Sexual identity and HIV: The male prostitute

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Abstract
We examined the relationships among sexual self‐identity, sexual and drug use behaviors, and human immunodeficiency virus (HIV) infection among a sample of 224 male street prostitutes. Structured interviews were administered, and blood samples were collected and tested for HIV, syphilis, and hepatitis B. The sample included 17.9% homosexual, 46.4% heterosexual, and 35.7% bisexually identified men. Congruence between the prostitutes’ non‐paid sexual behavior and their sexual self‐identification were closest for the heterosexual and homosexual identified men. The significant demographic and occupational differences between the prostitutes in each sexual self‐identity category included education, history of physical abuse, homelessness, and geographical mobility. Based on self‐identification, the rate of HIV infection was 50% for the homosexuals, 36.5% for the bisexuals, and 18.5% for the heterosexuals. The differences in HIV infection rates between the men of each sexual self‐identity category were significantly related to self‐reported receptive anal sex, number of non‐paid sexual partners, cocaine use, injection drug use, acquaintance with a person with AIDS, history of syphilis, and history of hepatitis. Sexual self‐identity was not a significant predictor of HIV serostatus.