DOI: 10.1590/1413-812320182412.27842017 4707 Male sex workers: between safe sex and risk. Ethnography in a free themes gay sauna in Barcelona, Spain Constanza Jacques-Aviñó (https://orcid.org/0000-0001-8506-780X) 1 Anna de Andrés (https://orcid.org/0000-0001-6980-2050) 1 Llanos Roldán (http://orcid.org/0000-0002-0198-9135) 1 Manuel Fernández-Quevedo (https://orcid.org/0000-0003-1835-4766) 1 Patricia García de Olalla (http://orcid.org/0000-0002-2293-3560) 1 Elia Díez (http://orcid.org/0000-0002-0353-3916) 1 Oriol Romaní (http://orcid.org/0000-0001-6939-0711) 2 Joan A. Caylà (http://orcid.org/0000-0003-3891-111X) 1 Abstract This ethnography was conducted in Barcelona, a city that provides different gay lei- sure resources, such as gay saunas. We aimed to analyze from studies on gender and masculinities, how sexuality, perception of HIV infection and other sexually transmitted infections (STIs), and preventive measures are articulated in gay sauna male sex workers (MSW). Ten in-depth inter- views and observation were conducted between 2012 and 2016. Safe sex practices are more fre- quent with clients, while risk practices are carried out more with non-commercial partners. Sexual orientation plays an important role. Homosexuals assume riskier practices in sex work than hetero- sexuals. Drug use or lack of support networks were associated with higher social vulnerability and risk behaviors. Contracting HIV still creates fear, while having other STIs is perceived as part of a man’s sexual life. The MSW affirms masculinity with concurrent sexual partners, breadwinner, and on the other hand, questions a heteronor- mative model. Interventions for the prevention of HIV and STIs in this group should consider social determinants such as inferior work alternatives and the provision of more significant social sup- port. 1 Servicio de Epidemiología, Key words Sex work, Masculinity, HIV, Ethnog- Agència de Salut Pública de Barcelona. Plaza Lesseps 1. raphy, Sauna 08023 Barcelona España. cjacques18@yahoo.es 2 Universitat Rovira i Virgili (URV), Tarragona, España. 4708 Jacques-Aviñó C et al. Introduction In this regard, ethnographic research is recommended in order to understand better Male sex workers (MSW) defined as men who the incidence, contexts, and risk behaviors sell or exchange sex for money or goods are a very associated with sexual relationsbetween men and diverse population among different countries, transmission to their sexual partners15. This study and even within the same country1. Although focused on indoor prostitution in a gay sauna, MSWs offer sexual services to men and women, and aimed to analyze, from the perspective of male clients are much more frequent2. Besides masculinities, how sexuality is articulated, the the risk involved in the practice of anal sex, perception of HIV infection and other STIs, and several social determinants such as having limited the preventive measures of MSWs that offer their economic opportunities, the lack of legislation services in gay saunas in Barcelona. and protective policies in matters of sex work (SW) and the invisible nature of this activity place MSWs in a position of vulnerability to Methods contracting HIV and other sexually transmitted infections (STIs)3. This research was developed from the socio- At the Spanish level, the self-reported constructionist perspective, which proposes prevalence of HIV was 17.5%4 in a sample of 487 that people’s experience and statements are men who declared having sex in exchange for the product of social and historical processes. money. In Barcelona, of 548 MSWs presumably An exploratory and ethnographic study was seronegative to HIV or with unknown serology conducted between 2012 and 2016 in a gay sauna and submitted to a rapid test in gay saunas, 8.7% in Barcelona, and 10 in-depth interviews with were reactive to this test5. However, studies on MSWs were held in 2015 and 2016. Observations male sex trade are scarce since research on HIV were made in the sauna, and field notes were and other STIs usually include it in the category taken. In the sauna, the research team, consisting of men who have sex with other men (MSM) or of a psychologist and anthropologist, two nurses within the group of people engaged in prostitution, and a doctor, participated in informal interactions which include women and transgender, groups with sex workers, clients, and employees of the with very different characteristics1. establishment. Prostitution is alegal in Spain; it is not This study was carried out within the regularized or penalized, what is condemned framework of the “Saunas Program” carried out is pimping, the fact of forcing someone into by the Public Health Agency of Barcelona (ASPB), prostitution and obtaining benefits from it. The which consists of providing rapid tests for HIV, press and the media set Spain as one of the leading other STIs, and vaccination against hepatitis destinations for