Sexual safety practices of massage parlor-based sex workers and their clients Kat Kolar a *, Chris Atchison b and Vicky Bungay a a School of Nursing, University of British Columbia, Vancouver, BC, Canada; b Department of Sociology and Anthropology, Simon Fraser University, Burnaby, BC, Canada (Received 11 June 2013; accepted 10 February 2014) The Outreach and Research in Community Health Initiatives and Development (ORCHID) project examines social and structural factors that contribute to HIV/AIDS risk among women working in Vancouver’ s indoor sex industry and their clients. From 2006 to 2009, two mixed method studies were undertaken in ORCHID: one exploring experiences of women working in the indoor sex industry, mainly in massage parlors, and the other exploring experiences of men as sex “buyers.” Both studies emphasize sexual health and safety, risk and protective behaviors, and related contextual factors. No analyses examining the sexual health and safety practices of massage parlor-based sex workers and clients exist in the Canadian context. To address this gap, we analyze two survey datasets – with 118 sex workers and 116 clients. Upon comparing demographics of sex workers and clients, we discuss their condom use and sexually transmitted infections (STI) and HIV testing practices. Sex workers and clients reported high rates of condom use for vaginal/anal intercourse. While both groups reported lower rates of condom use for oral sex during sex transactions, clients did so to a greater extent (p < 0.001). Condom use with noncommercial sex partners was reported to be less consistent by both groups. STI testing was higher among sex workers than clients (p < 0.001). Initiatives targeting clients of massage parlor-based sex workers for STI education and testing are needed. Future research should investigate how different types of relationships between sex workers and clients impact their sexual safety practices. Keywords: sex work; men who buy sex; sexually transmitted diseases; HIV; condoms There is a veritable lack of literature on the joint experi- ences of indoor sex workers and clients relating to sexual health. Indoor sex work refers to the exchange of sex for money in settings where the negotiation (i.e., advertising, communication about fees, services, and safety practices) of the exchange does not occur in a street-based setting. Common indoor settings include massage parlors, escort agencies, bars, hotels, and apartments (Handlovsky, Bungay, & Kolar, 2012). While some research engages with the health and safety of indoor sex workers (Bungay, Halpin, Atchison, & Johnston, 2011; Handlovsky et al., 2012; Jeal & Salisbury, 2007; Phillips & Benoit, 2005; Seib, Fischer, & Najman, 2009; Shaver, Lewis, & Maticka-Tyndale, 2011), and (rarely) that of sex buyers (Atchison, 2010; Barnard, McKeganey, & Leyland, 1993; Lowman & Atchison, 2006; Sanders, 2008), to date, little research addresses dyadic experiences of commer- cial sexual relationships (exceptions include Bloor, McKeganey, & Barnard, 1990; de Graaf, 1995; van Haastrecht et al., 1993; Wong, Lee, Lo, & Lo, 1994). No analyses of sexual health including both sex workers and their clients exist within the Canadian context. This analysis provides a descriptive overview of sexual safety and sexually transmitted infections (STI)/HIV testing practices of massage parlor-based female sex workers and their clients and identifies health outreach and education needs among these groups, and areas for future research. Methods Under the Outreach and Research in Community Health Initiatives and Development (ORCHID) project, two complementary mixed method studies were undertaken during 2006–2010. One explored experiences of women working as sex workers in massage parlor sex venues. “Johns’ Voice,” the clients of sex worker portion of ORCHID, explored experiences of sex buyers. Both studies emphasized sexual health and safety, risk and protective behaviors, and related contextual factors. We briefly describe survey recruitment and sampling strategies, as these have been published elsewhere (ASIA, 2003; Bungay, Halpin, Halpin, Johnston, & Patrick, 2012; Bungay et al., 2013; Handlovsky et al., 2012; Kolar & Atchison, 2013; Remple, Patrick, Johnston, Tyndall, & Jolly, 2007). Ethical approval was obtained through the University of British Columbia and Simon Fraser Uni- versity research ethics boards. Women were recruited through community outreach activities and were invited to participate in the study when they accessed services – including health educa- tion, health and social service referrals, and STI and HIV *Corresponding author. Email: kaca.kolar@gmail.com © 2014 Taylor & Francis AIDS Care, 2014 Vol. 26, No. 9, 1100–1104, http://dx.doi.org/10.1080/09540121.2014.894611