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Communications in sex work : a content analysis of online sex work advertisements among men, women and… Kille, Julie Ann 2015

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           COMMUNICATIONS IN SEX WORK: A CONTENT ANALYSIS OF ONLINE SEX WORK ADVERTISEMENTS AMONG MEN, WOMEN AND TRANSGENDER PEOPLE IN VANCOUVER  by  Julie Ann Kille  B.Sc.N., The University of Victoria 2003  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF  MASTER OF SCIENCE IN NURSING  in  The Faculty of Graduate and Postdoctoral Studies    THE UNIVERSITY OF BRITISH COLUMBIA  (Vancouver)  August 2015 © Julie Ann Kille 2015          ii   Abstract  The increased use of technology to purchase goods and services has changed the landscape of how we advertise, buy and sell commodities. This has contributed to an increase in off-street sex work advertised on the Internet. It is estimated that 80% of sex work in British Columbia occurs off street and the use of web advertising for services has grown exponentially (O‟Doherty, 2011).While street-based sex work has been well studied, and there is a significant and growing body of knowledge concerning off-street sex work, communications in advertising sex work online is an emerging field of inquiry.   There have been few studies that have examined these communications, and most have been population specific. In this study, 75 online advertisements for sex work in Vancouver, British Columbia were compared to determine what information was regularly communicated and how this information differed between men, women and transgender people using this medium to conduct business. Content analysis was employed as a method to extract the data from the websites in a systemized, categorical way and the results were analyzed to compare differences between groups, focusing on communications, health, safety, and business information.   The findings suggest that while there are similarities between men, women and transgender people advertising sex work online, there are important differences that require further study to determine if they have impacted the health and safety of sex workers. This study summarizes what is being communicated in online advertisements of sex workers and contributes to understandings about how sex workers are communicating about health, safety and business to their clients. These insights can assist health care providers and policy makers in creating interventions to improve health and safety for sex workers and their clients.              iii   Preface  This thesis was completed by me, Julie Ann Kille. The 75 online advertisement url‟s were collected by Dr. Vicky Bungay in December 2012. I was responsible for ensuring accuracy of url‟s and collecting all data used in this thesis. This information is detailed in Chapter 3.   This study was approved by the UBC Research Ethics Board; certificate number H12-00217; and project title HIV Vulnerability and the Work Environment of the Off-Street Sex Industry.                                  iv   Table of Contents  ABSTRACT ................................................................................................................................................................ ii PREFACE ...................................................................................................................................................................iii TABLE OF CONTENTS .......................................................................................................................................... iv LIST OF TABLES ...................................................................................................................................................... v ACKNOWLEDGMENTS ......................................................................................................................................... vi CHAPTER 1: BACKGROUND AND HISTORY ................................................................................................... 1 RESEARCH AIMS ...................................................................................................................................................................... 4 CHAPTER 2: LITERATURE REVIEW ................................................................................................................. 5 THE CONTEXT OF SEX WORK ................................................................................................................................................ 5 SEX WORK DEMOGRAPHICS .................................................................................................................................................. 7 SEX WORK AND HEALTH ....................................................................................................................................................... 8 WEB-BASED ADVERTISING ................................................................................................................................................. 13 STRENGTHS AND LIMITATIONS ........................................................................................................................................... 17 CHAPTER 3: RESEARCH DESIGN AND APPROACH ................................................................................... 20 RESEARCH APPROACH .......................................................................................................................................................... 20 SAMPLE ................................................................................................................................................................................... 22 DATA COLLECTION ............................................................................................................................................................... 23 DATA ANALYSIS ..................................................................................................................................................................... 25 SUMMARY ............................................................................................................................................................................... 26 CHAPTER 4: FINDINGS ...................................................................................................................................... 27 THEME ONE: DEMOGRAPHIC CHARACTERISTICS ............................................................................................................ 27 THEME TWO: HEALTH COMMUNICATIONS ...................................................................................................................... 31 THEME THREE: SERVICES AND RESTRICTIONS ................................................................................................................ 34 THEME FOUR: SAFETY ......................................................................................................................................................... 38 THEME FIVE: BUSINESS COMMUNICATIONS ..................................................................................................................... 39 SUMMARY ............................................................................................................................................................................... 43 CHAPTER 5: DISCUSSION AND RECOMMENDATIONS ............................................................................ 44 SUMMARY OF KEY FINDINGS ............................................................................................................................................... 44 Communication differences. ............................................................................................................................................ 44 Health and safety communications .............................................................................................................................. 47 Business Communications ................................................................................................................................................ 53 USEFULNESS OF THE RESEARCH ......................................................................................................................................... 55 LIMITATIONS .......................................................................................................................................................................... 56 CONCLUSION .......................................................................................................................................................................... 58 BIBLIOGRAPHY .................................................................................................................................................... 59 APPENDIX A: EXTRACTION TOOL CATEGORIES AND DESCRIPTIONS .............................................. 65    v   List of Tables    Table 1: Sex Worker Self-Description……………………………………………………. 36    Table 2: Population Characteristics of Sex Workers……………………………………… 37    Table 3: Health Information………………………………………………………………. 40    Table 4: Services Listed or Provided……………………………………………………… 44    Table 5: Restrictions………………………………………………………………………. 45    Table 6: Rate of Service per Hour………………………………………………………… 48    Table 7: Business Characteristics…………………………………………………………. 49                   vi   Acknowledgments  I would like to offer my gratitude to the faculty, students and staff at The University of British Columbia for the rich experience I‟ve had in the course of completing this degree. Thank-you to my committee members, Dr. John Oliffe and Mr. Chris Atchison for providing critical eyes that allowed me to improve my thesis.   To my supervisor, Dr. Vicky Bungay, I am eternally grateful. Her patience and understanding, along with her exceptional expertise in my field of study has made this journey one that I appreciate deeply.   I wish to thank my family: My parents, Ron and Mona and my siblings Erin and David for always believing in me and motivating me along the way. Lastly, I would like to extend special thanks to my life partner, Colin Lajeunesse who made my life easier so that I could do this work, loved me unwaveringly and proved that he is a very patient man.                   1   Chapter 1: Background and History   Commercial sex work,1 or the exchange of sexual services for goods or monetary gain has been part of most industrialized and non-industrialized societies for a very long time (Hubbard & Prior, 2013). As society and technology have evolved, so too have the ways in which sexual exchanges between sex buyers (clients) and sex sellers (sex workers) are procured. With the advent of the Internet, people‟s ability to search for and locate goods and services has improved and become more accessible. Therefore, the methods by which sexual services are advertised and purchased have expanded from the street and brothels to escort services via website advertisement on the Internet (Blevins & Holt, 2009; Parsons, Koken & Bimbi, 2007; Tewksbury, 2003). Additionally, the Internet has provided a platform for information to be shared with people seeking sexual services, in many cases assisting them in their decision to purchase from specific sex workers based on the details provided in advertisements (Pruitt & Krull, 2010).    The Internet is now a highly utilized and efficient way to conduct business and has become a primary location for advertising sexual services (Blackwell & Dziegielewski, 2013; Cunningham & Kendall, 2011; Lee-Gonyea, Castle and Gonyea, 2009; Pruitt, 2005). Some of the main reasons cited in the transformation from other forms of advertising such as print ads in newspapers, for example, are the convenience afforded to clients who can search a wider variety of advertisements from home, the ability to reach a large client base by the seller, and the ability to advertise more than just a small photo with contact information. Internet ads of sex workers                                                  1 I recognize that there are many different activities associated with commercial sex work. For the purpose of this study, I defined commercial sex work as the direct exchange of sexual services for money between adults and excluded internet advertising that pertained to pornography, webcam, or exotic dancing (Sharpe & Earle in Jewkes, 2003) The study was also limited to sex work in off-street settings.   2   frequently include more information than was previously possible in print and thus the sex buyer has an opportunity to view information such as a description of the sex workers style and personality in addition to viewing their physical attributes, what services they provide and sometimes what payment methods are available (Castle & Lee, 2008).   Review sites of sex workers reveal consumer experiences and offer potential clients information that may influence their decision to arrange services with a particular sex worker. Both sex workers and clients can participate in review sites where potential clients can read reviews by other clients in relation to their experience (Milrod & Monto, 2012). These review sites along with web-based advertisements for sex workers allow for more informed decision-making in advance and has changed the ways that transactional sex is considered and procured (Milrod & Monto, 2012).   Sex work advertisements often contain information such as types of sexual services offered and descriptions of physical characteristics. This information differs depending on the intended audience,  and information such as sexual position preferences may be noted where that information may play a role in decision-making (Lee-Gonyea et al., 2009). Additionally, some advertise sexual risk taking language, such as “always safe” or other information about what services they will provide (Blackwell & Dziegielewski, 2013), allowing sex buyers to find a sex worker who meets their particular desires based on what has been advertised.   