those seeking paid sex6. Barcelona A and B in different gay saunas. Users collect provides resources for leisure and consumption the test results at the ASPB, where they receive of paid sex aimed at the homosexual public, counseling, and HIV positive cases are referred as well as places to have sexual relationssuch to hospital units for confirmation and treatment. as gay saunas7. These places favor anonymous The sauna was selected by convenience since it is encounters for men to interact socially and one of the places where SW is exercised. sexually and are perceived as permissive and at Semi-structured interviews were conducted, risk of contracting HIV by the very users of these sociodemographic information was collected, places8,9. and six topics on the experiences and beliefs Gender studies show how sociocultural of the MSWs were explored through a script patterns, social and sexual practices are modeling (Chart 1). The interviews were recorded, except masculinities and influencing health10. The one, since the MSW wanted to keep his full literature on this subject has focused mainly on anonymity. Once interviews were transcribed and the hegemonic model related to assuming risk field notes compiled, an interpretative thematic behaviors, not showing weakness, and exhibiting analysis was carried out to identify underlying a high degree of virility11. They also point out that ideas, assumptions, and conceptualizations men are less willing to consult health professionals from which categories and subcategories and express their fears despite worrying about were established16. The analysis was flexible their health, an exacerbated situation in less and conducted throughout the fieldwork by favored social classes and stigmatized diseases researchers who participated in the observation such as HIV/AIDS12-14. and interviews, and was triangulated by experts 4709 Ciência & Saúde Coletiva, 24(12): 4707-4716, 2019 Chart 1. Script of the semi-structured interview conducted with male workers in gay saunas. Barcelona, 2015- 2016. Topics to explore Reasons for having started sex work Experiences associated with the exercise of sex work in the sauna, with clients and partners Socialization of sexuality and attitude towards homosexuality Experiences and representations about sexual practices by commercial and non-commercial sexual partners Representations of HIV and other sexually transmitted infections Perceived and proposed needs for the prevention of HIV and other sexually transmitted infections in MSW in Public Health and Medical Anthropology. This Sex work in gay saunas study was approved by the ethical committee of the Hospital del Mar de Barcelona and with the The sauna is open 24 hours a day, and is informed consent of the respondents. Those who equipped with swimming pools and offers agreed to participate received a 10-trip urban spa services, as well as a bar and rooms freely transport card worth 10 euros as compensation. available, and other more private rooms through extra payment. The user who enters receives a Contact with participants towel, pool sandals, a condom, and locker keys. This establishment does not obtain any direct The interviews were provided to the MSWs economic benefit from the SW. What happens contacted in saunas and those who came to inside is a transaction that managers say is not collect the result after the tests were carried out. their responsibility. The sauna exercises the right All interviews were conducted at the ASPB in of admission, as commented by some MSWs: order to preserve confidentiality and privacy. Of entrance is restricted, either through beauty the twelve MSWs that were offered to participate, criteria or for having caused some trouble before. two refused, claiming that they did not want to Among the benefits of working in the talk about their sexual relationships with other sauna, as opposed to offering sexual services in men and both self-defined as heterosexual. an apartment, the possibility of choosing the Finally, ten MSWs from different countries were client, freely managing time and having greater interviewed, four self-defined as heterosexuals, economic autonomy was noted since the gain five as homosexuals and one bisexual. The of transactional sex is an exclusive benefit of possibility of adding some information was the MSW. Sauna MSWs are, in general, young always left open, which allowed three of the gym-shaped and well-built bodies. Some MSWs informants to be interviewed more than once. spent the night in the sauna, especially those The characteristics of the respondents are who worked seasonally in different Spanish or described in Chart 2. The study was closed when European cities, thus saving the rent of a room or data saturation was reached. house while residing in Barcelona. MSWs referred to the sauna as “the office”, as a way to normalize the place and their professional Results activity. However, in one of the interviews, a self-defined heterosexual MSW called the sauna Six thematic categories were established: sex “hell”, since it was a place that questioned his work in gay saunas; sex work: benefits and sexual desire. disadvantages; dynamics and social relationships in the sauna; sex work as a man; sexual practices Sex work: benefits and disadvantages by type of partner and HIV/STI/prevention. Chart 3 shows a selection of textual quotes from The reasons for engaging in SW are diverse. the interviews. In most cases, one enters through a friend or 4710 Jacques-Aviñó C et al. acquaintance. On the one hand, there were talks TSI4 sex, without committing as a sChart partner. 