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The social, economic, and political changes that accompanied the collapse of the Soviet Union in the early 1990s were unprecedented and widespread. This period of transition, which was characterized by a rapid decline in gross domestic product that left many people economically vulnerable, coincided with a shift in moral norms among many segments of the population toward Western values (Atlani, Carael, Brunet, Frasca, & Chaika, 2000). Facilitated by changing social norms that increased the supply side, commercial sex work subsequently proliferated, for many as an adaptive response to loss of previous income (Levina et al., 2012).
Sadly, these economic and social changes also created a “perfect storm” for the emergence of HIV. While many regions of the world began to see a significant spread of HIV in the 1980s, the Soviet Union remained largely unaffected. In the mid-1990s, however, opening borders to trade allowed an illegal drug market to emerge, predominantly involving heroin from Afghanistan. Relaxation of state control and the desire of young Russians to embrace Western ideas and products resulted in a dramatic increase in injection drug use (Heimer, Booth, Irwin, & Merson, 2006) and permitted HIV to be seeded in this population. The rapid spread of HIV followed. A review of the early days of the HIV epidemic in Russia (Feshbach, 2006) sees a discussion of the role of drug use, sex workers in general (presumably female), men who have sex with men (MSM), nosocomial (hospital-based) transmission, and the general population in the transmission of the virus. Male sex workers (MSWs) were not mentioned, which reflects the limited knowledge available at the time about this population, relative to this pressing public health topic.
Since that time, the HIV epidemic has continued to expand unabated. While the HIV epidemic in Russia remains largely concentrated among injecting drug users and the subset of female sex workers who use drugs (Niccolai et al., 2010; UNAIDS, 2009, 2010; WHO, 2004), the estimated national prevalence of adult HIV now exceeds 1 percent (UNAIDS/WHO, 2009). Coupled with the increasing percentage of new cases attributed to sexual transmission (Pokrovsky, Ladnaya, Sokolova, & Buravtsova, 2011), this raises concern about the potential for transmission beyond known high-risk groups to a more generalized population (Lowndes et al., 2003; Niccolai, Shcherbakova, Toussova, Kozlov, & Heimer, 2009). In this context, a small body of research has been conducted about the risks for HIV among MSWs, another potentially important vulnerable population about which little is still known.
The literature reviewed for this chapter is primarily from the field of public health and derived from the pressing need to understand the trajectory of the HIV epidemic in Russia. It reviews what is known about male sex work in post-Soviet Russia, a time of rapid social transformation and economic upheaval. It begins with a brief overview of the Soviet period and then reviews the period from the late 1990s to the present day, with a focus on the two largest cities in Russia, Moscow and St. Petersburg, which reflects where research efforts have been concentrated.
Sex Work in Soviet Times
 
Prostitution in the Soviet era was associated with material and commercial interests and therefore not officially recognized by the communist state (Levina et al., 2012). Brothel owners and others who facilitated the exchange of sex for money were given penalties, including imprisonment, but not the women engaged in prostitution directly. Closed borders and tight state control limited research on this topic and resulted in a paucity of knowledge about sex work in that era. It is known that sex work existed in a variety of forms, as reviewed by Levina et al. (2012), but this is specific to female sex work. To the best of our knowledge, even less is known about male sex work in the Soviet Union.
Early Studies in Post-Soviet Russia: 1999-2002
 
As the Soviet era drew to a close in the 1980s, including
perestroika
(restructuring) and
glasnost
(openness), the landscape for sex work also changed. Public moral attitudes changed dramatically, and the purchase of sex by men came to be viewed by many as a normal and not uncommon behavior (Levina et al., 2012). Sex work, at least among women, became much more visible, such as women working on the streets, and sex work was legally classified as an administrative offense rather than a criminal one. In this setting, research began to expand.
Among the first studies published on sex work in post-Soviet Russia were two conducted from 1999 to 2002 in St. Petersburg (Aral, St. Lawrence, Dyatlov, & Kozlov, 2005) and Moscow (Aral et al., 2003). In both cities, sex work among females was more visible and readily described than among males. For context and comparison, a brief description of female sex work is provided here. Using qualitative and rapid assessment methods, female sex work in each city is described as occurring in various ways, including exclusive escort services; agency-based services, including use of the Internet; venues such as hotels, massage parlors, and brothels; and public locations including the street, railway and train stations, and truck stops. The hierarchical nature of female sex work is also described, with a more elite group of women working for escort services and in five-star hotels and the most economically vulnerable women working in public places. Female sex work in St. Petersburg is described as “ubiquitous,” and street-based female sex workers were often involved with drugs. Several types of agencies existed to facilitate female sex work, ranging from publicly advertised escort services to “marriage” agencies involved in trafficking. Brothels often operated in large apartment buildings. Virtual Internet brothels were another type of agency, which potential clients used to arrange for services online by visiting specific websites. Female sex work in Moscow was described as more socially organized and frequently involved pimps and assistants, including drivers, assistant female pimps, guards, and recruiters. Female sex work in Moscow was also linked to the internal and external migration of women and their clients.
In contrast to female sex work, these studies revealed little about male sex work. In St. Petersburg, male sex work was reported to occur less frequently than female sex work but to be getting more overt. Arranging for male sex services typically occurred either through agencies or in public places. Agencies included Internet brothels and those that also arranged for sex services from female sex workers. The best-known public place for arranging male sex services was a park on the main road running through the central city. Also of note were several gay clubs that opened in St. Petersburg during this time. In Moscow, male sex work was described as similarly hierarchical to that of female sex workers and often to be club-based in well-known districts of the city. The research noted that the volume and organization of sex work were sensitive to social, political, and economic contexts and thus variable and likely to change over time.
Another study conducted around the same time but using different research methods similarly revealed the presence of male sex workers in St. Petersburg. In 2000, 434 MSM were recruited in gay-identified venues to participate in structured interviews; 23 percent of them reported having sold sex for money or other valuables (Kelly et al., 2001). These men were relatively young, with a mean age of 23.8. They reported high levels of bisexual behavior, with a large majority (87 percent) reporting having had sex with a female, and nearly half (47 percent) reporting having had a female sex partner in the previous three months. These MSWs were more likely to be unemployed than MSM not engaged in male sex work, were less well-educated, and reported not having enough money to buy condoms. Risk behaviors were high among this group, who had had an average of three sex partners in the previous three months; 45 percent reported having unprotected anal intercourse in the previous three months, and 33 percent reported having had a sexually transmitted infection. Also of note, 28 percent of the men who reported selling sex also reported paying for sex. Collectively, these findings indicate that MSWs were a vulnerable population during those years in post-Soviet Russia, both economically and in terms of health risks, with a complex set of behaviors not yet well understood.
The Following Years: 2003-2010
 