To date, research in online sex work communications has focused on marketing strategies, privacy concerns about sex workers identities and risk associated with indoor sex work. Less attention has been paid to the types of health, safety and transactional information that are communicated within these sites. This research gap is important to fill as there is growing evidence that many initial connections made between sex workers and their clients  3   happen through engagement with sex worker advertisements, and that related knowledge and expectations about the industry originate in part from these ads (McLean, 2013; Sanders, 2008). Furthermore, preliminary studies have found that online advertisements may aid sex workers in avoiding conflict with clients as it allows them to clearly communicate the services offered and the conditions under which they are willing to provide them before a face-to-face occurs (Bimbi & Parsons, 2005; Castle & Lee, 2008; Sanders, 2010). How this information is provided remains largely under investigated and what little we do know is focused on women, mostly outside of North America. Yet, there is a growing body of evidence showing that the Internet is being utilized to advertise the services of male sex workers, primarily men who have sex with men (Mimiaga, Reisner, Tinsley, Mayer & Safren, 2008; Parsons, Bimbi & Halkitis, 2001; Uy, Parsons, Bimbi, Koken & Halkitis, 2004). It is clear that the use of the Internet to host advertising has become an essential element of the commercial sex industry (Sanders, 2010). It is also well established that websites play a critical role in how clients shop for sexual services marketed by sex workers (McLean, 2013; Sanders, 2008b).   Furthermore, e-health strategies to promote sexual health and safety are becoming more common in Canada and other parts of the world (Parsons, Koken & Bimbi, 2004; Rietmeijer, Mcfarlane, Bull & Lloyd, 2004); sex workers and their clients, and men who have sex with men are often among those targeted by such services. Given the predominant role of web-based advertising in the sex industry and the burgeoning evidence of its relevance in information sharing, it is essential to increase understandings of the health, safety and business information being communicated in these sites.  Without this information, health care strategies to promote health and safety for sex workers and their clients may be ineffectual.   4    Research Aims  The overarching purpose of the current study was to increase understandings of the types of health, safety and business information provided on sex workers‟ advertising websites and to compare the content within and between sub-groups of women, men, and transgender sex workers. The research questions guiding this study were: 1.     What types of health, safety and business information are communicated on sex workers‟ advertising websites? 2.     What are the similarities and differences in advertising content within and between women, men and transgender sex workers?            5   CHAPTER 2: LITERATURE REVIEW  To develop a broad understanding of indoor, Internet advertised commercial sex work and the nature of the health, safety and business communications in this setting, a literature search was conducted using the database search engines CINAHL, Google Scholar and PubMed. To provide an overview of the literature, I first situated the issue by exploring some contextual factors about commercial sex work central to my research. For example, it was essential to understand who is working in this context and what kinds of hegemonic assumptions require clarification to better understand health and safety in this field. I then reviewed the types of information described in previous studies about online advertisement of sexual services, specifically the types of health and safety and business related information described in the literature. I also described the use of information and communication technology, specifically the Internet, in the context of commercial sex work advertisements and how the use of the Internet has changed the ways in which sex is marketed and purchased, and what kinds information are prevalent in online ads. Finally, I summarized the state of current knowledge concerning the differences and similarities in the information provided by men, women and transgender sex workers to illustrate the research focus in this population, and the gaps that were addressed to some extent, by my research.  The Context of Sex Work   Sex work or the exchange of sexual services for monetary gain has been the topic of inquiry and discussion for over a century. Throughout history, sex workers have experienced substantial stigma and discrimination (Bruckert & Hannem, 2013). Sex workers have also been conceptualized as vectors for the spread of sexually transmitted infections and have been blamed for the disruption of society‟s moral foundations (Parsons et al., 2004; Sanders, 2006). Moreover,  6   sex workers are frequently described by some health and social scientists as prostituted women, victimized by violence and with minimal agency (Shaver, 2005). More recent research however has illustrated that the representation of sex workers as victims with minimal agency is problematic (Bungay, Halpin, Atchison & Johnston, 2011; O‟Doherty, 2011). Although there is ample evidence that females are disproportionately represented in sex work, significant numbers of male and transgender sex workers are actively engaged in this industry (Vanwesenbeeck, 2013). Additionally, there is substantial heterogeneity of sex workers‟ experiences that challenge the stereotype of agentless victims. Researchers have demonstrated that sex workers‟ agency needs to be understood as a capacity situated within diverse social and structural positions that people occupy and the array of contexts in which their work occurs (Showden & Majic, 2014).  The locations of sex work are diverse ranging along a continuum of street-based to off-street settings. Although the lack of information about population characteristics and parameters do not permit accurate estimates of population size and diversity, there is growing evidence that the majority of sex work in Canada and the US operates in an off-street context (O‟Doherty, 2011; Weitzer, 2012). The off-street industry is further diversified according to the location of where the sexual exchange for money occurs. Sex workers may operate in locales designed for the provision of sexual services (e.g., massage parlours, brothels, apartments) or may travel to the client‟s location (e.g., hotel, their home) (Bungay, Oliffe & Atchison, 2015). Moreover, the sex industry has changed in many ways over the years, and especially so with the increasing use of the Internet as a place to conduct business. The Internet has made it possible for people to advertise an array of goods and services from the comfort of their own homes and as such, sex has become increasingly recognized as another service that can be marketed and obtained using the vast reach of the World Wide Web (Blevins & Holt, 2009; Castle & Lee, 2008).    7   Sex Work Demographics  There is growing evidence regarding the diversity of demographic characteristics among those who engage in sex work. Sex workers have diverse gender, ethnic and social class backgrounds. Although much of the research in off street sex work has been conducted outside of Canada, there are some studies that provide sex work demographics in larger Canadian cities. For example, O‟Doherty (2011) conducted a study of off street female sex workers (n=39) in Vancouver, British Columbia, where the majority were Caucasian (79%), held Canadian citizenship and 90% had some post-secondary education. Wages from sex work were listed and more than half the sample made 5,000 Canadian dollars per month or more. Amongst this cohort, 57% started working as sex workers between the ages of 19-24 and many (42%) had started in massage parlours and moved on to independent work, or working for themselves without an agency or representation by a third party. In another Vancouver based study, Bungay et al. (2013) studied women sex workers in massage parlour settings (n=129) and found that approximately 42% had less than high school education, 62% were born outside of Canada, and the average age for first job in sex work was 27 years. This illustrates the diversity amongst off-street sex workers in Vancouver, BC, which was the locale of my research.  Male sex workers who advertise on the Internet are a growing population and the literature suggests that many are providing services to other men (Lee-Gonyea, Castle & Gonyea, 2008). In a study of male sex workers in the United States of America (USA) conducted by Parsons, Koken & Bimbi (2004), of their participants (n=46), 82.6% described their sexual orientation as homosexual/gay and the remaining 17.4% were bisexual. The majority of these male sex workers were well educated with only 4.3% of the sample listing high school or less as their highest level of education. The sample as a whole was predominantly Caucasian. The mean  8   age was 31.76 years old and the median income range from sex work was $20,000 – $29,000 (US dollars) per year. In this sample, all the men reported working in a role outside of sex work that provided them with some income, although the median income for work unrelated to sex work was $10,000 to $19,999. Another USA based study by Koken et al. (2004) compared street based sex workers to off street male sex workers who advertised on the Internet. The off street sex workers were fairly homogenous, most identified as gay (69%), educated (68% more than a high school education) or current full or part time students (31%) (Mimiaga et al., 2008). Notably, the street based male sex workers in the study were different in terms of their education levels, older with a median age of 42.6 years of age and only 47% identified as gay, despite offering services to men. Male sex workers who advertised on the Internet in the USA appeared to be a fairly homogenous group of well-educated, homosexual Caucasian men. There is a lack of information on male sex workers who advertise mainly to women in the literature and no articles that studied transgender sex workers were found.  Sex Work and Health  There is an assumption amongst some of the public that men seek out sex workers to perform acts that they do not perceive themselves to have the opportunity for with a non-commercial partner. Another assumption is that having sex with a sex worker is a risky activity unto itself (Milrod & Monto, 2012; Sanders, 2006). However, there is evidence throughout the literature that off-street female sex workers frequently engage in transactions that closely resemble non-commercial sexual relationships and are often referred to as the “girlfriend experience” (GFE) (Milrod & Monto, 2012; Pruitt & Krull, 2010). In a USA study conducted by Milrod & Monto, (2012) this point was emphasized by the most common activities that were provided to the participants in their study. In a sample of 584 male patrons of sex workers who  9   advertised on the Internet, the most common activity engaged in was penile-vaginal coitus with a condom, which is a low risk activity when the condom is used properly and doesn‟t fail. Other activities that were engaged in high frequencies were deep kissing with tongue, fellatio without a condom, cunnilingus and mutual masturbation without a condom. This shows that there are a wide variety of activities that sex workers engage in with their clients, but most would be common in a non-commercial relationship. It is notable that no condoms or barrier methods were utilized in those activities where there was oral-genital contact, which may be part of making the GFE more “real” and less like a commercial relationship.  Most female sex workers in the literature did not engage in uncovered riskier sexual activities such as penile-vaginal or anal sex. Researchers theorized that one reason for this may be that many consumers of sexual services read online reviews and that reports of a sexually transmitted infection would be bad for business (Cunningham & Kendall, 2010). There is literature that challenges the assumption that women sex workers are providing services out of necessity and that there is a high level of agency and an increased level of control over personal safety amongst Internet based sex workers (Castle & Lee, 2008). Given the higher levels of education and income in this population, sex workers described in this study would be able to purchase their own condoms, lubricants and other items that would make their work safer. In many cases independent off-street sex workers are well educated and may be more likely to understand sexual risk taking behaviors and make educated decisions about the services they provide. This translates to other aspects of the business of independent sex workers, as independents also choose how to conduct their affairs by deciding on variables such as payment methods and transportation if they are going to meet a client at their locale. Independent sex  10   workers have more control over how they conduct their business and often employ strategies to ensure their safety (Lucas, 2005).  