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I think alcohol is quite appropriate before the act, to relax, to create an atmosphere where people are more at ease. Especially when it’s the first encounter, when you see a person for the first time, so that you can have closer communication. (Boris, age 18, MSW6)
 
Current hard drug use was not reported by any respondents, although a small number reported earlier use they described mostly as experimental. Nitrites, commonly referred to as poppers, are recreational club drugs used to enhance sexual pleasure and were mentioned often. Use of poppers was typically by the client: “I know that there are a lot of things out there, for example poppers. But I don’t need them” (Maxim, age 18, MSW11). One hard drug mentioned was cocaine, which was used either by the client or in the past by the respondent:
I do not use drugs. There are a very few clients who use cocaine. It is relatively rare that they use poppers to enhance orgasms or to relax. But I have not tried them, and I have not tried cocaine. I am the kind of person who can easily get carried away, so it is better to not even try. (Dmitry, age 27, MSW8)
 
These responses stand in contrast, however, to the picture that emerges for street-based sex workers, about whom less is known:
It is obvious why women are working the streets: they work for the sake of a dose, earning money for a dose is at the top of the list, and then everything else. There are those among the men who work the streets that are there for the dose, but I don’t think that the percentage of drug users among men who have sex with men is that high. (Ivan, NGO1)
The Present Environment: Cause for Concern
 
Currently in Russia, male sex work occurs largely in an environment of intolerance and stigma. As a group that emerged after the collapse of the Soviet Union, civil society has had limited interaction with men who have sex with men, including MSWs. Targeted outreach activities for MSM that exist in Western Europe, North America, and Australia are relatively rare in Eastern Europe. Legally, individuals can be fined for sex work as an administrative offense, and the legal environment related to MSM more generally appears to be getting worse. A law passed in St. Petersburg in 2012 declared activities seen as promoting homosexuality to youth in public places an administrative offense (Statute 273-70 “Regarding administrative offences in St. Petersburg,” Article 7.1 Public actions aimed at promoting sodomy, lesbianism, bisexuality, transgenderism among minors). Individuals already have been fined under this new law, raising concern that it will be used to prevent social actions to support men who have sex with men (Associated Free Press, 2012; Schwirtz, 2012). This law has been described as discriminatory by the United Nations Human Rights Committee (Human Rights Watch, 2012a). Furthermore, the European Court of Human Rights found Russia in violation of laws permitting free assembly for denying activists the right to hold gay pride marches (Human Rights Watch, 2012b). Even more recently, in 2013, the State Duma (lower house of parliament) passed similar legislation at the national level in an overwhelming vote of 388 to 1; this law is largely seen as an attempt to crack down on Russia’s gay community (“Duma approves,” 2013).
The strong homophobic attitudes in Russia are also reflected in the media. At the time this chapter was written, a headline in a respected news source read, “Moscow rejects bid to hold gay rights parade” (Roth, 2013). An application to have a gay rights parade was rejected by city officials in order to “work clearly and consistently on maintaining morality, oriented toward the teaching of patriotism in the growing generation, and not toward incomprehensible aspirations.” One week later a headline read, “Officials say homophobia motivated murder in Russia” (Barry, 2013), followed by the lead, “The brutal murder of a 23-year-old man in the southern city of Volgograd was motivated by homophobia, investigators said Sunday, a rare acknowledgment that comes during a period of rising conservative and antigay sentiment from Russian officials.” Though specific to MSM, it is clear this environment also will have deleterious effects on MSWs, including violence they may experience related to their work.
Moving Forward
 
Two conclusions from the research can be stated with near certainty: male sex work is not uncommon in post-Soviet Russia, and the men involved experience multiple vulnerabilities. Vulnerabilities related to professional isolation, limited disclosure about their work, threats to personal safety, limited perceived HIV risk, and suboptimal condom use clearly put them at elevated risk for HIV and other negative health outcomes. Prevention planning should be an important priority.
Although important findings can be gleaned from this small body of research, gaps in knowledge about male sex work in Russia remain large. First, current research has not uncovered the range or depth of vulnerability for all types of sex workers. The least is probably known about the most vulnerable men, including street-based sex workers, migrants, and those who are addicted to drugs and engage in sex work for survival. Second, the landscape in which male sex work occurs is rapidly changing and needs to be monitored. For example, the emergence of the Internet as a tool to arrange sex services is a relatively new phenomenon that has changed the role of sex work in society. Also, as noted by others (Baral et al., 2010), more definitive research on MSWs in Russia is needed to address the dynamic nature of the economic status of Russians (e.g., increasing unemployment in the current global economy) and ongoing migration from nearby regions (e.g., former Eastern Bloc countries), as these circumstances may increase the likelihood of people engaging in commercial sex work.
Moving forward, increasing our knowledge about MSWs in Russia can be achieved most effectively using the framework of syndemics in public health. Proposed by medical anthropologists as a way to conceptualize the impact on health of synergistic interaction between two or more forces (Singer & Clair, 2003), this approach recognizes the intertwinement of social, physical, and psychological conditions that influence multiple and related health states. Addressing the needs of MSWs in Russia will require an understanding not just of their health behaviors but also of the environment of stigma, discrimination, and violence in which they work.
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Acknowledgments
 
The author would like to acknowledge Ksenia Eritsyan, Elizabeth King, Maia Rusakova, and Liliya Safiullina at the NGO Stellit in St. Petersburg, Russia, and Yale University in New Haven, Connecticut, for research and thoughtful discussions that contributed to this work.
Research on male sex workers brings alive some of the key concepts developed by theorists on masculinity. For example, this chapter shows the fluidity of sexualities, with men often positioning themselves as top, bottom, or versatile, and as offering services only for men or for both men and women. The notion of hegemonic masculinity is also clarified through research on male sex workers, where we find men who do not identify as gay and explain their sexual performance by taking on certain sexual acts, such as being the person who penetrates but is never penetrated himself. These men maintain their masculinity by avoiding sexual acts that can be defined as “whoredom,” which are only performed by clients and never by them. The diversity of body types, from body builder to a feminine hairless body, also illustrates how body types and sexual hierarchies are played and made real in the male sex worker encounter. Not surprisingly, most tops have physiques that embody masculinity, whereas most bottoms have physiques that emphasizes the feminine
.
What is striking about the images in this chapter is that many young male escorts openly display their faces and identities in the public domain. This is a significant development: for one, it indicates that some young men are no longer concerned about hiding their work as escorts or their personal identity. This is especially striking in South American culture, given that masculine norms there have tended to be more proximate to hegemonic notions of masculinity, which have largely rendered the male body invisible in public spaces. Social theorists often have spoken of the male gaze, which describes the tendency for cultural imagery to be displayed and consumed from a male viewpoint and thus to present females as subjects of male appreciation. In the images in this chapter, the male body is an object for consumption by men and women, and putting a face on diverse body types makes it clear that a male sex worker can be anyone in our society
.

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