Special dermatologic needs for men who have sex with men

2016-07-29

Inside the world of male sex workers

The well-dressed father of two earns good money. He speaks English and works for an international NGO that combats HIV/AIDS. He used to be a sex worker, a man who has sex with other men, and then became a government informer, reporting back to the police on other sex workers who were then arrested. He resorted to drink and drugs because of his shame and isolation. And now he wants to talk about it.

The root cause of all his problems, says Ko Kyaw Zayyar Swe, 38, is poverty. He was forced out of school at 15 because his soldier father could not afford the tuition fees. He worked as a waiter at a Chinese restaurant, but the owner cut his already low wages after giving him a dumpling for lunch instead of money. He quit.

Because he never made it to 10th standard, he could not find a good job, and money was always short. When he married at the age of 17, making ends meet became almost impossible.

“I was working in a shop in Bogyoke Market. One day, two foreigners I’d seen before in the market bought me jeans and shirts. Nobody had ever given me anything before,” he said.

The men invited him for drinks, then brought him back to their hotel room and asked for sex.

“I was shocked. But I needed money urgently for my family so I agreed to do it,” he said.

More contacts were made, and more money came in. He became a regular sex worker, offering services for gay men. Since foreigners paid much better than local men, Ko Kyaw Zayyar Swe decided to learn English.

He came to know many other male sex-workers like himself, working around Bogyoke and Theingyi Zay markets and Sule Pagoda Road, and even further afield.

In 2003 he was arrested under a law banning “inappropriate” sex, along with a friend and two foreigners, and spent two-and-a-half years in Insein Prison. The law is also used against transgender people.

This was the first time his parents and his wife became aware of his secret life.

When he was released, the Ministry of Home Affairs asked him to turn informer against the male prostitutes of Yangon. As his friends went to prison, he got paid. “I received K10,000 a day for some years. That was a lot of money. I didn’t want to destroy other people’s lives because I knew what it was like to be in that position. In the end, I stopped informing and went back to being a sex worker myself,” he said.

All the other sex workers did what they did because they were poor, he said, and saw no other way out. “We didn’t dream of this profession. But with no education and no work but odd jobs, how can you support a family? We didn’t want to be rich. We just wanted enough to get by for a family life.”

Conditions for sex workers changed with the advance of the internet. Now they don’t have to hang around on the street, but make contact online through dedicated websites. At one time, you could see up to 50 sex workers around the markets at night, chatting to customers. There is a thriving market for male sex-workers among gay men, with more male than female customers.

Though the money is the best they have ever made, male sex-workers feel disgusted, lonely and depressed. They feel nobody stands up for their rights, and everybody looks down on them.

“This way of life makes us angry. We can’t share our feelings with family or friends. It’s a big problem for society too,” said Ko Kyaw Zayyar Swe.

Many drink to forget, he said, and then go on to take drugs.

One day, a man from Bangladesh involved in promoting health awareness for male sex-workers asked him to take a part-time job at his NGO, which was gathering information about prostitution and developing training programs for public health professionals.

Ko Kyaw Zayyar Swe said sex workers needed both physical and mental support, as well as job opportunities, to be provided by the government, NGOs and INGOs.

“I never even knew how to use a condom with customers. Luckily, I didn’t get HIV. Knowledge is very important and we need that,” he said, adding that courses in leadership skills, empowerment and capacity building would also help to raise self-confidence.

Dr Aung Myo Min, director of Equality Myanmar Human Rights Group, said male sex workers were hard to reach because they isolated themselves. Too much isolation, he warned, could turn them into drug addicts, or even susceptible to becoming terrorists.

“They are ashamed of what they do. They only do it for the money. Even within the group, there are problems of competition for customers,” he said.

They are not even particularly high-profile. Most of the small counselling groups set up by NGOs in Myanmar for HIV and health awareness cater to female and transgender prostitutes because most of them suffer exploitation, discrimination and even torture. Male sex-workers are seen as being in the profession mainly for the money.

“Even their customers can find them difficult to deal with because of their lack of self-esteem and feelings of indignity. There has to be a way of allowing them to change their profession,” said Dr Aung Myo Min.

A doctor who provides health support for people living with HIV and AIDS said male sex-workers are particularly difficult to contact. “Both sex-workers and customers have to be aware of sexual health issues. Now there are many drop-in centres, including day-care centres for HIV-positive patients, where they can express their feelings and receive support,” said the doctor.

According to 2013 figures from the UN agency UNAIDS, there are an estimated 70,000 sex workers in Myanmar. About 8 percent of them are living with HIV.