There is little information available about decision making by clients seeking a sex worker online. Physical appearance was included as a point of inquiry in the literature as this was the basis for some clients for choosing a certain sex worker (Pruitt & Krull, 2010). Several studies made mention of photos included in advertisements, as this was a common occurrence for female websites (Capiola, Griffith, Balotti, Turner & Sharrah, 2014; Pruitt & Krull, 2010). Other kinds of health information such as smoking, diet and exercise were infrequently included but were listed in some advertisements (Castle & Lee, 2012).  There was some discussion of female sex workers as health educators. Sanders (2004) conducted a study highlighting the impact of focusing the majority of health interventions on female sex workers and almost none on men who visit sex workers. Sanders aptly described how this gendered approach to education is misguided as it is not only stigmatizing in terms of perpetuating the construction of female sex workers as vectors of disease, but it does not allow for male clients to assert and protect themselves in sexual transactions, commercial or otherwise. Sanders argued that there is an opportunity for men to engage with sex workers in receiving health information for reasons such as: female sex workers have access to men who may not seek out sexual health information otherwise, peer programs can be highly impactful, and because this may assist in reducing STI in the general population due to the prevalence of men who are clients of sex workers and would benefit from this information.  Health information on male sex workers was largely focused on risk taking behaviors and HIV (Bimbi & Parsons, 2005; Mimiaga et al., 2008). This is important information given that the literature on off-street male sex workers reveals that the majority are providing services to other  11   males, and in major North American cities, men who have sex with men are disproportionally impacted by HIV and other STI (Blackwell & Dziegielewski, 2013; Reisner, Mimiaga et al., 2008).   Bimbi & Parsons (2005) studied male sex workers who advertised their services to other men via the Internet and noted differences in practice between men who were HIV negative or of unknown HIV status as opposed to HIV positive. For example, the riskiest form of unprotected intercourse, anal receptive with ejaculation, was reported to have taken place between a sex worker who was HIV negative or of unknown status (n=42) and a client in 2.3% of the sample whereas 25% of HIV positive men (n=8) reported this activity between themselves and a client. Interestingly, in the same sample, these men were more likely to have unprotected anal sex with casual sexual partners with whom there was no commercial aspect to the relationship. Unprotected receptive anal sex with casual partners was reported in 11.9% in the HIV negative men and in 50% of HIV positive men. This suggests that there is a fairly low level of high-risk behavior in this sample of male sex workers when they are with clients, but with casual sex partners, they are engaging in high-risk sexual behaviors. This may have implications for the sex worker‟s health in addition to that of their casual sex partners. Health care providers who work with sex workers may be inclined to focus only on the commercial sexual encounters but this study shed light on the need to understand that outside risks may be associated between partners and clients, and to ensure that sex workers are educated in safe sexual practices from a holistic perspective that includes all sexual partners.   Other dominant themes in the literature specific to male sex workers were described by Parsons, Koken and Bimbi (2004), who studied a group of independent gay and bisexual male escorts in the United States who advertised on the Internet. Internet-based male sex workers  12   described themselves as having much more control over their environment than their street-based counterparts and also described differences in the clientele. One participant described clients as “a little bit more classy, a little bit more intelligent and very well to do” (Parsons, Koken & Bimbi, 2004, p. 1025).   However, off-street sex work still had challenges. The desire of clients for unprotected anal sex or “barebacking” was described in the same study wherein 80% of the men reported having been asked to either perform or receive anal penetrative sex without a condom in the course of their work. Most participants reported that they would not agree to barebacking, while others said that if they did do this, that they provided information to the client prior to agreeing to the activity. One participant said that when he did agree to barebacking, it was only after informing the client that he was HIV positive. Barebacking was an issue for many men in the study as they reported that refusing to provide this service cost them financially as some clients would not continue to see them if they did not provide this service. However despite this potential loss of client and income, most were firm that this was not something that they would do. A majority of participants used condoms and practiced safe sex most of the time. In fact, many were frequently educating their clients in the process of preparing or engaging in the sexual exchange.   Many of the male sex workers in this study reported that they described what they would and would not do in their online ad, therefore decreasing the chance that a client would be surprised or upset when they said no to an activity such as barebacking. A theme throughout the literature on both male and female sex workers was that there seems to be a high level of understanding of risk by sex workers (Parsons et al., 2004; Parsons et al., 2007; Sanders, 2006).   13    Web-Based Advertising   The Internet has changed the way that people connect and communicate, and has also provided an effective method of purchasing goods and services. Making online purchases differs from traditional ways of buying and selling, as there tends to be a greater sense of anonymity and security in purchasing things online (Blevins & Holt, 2009; Castle & Lee, 2008). The anonymity that the Internet can provide is beneficial in some cases as there are some commercial transactions that are highly stigmatized. Sex work has been systematically stigmatized, so the growing prevalence of on-line advertisements and the ability to arrange appointments for sexual services this way is not surprising (Sharpe & Earle in Jewkes, 2003).   The Internet has also provided virtual communities for sex workers and sex buyers as there are numerous forums to engage, discuss and review experiences in addition to areas where issues such as etiquette for clients can be discussed (Sharpe & Earle, 2003). This building of community, and the existence and volume of advertisement of sex for sale may be contributing to a normalization of sex work where paying for sex is becoming acceptable and rational to consumers and sex workers (Hughes, 2003; Milrod & Monto, 2012; Sharpe & Earle, 2003). Unlike street-based sex work where a client must go to the locale of the sex worker and spend time seeking their services and negotiating in person, the Internet provides time efficiencies and allows for control over location and setting and pre-empts what services the sex worker provides along with information about the cost of services (Pruitt & Krull, 2010). There is also a lesser threat of law enforcement to both the sex worker and the client in off-street settings where the communication to set up services happens online (Lee-Gonyea, Castle & Gonyea, 2009).   14    Content analysis and descriptive studies have been utilized in research on sex work advertisements on the Internet and there are now a small number of studies that have addressed questions of what is present and how this information is utilized. These studies have contributed to a small but significant knowledge base about the content in online sex work advertisements. I reviewed 15 studies that were directly related to advertising sex on the Internet. Nine were focused on male sex workers, 4 on female sex workers and there was one that was inclusive of both male, female and a small number of transgender sex workers.   Castle & Lee (2008) conducted a study including 61 female sites, 5 male sites, 6 sites that included both male and female sex workers and 4 that were a variety of male, female, transvestite, transsexual and couples advertising sexual services. This study included information about health, safety and business practices and provided an array of information about general practices in sex work advertisements.  This study contained sites both within and outside the USA with the majority of sites located outside the USA (64.5%). Business information such as prices listed, (79% contained this information) payment options, contact options and the presence of a rating system were studied. Health information was embedded in the narrative that was collected and notably, smoking and drinking behaviors, penis shape and size and sexual orientation were listed in some websites. Biographical sketches also captured information about the sex worker that might persuade a client to choose them such as listing interests or hobbies, self-descriptive statements about personality, demeanor and physical attributes. The researchers noted there were some relatively consistent areas where information listed which were hair and eye color, body type, and age. In this study, the 18-29 year old age category was most prevalent. There was no explicit safety related information listed, nor report of the sexual services listed by sex workers.    15      Milrod & Monto (2012), conducted a survey of 567 male clients of female sex workers through a review website. The study discussed characteristics that were most attractive in a sex worker. The top three included “happy and cheerful personality, beautiful and healthy appearance and acts like a girlfriend and not a prostitute” (Milrod & Monto, 2012, p. 804). These observations indicate that the majority of services utilized and desired characteristics are not extreme or far from what a non-commercial exchange might include and that the characteristics that were desirable in a sex worker were similar to those that one might seek from a non-commercial partner. The study also revealed that the men surveyed thought that sex workers found online were preferential because they met the criteria for the characteristics girlfriend-like characteristics over sex workers who were not procured online. Sharpe & Earle (2003) also studied the male client‟s perspective and noted the occurrence of desiring a sex worker who resembled a girlfriend and provided companionship. This study also discussed the male desire to provide pleasure to a partner, even when paying for sex where one might assume that it is primarily about the male client‟s physical satisfaction. This is of importance as there are some activities such as cunnilingus that may be sought out by some men and are not provided by all sex workers.  Blevins and Holt (2009) also studied male clients of female sex workers and discussed the online world of male reviews and the subculture and language that exists in this realm. This study was important in creating an understanding about how ancillary sites such as review forums shape the culture, norms and dominant discourses amongst males who seek female sex workers online. This study also confirmed that many clients see sex as a commodity and that increased satisfaction with a particular sex worker was likely to lead to repeat business. This satisfaction was frequently attributed to the ability for the sex worker to make the experience feel less transactional and more “authentic”.   16    Pruitt and Krull (2010) provided an analysis of Internet advertisements of female sex workers patronized by men along with the reasons that men sought their services. A content analysis approach was utilized to capture the information contained in the advertisements of 237 sex workers advertising through a female escort site in the United States of America in 2006. Some prevalent website information was description of beauty and measurements, personality, and assurances as “discreet” and “unrushed” service. Girlfriend experience (GFE) was mentioned in 20.3% of the advertisements; however the term was only defined in 0.4% of advertisements. “Given this, women obviously assumed men know what the „GFE‟ or the phrase „Girl Friend Experience‟ implies” (Pruitt & Krull, 2010, p.57). The “Girlfriend Experience” or “GFE” was widely described throughout the literature and generally meant that there was a relational aspect that felt like more like being with an intimate non-commercial partner than a sex worker (Blevins & Holt, 2009; Castle & Lee, 2008; Milrod & Monto, 2012; Sharp & Earle, 2003).    Other types of information described in the literature were those concerning physical attributes and health related characteristics such as breast, waist, and hip measurements in women, and penis size in men. In a study by Lee-Gonyea et al. (2008), male sex workers provided photographs on their websites 85.6% of the time, and included a physical description 89.2% of the time. This study also described the listed method of contact, prices, payment options, rating system and availability of in call/out call. The most common form of contact was call/e-mail (50.6%) followed by call/e-mail/website (12%), e-mail (10.8%) and call (7.2%). This also describes the multiple ways that a client can contact a sex worker advertising online. Payment options were equally diverse with the most commonly described payment option as cash only (6%). Though there were other options in multiple combinations, the majority (79.6)  17   did not indicate payment method. Despite the absence of payment information, 55.4% provided information about the price of services, with most being shown as price per hour. The range of price per hour in this particular study was $90/hour - $200/hour indicating that most of the sex workers had adequate incomes to meet their basic food, shelter and clothing needs, although this would vary depending on number of clients seen per day.   