men as inherently sensual yet dangerous [82].

MSW’s relationship to violence was further complicated by a minority of participants employing violence as a mechanism of financial gain. Oselin [74] highlighted how some MSWs used prostitution to put clients in vulnerable positions where they could be easily taken advantage of. While studies examining this phenomenon are nascent, evidence suggests that sex workers utilizing their profession to take advantage of clients are not uncommon. For instance, Nyangairi and Palmary [119] noted how brothels in South Africa specifically develop rules against fighting, using, and selling drugs, and stealing from clients to reduce police attention and unnecessary scrutiny from the outside world. Breaking these rules was met with informal sanctions that ranged from gossip to insults to direct violence [119].

Further research documenting MSWs’ experiences of violence remains nascent. The lack of attention to violence as relevant to the lives of MSWs may be partially explained by heteronormative beliefs (i.e., a worldview that promotes heterosexuality as the normal or preferred sexual orientation, desire, and practice) and assumptions of masculinity [5]. While evidence suggests that MSWs experience less violence than female sex workers, particularly since they are less likely to be pimp-controlled, violence remains a salient component of their experience [5]. The narratives of MSWs highlight how they too can be and are victimized by romantic partners, fellow prostitutes, and the police [101,120]. In addition, dozens of MSWs are assaulted and even murdered by clients every year [5].

Another possible explanation is the stereotyping of women as fragile and vulnerable and men as resilient and assertive, able to take care of themselves; thus, violence against women elicits concern, while violence against men is unrecognized, and at times expected [121]. A clear example of this discourse can be observed in depictions of MSWs in popular culture and media. MSWs are often depicted as muscular athletes, even bodybuilders, in control of their bodies and destinies. In this case, it is assumed that a client will be less likely to engage in violent behaviors toward MSWs [121]. Consequently, violence against MSWs is often diminished or overlooked.

4.6. Experiences of Discrimination and Social Stigma

Findings indicate the existence of an interdependent relationship between stigma-specifically associated with sex work and discrimination related to non-heterosexuality. Regardless of sexual orientation, none of the cisgender men included in this analysis refrained from offering sexual services to men, resulting in an implicit assumption of their queerness, regardless of accuracy, which served to undermine heterosexual MSW’s self-identity. Some cisgender men even reported being discriminated against and abused by other female sex workers, who see them as competition for their clients.

Our findings align with previous research that suggests that MSWs, as a result of their default status as members of the queer community, are confronted with physical and psychological violence from broader society, but also sometimes stigma and discrimination from within the LGBT community itself [122]. MSWs reported being marginalized by the wider non-sex worker LGBT community who hold negative views on sex work and its historical relationship to sex work [123]. Early research on the LGBT community frequently highlighted narratives demonstrating how homophobia and transphobia often manifested within the lives of individuals as family rejection, difficulty finding a job, and poverty, which resulted in LGBT people turning to sex work to support themselves and to escape physical violence from family and friends [124]. Essentially, early scholarship on the lived experiences of MSWs and the queer male community were nearly synonymous [125]. As such, early interventionists assumed all MSWs were queer-identified, which is no longer the case [126]. Consequently, some members of the LGBT community are highly critical of sex work, which marginalizes the lived experience of MSWs [125].

4.7. Sexual Health Behaviors

Several articles included in this analysis highlighted the unique pathways of risk and resilience MSWs utilize to protect themselves from being exposed to HIV and sexually transmitted infections (STIs). The negotiation of condom use between provider and worker was a salient component of this process as many MSWs reported being financially incentivized to engage in riskier forms of sexual interaction, such as condomless sex, while at the same time engaging in health-promoting behaviors intended to decrease the effects of their engagement in riskier forms of sexual interaction. Condom use within transactions has typically been framed as the responsibility of sex workers, with research overwhelmingly aimed toward identifying sex workers at high risk for condom non-use and implementing behavioral interventions (e.g., education, counseling) to increase condom use [127]. However, a growing body of research has acknowledged the importance of structural factors in shaping MSW’ vulnerability to HIV, including poverty and unstable housing, structural violence, and government policies surrounding the regulation of sex work [128,129,130,131]. This is consistent with previous studies which have documented a positive association between sex workers’ earning potential and willingness to engage in unprotected sex [132,133,134]. A study of MSWs in India conducted by Biello et al. [127] identified economic concerns as a driving factor for engaging in sex work and higher-risk sex with clients in this sample as over two-thirds of participants reported being offered more money to not use a condom with a client.