3 Regular status: having a residence or nationality that allows one to live in the European Union in an administratively legal way. 4 TSI: Individual Health Card, the document Advertisements: Offer of paid sex through the announcement on the app or Internet for sexual contacts. 2 Follamiga (Friendship with benefits): couple relationship that combines friendship and the possibility of having about the economic need related to emergencies Yes Yes Yes Yes Yes Yes Yes Yes No No experienced as extreme, such as paying rent HIV serological Regular or paying for the mother’s surgery in a foreign status3 country. In other cases, it was out of curiosity, Yes Yes Yes Yes Yes No No No No No in men who felt homoerotic desires but lived in homophobic environments where it was hard to relate to other men. status Negative Negative Negative Negative Negative Negative Negative Negative Negative Immigrant men in an irregular administrative Positive situation were faced with very reduced and scarce employment opportunities, especially during the socio-economic crisis. Although there were some start year Sex work Spanish MSWs, most were from Latin American countries and Eastern Europe. The difficulty of 2014 2015 2011 2010 2000 2014 2004 2006 2014 2009 entering the formal labor market was not only related to not having a work permit, and in some Places/strategy to Sauna / nightclubs cases, to the low educational level but also having Sauna /nightclubs contact clients advertisements1 advertisements advertisements advertisements advertisements experienced structural racism. On the other hand, the most accessible labor alternatives for some MSWs crossed the threshold of legality, Sauna / Sauna / Sauna / Sauna / Sauna / Sauna Sauna Sauna with which the SW became a good alternative. One of the worst problems perceived by the sexual orientation MSWs was drugs. Drug consumption occurred Self-reported at the customer’s request and to withstand Heterosexual Heterosexual Heterosexual Heterosexual Homosexual Homosexual Homosexual Homosexual Homosexual long work hours. Indeed, some respondents commented that they started to consume in the Bisexual Chart 2. Sociodemographic characteristics of the 10 male workers interviewed. Barcelona, 2015-2016. sauna. The use of sexual stimulants was also widespread. Some MSWs also used drugs outside friends with benefits)2 the workplace, at leisure or in other saunas. In Married to a woman With female partner Single (follamiga = With male partner Secondary School (Incomplete With male partner some cases, they participated in chemsex a session, Marital status which involves the consumption of some drugs for sexual purposes for several days. On the other hand, one could observe that, for Single Single Single Single Single some, the experience of having sex with men was lived with conflict, especially for heterosexuals Secondary School (Incomplete Secondary School (Incomplete or for those who had greater internalized homophobia. Another disadvantage mentioned was the lack of legal support regarding their Schooling rights as SW. Besides the risk of contracting that allows access to the benefits of the Spanish public health system. Higher Education) Higher Education) Higher Education) Secondary School Secondary School Secondary School diseases, they pointed out loneliness and that few Primary School Primary School Primary School people in the family or social environment knew what they were doing. Illiterate The economic benefits prevailed among the SW benefits. Depending on the days and the time of service with a client, one could earn up Country of birth (year of arrival) to 8,000 euros per month. The savings allowed Venezuela (2003) Romania (2007) Romania (2009) buying homes in the country of origin, investing Panama (2011) Senegal (2007) Brazil (2015) Brazil (2003) Brazil (2014) Brazil (2006) in training courses and sending money to their countries of origin to help support the family, Spain as well as acquiring new cutting-edge devices (mobile phones, headphones, among others). Age 26 21 29 26 37 26 29 30 26 34 10 Id 1 2 3 4 5 6 7 8 9 1 Chart 3. Textual quotes of the interviews made to the informants. Barcelona, 2015-2016. Topics Verbatim Sex work in a “That is why I left there (from the