Some studies indicated that sometimes sex workers listed the services they offered in the body of their advertisements. However, few studies examined the services that were offered to determine how this might impact health. Some studies offered insights into language utilized by both sex workers and sex buyers in advertisements and review sites. There are generally recognized short form or “code” words that describe certain services. For example, “greek” generally refers to anal sex and “BBBJ” stands for “bareback blow-job” or oral sex without a condom (Pruitt & Krull, 2010). These terms are part of the culture of Internet based sex work sites and as such, are understood by sex workers and their clients (Blevins & Holt, 2009). It wasn‟t clear in the literature how it came to be that services were described in this way, but in my data collection, there was one advertisement by a female sex worker who had a list of all of the explanations for the terminology and many can be found in the Urban Dictionary on the Internet at www.urbandictionary.com which is described as “A veritable cornucopia of streetwise lingo, posted and defined by its readers.”  Strengths and Limitations   The literature in advertising off-street sex workers on the Internet has assisted in creating an understanding of populations working in this realm, and established some key factors in motivation for clients to seek out sex workers this way. It is well established that sex work is advertised online and that women who advertise this way are often offering more than just sexual  18   services (Pruitt & Krull, 2010). Men who seek female sex workers using the Internet are a distinct group with a culture of their own, and may become regular clients if the experience seems “authentic” or non-commercial in nature (Sharpe & Earle, 2003). This facilitates shared understandings about sexual activities within the context of off-street sex work.   It is also well established that some women who work off-street have an understanding of safer sexual practices and often teach their clients about safe sex. However, it is difficult to generalize off-street sex workers as a group, as studies have also indicated that there are multiple environments where sex work occurs off-street and that some sex workers encounter barriers to achieving positive sexual health outcomes (Bungay, Kolar, Thindal, Remple, Johnston & Ogilvie, 2013).  There is also a significant body of knowledge on male sex workers advertising online. This data provides a basis for understanding male sub-groups engaging in this work, such as men who have sex with men. This information also helps in describing the sexual risk that exists for these men and potential consequences of engaging in off-street sex work. Some research lists content in online male sex work advertisements, but most has tended to focus on HIV to the exclusion of other health and safety issues. Men who advertise primarily to women are also an unstudied and poorly understood sub-group.   Similarly, transgender sex workers are not well understood. This is a major gap as transgender people are involved in sex work but are virtually invisible in the literature. This is also limiting in terms of understanding how transgender sex workers are advertising their services, how potential clients take up the services of transgender sex workers and the implications for the health and safety of this population.   19     There is little data contrasting male, female and transgender sex workers, the information listed on their websites, nor the implications of such information. The types of information being communicated by Canadian sex workers advertising online have not yet been detailed. In my study, I provide a synthesis of the communications affording an important foundation from which to build, and answer the research questions: 1.     What types of health, safety and business information are communicated on sex workers‟ advertising websites? 2.     What are the similarities and differences in advertising content within and between women, men and transgender sex workers?             20   Chapter 3: Research Design and Approach   In my earlier chapters I detailed the shifting market place of the off-street sex industry and the growth of web-based advertisements communicating sexual service provision and linking providers and consumers. I also illustrated that there has been scant Canadian research about the content of sex workers‟ web advertisements and an absence of health specific content analysis or comparisons of men, women, and transgender sex workers‟ web advertising. In this chapter I provide a detailed overview of content analysis as the research approach undertaken in the current study. I also detail data collection and analysis methods amid addressing the scientific quality in answering the following research questions:  1.     What types of health, safety and business information are communicated on sex workers‟ advertising websites? 2.     What are the similarities and differences in advertising content within and between women, men and transgender sex workers? Research Approach   I used content analysis as the overarching research approach. Although varying perspectives of content analysis exist, for the purpose of this study I drew on central tenets of content analysis as described by Polit & Hungler (1991) and Krippendorff (2004). Content analysis is a method to quantitatively analyze the content of communications in a systematic and empirically informed manner that would permit similar or reproducible results (Polit & Hunger, 1991). It involves a series of iterative and systematic processes that include creating an empirically derived sample of communications (e.g., websites), determining the unit of analysis (e.g., words, phrases), developing a categorical scheme for coding data, data analysis, and reporting of the findings. Prior to outlining my activities in undertaking these activities, I first  21   provide an overview of key concepts informing my work.  Within content analysis, communications can take varying forms including for instance, written text, verbal communications, video communications, and hypertexts defined as the array of texts or communications found within internet and web settings (Krippendorff, 2004). Although content analysis can be used to analyze multiple aspects of communications including the attributes of the content, the meaning of the information communicated, the processes used in communication, and the effects of the communication (Polit & Hunger, 1991), I focused my research on the attributes of the content and its related meaning within the context of information about health, sexual acts and restrictions, and other forms of business communications (e.g., payment, contact procedures) that pertain to communicating about sex work.  I also considered the context in which the communications were occurring as required when employing content analysis (Krippendorff, 2004). I identified economic, social, political, and gendered contexts as central contextual factors of concern. At the time of the study for instance, communicating for the purpose of providing or buying sexual services in a public space was illegal (Government of Canada, 2015) and as such I had to consider how this may affect the nature of information communicated in a website. Furthermore I situated the work within an understanding that web advertising serves an economic purpose of communicating to potential buyers that the specific people situated within these ads are available to provide services for payment. Within the social realm, sex workers have long experienced significant stigma and discrimination that have contributed to arrest and harassment (Krusi, Chettiar, Ridgway, Abbott, Strathdee & Shannon, 2012) and therefore I had to consider that information might be communicated in such a way to protect sex workers‟ privacy. Finally, I was concerned with gender and gender relations within sex for money exchanges and paid attention to how gender  22   relations could potentially influence the communications (Johnson & Repta in Oliffe & Greaves, 2012).   It was additionally important that I position my work within select aspects of communication theory. For the purpose of my research, communication was defined as the process of sharing information and conveying meaning through a shared system of semiotic rules and symbols (Knapp & Daly, 2011).  I was specifically concerned with language within the advertisements and the words and phrases concerned with conveying information. I recognized that I was investigating one aspect of the interpersonal dynamics of web advertising between sex workers and sex buyers; however this was appropriate given my overarching aims to expand understandings of the information communicated within the advertisements and not the effects of ads on the sex for money exchange.  Sample  This project was situated in a larger project aimed at examining the relationships between organizational and operational features of the off-street sex industry in Vancouver, British Columbia, Canada, and the health and safety of female, male, and transgender sex workers. The data used in my study was collected from a database of 226 web advertisements developed during ethnographic mapping activities within the larger study. All 226 sites were verified as sexual service provision web advertisements through key informant interviews, reviews of online forums and other related field work, the details of which are published elsewhere (Bungay, Oliffe & Atchison, 2015). The advertisements were systematically selected from the larger data set of women (n=173), men (35) and transgender (n=20) sex worker web advertisements and captured 33% of the original data. The non-probability sample included 75 verified web advertisements with female (n=45), male (n=24) and transgender people (n=6) advertising sexual services in  23   Vancouver, British Columbia. All advertisements were publicly accessible via the web and I did not access any communications that had closed membership (i.e., required a username and password). Ethical approval to conduct this study was obtained through the University of British Columbia. It is important to note that due to the transient nature of sex work in general, there were some websites that were intermittently unavailable, or disappeared during the course of the study.  Data Collection  To guide data extraction I developed a tool in Microsoft Excel that allowed me to collect data based on predetermined categories relevant to the study aims (Polit & Hunger, 1991). I identified several themes that provided an appropriate unit for the final analysis. Themes within content analysis represent words, phrases or images making assertions about a topic and included: (a) demographics (b) health communications (c) safety communications and (d) business communications. I then operationalized each of the themes to ensure consistency in how the information was extracted within each of the categories.  Demographic details included self-described role (e.g., escort, courtesan, companion) and observed characteristics including age, ethnicity, gender, and business types (e.g., in-call and out-call). Health communications included information posted for potential clients and specific health related terminology. Communications pertaining to services provided and the restrictions listed were also extracted and categorized. I was also interested in the clarity of the communications within the advertisements because, as noted in the literature review, the potential for violence or problem behaviors have been associated with discrepancies between what the client expected and what happens at the time of sex for money exchange (Atchison, 2010). Safety communications were defined as those that could potentially impact a sex worker‟s  24   well-being including location of work and willingness to travel. Lastly, I categorized business communications to identify booking information, the stated type of contact required for booking, and payment information including currency, methods, and prices. I had initially planned to define how much was being charged per service but all advertisements listed rates indicated by hourly or time based rate, for example, a weekend.  To further aid in data extraction I drew from the empirical literature, my research objectives, the organizational themes, and my working knowledge of web advertisement to generate key categories for data extraction that would augment the data collected and aid analyses through triangulation. These categories included (see Appendix A for detailed descriptions):    sex worker self-description   age  gender (male, female, transgender)  ethnicity (noting if it was stated in the text or if it was my observation)  weight (numerical value as stated if provided in advertisement)  discernable face photo (if provided, if it was full or partial)  fees or service rates   services listed (including subcategories for location and types - incall, outcall, massage, escort, full service, fetish, companionship, duo and other listed services)  service restrictions  health information  booking process  payment process   25   To extract the data I initially took screen shots of all the information housed within the advertisement and saved these in an encrypted file. I then reviewed the communications located within each advertisement to extract the content to the data extraction file. I primarily extracted words and phrases and I copied and pasted directly from the advertisement to the relevant categories. I also recorded when there was no categorical content within the advertisement. In coding individual advertising sites, I assigned a numerical code that was matched with the filing system for the screen shots.  