18/01/2022 | Writer: Hans Knutagard

What are tomorrow’s challenges for social and health work with gay and bisexual male sex workers?

Challenges for social and health work with gay and bisexual male sex workers Kaos GL - News Portal for LGBTI+

This short essay is built upon a case study of one young Swedish gay male sex worker I have followed at different venues in his work life that have included a brothel, an escort agency, and his private business (Knutagård 2016). The aim was to investigate ways to enhance health equality for male sex workers, despite the discrimination, stigmatization and violence they face. The study also involved eight semi-structured qualitative interviews with him, informal conversations, ethnographic fieldwork, and access to his personal diary. The collection of data, coding, and analysis of the material were interrelated processes and the theoretical positions used to analyse the material were based on the notion of social capital and cultural historical activity theory.

Research on male sex workers is sparse, compared to that on female sex workers, even though more research has been done in recent decades. The phenomenon of people selling and buying sex and the sex trade industry has been high up on the public agenda, not only in Sweden. There is a wide range of perspectives on the phenomenon of sex workers. Despite this variation, it is possible to distinguish two major themes in the discourse. The first theme is the sex worker as an exploited victim – where s/he is regarded as an individual with limited control over her/his own life and their role in the sex-selling trade. Conversely, there is the situation where the sex worker is in charge of her/his own life and own agency. This essay assumes male sex workers to be both victims and agents. Second, most studies base their perspectives on either the environment or the personal character of the sex worker. This essay takes its point of departure from where these two perspectives meet – in the reciprocal interrelation between the person who sells sex and the sex-selling activity.

Ethan’s story in brief

Ethan (pseudonym) was born in Sweden 1984 of parents from varied ethnic backgrounds and different religions. As a result, he has an indeterminate Mediterranean and androgynous appearance, which makes him appear younger, something he used in his favor when it came to his sex work. Ethan has always been very sexually active. He “came out” as gay in high school after he mobilized some friends to support him. At the age of 14 Ethan consciously sold sex for the first time. Cruising for friends on a gay-community site on the Internet, he was offered remuneration for sex from a 40-year-old man. It sounded interesting, and he wanted to try it out. In return for the sexual encounter Ethan got €200. Drawing on this experience, he began strategically to sell sexual services now and then in return for money and gifts, and by doing so he acquired negotiating and social skills and proficiency in the sexual activities clients wanted.

At 20 Ethan was travelling around Europe during the summer, he ran out of money when he was visiting a major capital and stayed to try his luck; “I’m on an adventure trip,” he writes in his diary. At the youth hostel, with only €50 in his pocket, he opened a gay map and found a gay brothel just around the corner. He took the opportunity at once. At the brothel, Ethan said, he could choose clients and was not forced to meet with a client whose sex preferences he could not meet. He describes that he felt most secure and experienced and had the most power over his own life when he worked at the brothel. Working full-time in the brothel gave him both resources and the possibility for building up a network of friends in order to generate returns – social capital. Ethan was able to rent a small room and was also admitted to study for his future profession. Work at the brothel shifted to a part-time job when he needed the money.

A year later when Ethan needed money again he start working for a gay escort service. Ethan felt like an object with no influence whatsoever over the client, the kind of sex, or the payment. He said, “I felt I was stripped of all dignity.” He had no control over when the agency called him; he could be interrupted at the university where he studied. Ethan experienced himself as a commodity being chosen because of factors he was not aware of and could not influence. He was picked up by a taxi and driven to some place unknown, with no contact whatsoever with the client before the sex work. This approach resulted in Ethan bit by bit losing his willingness to follow his life goals. When he had no control, he felt drained of his power to control himself, like a victim of circumstances. Ethan got back into the university and he stopped active sex work for a while because he was studying full-time. Three years later Ethan started his own business and as head of his own small enterprise, he felt in charge, in control, and organized. He could present himself as he wished and could describe in detail what kind of sex he could perform or engage in.

How are we going to understand this theoretically?