apartment) … once the client went to pay me… and I discovered that they paid € 150 an hour and… the owner paid me € 40 per hour, and when gay sauna I discovered what the owner was charging, I saw that it was not fair” (Id6) “I do a ritual of spiritual, emotional, and physical cleansing. I wake up, I pray, and I engage in physical activity, and in the end, I go to work and enter hell, that’s what we, who do not like women, call the sauna.” (Id8) Sex work: ““I stayed four years in jail… I had been there several times (for theft), I am very grateful to be living in Spain and for the opportunity to have a more honest job that generates benefits and money for me, such as prostitution” (Id3). disadvantages “You can earn money if you are clever. I have bought two apartments over two years” (Id6) “People need the drug to stay awake, to fuck with people” (Id9) “(With the tub) What I noticed sexually is that I began to have thoughts that seemed like they were not mine: from dirty talking or fetishes, you dare to do certain things that you would not do regularly, you break barriers.” (Id 5) Dynamics “The client likes me, and he is not any client. He knows that there is a price and a special place for them… he will want a drug-and-sex party and have a good time…” (Id1) and social “Poop, piss, vomiting... Complicated people, which I think are a little retarded. You can end up crazy if you are not mentally strong.” (Id8) relationships “They like to pay because they get the idea that this is a product that it is a boy who is rented for specific practice and the customer likes that kind of idea or vice or morbidity…” in the sauna (Id9) “Many clients make you feel good, they treat you very well, and you feel loved and accepted…” (Id7) Sex work as a “... I don’t like to call myself a prostitute, nor do I like to be called hustler, because we are all promiscuous; men, in general, are promiscuous; they are promiscuous by nature” (Id 9) man “I started very early, with my cousins, with the female housekeeper who worked in my house. Nothing homosexual, I learned through experience. In Brazil, things are clear. I saw my aunt from my room, fucking ... I was 7 or 8 years old. Then I saw another aunt...” (Id 8) “Most gays are very vicious and use many drugs, and don’t think much about the risks.” (Id2) “… Normally they look for very unclean guys, very slender bodies, curved bodies: the fat ones would not enter there… for work no, as clients yes.” (Id9) “What is it to be a man? Be clear and make things clear. I seek life here” (Id1) Sexual “With customers, it is colder than with the boy I am with. No kisses, always with a condom ..., sometimes, I don’t use a condom with non-commercial partners.” (Id2) practices “Me and most of the guys use prevention with customers, but not with their partners.” (Id5) by type of “With women, I use it (the condom) at first, but then not; why? Because I always trust… the clients... with women, I ask for the tests [and if they don’t do it?] then I’m going to do couple them...” (Id3) “Gays are more likely to catch a disease because they like what they do. As if I had to work with women.” (Id8) HIV / STI / “Doing it without a condom ... gonorrhea, things like that ... because I have touched that girl you know and after a month you get these things... I get angry because I have not taken Prevention care of myself, and it could have been worse” (Id1) “(HIV) That you can die, there are medications but I am very afraid” (Id2) “I had some of these, syphilis, perhaps… I went to the pharmacy, they gave me an antibiotic and it disappeared” (Id7) “Those who want everything… if a client asks you if you fuck without a condom, for me he is already showing that he has AIDS. If he sucks your semen... and you don’t know that person, it means that he does it with everyone and is not healthy.” (Id8) “There’s nothing you can do. It’s all the same to them, they like what’s behind ... boys are informed but don’t want to take care of themselves.” (Id 3) 4711 Ciência & Saúde Coletiva, 24(12): 4707-4716, 2019 4712 Jacques-Aviñó C et al. Dynamics and social relationships in the the institutional environment was the source sauna of sexual education. For example, observing sexual experiences during childhood or living In general, the relationship with customers in environments where social relationships were was appreciable. Problems emerged when mediated by strong erotic content, especially in someone did not want to pay what was agreed. MSWs from Latin American countries. In one Usually, the services that were requested were case, sexual abuse was reported at puberty. The massages and sexual intercourse, but some respondent hinted that it was the reason he had practices could stress MSWs when clients sex with men. requested MSWs to defecate or vomit on them. The MSWs that agreed to participate in the On the other hand, the demands did not always interviews indicated that they had no prejudice