At the risk of being called a political insensitive lout (at best) and far worse Im sure, I pose the following question: Is there any representative data regarding the incidence of sexually transmitted deseases and providers catagorized by a)typical clientel, b)prices charged c)range of services offered d)drug use e)age and lengh of time in business or any other segregation of data that offers specific creditable information. It seems to me, the patrons of this venue have relations with the middle to upper range, if not the highest level of provider available. The fees charged and the screening methods employed by both parties would appear to provide a considerable advantage over the more customary clientele and providers one sees offered up by the media as being indicative of what is "normal" and expected if one engages a professional provider.
As a relative newcomer I have been bowled over by the quality of people who work as professional courteasns(sp sorry its late) and their views and opinions. Im also quite sure this is not universal in the industry and we here are very possibly dealing with a more risk averse group than the norm. To me it would follow our exposure to STDs, in general, should be less. The proof is in the pudding and so I ask the question. If such a study hasnt been done it should be. The board's thoughts on the matter?

the major vectors for the std's that matter are anal sex without a condom, sex without a condom, intravenous drug use, and sex with individuals who have anal sex without a condom, sex without a condom, or are intravenous drug users.

near as i can gather from all the posts here and my own background reading, bbbj is of low but not zero risk to the man, and daty is of low but not zero risk to the woman, but they are a gray area as regards many "minor" kinds of std's and things like hepatitis.

i personally believe very strongly that safe people having sex with safe people have a much lower risk of std's than some guy who pays a crack hoor into the back of his explorer suv ... so i think yes, the upscale escorts who love their life and the professional men who can afford them are the lowest risk group you can deal with.

but i also believe it's not realistic to predict your personal risk-- you play by your personal set of rules, based on your best judgment, and hope you never have reason to change them, or regret them.

-- Modified on 8/19/2002 6:15:25 PM

There is nothing technically to prevent a study such as you describe from being done. This could be done as a clinical epidemiology investigation, in which you would enroll both providers and clients, test them for a wide panel of STD's, interview them regularly as to their sexual activities and the use of condoms, spermicides etc.

Gee, sounds simple. Except that a study like this would never be funded by the granting agencies, which in the U.S. is principally NIH. The liability issues alone to the investigator and sponsoring organizations (grantor, medical school or hospital) could be staggering, if test subjects in the study contracted diseases and filed suit. There are some elements of the Tuskegee-syphilis disaster of ~60 years ago. Also, I would imagine it would be very difficult to find subjects for such invasive testing. Privacy issues would also limit participation.

A very worthwhile NIH-sponsored study into the efficacy of condoms in preventing HIV infections was suspended mid-project nearly a decade ago, largely because of the above liability concerns and political problems.

So I'm afraid that a rigorous study along the lines that you suggest is not in the cards.

-- Modified on 8/19/2002 6:50:24 PM

And so they use the lowest common denominator and call that the 'norm.' Studies that have dealt with STD factors among prostitutes look at the dirtiest, drug addicted, derelict streetwalkers they can find.

Our little community would fall much closer to the overall National average among people in general. Mid to upper range escorts may actually fall in lesser risk category than your average bar hopper, since they are more safety conscious and less intoxicated (while certainly being more intoxicating). They're STD risk factor may go up, due to the volume of sexual activity, bringing them back to average.

No data, but my opinion is (use a condom) you're at the same average risk having sex with a classy escort as having sex with anybody.

A study in Haiti of "discordant" heterosexual couples -- those in which one partner is HIV-infected and the other uninfected -- found that almost half of sexually active couples receiving counseling and free condoms adopted safe sex practices (either abstinence or consistent condom use), according to investigations supported in part by the National Institute of Allergy and Infectious Deseases (NIAID). The rate of new HIV infections among couples who consistently used condoms was one-seventh as high as those who did not.

See link for complete text of report.

-- Modified on 8/19/2002 7:22:32 PM

Yes, Mathesar is correct about the Haitian study. My comments were mostly focussed on the problems about doing such a study in the U.S. Informed consent issues are a particular concern here in the States, with a number of medical schools/hospital losing their Institutional Review Board (IRB) accreditations to do clinical investigations. These include some of our very best medical schools, such as Johns Hopkins.

In terms of HIV transmission, we are 20 years into the epidemic. Why aren't we looking at infection rates, and ways to mitigate them, in the U.S. instead of just foreign counties? It's these ancilliary issues which tend to complicate things.


