Open Road Project

1. Open Road Project West Glasgow CHCP c/o Glasgow LGBT Centre 84 Bell Street Glasgow G1 1LQ Tel: (0141) 552 4789 Email: julian.heng@nhs.net or philip.forbes@nhs.net

2. Purpose • To identify the hidden population of men currently involved in prostitution and to ensure that this population receive the appropriate service provision from statutory services across NHS Greater Glasgow & Clyde. • The Open Road Project defines prostitution as: Males who engage in sexual activity in exchange for some form of payment such as: money, drinks, drugs, consumer goods or a bed or roof over their head for a night. This may take place in a variety of settings including private accommodation, brothels or on the street. • Health outcomes? Frequent reports of depression, suicidal ideation, attempted suicide, addiction, sexual ill health including risk of exposure to HIV and other STI’s.

3. Strategic Background • “…a real and meaningful commitment to promote and reinforce the rights of people to have mutually respectful, happy, healthy and fulfilled sexual relationships free from discrimination, abuse, violence or coercion as advocated by the World Health Organisation.” (p.2, Respect & Responsibility, Scottish Executive, 2005) • “Our objective is to improve Scotland’s health and reduce the health inequalities within our society. Poor health is strongly linked to deprivation and inequality. Our commitment to improving health in Scotland is integral to closing the opportunity gap… with a particular focus on the social groups most at risk.” (p.11, Partnership For Care, Scottish Executive, 2003)

4. Evidence base: on-street • An Overview of Male Sex Work in Edinburgh & Glasgow: The Male Sex Worker PerspectiveMRC, 2003 • Many men had not considered the potential impact of prostitution on their sexual health; attributed to young age, a lack of information & awareness, money not health was their primary priority and an initial feeling of being infallible. • “When you’re young you think nothing’s going to get me, I’ll be ok” • Intermittent condom use during involvement in prostitution was attributed to risk assessment based on client presentation/image, client preference, desperation for money, access to condoms.

5. Evidence base: on-street • An Overview of Male Sex Work in Edinburgh & Glasgow: The Male Sex Worker PerspectiveMRC, 2003 • Majority of men were unaware of their HIV status and attributed fear of result as their primary barrier: • “It’s not the actual test result but how I would handle the result if it was HIV positive and it was the case you have x amount of time left. I have kind of up in the air plans for the future, to suddenly have a time frame put on those plans, no, that is not what I’m looking for, that is not the idea” • “GUM, I went once, it wasn’t my thing.”

6. Evidence base: off-street • An ethnographic analysis of male escorting websitesP Eaglesham, Glasgow Caledonian University, 2008 • “Indoor” activity encouraged through the perception/seeking of less violence and the perception/seeking of self autonomy. • 20 key internet sites 398 “escort” listings in Scotland 183 listings in Greater Glasgow & Clyde 96% increase 2005-07 15% increase August – November 2007 • Trading on intimacy as well as sex – a real “boyfriend experience” • Websites claim to be community resources and liberating in spite of clear commercial interests and potential exploitation • The men involved appeared to be mainly Caucasian (84%), aged 18-30 and prefer out-calls.

7. HIV prevalence • HIV prevalence general population: 3.5% men who have sex with men: 7% men involved in prostitution: 9.3% HIV, STIs and risk behaviours in male sex workers in London over a 10 year period; G Sethi et. al., BMJ, 2006 • Outbreak of syphilis among men involved in prostitution in London, 2002. • Also, prevalence of gonorrhoea increased over time.

8. Sandyford Protocol • Women and Men involved in prostitution Nov 2007 • Offer a full sexual health screen Men involved in prostitution are often concerned about HIV infection Discuss HCV testing if there is a history of injecting drug use Offer HAV & HBV vaccination Discuss the use of condoms and lubricants • Open Road – Sandyford fast track card Potentially identifies client as being involved in prostitution Priority client for Health Advisor or Lead Nurse • Partners and concurrent partners