An important factor, based on the cultural-historical activity theory, is that an individual does not meet other people or her/his social context directly; they are mediated through human activity. An individual develops through those activities, where activities are an endless process of movements, changes, remodelling, and development. Throughout a person’s lifetime she/he expands the number of activities she/he is part of, by consciously or unconsciously “stepping into them”. In all of the everyday activities an individual “steps into,” she/he has experiences, and through these experiences she/he build her/his self-image, personality and becomes socialized. In this dialectic relation, collective development always precedes individual development.

A few words about vulnerability and violence are required here

In Ethan’s case we can regard selling sex as a choice by himself, but for many boys and men it is a result of various ties to vulnerability in their situation. One is vulnerability to sexual and physical abuse in the domestic sphere at an early age, which can result in boys leaving home. Due to the abuse in the home, they are separated from the protective family unit and enter unprotected situations of street living or into low-level unaccompanied child labour situations. While in this state, they are often exposed to sex work as an alternative way of surviving. At a more extreme tier of vulnerability they become exposed to multiple levels of sexual and economic exploitation like sex-selling, trafficking, making of pornography, sex traveling and sex tourism.

Another factor making a homosexual boy leave home can be honour violence and oppression. Nasif, a 18-year old Afghan who lived in Iran and migrated to Sweden 2015 told me about the structural system of oppression and threat which made it impossible for him to stay with his family and forced him onto the street and then to Sweden.

Nasif: “You work to buy food, like milk, eggs and so on. After you have eaten what happens then? They gather together like garbage. What do you do with the garbage? Who is responsible for them? Who reminds the family of throwing the garbage? The person in charge, the mother or the father. Who is responsible for throwing the garbage collected on the street? Ultimately the government. If someone in the family doesn’t throw away the garbage, what happens? First, the family forces someone in the family to do so. If not, the neighbours will notify the police and in the end the government comes. I'm just like garbage for them in Iran. They look at me just like garbage. Even if one person has treats me kindly, others can’t forgive me. I can have value and live only if they think I'm not like garbage. For example, in my country and for the people there, being gay means being a “nothing”. Being gay is just like being perverted. Gay – that means a dangerous thing in my home country. My family they believe in this and take responsibility for removing garbage from their home. So me! But I am their child. Why should they kill me? Because they think I'm wrong.”

Another force putting young boys into the street and forcing them to get involved with sex-selling in order to survive is totalitarian family violence. Jamal express that like this:

Jamal: “My relationship with my dad is pretty bad, even before he found out that I was gay. So he like to harass me, bully me, and hit me, everything since I was born. When I was seventeen he suspected I was gay. What happens is that he came back home one day and he kept punching me, kicking me, he broke my bones, my face was totally bleeding, everything was so bad, everything hurts.  I was sent to the hospital. I had long hair before, I didn’t have beard or anything, I was young. He shaved me, he came to my room after he hit me to the floor, he went and brought a machine and he shaved all of my head, he shaved all of my hair, and he kept me grounded for three years. Yes for three years. I never left the house for three years. I was in my room, not even the house, only in my room, I was only allowed to go out to the toilet and go back to my room. My dad told me ‘if we were in Jordan I would have killed you and buried you under the ground without people knowing because you brought shame to the family’”.

Jamal is highlighting different kinds of violence that we must be aware of as social workers. We have the most common violence that is targeting the physical body, with the goal to harm or inflict pain, from death to a slap, like rape as we mentioned in an earlier lecture. The mental health could also be the direct or indirect goal for violence through fear, discomfort, uncertainty, but also harassment and bullying. Other forms of mental violence are non-recognition or mis-recognition. There is also the power to construct reality according to one’s own interests that then threatens or exert violence against another person’s integrity. That is called symbolic violence. Finally there is structural and social violence which is expressed via methods that are ruler or power based techniques for sorting people, isolating, spacing and for creating social hierarchies, like hate crime, homophobic violence, honour violence and discriminating and or punishing legislation.

These kinds of violence make HBTQ-boys feel bad during their socialization and are a basis for mental ill health. Nasif explain how he internalized the interpersonal opinions in his surroundings during his teenage year and how he feels participating in a gay-friendly organization, where he can gain new social capital.