respond to sexual fantasies, since sometimes towards homosexuality, although their culture of clients only wanted to share drug use or talk. The origin (religion, family, and the like) stigmatized sauna was considered a good place to contact it. Instead, we could see how some MSWs customers who later became fixed clients and showed rough masculinity and claimed that they with whom they could have relationships for only liked women, denying their sexual desires years. Indeed, it could be the case that the client towards men. became a supportive relationship, not only The typical characteristics of men included economic but also emotional. honesty, fulfillment of certain obligations, being In an interview with a client, a retired doctor, good people, and having a good job. Statements he commented that the boys (MSW) held power that pointed to man as an irrational being in the relationship since an older man cannot who only seeks sex also emerged. Although have sex with a young and attractive man if men were referred to as equals, the interviews it is not through payment. However, this was evidenced gaps between homosexuals and not the MSWs’ perception, which competed to heterosexuals, although some doubted that attract the customer that could generate more there were heterosexual men in the sauna. It was significant benefits; in that way, the money commented that homosexuals fell in love more became a demonstration of the client’s power in easily, were more sensitive and more vicious than the relationship with the MSW. heterosexuals, which led to greater risk-taking. Concerning the relationship with the The fact of having a stable partner led the MSWs MSW partners, we could observe how social to adopt more preventive measures for fear of relationships were established between those infecting him. from the same country or “friendly countries”. MSWs stated that clients are looking for men It was also commented that they competed with with traditionally manly traits, male models that each other, and sometimes some prejudice and respond to beauty criteria related to strength and racist attitudes emerged among the different youth. However, one MSW said that masculinity groups, giving certain groups less social status. was not there to show certain patterns but to For example, Brazilians commented that they assume specific values. were the oldest in the sauna and those that generated the least problems. The few Hungarians Sexual practices by type of partner there considered they had better education and economic status than the Romanians. In general, the MSWs associated the risky sexual practices with the fact of not using the Sex work as a man condom in anal or vaginal sex, although they also related it with kisses, putting the fingers Few MSWs expressed shame or guilt in the anus or with anal penetration without for performing SW. Those who did were ejaculation. Sexual practices and prevention heterosexuals since money was considered a measures were different with non-commercial good source of compensation. Some did not sexual partners and clients. feel identified as sex workers, but rather SW was Condom use was more frequent in paid understood as an activity that prolonged what is sex, while with non-commercial couples, typical of men: having many and varied sexual where relationships sought pleasure, there was intercourses. less condom use, especially after some time Regarding the development of sexuality, of relationship. That is, there was a higher what was commented is that the social, and not perception of risk towards customers than with 4713 Ciência & Saúde Coletiva, 24(12): 4707-4716, 2019 non-commercial partners. However, on one been residing in Spain or Barcelona for years had occasion, for a large sum of money associated no TSI, since they did not consider it especially with a perception of trust, one of the MSWs a priority. When a suspected STI emerged, and did not use the condom with a fixed client and they did not go to an emergency care center, became infected with HIV. they bought the medications they had previously MSWs believed that homosexuals were more used or followed the advice of a partner. In some exposed to STIs since their sexual relations was cases, those who did not have a TSI and required mediated by pleasure, not only in the context medical care used the private health system. of occasional partners but also among the A Senegalese MSW used medicinal plants for MSWs partners, when, for example, a client disease prevention shipped from his country. requested to perform group sex. In the case of Concerning the intervention proposals, in heterosexual MSWs, pleasure was also related general, they expressed low expectations. On the to lower levels of prevention measures, but with one hand, it was commented that the problem women. Some of them believed that the only was in the individual who, as a result of loneliness preventive measure was to