-- Modified on 8/19/2002 8:29:32 PM

Thanks for the comments. Thats pretty much what I expected and I would welcome the distaff side(ahmm) of the board to give me their thoughts. One note I want to make, is that I wasnt suggesting we were in a no risk situation, but I found the comment made somewhere on pickups in local bars offering the potential for greater risk, making some sense.
It appears we all do much more than a large percentage of guys hiting on bar chicks after some brewskis and, as a result, may have a healthier life stye due to the very women we spend our money on. Funny how things can work out. As to the prospects of a study, I'd be happy to take a confidential anonymous survey on the subject. It seems to me we have the ideal universe to use right in front of us.
If you like send me a private note. This is an important subject and one maybe we, as a group, can have some positive imput on.

Pretty interesting, and for the most part accurate comments. (This is an area in which I have had some professional involvement). For what's it's worth, I would like to add some additional info:
a) I totally agree that there are no representative data addressing prevalence of STDs among "upscale" commercial sex workers (CSWs) nor their clients in the US.  (Though there has been some work done in the UK). The reason is really not one of liability, nor one of politics (there are those out there that would like nothing better than to demonstrate how murderously unsafe and reckless is this hobby of ours!) but rather: 1) it's not really seen as an important public health problem here, i.e., upscale CSWs probably do not contribute importantly to much ongoing transmission of STD/HIVs, and 2) it would be almost impossible to enroll a "representative" sample of upscale CSWs. Any study would at best accrue what researchers would consider a "convenience sample." And how in god's name would anyone be able to enroll "hobbyists" and assess their sexual behavior and STD prevalence?? It is beyond ludicrious to consider obtaining informed consent (a necessary step in research involving human subjects) from them!! I can just imagine being approached by a young investigator at my next "session" and offered enrollment! It would make a pretty funny movie scene. Steve Martin would be able to do wonders with it.
b) It may well be that steady boyfriends (and other non-clients) pose the greatest STD risk to CSWs, basically because condoms are not used in those relationships, and I would not be surprised if STD prevalence among them (i.e., the boyfriends, etc) is higher than among hobbyists. (Although this is speculation, it's pretty well documented for HIV risk; as far as I know, there aren't data addressing other STDs. And existing studies are among a different class of CSWs. But I would expect that the pattern of non-condom use among non-clients to be pretty universal, regardless of class).

This is my first post here and hope some find it useful; I have benefited enormously from the collective wisdom available here and am very pleased to be able to give something back!

it's important to remember that the escort's actual risk has to include the safety preferences of *all* her partners, not just with her but also with all other sexual or intravenous drug contacts they may have with people the minx may never find out about (and that especially includes the "boyfriend"). this is why providers with many "repeat" clients are preferable: they see fewer men month to month.

i like to keep it hot and physical on the first date, but if i'm going to see a minx on a repeat or regular basis, on the next few dates i usually ask her about (1) the number and type of her sexual contacts, including personal ones, (2) her safety practices during sex, and (3) her program of health screening for std's. point (1) includes the total number of clients she sees in a week, and roughly how many of them are "regulars."

this done not as a checklist interrogation, but as questions asked at the appropriate moment during our pillow talk. these are perfectly legitimate "service contract" issues; at the same time, they are a stellar way to test the lady's candor and comfort with me.

my current atf is the mother of a preschooler. to me, nothing is a better guarantee that she will always exercise common sense than her love for that boy.

Welcome to TER and thanks for the excellent input. This may be the best discourse on the subject that I've seen.
riker

There is a plethora of information, including statistics on subgroups affected the most by HIV, according to race.  For instance, in the United States, there is a higher incidence of HIV among Blacks > Hispanics > Whites and Asians.   This is all well documented info easily obtained.

Lately, there has been an increase in the incidence of syphilis in the United States, and the its presence increases the chances of transmitting the HIV virus.  This is a departure from the all time low experienced in the late 1990's.

We can think about what type of providers may be "less" apt to spread STDs, but honestly, I feel this type of thinking is silly.   Anyone who has multiple sex partners, whether they have elite clientelle or not, is putting him/herself at risk.   Magic Johnson, Rebekka Armstrong (a 23-yr old former playboy bunny) and a host of others have been infected by the HIV virus.   The virus does not discriminate based on socieconomic class or clientelle.   High end clientelle also contract STDs, and it takes only one person to infect everyone.  The fact is, providers make a living providing services that put them in contact with everyone their contacts have been sexually active with.   Use the analogy of a tree and its branches.   Jane sleeps with Dick, Harry, and Fred.   Dick has slept with Mary, Lisa and Rochelle.   Each one of them have been with others, and you start to realize that the chances for capturing an infected individual begins to exponentiate like the number of branches on a huge tree.  Sexual providers are a part of the "high risk group."

The argument that seeing a "high-end" provider reduces the risk of getting an STD does not hold water.   The only true way to reduce the risk of contracting the disease is to abstain or to use barrier means of contraception with spermicide.

