In the United States, men who have sex with men (MSM) are at increased risk for HIV, and transactional sex (sex work) is concurrently associated with elevated HIV risk.  In existing sample studies, male sex workers (who have sex with other men in the context of their sex work) have been shown to be at increased risk of HIV infection1-5 compared to MSM who do not engage in sex work, with a significantly higher HIV prevalence (7.3% versus 1.1%) and annual HIV incidence (4.7% versus 0.9%)1.  Recent studies6-7 have also revealed an association between sex work, substance use/abuse, and other psychosocial factors (e.g., depression) that function independently of sex work8 but that influence sex workers in greater proportion than other groups of MSM.9-11

Research on male sex workers is generally lacking; in particular, there is little understanding of how networks of male sex workers facilitate or impede HIV infection and transmission.  The Nexus Study’s innovative approach focuses on the social, sexual and drug use networks of this high-risk population—the first longitudinal study to understand these network characteristics and their impact on MSM sex workers in Massachusetts and Rhode Island.  Preliminary research done by this study team12 affirmed that the male sex workers in Boston are networked together via social and sexual links.  Understanding the relationships and connections among and between these men is the basis of this 2-year National Institute on Drug Abuse funded project.

Because HIV and sexually transmitted infections (STIs) are transmitted relationally and spread in and through intimate contact between people, focusing on relationships rather than individual attributes may prove a useful prevention strategy to curb infection among male sex workers, and both their clients as well as their personal sexual partners.  Furthermore, given that social/sexual networks can facilitate risky behaviors as well as transmit positive information and behavior change, characterizing social, sexual and drug use networks will not only help to identify risk factors that affect HIV transmission dynamics, but will also allow us to assess protective factors that may be essential components to include when developing culturally appropriate and effective intervention studies with male sex workers in the future.

Pending IRB approval, Fenway Health will begin enrolling men who are engaged in the sex industry to participate in The Nexus Study, consisting of 3 study visits over one year.  Each study visit includes a confidential survey as well as optional HIV and STI testing.  Participants can earn up to $200 for their involvement.

Who may be eligible to participate:

  • Age 18 or older
  • A man that is sexually active with other men
  • Get paid for sex

For more information and to see if you may be eligible for this research study, call or text The Nexus Study at 617.860.3553 or email us at



  1. Weber AE, Craib KJ, Chan K, et al. (2001). Sex trade involvement and rates of human immunodeficiency virus positivity among young gay and bisexual men. International Journal of Epidemiology, 30: 1449-1456.
  2. Bacon O., Lum P., and J. Hahn. (2006). Commercial sex work and risk of HIV infection among young drug-injecting men who have sex with men in San Francisco. . Sexually Transmitted Diseases, 33: 228-234.
  3. Timpson SC, Ross MW, Williams ML, et al. (2007). Characteristics, drug use, and sex partners of a sample of male sex workers. American Journal of Drug and Alcohol Abuse, 33: 63-69.
  4. Rietmeijer CA, Wolitski RJ, and M. Fishbein. (1998). Sex hustling, injection drug use, and non-gay identification by men who have sex with men: Associations with high-risk sexual behaviors and condom use. Sexually Transmitted Diseases, 25: 353-360.
  5. Robertson MJ, Clark RA, and Cherlebois ED. (2004). HIV seroprevalence among homeless and marginally housed adults in San Francisco. American Journal of Public Health, 94: 1207-1217.
  6. Campsmith M.L., A.K. Nakashima, and J.L. Jones. (2000). Association between crack cocaine use and high-risk sexual behaviors after HIV diagnosis. Journal of Acquired Immune Deficiency Syndromes, 25: 192-198.
  7. Newman PA, Rhodes F, and R.E. Weiss. (2004). Correlates of sex trading among drug-using men who have sex with men. . American Journal of Public Health, 94: 1998-2003.
  8. Parker, M. (2006). Core groups and the transmission of HIV: Learning from male sex workers. Journal of Biosocial Science, 38: 117-131.
  9. Lankenau SE, Clatts MC, Welle D, et al. (2005). Street careers: Homelessness, drug use, and sex work among young men who have sex with men (YMSM). International Journal of Drug Policy, 16: 10-18.
  10. Smith MD and D.W. Seal. (2008). Motivational influences on the safer sex behavior of agency-based male sex  workers. Archives of Sexual Behavior, 37: 845-853.
  11. Koken JA, Parsons JT, J. Severino, et al. (2005). Exploring commercial sex encounters in an urban community  sample of gay and bisexual men: A preliminary report. Journal of Psychology and Human Sexuality, 17: 197-213.
  12. Mimiaga MJ, Reisner SL, and J.P. Tinsley. (2009). Street workers and internet escorts: Contextual and psychosocial factors surrounding HIV risk behavior among men who engage in sex work with other men. Journal of Urban Health, 86: 54-66.



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