In the context of these structural and environmental factors, clients of MSWs play a substantial and frequently unacknowledged role in determining the use of condoms for the prevention of HIV and other STIs within commercial sex transactions [135]. Negotiations for condom use between MSWs and clients are situated within the interpersonal social environment of MSWs and are influenced by several factors exogenous to individual SWs (e.g., sex work environment; client-related factors) [136]. For instance, evidence indicates that client-intimated condomless sex is highly prevalent [135]. Clients’ resistance towards using condoms often takes the form of monetary compensation, as MSWs are offered more money for condomless sex. MSWs are thus incentivized to engage in riskier sex practices [135,136,137].

Although MSWs may face opposition and pressure to not use condoms by clients, it is important to acknowledge MSWs’ agency, the complex negotiation process that occurs within transactions, and MSW’s prioritizing of their physical health as it is their primary mechanism of economic stability [136]. MSWs often must make difficult micro-level decisions regarding their health and safety in the face of financial pressures and structural inequities and face pressure to agree to sex without a condom in exchange for a higher fee [136,137]. While most MSWs who understand the personal risks would rather use condoms, some MSWs may be prepared to make a tradeoff in terms of their health and safety [137]. To supplement this tradeoff, MSWs may utilize various health-promoting behaviors such as taking HIV pre-exposure prophylaxis (PrEP; i.e., the medication that HIV-negative individuals can take to prevent contracting HIV) to protect their health and wellbeing [87]. MSWs in a recent study reported a greater willingness to use PrEP than men who have sex with men overall [138]. Interest in preventive HIV care among MSWs stems from their desire to protect non-occupational intimate partners and knowledge of positive HIV tests among friends and family [139].

4.8. Occupational Identity, Pleasure, Community, and Invisibility

Several articles discussed the complexities of MSWs developing a work identity that may or may not have been congruent with their sexual identity. As noted previously, heterosexual MSWs discussed significant distress regarding offering sexual services to men. Regardless of sexual orientation, many MSWs referenced the discomfort of engaging in sexual activities with people they didn’t find attractive as an occupational hazard inherent to their line of work. These findings are consistent with previous research on the relationship between mental health and sexual identity for MSWs. Findings of Bar-Johnson & Weiss’ [140] study of MSWs in the Czech Republic indicated that for queer men, working as an MSW was not related to any serious mental health problems. However, heterosexual and bisexual MSWs frequently reported symptoms of depression, with bisexual men showing significantly more anxiety than either heterosexual or queer men. They further posit that heterosexual and bisexual MSW may fear being ostracized by their heterosexual non-sex working peers due to an implicit assumption of queerness born out of MSWs’ engagement in commercial sex with men [140]. Simultaneously, heterosexual and bisexual MSWs may distance themselves from the gay community by emphasizing their desire for sex with women and playing a macho and homophobic role [140].

Discussions of an MSW identity are inextricably linked to discussions of patriarchy, masculinity, and of men subjugating, objectifying, purchasing, possessing, and degrading the female body to maintain or increase their political, social, and economic dominance [141,142,143]. Within sex work literature, men are frequently positioned as consumers, as highlighted by Miriam [144] (p. 2) who notes that “men create the demand, women are the supply”. Letiche and van Mens [145] (p. 171) further elaborate on this perspective by stating “women are necessary for the exchange economy as status objects and in the operation of male desire” promoting the heteronormative notion that male desire is synonymous with a desire for women. Indeed, the inclusion of the male body as an object of possession, objectification, and degradation by another man disrupts many scholars’ assumption that sex work is heterosexual and that the power differential inherent in sex work is a manifestation of the heterosexual sexual contract that forms the basis of all social relations between men and women [146]. As a result, when MSWs are mentioned, scholars frequently emphasize their agency, and ability to capitalize on their talents or run their own businesses and rarely discuss their experiences of degradation and coercion [5].