Foreplay Techniques She’ll Crave

Men are ready at the flip of a switch. Women however take some time to get in the mood both physically and psychologically. As a guy it’s your job to warm up her engine. Foreplay isn’t always easy. It takes time, patience and forethought to pull off right. Of course it all depends on what mood she’s in, what she’s doing, if it’s a good time. Women are complicated. What you need to do is strike at the right time. Not when she’s first come in the door from work, but after supper, say when you’re getting cozy on the couch. But that’s not enough. You also need the right approach. Here are some foreplay techniques that she will crave, upping your chances of success, and making it a wild ride. Remember how hot it was to make out on the couch as teenagers? Why does that have to end? Don’t try to take her clothes off just yet. Don’t let the pressure of sex weigh on her. Instead take some time. Tease her and let her feel how excited she makes you. What really turns a woman on is being desired. If you can make her feel how much you want her, she’ll want you back. Keep ramping it up and she’ll want you so bad.

Why not sext with her earlier in the day? Don’t outline every detail. Instead, add in a little mystery. Let her imagination start to work. Remember that some women don’t like it if you are too graphic. Err on the side of subtlety. The mind is where it all begins. So if you can, get her all riled up before she even gets home, if she’s turned on when she comes to see you, half the battle is already won. And who doesn’t like it when a turned on female shows up at your door? If you are out and about together, do secret naughty things to her. That will get her so turned on. Slip your hand up her shirt when sitting in a darkened theater. Work your hand up her thigh at the coffee house. Play footsie under the table when out at the bar with friends. Pull her into darkened corners and kiss her passionately. When you’re at a show or concert, slip your hand down her pants and play with her a little. Chances are you’ll be driving to a secluded spot or jumping right in the back seat because neither one of you can wait until you get home. The number one rule in foreplay is to take your time. Think of foreplay as enjoying the courses to a fine meal. Don’t rush through the appetizer and main course just to get to dessert. Savor each and every course. She’ll be quivering in your arms if you are passionately touching and kissing her all over. With dirty talk, remember a little goes a long way. Compliment her then say something naughty in a low and sexy tone. Whisper it breathlessly in her ear and she’ll be all over you.

Drinks that Increase or Dampen your Sex Drive

When it comes time to order a drink, do you ever consider your sex life in the decision? Most men don’t. But what’s in your cup may be ramping up your libido or killing it. Lots of times when we have a drink, we never even consider how it will affect our sex drive. But believe it or not, what’s filling your glass may give you a boost or hinder your desire, even your ability to perform. Here are some drinks that increase your sex drive and others that dampen it. A lot of guys use booze to loosen up, shake off the jitters and get into the mood. But in fact, it can have the opposite effect, making you too sluggish to “get-it-on.” One or two drinks might be okay, but any more than that and you are risking a night of celibacy. For those who have functioning issues, perhaps skip the alcohol altogether. Whatever you do, don’t have a gin and tonic. Quinine, the active ingredient in tonic, was shown to lower testosterone in one German study.

The cooler months bring with them a delicious treat, apple cider. Try it warm with some cinnamon and cloves. Cinnamon is a proven libido booster for men, and cloves give the reproductive system an overall boost. Some guys are soda guys. No matter where they go, they always order a cola. But all of that sugar isn’t good for your waistline. Extra body fat sucks up testosterone, lowering your sex drive and functionality. For those who opt for diet soda, look out for the artificial sweetener, aspartame. This has been proven to lower sex drive. Why not sweeten some lemon seltzer or fresh iced tea with honey instead? Honey aids in the production of testosterone and so helps stoke the fires of desire. Try honey in ginseng tea. Ginseng was shown in one South Korean study to go so far as to reverse ED. Now that you know, you can select a beverage that will get your engine running, instead of having one that revs but never starts.

Worried About ED? Look at Your Diet

Lots of things can cause erectile dysfunction. But the most common is the onset of heart disease. In this case, ED is generally brought on by a poor diet and lack of exercise. Foods high in fat, sugar, and cholesterol add to the buildup of plaque on artery walls.

Since the arteries that supply the penis with blood and create an erection are much smaller than those in other parts of the body, they tend to clog up first, which is why physicians count ED as an early symptom to a more pressing problem. If left unchecked, it could lead to a heart attack or stroke. Too much sugar in the diet, along with a lack of exercise and being obese, can also lead to type 2 diabetes. If left uncontrolled, the elevated sugar level can damage nerves and tissues, including the nerves which cause an erection. So diet can lead to ED in that sense as well.

Obesity may also cause a lack of testosterone. This is a crucial hormone for the sex drive and erection formation. Fat cells trap testosterone. But the body does not make more, thinking that there is enough in the system. In this way, a high fat diet can also affect male fertility, as a certain level of testosterone is required for proper sperm production. One’s diet should consist mostly of fruits and vegetables.

When you look at your plate, two-thirds of it should be from produce. Lean proteins such as chicken or fish, and whole grains are also important, and should make up the other third. Red meat and high fat or high caloric foods can be eaten occasionally, red meat just once per week. But the majority of one’s diet should be healthful. With the right diet and cardiovascular exercise, most of the time, ED can be avoided. If you are already experiencing the condition, be sure to talk to a doctor or urologist. A serious medical condition could be causing it. Take heart. There are also many treatment options. One is sure to help you.