As for BBBJ, HSV-1 and HSV-2 (Herpes viruses) can both be present in the oral cavity as open sores, and transmitted via oral-genital contact.   The same applies for syphilis, as this spirochete (Treponema pallidum) is transmitted via person-to-person contact, usually on mucous membranes.   HIV has been found in all body fluids, including saliva, though saliva seems to decrease the viability of the AIDS virus, perhaps because of the amylase in saliva.   Likewise, the HIV virus doesn't survive very well in the hostile environment of the gastric (stomach) juices.  

If there are open sores in the mouth, or mucous membranes in contact with an infected person, the chances of contracting HIV are greater.

Also remember that there are several people who are not aware they are infected by HIV, even if they test negative.  The majority of people will test seropositive 6 months after contracting the disease.

You can read more about this in the NIH and CDC sites:
http://www.niaid.nih.gov/daids/fundedresearch.htm

http://www.thebody.com/cdc/news_updates_archive/oct19_01/10_19_01.html

aznboy must believe that blacks are *genetically* more susceptible to hiv than whites or asians, because he dismisses any behavioral or environmental contributors to the spread of infections.

magic johnson admitted to having hundreds and hundreds of unprotected sexual encounters, and regretted it, but aznboy only concludes that the virus *does not discriminate* ... well, it seems to me the virus discriminated pretty when it infected someone with a grossly promiscuous behavioral pattern, just as it is supposed to. but behavior differences don't matter much in aznboy's world.

i like the way "exponentiate" is thrown around in the image of a "huge tree." turns out, the limbs in that tree are only as strong as the probability of infection at each branch. for example, if my risk of contracting hiv by frolicking with a minx one time is only 1% (it's actually lower), then the risk to my girlfriend is 1% of 1%, and the risk to her lover is only 1% of 1% of 1% -- that's 1 in one million, just for the infection to cross two branches. turns out to be a pretty scrawny tree!

in fact, aids has not spread widely because of *single* unprotected vaginal intercourse between an infected female and an uninfected male, but because of *repeated* unprotected vaginal intercourse between an infected male and an uninfected female, *repeated* anal intercourse with either sex, or intravenous drug use. but these are all behaviorial nuances, and of course those don't matter.

it's sad, but we live in a scientific culture with very low scientific literacy. behavior does matter -- a lot -- in the spread of a disease. any behavior that reduces infection is an advantage. aznboy can have the crack hoors who trade their hersey highway down by the dumpsters; i'll stick with the penthouse minxes who know how to distinguish safe behavior from unsafe, and keep the branches on my bush closely pruned.

I never said, nor did I imply that there was some mystical genetic predisposition to becoming infected with the AIDS virus.   You only assumed I meant that, because you are ignorant.    

If a monagamous relationship with a noninfected individual is considered "safe," do we need you to point out that someone who promiscuously engages in multiple sex partners is increasing his risk for becoming infected?    The point that I was making--the one you obviously missed--is that HIV doesn't care who it infects.  

The original message I was responding to made reference to "...data regarding the incidence of sexually transmitted deseases and providers catagorized by a)typical clientel, b)prices charged c)range of services offered d)drug use e)age and lengh of time in business or any other segregation of data...."   Interestingly, the reply to that message stated, "i personally believe very strongly that safe people having sex with safe people have a much lower risk of std's than some guy who pays a crack hoor into the back of his explorer suv ... so i think yes, the upscale escorts who love their life and the professional men who can afford them are the lowest risk group you can deal with."    I was compelled to reply to this post only because some of its readers might assume that "upscale escorts who love their life" are relatively safe and innocuous as far as HIV risks are concerned, and because I am a physician simply interested in providing a professional opinion.

As for your tree branch metaphor criticism, either you missed what I was saying, or do not understand the epidemiology of how diseases can be spread.   If you are the type of person who feels safe having unprotected sex with a potentially HIV-infected invidual because the original person within her tree of acquaintances is several "branches" away, so be it.    

As human beings, we strive to make reasonable decisions.   We take certain risks in life, weigh the risks and benefits, and hope for the best.   We sometimes make justifications and rationalizations for behaviors that put us at risk.   Sometimes we simply do that which makes us feel good, and that's understandable.    

My opinion and statement is simply that to say having sex with a well-to-do, high-class provider puts one at a relatively low risk for getting infected with a STD is silly, when you consider that this person's livelihood relies on having multiple clients (i.e., sex partners).    Among individuals who share this occupation, I agree that certain factors (e.g., high risk exposure categories:  illicit IV drug use, anal intercourse, indiscriminate behavior, etc.) could very well increase the probability of infection.   However, anyone who has multiple sex partners is at risk, unless the one provider you see, is intimate with only you.

Are we on the same wavelength yet or would you feel better venting one more time?