Nasif: “In the past, I thought it was me. In my heart, for example, I liked a guy, but my thoughts said ‘it´s wrong’. Everyone tells me ‘it´s wrong’. God tells me ‘it´s wrong’. My family tells me ‘it´s wrong’. Everyone in the family tells me ‘it´s wrong’– that's why I also think it´s wrong with me. Maybe I´m wrong? In my country, for example, I can´t hug a guy, kiss a guy, because then people will kill me. That´s why they think it´s wrong with me. But when I come here and I meet other gay people, who have experienced the same thing as me, I understand slowly, slowly and slowly I feel that ‘I am not wrong’. Because there are other people just like me”.

Social capital

The notion of social capital is described on an individual level as an investment in social relations in order to get reimbursement, along with the resources embedded in the social structure that are accessible and mobilized by goal-directed actions (Lin 2008). Returning to Ethan we find that in different activities he meets other people and interacts with diverse environments. But when Ethan strives upward, he has to concentrate on sex work and has to leave friends in the non-sex activities. Because he is in the sex trade, he meets people in these activities, and therefore most recommendations he gets will be for such activities. On the other hand, only his closest friends know about his sex work; he has not revealed it to his family or others, not even his mother, because he feels it would be so stigmatizing. Therefore is he not able to benefit from their support, and covering up his sex work takes massive amounts of energy and time, which is indeed stressful for him. At least two factors prevented him from using his experience to get back into “society”; first, sex work is “anonymous” and, second, it is hard to find people, in the society’s “dammed sexualities” who know people and would be able to connect him to employment or study outside the sex industry. His chances are limited when his everyday life consists of sex work activities. In other words he had access to only a limited number of activities, which were all connected with sex work. To make a shift in his life, he needs to develop and sustain a broad variety of relations to people in other activities not connected to the stigmatizing sex work.

Rethink new and different approaches to health prevention

Social service is often unsuccessful in reaching out to Ethan or other boys and men selling sex with offers of assistance. Nor are they offered sufficient educational and employment skills. One of the major reasons that they are overlooked is that that social services and public health programs do not recognize male sex work as the complex issue it can represent. The key finding of my study is that there is a reciprocal connection between the structure of the external sex working activity, a brothel, an escort agency, and his private business, and the internal experience of ownership (capacity of agency) by the young man. Furthermore the sex selling activities are embedded in the larger structures of society. This orchestrates the norms of and actions in the activity, which makes male sex work shameful, stigmatizing, invisible and can lead to victimization and overt violence. Depending on the degree of his agency – his consciousness of and ability to cope with vulnerability altered. The study concludes that when individuals feel in charge of their life, they are more likely to take care of their health and their social and economic future.

So, what to do?

The most important thing we can do is promote positive sexual identity development for people and to promote diversity and pluralism in the meeting with the individual. We also need to help the individual make well-founded decisions when it comes to sex and risky behaviour and to support people in their decision whether come out of the sex work or continue to work in the sex. Out of a human rights perspective we should counteract all forms of discrimination and have a holistic view of the individual's life. In order to do so we need to dare to stick around and listen to what they have to say.

Knutagård H. (2003) Introduktion till Verksamhetsteori. [Introduction to Activity Theory] Lund:


Knutagård, H. (2016) To do or not do, that is the question: A male sex worker’s perspective.

         International Public Health Journal 2016;8(2).

Knutagård, H. (2021) Där, här och mittemellan – några migrerade hbt-mäns röster om sexuell

utsatthet. In: Pernilla Ouis (red.) Sexualitet och migration i välfärdsarbetet. Lund: Studentlitteratur.

Lin N. (2008) Building a Network Theory of Social Capital. In: Lin N, Cook K, Burt RS. Social

         Capital, Theory and Research. New Brunswich, London: Aldine Transaction.

*This article was produced with the financial support of the European Union. Its contents are the sole responsibility of Kaos GL Association and do not necessarily reflect the views of the European Union.


Tags: human rights, labour