The stereotyping of MSWs’ lived experiences and material realities are further reinforced by implicit social biases related to men’s relationship to sexuality. In essence, there is an implicit global assumption that women view their sexuality as a precious commodity, while men view their sexuality as a form of recreation and exploration [147,148]. Although this may be true for some, men’s relationship to sexuality is not homogeneous. Specifically, some MSWs, especially juveniles, are homophobic and despise themselves for the “failed” masculinity that their acts imply [149]. Many MSWs grow up among homophobic parents and peers and often enter sex work after being ejected from their homes for being gay; they may believe that their sexual acts brand them as inferior, sinful, wrong, and unwelcome in the “normal” world [150,151]. Even those who are gay and self-actualized may easily feel that they are being taken advantage of and therefore degraded by sexual exchange [5].

Evidence suggests that MSWs respond to stigma and status loss by harboring the desire to be a part of the dominant group [152]. People cope with “spoiled identities” through passing, selective disclosure, and even resistance [153]. Research illustrates that many MSWs try to conceal their involvement in sex work by denying it when confronted and developing secondary personas when engaging in their work [129,154]. Despite such efforts, sex workers may still internalize the negative label assigned to them by external actors, thereby affecting their self-image [155]. Moreover, MSWs can compensate for their involvement in a low-status stigmatized occupation by emphasizing their possession of other socially desirable traits, such as athletic bodies or entrepreneurial skills [4,49].

Bimbi [1] asserts that MSWs are doubly stigmatized due to immersion in a feminine trade and their violation of heteronormative conduct. However, other scholars point out that MSWs’ experiences of stigma vary according to context. For instance, the findings of recent US-based studies revealed that gay and bisexual MSWs experience increased validation, and lower stigma, and are more likely to be viewed as an object of fantasy if they are embedded within gay communities [156,157]. For those outside of predominantly gay spaces or in spaces where queerness is still taboo, stigmatization is more likely to occur. For example, Bar-Johnson & Weiss’ [140] analysis of men in the Czech Republic demonstrated that a heterosexual or bisexual identity for MSW does not offer them the support of belonging to a sexual minority but incurs the greatest prejudice against them [140].

In general, Western cisgender men who consider sex work an occupation report a higher positive perception regarding their involvement [158]. Research suggests there is added incentive for MSWs to immerse themselves within queer communities (e.g., through the recruitment of a primarily queer clientele or creating social networks comprised of queer individuals) because they are likely to experience greater tolerance and acceptance from community members due to less stringent norms regarding sexual conduct [156,157]. Some MSWs articulate their participation in the sex trade as a viable occupational choice, one that validates and affirms their sexual desire for other men [156,157]. It affords them frequent opportunities to interact with many gay and bisexual cisgender men, both fellow sex workers and customers [156,157]. Thus, many cisgender men embrace, rather than imply separation from, the role and associations connected to sex trading [156,157].

Another important finding that emerged from our analysis was cisgender men’s relationship with a broader community of sex workers. MSWs often rely upon these relationships for mentorship, peer support, and client screening. This finding is consistent with previous research on both male and female sex workers that suggested the broader sex-working community is often integral in providing safe and healthy entrances into sex work for new sex workers and could promote and support the continuation of healthy sex work practices throughout individuals’ careers [14,159]. According to Robinson & Davies [160], the MSW community offers its members peer interaction, gay community integration, and empowerment through exchanging HIV-related knowledge, collective decision-making, and the exercise of group pressure.