Data Analysis  Data were initially analyzed using descriptive statistics. I calculated the frequencies among advertisements that included categorical information pertaining to the four organizational themes of demographic, health, safety, and business practice communications identified above. Each category (Appendix A) was initially coded as a categorical “yes” or “no” to calculate these frequencies. I further tabulated these details according to the gender of the person represented in the advertisement.  I then calculated frequencies to capture the variation within each of the categories detailed in Appendix A. For example, I reviewed all advertisements to calculate the total number of advertisements where the sex workers‟ age was provided and noted this according to gender. Based on the distribution among those advertisements that specified age, I further categorized the information into ranges (e.g., 20-29; 30-39; 40-49) according to the gender of the person in the advertisement. Upon completion of the categories‟ frequencies, I undertook a structured, theoretical analysis of the data within several categories. Within the category sex worker role self-description used in the advertisement (e.g., escort, courtesan, playmate), I combined categories sharing similar properties to generate four sub-categories that represented the data:  26   escort, companion, combination, or other (see Chapter 4 for analysis). Health information was analyzed according to the topics identified within the advertisements and combined into categories of drug use, STI/HIV and other. In addition to the frequencies calculated according to the male, female and transgender sub-groups I maintained a narrative account of the similarities and differences within these sites, the results of which are reported in Chapter 4.  Summary   In summary, I viewed and categorized 75 websites advertising sex work services in Vancouver, British Columbia. I systematically documented these findings in order to address my research questions and provide understandings of the communications by addressing demographic communications, health communications and business communications. Additionally, I captured narratives that would assist in providing a comprehensive analysis of the information.           27   Chapter 4: Findings  In this chapter I present the study findings. To aid in the reporting, I have organized the findings according to five central themes: Demographic Characteristics; Health Communications; Services and Restrictions; Safety and Business Communications. It is important to note that although these themes or descriptive labels are discussed separately there was overlap, and elements both potentially protective and harmful to sex workers‟ health and safety. Furthermore, where applicable I provide some narrative accounts of the findings to illustrate where communications were similar or different between the sexes.  Theme One: Demographic Characteristics  The sample consisted of 45 women, 24 men and 6 transgender sex workers advertising sexual services. Thirty-five were located within an independent website (e.g., the sex workers‟ personal business website) and 40 were a profile on a website that offered a platform for multiple advertisements. The advertisements varied greatly in terms of identifying their explicit purpose, which may be indicative of sex workers‟ working within the constraints of law that criminalizes the sale of sexual services in Canada (Government of Canada, 2014). The advertisements also varied in how sex workers self-described their role. As noted in Table 1, 67 (n=75) advertisements included a self-description. Escort was the most commonly found term amongst all genders. In men and transgender sex workers, escort was the only term utilized.  In determining ethnicity of sex workers, 25 (33%) advertisements did not specify the sex worker‟s ethnicity. The photos provided an indication from which I estimated ethnicity in those not stated. Women‟s and transgender people‟s advertisements were less likely to specify ethnicity; 45 (44%) women and 6 (33%) of transgender adds specified their ethnicity as opposed to 24 (96%) of the men‟s advertisements. Caucasian was the most common ethnicity stated or  28   observed (see Table 2). Among the sex workers who self-identified as Multi-Ethnic, they primarily described themselves as having multiple ethnicities with some people listing more than two ethnicities. Some sex workers used words to describe their appearance. “Exotic” was one of the more commonly utilized words in women who described themselves as multi-ethnic. The format of the advertisements were also analyzed and compared. The men‟s advertisements appeared to adhere to a template in which men could input information into categories to describe themselves to potential clients. The women and transgender sex worker‟s advertisements in contrast, were unique in appearance and did not appear to be form-based. Furthermore, 35 (78%) of the women‟s advertisements were independent versus being hosted by a shared web-advertising site.  Twenty-four (32%) advertisements did not include a specified age for the sex worker. No stated age was more common among women‟s ads;  21 (47%) women did not state their age as compared to 1 (4%) man and 2 (33%) transgender people (see Table 2). Men listed their weight 100% of the time but this again was likely because there was a pre-determined category for this on the template for their advertisement on a group site. Only 56% of females and 67% of the transgender sex worker advertisement listed body weight (See Table 2).                29   Table 1* Sex Worker Self-Description   Description   Female (n = 45)   Male (n = 24)  Trans (n = 6)  Escort, Escort/Masseur  18   24   6  Companion    5   0   0  Multiple Roles                                    4                                  0                                  0  Other                                                  10                                 0                                  0  Not Specified    8   0   0  * Sub categories refer to: escort (escort, escort/masseur); companion; multiple roles; other (e.g., courtesan, dominatrix, playmate, sugarbaby, other)  ______________________________________________________________________________                            30   Table 2 Population Characteristics of Sex Workers    Listed age (years)  Female (n = 45)   Male (n = 24)  Trans (n = 6)_______   20 – 29   14   16   2   30 – 39   9   4   1   40 – 49   1   3   1   Not specified   21   1   2  Ethnicity   Caucasian   29   13   4   Black    2   1   0   Latino/Hispanic  1   3   0   Asian    9   4   1   Multi-Ethnic   4   3   1   Weight   Specified   25   24   4   Not specified   20   0   2   Average  Weight (lbs.)   118.52   167.17   135  ______________________________________________________________________________   31   Theme Two: Health Communications   As noted in chapter three, health communications were coded in two primary ways. The first was to identify topics, words or phrases that were noted in the advertisement that would help me to understand the types of personal health information they wanted to impart to a client, such as whether or not they smoke, do drugs or are free of infection, and aspects of personal health practices such as working out or yoga. The second way was to describe what was communicated via the advertisements that had potential to impact the health or well-being, such as types of services provided and listed physical restrictions. It is important to note that I am not making claims on actual threats to health and well-being that a sex worker might have experienced, but instead to describe the nature and scope of the communications.   There were some noteworthy sex-based variations in personal health information communications. Transgender sex worker advertisements rarely communicated any personal health information. Men and women consistently provided some type of health information whereas none of the transgender people‟s advertisements included health communications. Being a non-smoker was the most common personal health communication. Three (7%) women‟s advertisements contained communications requesting that clients refrained from smoking prior to or during appointments and one (2%) indicated that they would not visit smoking rooms in hotels.   Drug use and tolerance for drug use by clients was also communicated within the sites (see Table 3). A quarter of the male sex workers‟ advertisements stated that they did use drugs or were okay with “party and play”. Party and play (PNP) is a euphemism for acknowledgement of the availability for drugs, frequently crystal methamphetamine, to be taken in conjunction with having sex (Frederick & Perrone, 2014). None of the ads stated specific illicit drugs that would  32   be acceptable; with the exception of a small number of women who specified that they were “420 friendly”, indicating that marijuana is acceptable for them.   Communications about sexually transmitted infections were more commonly seen in men‟s ads. Seven (29%) men indicated that they were STI/HIV free while just 7 (11%) women made this statement. None of the transgender people communicated about sexually transmitted infections. Men were also likely to enter some information about their muscular build or work-out routine. All men‟s advertisements had categorical information about physical characteristics. The most common were weight, body hair, body type, penis size and sexual position preference. This differed from women and transgender ads where physical descriptions were present, but they did not appear uniformly as they were independently developed websites and thus did not have categories to fill in. Eleven percent of the women‟s advertisements also requested “good hygiene” from their clients and these ads frequently included information about the ability to shower at their in call prior to and after services.                33   Table 3 Health Information   Listed  Female (n = 45)  Male (n = 24)   Trans (n = 6)   ____________  Non-smoker  16   9   0   Drug Use   Yes                              2                                  6                                  0  No                               13                                3                                  0   Light/social/ no alcohol  7   4   0   STI/HIV/clean  5   7   0   ______________________________________________________________________________                 34    Theme Three: Services and Restrictions  There were a plethora of terms utilized throughout the sites to describe services within the body of the websites. The terminology utilized between genders varied, but within gender the terms used were homogenous. For example, 44% of females offered “full service” meaning the worker would engage in activities including sexual intercourse. This term was not used in men‟s or transgender people‟s sites, although they used other terms such as “top” or “bottom” indicating their position of preference for sexual intercourse. All but two of the men in this sample were offering services exclusively to other men. One term predominantly utilized by women was the “girlfriend experience” which can be described as engaging in activities and sex that would be expected in a non-commercial adult relationship (Sharpe & Earle, 2003). Men were often more direct in their advertisements about what they were offering with some including a lengthy list of sexual acts that they were willing to participate which included terms such as “rimming, fisting, and watersports”. Boyfriend experience was seen in some men‟s ads but less so than in women who were offering GFE.  Fifty percent of men offered fetish services of some type where 27% of women offered this. Fetishes are described as intense sexual urges and fantasies based on non-living objects (Kim, Paek & Lynn, 2010) but in the context of the advertisements, this definition included domination service; listing bondage, domination and sadomasochism (BDSM) and humiliation as services within that realm. The women who offered professional dominatrix services went into great detail about health and safety, for example asking clients to reveal any medical issues prior to services and a requirement for full consent to be obtained along with safety words to indicate the client wanted to revoke their consent and stop the activity. The spectrum of stated services  35   was vast, with most sex workers of all genders offering some kind of companionship, escort or massage service (See Table IV). Women were more likely to offer “duo” services and listed other sex workers, male and female who they would work with, some offering links to the other independent sex worker‟s sites via their own page. Only 4% of men and no transgender people offered duos in comparison.  Uncovered (i.e., no condom required) sexual services were offered in some advertisements for oral-genital, oral-anal sexual exchanges or some other form of body fluid contact. Women were more likely than men to advertise uncovered oral-genital sex. Eleven (24%) women offered services such as BBBJ (bareback blowjob), CIM (cum in mouth), DATY, (dining at the Y/cunnilingus), and DATO (dining at the O/analingus). Men referred to analingus as “rimming” and there were 6 (25%) men offering this service. Only 1 (17%) transgender person offered uncovered oral/genital service. Most did not say explicitly that no barrier was required, but stating that services were offered “bareback” indicating condoms were not required. Only one advertisement said that they offered intercourse without a condom, as the sex worker stated they “prefer bareback but will fuck safe”. This sex worker indicated that they were HIV positive but that they were “undetectable” referring to HIV viral load. Studies have shown that “some men who have sex with men (MSM) perceive that having an undetectable HIV load reduces the risk of HIV transmission” (Van Den Boom et al., 2013). Thirteen percent of females, 25% of males and no transgender listed one or more uncovered services on their sites.   