Despite the early literature documenting the existence of male sex workers in post-Soviet Russia, limited research followed. We are aware of only one public health study that specifically targeted this population shortly thereafter. A pilot study of MSWs was conducted in Moscow in 2005-2006, in which 50 men were recruited through venue-based and snowball sampling methods (Baral et al., 2010). Results of a structured survey suggested that these men face myriad risks related to migration status, violence, substance use (predominantly alcohol), and sexual behavior. Furthermore, testing showed an HIV prevalence of 18 percent, or 9 of the 50. Although easily identified and recruited into this study, the population was difficult to follow over time, in part due to the men’s intermittent involvement in sex work. The authors also noted the men’s relative autonomy as compared to female sex workers, who often are under the control of pimps. Although limited in scope, this study described a population clearly engaged in risk behaviors and in need of further study in order to gain a more complete understanding of the contexts in which they worked.
The Current Situation: 2011-Present
 
The most recent and in-depth research on male sex work was conducted during 2011 in St. Petersburg, the western-most city in Russia, which has approximately 4.5 million residents. It is also considered the cultural capital of Russia with its rich tradition in the arts, education, and science. Unfortunately, St. Petersburg is also one of the cities most affected by the explosive HIV epidemic in this vast nation, which has revealed the presence of highly vulnerable groups, including injection drug users and sex workers. To learn more about the nature of male sex work in this city, we conducted a qualitative study among male sex workers and other key informants in 2011, for which the methods and results have been reported previously (Niccolai, King, Eritsyan, Safiullina, & Rusakova, 2013). Here we summarize our key findings related to patterns of sex work and social vulnerability. The quotations are attributed to MSW participants using pseudonyms.
Patterns of Male Sex Work
 
Male sex work in St. Petersburg occurs in both organized and unaffiliated ways, and it spans the spectrum from highly paid escorts to men who work on the streets for subsistence. There also appears to be a hierarchy of risk, with those working on the streets most vulnerable because of their poor economic and social standing. In general, male sex work was reported to be a practice that “happens a great deal” (Ilya, age 31, MSW3); one MSW said that “everyone is ready to take the opportunity” (Sergei, age 27, MSW12). It was also noted that what MSWs receive as payment varies, with sex for clothes, meals in restaurants, or gifts instead of money being “far more common” (Dmitry, age 27, MSW8):
Yes, sex is sold for money all the time. Sex for clothes, too. It is not that it is exactly prostitution … It is a common practice. People meet up with each other, and someone buys someone clothes. And that is it. (Anatoly, age 21, MSW1)
 
The types of male sex work vary according to the locations used to arrange and negotiate sex work, including recruiting clients on the Internet, through organized agencies, at social venues, and in public spaces. Like geographic locations (McFarlane, Bull, & Rietmeijer, 2000; Nureña et al., 2011), the Internet clearly has greatly facilitated finding paying sex partners in St. Petersburg in a variety of ways. For example, it is used by both individuals and agencies and helps in arranging commercial sex across broad geographical regions. The Internet offers other advantages, such as being able to negotiate a price in advance and to converse with a client, albeit virtually, before an in-person meeting. However, the Internet also allows men to work in relative isolation and may contribute to the lack of social cohesiveness among male sex workers (discussed further below). The participants mentioned several websites that facilitate male sex work: “There might be 20 addresses, I do not remember them all” (Ivan, NGO1). Many websites they mentioned are dating sites where men can either indicate that they are interested in finding sex partners who will pay them (e.g., clients) or discuss this after communication has been initiated. Online message boards were also commonly reported as places where individuals post advertisements, to which potential clients can respond electronically:
I submit the advertisement on the Internet … and I write up front why I need this meeting. It is specified up front that it is sex for money or something else … They already know what this is. And they already want it. (Nikolai, age 22, MSW7)
 
The ease of finding clients via the Internet was cited as a reason for its increased use: “Since the Internet became widespread [for meeting sex partners], club culture has become more a social place than a hook-up place … If it [sex] is for money, then it is mostly through the Internet. There it can all be negotiated up front and where messages are exchanged” (Peter, NGO2). “In general, prostitution is not happening in the clubs, it is on the web” (Andrei, CLUB1). The Internet also was said to facilitate male sex work by helping men make connections in different cities (e.g., Moscow). Others noted that the Internet facilitates finding gay clubs, where sex is sometimes sold: “(Interviewer: And where does the information about this [clubs] come from? The Internet?) Of course, the Internet” (Anatoly, age 21, MSW1).

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