P145 A qualitative study on sexualised drug use among male and transgender women sex workers in Amsterdam, the Netherlands

Background The objective of this study was to provide insight into the motives of drug use during work among male sex workers (MSW) and transgender women sex workers (TSW) and its possible effect on sexual behaviour that may increase the chance of STIs and/or HIV acquisition. Methods From March to June 2018, we conducted semi-structured in-depth interviews among MSW and TSW visiting the Prostitution and Health Center in Amsterdam. Transcribed interviews were analysed by two researchers with an open-coding process, after which similar codes were categorized into themes. Results We conducted 23 interviews among 15 MSW and 8 TSW. Almost all sex workers (n=21) reported any sexualised drug use (irrespectively of work or private situation) and the majority (n=14) reported illicit drug use during work. The initiative of using drugs most often comes from the clients. Motives for using or not using drugs during work were categorized into self-oriented and client-oriented motives. Self-oriented motives to use drugs included receiving more money, increasing pleasure during sex and the ability to work more hours. Self-oriented motives for NOT using drugs included to keep track of time, to control safe sex and to maintain professional distance. Client-oriented motives to use drugs included client asks for it and to make client happy. Client-oriented motives to NOT use drugs included preserving sexual functioning. Participants reported that due to drug use they forget/stop/skip using condoms during oral or anal sex. A self-applied prevention strategy that was described was staying away from actual sex acts when using drugs because the judgment over condom use could get influenced. Conclusions Future prevention should take into account that the initiative of using drugs most often comes from the clients and provides work-related added value. Assertively training and harm-reduction strategies described by the sex workers can be used by developing interventions.