Forty-seven percent of women, 38% of the men and 17% of the transgender people‟s ads said explicitly that they never provided uncovered services, or made the statement that they were “always safe”. Refusal to answer calls from blocked numbers were communicated by all groups: 5 (11%) of women, 1(4%) man and 1(17%) transgender person listed this as a restriction.  36   Twenty percent of women stated that they would not engage in anal sex or “greek” as it is commonly referred to, while no men or transgender people listed this as a restriction, which makes sense given this sample was advertising predominantly to men. Twenty-two percent of females indicated that they would not see a client who was or appeared to be under the influence of drugs or alcohol. In contrast, none of the men or transgender people listed drug and alcohol use of a client. Five (11%) of the women listed light or deep French kissing as a restriction while this was never listed as a restriction for men or transgender sex workers. Women communicated more restrictions overall, sometimes having a section titled “etiquette” or “frequently asked questions” that included restrictions.                               37   Table 4 Services Listed or Provided   Type  Female (n = 45) %  Male (n = 24)  % Trans (n = 6)  %________________  Listed: Yes  35 78  23 96  6 100  Listed: No  10 22  1 4  0 0  In call   35 78  12  50  3 50  Out call  34 76  18 75  4 67  Massage  18 40  18 75  0 0  Escort   20 44  23 96  6 100  Full service  20 44  0 0  0 0  Fetish   12 27  12 50  1 17  Companionship 12 27  12 50  0 0  Duo   12 27  1 4  0 0  GFE/BFE  17 38  2 8  1 17  Uncovered oral/ Genital                  11 24  6          25  1 17  Travel   9 20  7 29  0 0  Anal   6 13  16 67  3 50  ______________________________________________________________________________           38   Table 5 Restrictions   Type    Female (n=45) %  Male(n=24) %    Trans(n=6)________  Greek/Anal   9 20  0 0  0 0  Uncovered services  21 47  9 38  1 17  Client under the Influence 10 22  0 0  0 0    Photos/Videos   2 4  0 0  0 0  Deep/Light French Kissing 5 11  0 0  0 0  Other Physical Restrictions 7 16  1 4  1 17  Outcall to Private Residence 3 7  1 4  1 17  Blocked Numbers  5 11  1 4  1 17    Theme Four: Safety  Safety information was discussed in terms of spaces where sex work was provided and the stipulations that were listed indicating how a client should be prepared for the encounter. Recognition information related to the presence of facial photos is captured due to the potential for sex workers to be “outed” or recognized by anyone viewing the site.  Spaces where sexual transactions take place were often identified in advertisements. Seventy-eight percent of women and 50% of both men and transgender sex workers‟ ads identified that they provided services within in call locations; thereby providing a space such as an apartment or house for the sexual exchange for money to occur. Women frequently described their spaces in detail with emphasis on the relaxing atmosphere they were providing. Many of the women‟s ads showed photos of the space with bedroom photos. Men and transgender people‟s  39   advertisements generally did not describe the space, but indicated that they provided one. Outcall services were also offered within the majority of advertisements (see table IV), but women often had outcall location restrictions. Three (7%) women communicated that they would not do outcall to private residences and some identified that they would provide services in only four and five star hotels. Four (9%) of the women required references from another provider and one woman required clients to check in with security at the beginning of the visit. Nine (20%) women and 7 (29%) men indicated that they would travel, while this was not a service offered within transgender people‟s advertisements. Women regularly communicated travel rates, which in most cases were in weekend, or weekly rates. None of the men‟s or transgender peoples‟ ads communicated the need for referrals or communicated any details about security personnel.  While many advertisements included some kind of photograph of the sex worker advertising their services, few had viewable facial photos. There were 13 full facial photos in the women‟s ads, 9 in the men‟s ads and 5 in the transgender people‟s ads.  Partial face photos were seen in 9 of the women‟s ads, 2 of the men‟s ads and in none of the transgender people‟s ads. The partial face photos revealed features such as eyes or lips, or in some cases a side profile with shadowing that would make it more difficult to identify the person based on the photo. There were two women‟s ads offering photos or videos with the clients. One of the advertisements stated that she would only agree to photos and videos if she were confident they won‟t end up on the Internet, but did not state how that was determined.  Theme Five: Business Communications  Two areas of communication were considered business communications: the booking process and the payment process (See Table VII). The booking process that was utilized was fairly consistent, although there were a couple of exceptions that can be explained by the way  40   that the websites for men were set up. Men were most likely to utilize the website itself as a messaging center for setting up appointments, whereas a third of the women had set their websites up to allow for this and 50% of transgender people were using their website for this purpose. Thirty-six (80%) women, 15 (63%) men and 5 (83%) transgender people included a phone number and wanted the client to call directly to set up appointments rather than texting. E-mail was utilized by 6 (100%) transgender people, 18 (40%) women and 5 (21%) men. Nineteen (79%) of the men provided a means to contact them directly through the website that they were advertising on, as it appeared that this was a feature of the platform that they were using. Fifteen (33%) of women had also set up their websites to allow for direct messaging via the website and 3 (50%) of transgender people could be contacted this way.  Given the widespread use of social networking to communicate, it was interesting that no one was booking clients in this way. However, there was one woman who had links to her Twitter and Facebook so that clients could access those, although it did not appear that this was related to the booking process.  The price of service was listed in most of the advertisements and differed slightly between the sexes in range. However, the average price per hour was fairly close between the groups (See Table VI). Women had the highest rates with one woman charging 700 Canadian dollars per hour. Of note, her site was very professionally done in appearance, and she was set up with payment processes such as credit card that were seldom seen on other sites. Transgender people had very little variation in price with the lowest being 200 and the highest being 250 per hour. Men also had a fairly consistent price per hour and most charged significantly more for travel, which did not include the price of airfare, hotels and meals, which was specified. The prices per hour indicate that most sex workers in this study had the potential to make a living wage by working consistently. As independent providers, sex workers would have to save money  41   for episodic illnesses and other instances where they were unable to work. There is no indication that older sex workers are unable to work, but there were very few in this sample that stated that they were over the age of 40. This may have implications for financial planning for later in life, but the literature suggests that some sex workers have other employment offering benefits such as pensions and medical/dental coverage and that sex work is a supplementary source of income rather than the sole one.  The payment process was not well communicated in the overall sample. Only 15 (33%) women and 2 (33%) transgender people specified the payment process (type of payment options, when to pay). Men did not include this information at all. Of those who did specify payment, cash was the preferred method and was frequently referred to as a “donation”, especially in the female sample. There were four women who offered a bank transfer or debit option and 2 women and one transgender person offered credit card payment. The payment process is one that requires examination due to the potential for conflict around payment or non-payment following services and is discussed in the chapter that follows. Table 6 Rate of Service per Hour                                  Female (n = 45)   Male (n = 24)           Trans (n = 6)____________________  Minimum Rate (CAD$) 140  180  200   Maximum Rate (CAD$) 700  450  250  Average Rate (CAD$) 313  247          233    ______________________________________________________________________________       42   Table 7 Business Characteristics   Booking Method Specified  Female (n = 45)       Male (n = 24)   Trans (n = 6)________  Yes      44   24  6  No      1   0  0  Booking Contact Process_________________________________________________________   Phone     36  15  5   Website    15  19  3   Text     8  1  1   Email     18  5  6   Social media    0  0  0  Payment Processes______________________________________________________________   Yes     15  0  2   No     30  24  4  Payment Process Type___________________________________________________________    Donation/Cash   13  0  1   Bank transfer/debit   4  0  0   Credit card    2  0  1      43    Summary  This chapter has allowed me to describe the findings of my study by themes that emerged from the data. These themes described demographic characteristics, health communications, services and restrictions, safety and business communications that were found within the sex work websites. These themes allow for discussion about what types of information are included and by whom, as men, women and transgender can differ in their communications. This leads me to the next chapter where I discuss the findings, limitations, and usefulness of the research.                  44   Chapter 5: Discussion and Recommendations  In this final chapter I discuss the study findings regarding website information as situated within the context of gender and gender relations, and how the findings contribute to health care providers understanding of commercial sex work communications. Gender is a phenomenon that shape our experiences, behaviors, choices and the ways we are understood by others. Gender is not static but is a social construct that shapes and is shaped by structures (Johnson & Repta in Oliffe & Greaves, 2012). The findings indicate that in advertising sex, there is an intended audience, which is not always, but often implicit to the online content. It was also apparent that gender roles and relations played a part in how men, women and transgender people advertise themselves and their services. The way that people communicate in association to gender may offer some insights in how people behave and what is expected in the context of social interactions (Johnson & Repta, 2012). Gender also has implications for how we learn and interpret interventions aimed at improving our health.  Therefore, knowing more about how sex workers communicate to others will allow us to understand what may be effective in translating knowledge to diverse sub-groups of sex workers. In this chapter I address communications by sex workers in relation to health, safety and processes related to conducting business, and discuss how these findings contribute to better understanding the landscape of indoor commercial sex work in Vancouver. Following this, recommendations for nursing practice and limitations of this study are presented.  Summary of Key Findings  Communication differences. The language and ways that we describe ourselves are shaped in many ways by how we perceive ourselves in terms of gender, regardless of what sex we are born (Johnson & Repta, 2012). The findings in my study revealed that there are  45   differences in the ways that men, women and transgender people communicate when advertising sex work online. However, the group comparisons revealed that there were similarities in the information communicated.   The website formats in this study differed between men, women rates, reviews, photo galleries and bios. They appeared to professionally done in many cases, with varying levels of technology and ease of use. Men‟s sites were all located in platforms for advertising male sex work services. They were set up so that a reader could choose the city, and then browse photos and click on individual profiles for more information. Men often utilized photos of their bodies and genitals for many of these “catch” photos. Men‟s sites typically captured all of the information on one-page profiles and contained information that appeared to be constructed by filling out a form with distinct categorical information. The men‟s sites overall were more generic than those of women and transgender people and were utilized mainly by men advertising sex to other men. In men‟s sites the categories were very clear and offered clients fast and direct information about the sex worker.  