be tested for HIV and other social problems, did not care about periodically. Another essential element was the himself and his health. On the other hand, it was need to feel sexually desired where situations of pointed out that they had information to prevent loneliness, lack of supportive social networks, HIV and other STIs and that, also, thank to and search for affection were factors that increase information and communication technologies, it the vulnerability to participate in risky sexual was easily accessible. encounters. The lack of prevention campaigns was commented, although they were not perceived HIV/STI/Prevention especially necessary since the “bad life” that some people led generated poor self-care. The The perception of HIV infection and STIs is sauna was perceived as a place where it was different. In the case of HIV, social stigma and challenging to be healthy. An informant said that fear persist, and in some cases, it was related the prevention proposals required “removing to a death sentence, which led to some MSWs them from the sauna and taking them to the not wanting to be tested. Some statements also countryside to see flowers”. The need to facilitate expressed serophobia; that is, they refused to have access and supply of condoms in gay leisure sex with people with HIV. There was a perception venues was noted. that people with HIV engaged in riskier sexual Concerning the Pre-Exposure Prophylaxis, practices, and some claimed that all clients had they commented that it was a good measure to this infection. prevent HIV, especially for those engaging in SW, The perception of STIs was more normalized, although these would lead to decreased condom considering that they were part of active sex life. use. It was also said that some would continue An MSW living with HIV infection said that using the condom since this treatment does not hepatitis was more dangerous and destructive prevent other STIs. than HIV but that the other MSWs were not aware of it. On the other hand, it was noted that there was no talk about STIs or other preventive Discussion measures among friends, or in the sauna environment. Also, being under the influence of This is an ethnographic work carried out in a drugs led to forgetting safe sex practices. gay sauna that addresses the sexual and social Concerning access to the health system, the relationships of MSWs from a gender perspective. difficulties and lack of knowledge about obtaining This study shows that SW is articulated based on the individual health card (TSI) were discussed masculinity characterized by having multiple among the barriers. During fieldwork, one sexual partners, a virile appearance, and the MSW who had had a receptive anal penetration ability to generate money as a strategy to achieve without a condom, a high-risk practice of status. This pattern responds to a hegemonic HIV infection, was not given post-exposure cultural model associated with domination, prophylactic treatment because he did not have social ascent, and holding hierarchy positions17. the TSI. On the other hand, there was a perceived On the other hand, the MSW questions the easy acquisition of drugs in pharmacies, so it was heteronormative model where identity, desire, not surprising that immigrant MSWs who had and sexual behavior coexist in relationships 4714 Jacques-Aviñó C et al. among men. Thus, living in a city like Barcelona men or women. Those who self-defined as allows you to explore and live homosexuality homosexuals engaged in riskier sexual practices with greater freedom and anonymity, since in the context of the sauna than heterosexuals, it has places that facilitate social and sexual who experienced more significant conflict in encounters among men, such as saunas9. These this environment. It has been hypothesized establishments open options for interactions, that MSWs that are defined as heterosexual or where homosexuality and heterosexuality can be bisexual may have more symptoms of depression drawn together, and to some extent, integrated or anxiety, respectively, which varies according to into the erotic field of same-sex practices18. the definition of sexual orientation and attitude Indeed, the MSWs that are presented from a towards homosexuality26. heterosexual model feed the erotic fantasy of On the other hand, situations such as a rough, strong, and protective masculinity. loneliness or lack of supportive social networks Moreover, in gay iconography, an essential part were associated with lower self-care. In this of the texts realize that the homophobic cult of regard, it is essential to consider a syndemic virility is not a heterosexual specificity19. On the approach that allows explaining behaviors from other hand, the results show, as in other studies, different levels, as well as the social determinants that economic aspects or sexual desires invite of health27. From this perspective, the importance the SW20. Also, money