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The rise of sex tourism is challenging the accepted view of a predominantly "heterosexual" HIV/AIDS epidemic in the Caribbean.

Miguel left his troubled home in the Dominican Republic at age nine and became a street kid in a nearby city. By age 12, he was supporting himself through sex work with male tourists. Twenty years later, the sex industry is still Miguel’s main source of what he calls “easy money,” and it helps him to provide for his common-law wife and three children.

Miguel is one of hundreds of Dominican MSM (men who have sex with men) interviewed in their native Spanish by medical anthropologist Mark Padilla. He’s an assistant professor of health behavior and health education at SPH and author of the recent University of Chicago Press book Caribbean Pleasure Industry: Tourism, Sexuality, and AIDS in the Dominican Republic. The book shows that the rise of sex tourism in an era of rapid globalization, combined with a culture of silence about bisexual behavior and male sex work, challenges the accepted view of a predominantly “heterosexual” HIV/AIDS epidemic in the Caribbean.

Most of the men Padilla interviewed were bisexually behaving, although they defined their sexual identity in a range of ways; very few described themselves as homosexual or gay, and most understood themselves as “normal men.”

Padilla discovered in his subjects a range of stigma-management techniques —from “little lies” to outright deception—used to minimize the marginality they experience due to homosexual behavior and prostitution. “These techniques imposed severe constraints on men’s sexual-risk disclosure, and potentially elevated their own and their female partners’ vulnerability to HIV infection,” he argues.

“The fact that gay clients often eroticize and pursue Dominican men whom they regard as ‘straight’ suggests that often it is precisely non-gay-identified men who must manage the potential social consequences of association with gay tourism,” says Padilla. And men actively engaged in economically motivated same-sex behavior aren’t likely to benefit fully from health outreach for self-identified gay men.

Padilla’s approach contributes to what Paul Farmer of Partners in Health calls “critical epidemiology”—an examination of health outcomes as products of social and structural inequalities at both local and global levels. Padilla argues that the intersection between political-economic analysis and local sex/gender systems is emerging as an important area for the next generation of HIV and STD research.

—by Mary Beth Lewis

Top photograph by Mark Padilla.

To learn more:
www.pih.org (Partners in Health)
puffin.creighton.edu/aarg (AIDS and Anthropology Research Group)
www.press.uchicago.edu/Complete/Series/WD-CSSGC.html (Worlds of Desire: The Chicago Series on Sexuality, Gender, and Culture)

Send correspondence about this or any Findings article to the editor at sph.findings@umich.edu. You will be contacted if your letter is considered for publication.

factCHECK, 2007

> The Dominican economy has moved from male-dominated fields such as agriculture to the service industry, and tourism is now the principal revenue generator.

> Numerous studies have shown that Latino men who have sex with men are likely to encounter societal disadvantages such as poverty, discrimination, kinship-structure disconnections, elevated unemployment, and other risks to their health.

> Of the 83 study subjects who reported they “always” have condoms, only 37 percent were able to show a condom to researchers when asked

> Male sex workers rarely used condoms with their wives, with whom condoms were viewed as shameful or symbolic of mistrust.