One unexpected finding was the extent to which MSWs reported feeling invisible to the global sex trading enterprise. MSWs reported this experience was further emphasized by social service agencies, administrative bodies, the mass media, and scholarship, often excluding their existence. For instance, while cisgender men comprise about 20% of the individuals arrested as vendors of sexual services in the US each year, scholars predict the actual MSW population to be much higher as police often mistake MSWs for queer cisgender men seeking noncommercial sex experiences [161].

A systemic review of 166 articles related to the global sex trade conducted by Dennis [5] documented how cisgender men are systemically excluded from studies involving the sex trading industry. The findings of their study indicated problems related to the very conceptualization of sex work as most of the articles included in their analysis, 67%, presented the term prostitute as precisely identical to a female prostitute and sex worker as precisely identical to a female sex worker [5]. Deeper levels of analysis further indicated that authors were not consciously limiting their populations to “the majority” but that they believed that only women participated in the sex industry as providers [5]. Even the 28 articles that specified women and girls as the group of interest often failed to acknowledge that the sample was limited; they presented female sex workers as the totality of the population [5]. Davidson [162] refers to sex workers with the pronoun she sometimes and the inclusive he or she at other times, but always typifies prostitution as the male desire for an objectified female body, not an objectified body [163]. This process heavily informs how social service agencies, administrative bodies, and scholars come to understand the phenomena of sex work. Edlund and Korn [164] assert that prostitution is by definition “low-skill, labor-intensive, female” and thus can be explained as the result of male attempts to maintain their social dominance by regulating and oppressing women. When cisgender men purchase the services of male prostitutes, they do not contribute to the regulation, oppression, or harm towards cisgender women; thus, they can safely be excluded from further consideration [164].

Recent research, including this study, demonstrates the limitation of this perspective; however, the effects of this level of ignorance are still quite prevalent. For instance, discussions of sex work are frequently scaffolded by heteronormative beliefs that equate being “male” to “one who desires the female” resulting in the existence of MSWs being “considered merely an unusual aberration, sometimes mentioned as an afterthought but more often ignored altogether” [148]. This process has material consequences for MSWs. First, participants discussed how they are less likely to be identified as sex workers, thus increasing their ability to manage their identity as sex workers and decreasing their chances of being arrested. Second, participants discussed being excluded from the development of intervention programs and policies and laws governing the regulation of sex work, thus increasing their vocational risk and decreasing their ability to access resources that would sustain a successful transition outside of the sex industry.

4.9. Exiting the Sex Industry

Congruent with previous research, participants discussed the short-term temporality of the sex industry and their ineffective attempts to find alternative forms of employment to exit the sex industry. Several MSWs found this process to be difficult as they could not secure resources that would adequately support their transition. According to Murphy & Venkatesh [165], sex workers often find difficulty transitioning completely out of the sex industry due to the wage discrepancy between their earning potential as a sex worker and their access to comparable traditional employment. Frequently, sex trading is more lucrative than other industries, such as retail or construction. As such, sex workers frequently find it difficult to secure employment outside of the industry that will maintain the lifestyles they have built [165]. Indeed, MSWs often recount feeling “pulled back” into the industry, even after securing employment within another field [166,167]. Consequently, MSWs seeking to transition out of the industry often find themselves reentering the industry when faced with a socioeconomic crisis [166,167].

The notion of exiting the sex industry (i.e., ceasing employment as a sex worker) plays a powerful symbolic role in the intense debate regarding the morality, legitimacy, and regulation of sex work [123]. Exit programs range from holistic support services to coercive interventions and are implemented by various organizations, including NGOs, government-funded health and support services, and church groups [123]. However, MSWs included in this article were hesitant to engage in these services due to concerns regarding the potential for discrimination that is frequently entrenched in exit programming, as many were conceptualized and built to support the transition of women out of the industry [123].

Programs and policies that do attempt to foster the inclusion of MSWs are often delivered in a manner that excludes potential service recipients [168]. For example, many programs present themselves as offering gay-oriented services (despite many MSW not identifying as gay), services themed around homelessness and/or substance use (while it is undeniable that some MSWs are homeless and do use substances, many do not), or more problematic service delivery models such a coercive intervention program (many sex workers choose this work as an occupation and thus corrective programs are do not attend to their unique needs) [169].