For example, men‟s advertisements in this study consistently contained weight, body hair, body type, penis size and sexual position preference. These profiles assist men who wish to procure sexual services by allowing them to select a sex worker that suits their preferences without having to read through several pages of dialogue.  Lee-Gonyea, Castle & Gonyea (2009) conducted a content analysis of indoor male sex workers advertisements and found that these descriptive communications were common amongst all men in their study. Their sample included both men advertising to other men and men advertising to women. They noted differences between these two groups in how they communicated, notably that those who were advertising to women had sites that were not unlike dating sites with information about personality and hobbies, while men advertising to men were  46   more direct about advertising sexual services. In this study, where men were primarily advertising to other men, it was clear that they were offering sexual services. This study showed consistency in the findings of the communications of men advertising to other men, in that their intentions of offering sexual services were clear, with multiple sexual activities listed in their ads.  Women often described similar descriptive information in their ads, but it was embedded in narrative with language that was meant to entice such as beautiful blue eyes or my deliciously curvy body, which were consistent with findings from a content analysis conduced by Castle & Lee (2008) who described similar language in biographical sketches in Internet ads of sex workers. Transgender sites were almost a hybrid with categorical information similar to the sites of men, but were generally accompanied by more photos along with other information about themselves. One distinct difference within the transgender group was that they described their anatomy, using terms such as “pre-op” presumably so that the client had a clear understanding of what to expect in the sexual exchange. There were also communications in the transgender group about how they would like clients to interact with them; for example, “do not treat me as anything other than a woman”.  Almost half of the women in this study advertised escort and massage services and 17 (38%) offered the “girlfriend experience” which supports previous studies with findings that suggest that female sex workers are often sought out for more than sex (Blevins & Holt, 2009; Pruitt & Krull, 2011). The Internet has provided a way for women advertising sexual services to men to place emphasis on their style and personality, reflecting their ability to provide an experience that would resemble a non-commercial date. This advertisement strategy may contribute to an improved perception of sex work as some women described their enjoyment and  47   pride in the work that they did, suggesting that they had a high level of agency over their activities. The ability to showcase oneself in a desirable way is crucial to attracting clients. Therefore it makes sense that women‟s advertisements are fairly consistent in their structure as they are likely to advertise what they believe potential clients will be most likely to respond to, or what has worked well for them through a trial and error process of advertising (Pruitt & Krull, 2011).  It is possible that women who are setting up web advertisements view the sites of others to determine what types of communications are present on websites advertising similar services. Future studies to determine how sex workers build their websites, and whether there is a market that caters to the production of sex work websites may assist in creating a more robust understanding of why the websites of men, women and transgender people appear to have similarities within each group but differences between sexes.  Health and safety communications. Health and safety communications were prevalent in both men‟s and women‟s advertisements. Transgender people‟s ads differed as there was minimal information regarding health status or safety overall. One of the notable differences was the emphasis that women placed on the health of their clients in addition to their own. For example, client hygiene was a common theme in women‟s advertisements. 7 of the women specifically listed client hygiene as being important, and most offered shower services at their in call location.   Eleven of the women communicated about client‟s utilization of alcohol or drugs prior to the visit. Most of the language used was very direct such as no alcohol or drug use is permitted. The ability to set the standard for the visit in advance may be helpful to women in avoiding conflict between them and a client. O‟Doherty (2011) conducted a study of victimization of  48   indoor sex workers in Vancouver and noted that “women may be safer when they are able to structure their working environments and deal directly with potential clients” (p.957).   The women in the current study were detailed in describing the expected health status of their clients and listed specific restrictions around health behaviors. They also utilized language that made the sexual exchange one of mutual responsibility. One woman stated “I do not take part in unprotected activities for our health and safety”. Utilizing terms like “our” may benefit the sex worker by making clients feel that they are part of a mutually understood relationship akin to a consensual non-commercial relationship.   Clients were advised on health related matters in some of the ads. One woman did this by including the following statement on her website; the session is terminated without refund immediately if you are rude, play unsafe, jeopardize my safety or if I see health concerns. For women, the emphasis on client health may assist in creating an image that is healthy, caring and of a woman who is in control of her environment. This emphasis on client wellness was not seen in men or transgender people‟s ads.   Women were more likely to advertise unprotected oral-genital sex than men and transgender sex workers. The reason for women offering uncovered services more often is likely related to creating the illusion of a noncommercial partnership consistent with the GFE. Milrod & Monto (2012) described this phenomenon and noted that uncovered fellatio was the second most common activity engaged in by men and sex workers who advertised GFE online. Sharpe & Earle (2002) also describe men‟s desire to pleasure their partners and so offering the opportunity for cunnilingus is not surprising in this context. Women may mitigate risk by limiting oral sex or kissing for example, if they see that a partner has the potential to cause harm because of an obvious communicable physical condition such as a cold sore. It is possible that  49   men offer uncovered fellatio but in this study, it was not something that was seen within the content of their websites. Kissing was listed as a restriction in 5 (11%) of the women‟s ads, while this was not seen in those of men or transgender people. There could be multiple reasons for this, but because women communicated more about client health, this could be related to illness avoidance. Kissing may also be considered an intimate activity, as it was restricted in some ads by women who advertised themselves as “non-GFE”.   Men communicated about sexual health in more of their ads than women or transgender people. 29% of men, 11% of women and none of the transgender people communicated about STIs. Men were more direct in their terminology and used “STI/HIV free” frequently. Women used the term “clean” much of the time, presumably to describe their sexual health status, but in some cases it was used to describe lack of body hair.   This sample consists of predominantly MSM sex workers in Vancouver, BC. Given that “MSM are thought to comprise 45% or more of the estimated 9,300-113,500 individuals infected with HIV in BC (Moore et al., 2012, p.142), it is likely that this population of men are aware of the risks of unprotected anal sex with other men as there are many public health activities in place to ensure men in this community are aware of the need for HIV prevention strategies to be employed. The client population in this study is not known so it is difficult to determine the level of client awareness of prevention strategies. Parsons, Koken and Bimbi (2004) identify that male sex workers advertising on the Internet take steps to educate their clients about risky sexual practices, so maybe this directness and higher prevalence of men listing information about their sexual health status is part of the culture of male sex workers.  One area of concern was the small population of MSM sex workers offering PNP. The uses of drugs such as crystal methamphetamine, nitrate inhalants or “poppers” and Viagra have been shown to increase the  50   occurrence of engaging in unprotected anal sex (Mimiaga et al., 2008). Specific strategies may be required to enhance health and safety in this group of men.   Male to male sex workers who advertise online likely have greater control over their environment and studies have shown that this population is consistent in condom use with clients (Bimbi & Parsons, 2005; Parsons, Koken & Bimbi, 2007). 67% of the men in the current study said that they offered anal sex and only one man said that he provided bareback service. Although it is not known how often male sex workers in Vancouver, BC engage in unprotected anal sex, from the information provided online it would appear that there is likely a high level of understanding within the population that contributes to the safety of both sex workers and clients. Since transgender sex workers in this study did not communicate a lot about health and safety, very little information can be gleaned about the understanding of HIV/STI prevention and how transgender people negotiate safer sex in the sexual exchange.  Women‟s advertisements contained more information about safety in general than did those of men and transgender. There were 4 women who stated that references would be required for any new client, either from another reputable provider or from sites that host this information; “P411” and “Datecheck” were listed as acceptable sources of reference. One provider stated she would ask for identification if the client appeared to be too young and another stated that they were not liable for any injuries sustained as part of the visit. This illustrates that there are many kinds of information communicated that contribute to the personal safety of sex workers and that websites are not uniform in the information they provide. This reveals that sex workers likely have different perceptions of safety. These may be based on past personal experiences or those of other sex workers in the community and should be explored in future studies to determine if there are common practices that contribute to safer working environments.   51   Practices that would assist women in keeping safe were communicated in advance. For example, there were women who communicated that they would not visit private homes, or hotels that were less than 4 or 5 stars. It is possible that women choose to do more in call than out call as it allows them more control over their environment and allows them to put in safeguards such as checking in with building security or choosing a location that is obviously monitored with cameras. These kinds of safeguards may deter clients from behaving badly. One female sex worker in this study stated in her ad that clients would be required to check in with security, which indicates that some sex workers are enlisting the services of others to keep them safe and accounted for. It may be that some sex workers have relationships with higher end hotels so that someone is aware of their location and the expected time that they will be there. This theory is not well documented in the literature, but since several of the women in this sample stated that they would only see clients in these spaces, there is a possibility that there may be a business relationship between female sex workers and hotel employees such as the concierge. These relationships may be informal and likely unbeknownst to hotel management. This kind of network may be very helpful in maintaining safety for both sex workers and their clients.  Men and transgender differed greatly from women in their communication about safety and the spaces that they would be comfortable visiting. Seventy–eight percent of women had their own space to conduct business, while only 50% of men and transgender people offered in call services. The percentage of those who did out call was similar between all of the groups but men and transgender did not list restrictions on where they would go to provide out call services. This may mean that men and transgender work more outside of their own space and work more in private homes or apartments. Males may be more comfortable with outcall and entering spaces  52   that are not as controlled as women due to the self-perception that they would be able to physically defend themselves in an altercation. Their perception of themselves as masculine and able to defend themselves may be responsible for their lack of communications around safety. Oliffe and Greaves (2012) describe traits of hegemonic masculinity such as “strength, aggression, courage, independence and virility” (p. 26). If men‟s perception is that these are the traits that other men are seeking when they are looking for a sexual partner, it may not be favorable to include things like reference checks, security check in or to place restrictions on where they will see clients. Perhaps the power dynamics amongst male and transgender sex workers and their clients are different from those between female sex workers and their clients. Women use strategies to mitigate perceived power imbalances whereas men and transgender sex workers do not see the need to do this.  