is linked to independence of having the social support of family and friends and the aspiration of material consumption, has been shown, since the absence of social capital which give prestige, control over work, and self- is a factor that promotes risky sexual practices development21,22. Therefore, SW allows achieving and, thus, the vulnerability to contracting HIV an economic and social status that outweighs and other STIs28. It should also be noted that engaging in a socially stigmatized activity. STIs are perceived, unlike HIV, as part of a man’s The stigma of engaging in SW adopts sexual life. differences by gender: while in women, the fact It is also essential to address the issue of of having multiple sexual partners is morally drugs, consider the interrelation between the questioned, men are encouraged and even subject, the substance and the socio-cultural allowed a greater right to leisure and pleasure23. contexts in which consumption occurs29 to The stigma in them is produced by having understand better, for example, the emergence of relationships with men. Indeed, some young the Chemsex phenomenon and increasing sexual people believe that MSWs become an option practices that facilitate the transmission of STIs. to “come out of the closet”, especially for those Therefore, it would be advisable to exchange who had few options to have homosexual knowledge between STI services and drug relationships in their environment. From a health specialists, as well as identify the reasons that lead perspective, it has been shown that there is an people to participate in these practices30. association between being attracted to someone One of the limitations of this study was not of the same sex and worse self-perceived health, having dwelt further on the MSW’s knowledge more problems with chronic disorders and about STIs, although attitudes towards increased consumption of alcohol and other prevention and care could be explored. On the drugs24. It should also be considered that in a other hand, the observation time in the sauna market with precarious work alternatives, it was sufficient and led to information saturation. influences the ethnic employment segmentation. There are few opportunities to participate so That is, immigrant or ethnic minorities’ MSM continuously and regularly in this environment, who experience more significant racism and a factor that allowed to create the necessary economic deprivation find a work alternative in confidence for contact with informants. Besides, the sex market, albeit with a higher proportion we must consider that studies on MSWs are of unprotected sex and greater vulnerability to increasingly complex, due to the use of apps that contracting HIV25. facilitate sexual contacts with clients online and A vital element of this study was to consider via meetings in private quarters31. sexual orientations, desire, and their relationship All of the above allows us to reflect on what with sexual practices in the sauna’s MSWs. SW implies in men. On the one hand, it increases Despite adopting an attitude of complacency economic and social status, and can even become towards the client, prevention measures a platform for emotional networks. On the other, were assumed, while this changed with non- it means entering a world where risk and harm commercial sexual partners, whether they were to personal and community health coexist with 4715 Ciência & Saúde Coletiva, 24(12): 4707-4716, 2019 essential repercussions for one’s well-being. using drugs, not having a steady partner, and This topic should be further analyzed and not having supportive social networks are factors include MSWs’ clients since they can provide that increase the MSWs’ social vulnerability. The valuable information on the established power interventions for the prevention of HIV and STIs relationships, the mechanisms of economic in this group would have to consider the social transaction, and negotiation of sexual and social determinants and needs of the MSWs, create practices. synergy with the owners and workers of these In a nutshell, it was observed that risky establishments, the health system, community sexual practices occurred mainly with non- entities and public health in order to respond commercial sexual partners. Desire and pleasure to complex problems that foster a model of mediated relationships, which meant that the masculinity aimed at better personal and MSWs self-defined as homosexuals engaged in community care. less safe sexual dynamics. On the other hand, Collaborations C Jacques-Aviñó, JA Caylà, O Romaní and PG Olalla collaborated in the design of the project. 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Using thematic analysis in psycholo- Approved 11/05/2018 gy. Qual Res Psychol 2006; 3(May 2015):77-101. Final version 13/05/2018 CC BY This is an Open Access article distributed under the terms of the Creative Commons Attribution License