HIV/AIDS has had a significant impact on how we understand male sex work. The initial ambiguity surrounding HIV/AIDS—Where did it come from? What causes it? Who does and doesn’t it affect?—meant that it could have been characterized in a number of ways, but its being linked to sexually active gay men early in the epidemic meant that it was characterized as a sexually transmitted disease. The link between promiscuity and the risk of contracting HIV led to sex workers being identified as a problematic group—the possible vectors of transmission to the broader public.

Before the HIV/AIDS epidemic, male sex work was rarely considered a public health problem. While sexually transmitted infections had long been associated with female sex workers, health professionals seemed unconcerned about the physical health of male sex workers and their clients. HIV/AIDS changed this, to some degree because at the time it appeared that a more fluid conception of human sexuality had emerged, which acknowledged that sexual practices were not equivalent to sexual identities. Bisexuality was viewed as putting people at risk of contracting the virus because male sex workers were thought to provide a bridge for infection between deviant and mainstream populations.

What stands out for us in reading this chapter, along with some of the others in the book, is the evidence of the benefits in decriminalizing homosexuality and the sex industry. These moves promote proactive public health measures that create safer and more professional interactions between clients and workers, and between these groups and society. Societies that have adopted liberal reforms fare much better on a wider range of indictors compared with societies that remain punitive. The more liberal societies report less violence, safer and more productive client-worker interactions, and the development of a leisure sex industry that is both professional and responsible. In contrast, criminalization tends to drive the sex industry underground and leaves it open to criminal manipulation and poor health standards, which have an impact on everyone. The sex industry need not have such a dark underbelly.