As social communities for gay men are often close knit and geographically small, it may be the case that sex workers and their clients are known to each other. However, this would not be the case at all times as there are men who seek services from MSM sex workers who do not identify as gay or are partnered or married and would want to be discreet. Men and transgender sex workers may hold more power in an exchange where the client would not want any attention drawn to the fact that they were seeking services in this manner. In contrast, while some men seeking services from women may want discretion, there are some seeking GFE which may include being in public places such as restaurants where it is part of the experience to be seen with a beautiful woman. Women advertised this type of service in their narratives while men and transgender were focused heavily on sexual activity.     53    Business Communications. Business communications are important as they assist sex workers in ensuring expectations are known to their clients in advance of meeting in person. These kinds of communications can allow the sex worker to be clear about what is being offered, how much it costs and how the client is expected to pay. This can aid sex workers in mitigating the risk of violence from disputes over payment or services (Sanders in Jewkes & Yar, 2010). All but one of the sex workers specified a booking process, beginning with the method used to contact the sex worker. The most common method of contact was to call the worker via a phone number provided on the website. Many sex workers stated that they would not answer blocked or private numbers. Other common methods were to contact the sex worker through an on-line form on the website and via e-mail. Social media with messaging capabilities such as Facebook was not used by any of the providers to communicate, which is interesting given the large reach and influence of social media. However, privacy concerns may reduce the appeal in utilizing these sites for both sex workers and their clients.  Payment type was specified more often by women and transgender people who did so 33% of the time. None of the men specified how they would like to be paid. Cash may be the preferred currency as is it hard for the government or anyone else to track in terms of income, but it may not be the safest in that it can easily be taken back if someone is unsatisfied. Women predominantly asked for cash, but bank transfer, credit or debit also appeared in ads. Women often referred to payment as a “donation” and specified that they would like it at the beginning of the visit. Using this term is likely a way to avoid unwanted attention from police. There were also many ads that included a phrase indicating that any money exchanged was for time spent only and that any other activities that may occur would be between two consenting adults.   54   Payment up front is one way that sex workers can attempt to keep themselves safe and to ensure that clients do not leave without paying. Conflict over payment can still happen after the sexual exchange occurs, one reason being dissatisfaction with the experience or services provided (Atchison, 2010). The absence of this information in men‟s ads may indicate that there is less conflict over money between male to male sexual exchange, but further studies would need to be conducted to test this theory. Perhaps it is simply seen as unnecessary for men to provide this information in advance or because websites did not have a place for this in their platform.    As discussed in the findings, the average price of service was similar amongst the sexes, with a greater range seen in women, which was 140 dollars per hour at minimum and  700 dollars per hour at maximum. This highlights the diversity of income within the population of indoor commercial sex workers in this study. For sex workers whose fees were in the higher range and seeing clients regularly, there may be an improved opportunity to purchase or trade for services such as security, or drivers who wait for the worker when they are providing out call services. The men and transgender people had a closer minimum and maximum range. Since their advertisements were all fairly similar in format, it may be harder for a man or a transgender woman to set themselves so far apart from the rest of the sex workers advertising on the Internet that they would be able to ask for a price far above the average that others were charging. The few women who charged much more per hour than others tended to have narratives describing what could be expected in spending time. They described themselves using terms such as “high-end” and “exclusive”. They also described their clients in favorable ways, utilizing words like "classy" or "upscale" to describe them. Therefore, women appeared to utilize their advertisements to attract the kind of clients that they want to see. The term “generous” also  55   appeared in many of the women‟s ads and many had wish lists with links to gifts that could be purchased for the sex worker. One woman had a link where clients could donate to a charity for street based survival sex workers which shows that there is an awareness of the great divide between a sex worker in her position and one who is on the street, trying to survive.  Usefulness of the Research   While there were some similarities in the information contained in men, women and transgender people‟s online advertisements, there were important differences noted that might assist us in better understanding these sub-populations. There appears to be standard information that sex workers share so that clients can make choices based on physical characteristics. However, there are some distinct differences in the advertisements of men, women and transgender people. This is likely because clients of each sub-group are seeking a slightly different experience. While men and transgender people were focused on the sexual exchanges, listing details about their anatomy and what activities they would provide, women‟s ads contained much more information about personality, spaces and the experience they would provide in addition to information about services. This by no means indicates that men who seek the services of women are not looking to engage in sexual activities, but it does tell us that they wish to engage with someone who is healthy and beautiful in appearance (Milrod & Monto, 2012), and who creates an image of themselves that is consistent with what a man would want in any sexual partner.  Women employ more strategies overall to ensure that clients knew what to expect in advance. These strategies may be effective in providing clarity to clients so that the potential for conflict over services and payment is reduced. Women often provided specific instruction around payment whereas men did not discuss payment type or process at all. This may be indicative of  56   differences in men and women‟s experiences with being victimized over payment in the past, or may just be a safeguard that women employ to reduce the chances of victimization. Women‟s focus on the health of their clients is likely to reduce the risk of exposure to illness and communicable disease, and allows for control over their working environment. Men focused more on their own health, providing information on STIs and HIV, which may be due to hyper awareness of sexual health issues in their community. It is unclear what strategies transgender people employ to discuss matters of safety with their clients; however the emphasis on providing information on anatomy might indicate that this has been a point of concern or conflict in the past. Further studies should be done to examine if and how past conflict leads to shaping information provided by sex workers advertising online, as this may be of benefit in helping sex workers to standardize certain aspects of their advertisements to communicate information that avoids potential conflict.  Limitations    While this study told us much about how men, women and transgender sex workers advertise in the Vancouver, B.C. market using an online medium, there are limitations that need to be discussed. The sample was taken from a group of websites that was by no means exhaustive of the population. This means that there are likely broader ranges of websites or escorts who advertise online within the Vancouver area. The information that may be included in other websites such as escort agencies where women advertise may be different, but would have to be further explored to determine if their advertisements differed greatly from the ones that were studied here.  In the study, I discovered that sex work websites were not always maintained over time. There were some websites that were available in the initial review, but as time passed sites  57   became unavailable, so some of the data was not collectible due to the time taken to review each site. This may be reflective of sex workers working for short periods of time or intermittently, but it was not completely clear why some sites disappeared. Some of them had clearly expired and there was a message to contact the administrator if this website was previously registered so it seemed that there may not be an awareness by the sex worker that the site had become obsolete or that payment was required to maintain the domain name associated with the site. I did note that the websites of those who were charging higher rates and those that were professional in appearance were less likely to have become obsolete or expired. Those sites which appeared to be done professionally, had ease of use and contained robust narratives and had multiple photos belonged to some of the most highly paid women. Although this is an observation and cannot be quantified in the current study, it is an area that may be useful to address in future studies. Women who are able to charge more per hour may be able to support themselves and expand by employing others such as web designers and photographers to improve their online advertisements.  The number of websites that were studied were sufficient to provide understandings about what was being communicated by men, women and transgender people in Vancouver, BC overall. However, it is difficult to generalize to populations outside of Vancouver, as the West Coast cultures here are unlikely to prevail in other cities. Future research could study Internet based sex work websites from all major cities in Canada to determine how similar the information is within Canada. Since there were only 6 transgender sex work sites, (all MTF) it is difficult to understand if the communications would be different if other transgender sub-groups were included. The numbers of female to male (FTM) transgender people engaging in sex work is not known. There was one FTM advertisement in the initial sample but it had to be eliminated  58   due to the location, which was in another Canadian city. Transgender people are not well represented in the literature describing indoor sex work and as such, more studies may be needed to understand the uniqueness of this group of people. Also underrepresented were male sex workers advertising to females, who may also vary in their ways of communicating. Conclusion    Sex work in Canada and other developed nations is shifting and in Vancouver, BC where it is estimated that approximately 80% of sex work occurs indoors (O‟Doherty, 2011). It is important to gain a better understanding of all aspects of off-street, Internet based sex work and how people who engage. This study has provided a picture of how information is being communicated by women, men and transgender sex workers in Vancouver, BC. Important differences have been described to allow for other questions to be asked in the quest to better understand indoor sex work amongst different populations. This information may assist in health provision by providing information to health care providers that challenge assumptions they may have about sex workers in general, and to ensure that there is an understanding that there is much diversity within the sex industry. When clarity is achieved, more collaboration can occur between sex workers, their clients and health care providers.  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New York: New York University Press.                  65   Appendix A: Extraction Tool Categories and Descriptions     Category  Description Descriptive information a) Sex worker self-description: The terms utilized to describe the sex worker within the advertisement b) Viewable facial photo: Description of facial photos by fully viewable, partially viewable or not viewable Demographics  a) Gender b) Stated age (20-29);(30-39);(40-49); (not stated) c) Ethnicity: Stated or Observed (Caucasian, Black, Latino, Asian, Multiple Ethnicity) d) Weight in lbs if stated Services Listed a) Incall b) Outcall c) Massage d) Escort e) Full Service f) Fetish g) Companionship h) Duo i) GFE/BFE j) Uncovered oral (DATY/DATO/Rimming) k) Other uncovered l) Travel m) Anal n) Other  Restrictions a) Anal “greek” b) Uncovered Services/states “safe”  c) Client under the influence  d) Photo/Video e) Deep French kissing/light French kissing f) Other physical restrictions  g) Outcall to private residence  Health Information  a) Booking process specified (phone/e-mail/online form/text) b) Payment process specified (cash/debit/bank transfer/credit) c) Listed rate (Yes/No) d) List of Services (Yes/No) e) Price by time (By highest hourly rate listed as some services increased the price) 

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