Hidden away in the labyrinthine corridors of St Mary's hospital, just next to Paddington station, lurks a secret office. From the outside, the regulation magnolia paint gives no clue to what goes on there. There is reason for the cloak and dagger approach: this is London's first health clinic for male prostitutes.

The clinic has already seen some 200 male sex industry workers - the clinic's preferred term for male prostitutes - since it began to operate full time in February. The men range from escort agency workers through to rent boys.

Although many are aware of the risks of HIV and Aids, their knowledge of other sexual diseases is often limited. Few use condoms for oral sex, although there is a risk of some diseases being transmitted that way. While escort workers tend to use them for anal sex, the clinic discovered that among rent boys, condom use is relatively low, with fewer than half using them. Unlike escorts, rent boys will often be picked up by a client without a word spoken, just through a series of meaningful looks. The silence may heighten the excitement for the customer, so to suddenly ask them to use a condom, having said nothing up until then, would be difficult.

This is the first clinic to offer a specialist service for men who sell sex to other men. It aims to provide general advice on sexual health - not just about Aids and HIV - to men who would otherwise find it difficult to access mainstream services. Funded by North Thames regional health authority, it is in line with government targets of reducing the spread of sexually transmitted diseases (STDs), especially gonorrhoea.

Latest Department of Health figures show gonorrhoea is at its lowest level for 75 years, down to 38 cases per 100,000 people and well inside government targets. Cases of non-specific genital infection and chlamydia have also fallen, although there has been a 5 per cent increase in herpes. Wart infection and syphilis cases have remained at previous levels.

But because male prostitutes are having sex so frequently, they are more at risk of picking up STDs and unwittingly passing them. A male escort could have at least six partners a day, charging anything from pounds 50 to pounds 100 an hour. A rent boy could be working with as many as 15 different men on a busy night, usually at about pounds 50 a time.

'Quite a few guys are very aware of HIV and how it is transmitted,' said Justin, the specialist nurse who runs the service.

'They will practise safer sex, especially with paying partners. What we then find out is they are not using condoms for oral sex and don't realise most STDs can be transmitted orally.

'You mention something like hepatitis B or gonorrhoea and they say what's that.'

If a male prostitute does catch an infection, the chances of him going to a clinic, where they will be questioned about their sexual partners, are slim.

'These men are not likely to say, 'I had sex 40 minutes ago, it was with a man I didn't know, the time before that was an hour before, and no they cannot be traced',' explained Justin.

'If they say, 'I had 50 partners over the last week', I am not going to bat an eyelid.' He has worked in the main sexually transmitted disease clinic and believes nothing they tell him will shock him.

Confidentiality is crucial for such a sensitive service. The exact location of the clinic has to be kept secret to protect the clients from men looking to contact a male prostitute - and journalists looking for salacious stories.

Instead, visitors wait in the main clinic of the Jefferiss Wing, a specialist centre for sexual health. Justin collects them and takes them to his clinic, providing they look bona fide. 'If there were any concerns, I would see them over at the main clinic.

'Quite a few of the guys who do register with us use false names. That's fine,' said Justin, who prefers to use just his first name. Having his name in the press might make it difficult for him to approach escort agencies and gay bars when doing 'outreach work.

Beyond the anonymous magnolia door to his office is a stylish room, decorated in blacks, greys and royal blues, with Thirties-style uplighters and classic black and chrome fan.

Two enormous dildos, one black, one white, sit on the shelf by the coffee table, alongside boxes of assorted flavoured condoms. Justin prefers to demonstrate the condoms on sex toys which would be used by his clients. And having them sitting there tends to make people joke and be more prepared to talk openly about their work. The information about clients' sexual practices is collated for inclusion in research being carried out by the

clinic into homosexual lifestyles and is used to assess various health risks.

The most common disease is chlamydia, a germ which infects the genitals and sometimes the eyes and throats. It can be passed on through vaginal, anal or oral sex. In men, the infection can lead to a burning sensation when urinating or a slight discharge from the penis. Or there may be no obvious signs at all.

The clinic offers a range of tests, from basic screening to a full blood test. Further counselling would be available if the client chose to have an HIV test. Free condoms are available, including mint and pina-colada flavoured varieties for oral sex, extra strong for anal sex and small sachets of lubricant. Dental dams - a thin four-inch square piece of latex which comes in a bubble gum flavour - are also available for safer oral sex. These are placed over the genitals or anus and offer protection against mouth infections.

Many of the clients take up the offer of vaccination against hepatitis B, which is also more prevalent among gay men.

Justin also discusses intravenous drug use and HIV, the risks of piercing and of tattoos. Very few patients use drugs. Those who do tend to use drugs associated with the gay scene, such as ecstasy and amyl nitrate.

He advises them to return every six months for a general health check, whether or not they have any symptoms. It also offers general health advice and support through an out of hours emergency service in cases of assault.

There is also an advice clinic which covers welfare and legal rights.

Justin has also been teaching rent boys negotiating skills so they feel more able to demand the client uses a condom. According to research by the clinic, of those rent boys offering receptive anal intercourse - 11 per cent of those surveyed - only half insisted the client used a condom.

He advises his clients to show the condom in their hand before finally agreeing to sex: 'It doesn't have to be verbal.'

According to Justin, the majority of rent boy's clients sexually identify as heterosexual. 'It may be someone married 30 years. They pick up a

rent boy on the way home for a quick blow job. The opportunity is there, so they utilise it. This way we are protecting the rent boy, his client and his client's wife.'


There is no such thing as a typical male sex worker, they range from rent boys to male escorts. Thirty two per cent of rent boys identify as heterosexual. A very small proportion of male escorts offer sex to women as well.

The stigma attached to male prostitution is even stronger than to women.

Researchers identify

several types, including:

Kept boys: often short-lived relationships between younger boys and older men in return for financial inducements such as luxury accommodation and holidays.

Masseurs: many men advertising through the gay press sell sexual services as well.

Escorts: very few provide a pure 'escorting service but sell sex. It is the male equivalent of a brothel, although some men

offer specialist services, such as sadomasochism. Many escorts may

have hit hard times in their main career and turned to an agency to make extra money. They charge from pounds 50

to pounds 100 an hour and could have up to six clients a day.

Rent boys: younger men who sell sex in public places and often fit into street culture. They charge about pounds 50 and could have as many as 15 clients a night.

The Working Men Project at St Mary's hospital, Paddington, has compiled a database of patients . The mean age of rent boys was 19.7 years; escorts and masseurs 24.6 years.

For further information contact Justin on 071-725 1524. The clinic is open Monday to Thursday 10am -4pm, Friday 10am to 3pm. Appointments can be made by telephone, or by calling into the reception of the Jefferiss Wing and asking for Justin.

(Photograph omitted)