Self-portrait of a young man for rent', by Sterry (2002), is a memoir of the author's experiences working as a teenage gigolo with a primarily female clientele in the early 1970s. Sterry recounts the circumstances leading up to his situation, characterized by desperation, need for love, and sexual assault. According to a recent comparative study (McCarthy, Benoit, & Jansson, 2014), both immediate circumstances like limited education, and negative experiences from early life, especially childhood poverty, abuse and family instability, are independently associated with adult sex work. According to reviews, paid male sexual services are largely invisible in the global sex trade, but in growing demand. Dennis (2008) concluded that in Western countries, more adolescent boys than adolescent girls participate in sex exchange for money, and men comprise about 20-30% of the individuals arrested as vendors of sexual services each year. Recently, a content analysis of 499 male escort websites across 60 countries found that while most escorts advertise to other men, 11% of the sites were specifically for female clients and 10% for heterosexual couples (Kumar, Minichiello, Scott, & Harrington, 2017). Another website survey found comparable numbers (Scott & Minichiello, 2017). Similarly, Lee-Gonyea, Castle, and Gonyea's (2009) review identified 17% of websites that advertised male escorts as catering to female clientele only and an ongoing study conducted in the UK found that 66% of escorts advertised to female clients (Smith & Kingston, in Kumar et al., 2017). Indications of a growing market for women who seek paid sexual services with men are not only found online. Since the 1990s, Japan has seen a rapid increase in the number of host clubsvenues where men work as hosts to 'entertain' a mostly migrant female clientelewith over 200 clubs in Tokyo alone (Mahdavi, 2018). The entertainment varies by club and location, but most hosts describe it as selling romance, love and sex to their clients (

This study, including the largest cohort of women reporting life-time exclusively female partners in an STI study, shows that WSW generally are at lower risk for acquiring STIs than WSM. Smoking WSW, however, had the same risk for acquiring bacterial STIs as WSM and WSWM. Our study suggests that all WSW should receive the same encouragement to test for STIs as WSM.

Summary Mortality and morbidity for high‐risk surgical patients are often high, especially in low‐resource settings. Enhanced peri‐operative care has the potential to reduce preventable deaths but must be designed to meet local needs. This before‐and‐after cohort study aimed to assess the effectiveness of a postoperative 48‐hour enhanced care pathway for high‐risk surgical patients (‘high‐risk surgical bundle’) who did not meet the criteria for elective admission to intensive care. The pathway comprised of six elements: risk identification and communication; adoption of a high‐risk post‐anaesthesia care unit discharge checklist; prompt nursing admission to ward; intensification of vital signs monitoring; troponin measurement; and prompt access to medical support if required. The primary outcome was in‐hospital mortality. Data describing 1189 patients from two groups, before and after implementation of the pathway, were compared. The usual care group comprised a retrospective cohort of high‐risk surgical patients between September 2015 and December 2016. The intervention group prospectively included high‐risk surgical patients from February 2019 to March 2020. Unadjusted mortality rate was 10.5% (78/746) for the usual care and 6.3% (28/443) for the intervention group. After adjustment, the intervention effect remained significant (RR 0.46 (95%CI 0.30–0.72). The high‐risk surgical bundle group received more rapid response team calls (24% vs. 12.6%; RR 0.63 [95%CI 0.49–0.80]) and surgical re‐interventions (18.9 vs. 7.5%; RR 0.41 [95%CI 0.30–0.59]). These data suggest that a clinical pathway based on enhanced surveillance for high‐risk surgical patients in a resource‐constrained setting could reduce in‐hospital mortality.

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