Emerging research regarding the efficacy of certain existing programs indicates for an MSW to successfully transition out of the sex industry, they must do so within safe and supportive environments [168]. Several studies have documented that providing specialized housing for sex workers (both in the form of shelter and transitional housing) which is 24 h staffed, low-barrier, free of arbitrary and exclusionary policies, and supports transitioning along with the provision of other essential services, such as harm reduction, permanent housing support, substance use support, and case-management communities and programs can facilitate female sex workers’ successful transition out of the sex industry [170,171]. It is essential that such services also be open to MSWs. McIntyre [172] states that most of the participants in their study reported that they felt they would be able to abstain from sex work if they could access a safe residential space for MSWs that would approach their unique needs through a male lens.

4.10. Limitations

It is important to note certain limitations of the study. First, we intentionally focused our attention on qualitative studies that documented the lived experiences of MSWs from their perspectives, meaning that we excluded observational studies, as they did not rely upon MSWs’ narratives to interpret their trends in behavior or that did not explicitly disentangle the experiences of MSWs from that from other sex workers. Second, our study was also limited by our criteria of only including studies published between January 2000 and November 2021. However, this limitation permitted us to capture recent macro-level trends in scholarship and micro-level trends in men’s discursive construction of their experience as sex workers. Third, although we focus on MSWs’ experiences, the studies included in this analysis focused on the experiences of cisgender men. As such, we are not able to present the experiences of transgender men who engage in sex work. Last, although unlikely, we may have missed articles that may have further contextualized the experience of MSWs; however, many of our findings were congruent with developing scholarship in this area, suggesting that further studies may simply serve to complement our findings. These limitations notwithstanding, the present study provides among the first qualitative systematic examinations of the lived experiences of male members of the global sex trading industry.

4.11. Future Research

The findings of this analysis highlight one of the first attempts to systemically describe the lived experiences of MSWs from a global perspective. Our analysis documents the heterogeneity that cisgender men experience within the sex trading industry and the diverse ways in which men’s lives are biologically, psychologically, socially, and politically intertwined with their profession. As referenced several times throughout this paper, further research on cisgender men’s experiences of the sex trading industry is needed. There is a need for further research on the employment trajectories of cisgender men engaged in the sex industry. Although there is plentiful evidence documenting why and how men entered the industry, there is little evidence regarding the factors influencing their working conditions, longevity in the sex industry, and plans for retiring from the industry. More research should also be dedicated to closely examining the influences that the commercial sex industry has on heterosexual MSWs’ intrapsychic experience (e.g., feelings of worth and esteem) as these factors remain largely unexplored within scholarly literature, despite the growing presence of heterosexual, cisgender men within the industry. Further research might also explore how intimate partners in the sex industry navigate the industry’s practicalities while maintaining an adaptive intimate relationship, as several participants in this study were in or were currently pursuing committed noncommercial relationships. Lastly, future research could be dedicated to assessing the degree to which cisgender female sex workers lived experiences agree, complement, or contradict the lived experiences of male sex workers.

5. Conclusions

The purpose of this study was to highlight the lived experiences of MSWs from a global perspective. The findings of this study document how MSWs experience many of the same benefits and challenges that have previously been foregrounded in scholarship regarding the lived experiences of female sex workers, such as work-related violence, social discrimination, and isolation. Findings also indicated that men experience unique privileges and vulnerabilities that aren’t experienced by female sex workers, such as homophobia resulting from assumptions of queerness and invisibility in scholarship, policymaking, and supportive services. These factors become even more pronounced when men engage in sex trading in countries where sex work or sexual minorities are criminalized or decriminalized but not legalized. The information presented in this study can be used to develop future scholarship and targeted interventions to identify and address the unique needs of MSWs to improve their health and wellbeing.