Medical Care |

Medical Care




â•œthe lingha boys of siem reapâ•š a baseline study of sexually-exploited young men in siem reap, cambodia

University of Nebraska - Lincoln

"The Lingha Boys of Siem Reap" A Baseline Study of Sexually-Exploited Young Men in Siem Reap, CambodiaJarrett DavisChab Dai, [email protected] Glenn MilesLove146, [email protected] Follow this and additional works at: Davis, Jarrett and Miles, Glenn, ""The Lingha Boys of Siem Reap" A Baseline Study of Sexually-Exploited Young Men in Siem Reap,Cambodia" (2012). Fourth Annual Interdisciplinary Conference on Human Trafficking, 2012. Paper 12.
This Conference Proceeding is brought to you for free and open access by the Human Trafficking Team at DigitalCommons@University of Nebraska -Lincoln. It has been accepted for inclusion in Fourth Annual Interdisciplinary Conference on Human Trafficking, 2012 by an authorized administratorof DigitalCommons@University of Nebraska - Lincoln.

"The Lingha Boys of Siem Reap"
A Baseline Study of Sexually-Exploited Young Men in Siem Reap, Cambodia Jarrett Davis, MA Glenn Miles, PhD "The Lingha Boys of Siem Reap"
A Baseline Study of Sexually-Exploited Young Men in Siem Reap, Cambodia Jarrett Davis, MAGlenn Miles, PhD Field Researchers:
Helen Sworn, International Director Glenn Miles, PhD, Asia Community Building Facilitator The Hard Places Community
Alli Mellon, Executive Director Stacey Panozzo, PhD Independent consultant, Phnom First Step
Table of Contents
Executive Summary. 5 Literature Review. 6 A Gender-Exclusive Approach to the Global Sex-trade. 6 A Matter of Choice Vs. Victimization.
MSM and Sexual Identity in Cambodia. 10 The Cambodian Male Sex Industry.
Male Sexual Abuse. 12 Prevalence and Understanding of Sexual Abuse in Asia.
Male Sexual Abuse in Cambodia.
Entering the Massage Industry. 23 Financial Implications. 24 Savings and Debts.
Effects on Relationships. 28 Sexual Experiences.
Sexual Experiences as a Masseur. 35 Sexual Education and Health.
Substance Abuse.
Experiences of Violence.
Faith and Dignity. 43 Present Skills, Future Plans. 45 The sexual exploitation of women and girls in Southeast Asia continues to be the subject of much research and remains a central concern among NGO's and Anti- trafficking organizations. As these concerns remain central, sexual violence against men and boys is often little understood or acknowledged. This study aims to pro- vide a baseline of information of young men working in the male-to-male sex indus- try in Siem Reap, Cambodia. It serves to uncover some of the vulnerabilities of the young men working in this industry in order for NGOs and social service providers to better understand them. Structured interviews were conducted with 50 young men from numerous massage establishments within a 1km radius of the Siem Reap town center. Vulnerabilities of these young men were assessed regarding a number of ar- eas including financial security, sexual history and health, violence, faith and future plans. This information was collected to determine the needs these young men may have and provide initial data as a basis for understanding and future research. This study serves as one of the few attempts to understand the situation of young males in potential sexually exploitive careers in Cambodia and serves as a compliment to a similar study conducted in Phnom Penh in 2011 (Miles and Blanch, 2011). This previous research focused exclusively on sexual exploitation within male to male massage parlors. The present study expands that sampling to males working in both male to male and mixed gender massage establishments (locations having both male and female masseurs catering to both male and female clients). This was done, in part, to provide a broader understanding of the situation of males working in potentially exploitive careers, as well as to provide a comparison of the potential vulnerabilities of men working in both types of establishments. A recent surge in night-clubs, gay bars, and internet chat rooms where Cambodian young men can be ‘picked up' for paid sex seems to indicate a surge in demand in male sexual service. The research team believes the data in this study to provide merely a glimpse at the ‘tip of the ice berg.' It is their hope that this data will serve to pro- vide a clearer picture of the male sex industry and provoke numerous questions for future research. A Gender-Exclusive Approach to the Global Sex-trade
Sexually exploited males are visible around the world. They advertise as escorts, masseurs, models, or openly as sex workers. They are found hanging out on street corners, train stations, and public parks the world over. Thousands of male sex workers are available in online directories, searchable by physical attributes, serv- ices provided, and price. However, despite their global presence, males in the sex industry are often ignored by social services, administrative bodies, mass media, and social research (Dennis, 2008, 11-12). In a 2008 review of 166 scholarly articles on the global sex industry, 84% exclusively discussed female sex workers and made no mention of males (2008, p. 13). This is sometimes attributed to a western world-view, held by those funding such research, which views young men as resil- ient and able to take care of themselves, while young women are seem vulnerable and in need of rescue (Miles & Blanch, Unpublished, p. 2). A similar neglect is found in the media within discussions of human trafficking. The traditional narrative talks about "women" or "girls" to describe--often in explicit detail--occasions when men enslave and sexually abuse females (Jones, 2010, 1144). The discussion is usually framed as good versus evil in a story about misog- yny and the sexual exploitation of women, while ignoring the significant number of male victims of forced labor and sex trafficking". An article in the Utah Law Review suggests, "to some extent, men and boys have become the victims of this media- driven, socially constructed conception of maleness" (2010, 1145). Part of this conception of males may stem from a significant portion of scholarship on the global sex trade which has been led by feminists theorists, who take a strong gender-centric approach to this issue (Graham, 2006). Melissa Farley is a leading expert of prostitution and the global sex trade. In a Cambodian study entitled, "A Thorn in the Heart: Cambodian Men who Buy Sex", Farley and her research team describe the social function of sex workers in Cambodian culture. Their research details the kinds of violence that is perpetrated against Cambodian women in the sex industry by their buyers, brothel owners, pimps and even police officers. Furthermore, this research discusses the implications of violent or hard core por- nography in Cambodian society. Farley notes that 79% of the men in her study noted that their sexual acts had changed over time and the majority of these changes were due to a desire to imitate the styles and positions that they had viewed in the pornographic materials that they had viewed (Farley, 2010, p.9). While Farley's discussion does little to discuss the men who are exploited in the sex industry, she does discuss the dangers that male clients pose to prostituted fe- males as they use hardcore pornography as a kind of "script" for their sexual acts. This raises some important questions with regards to gay pornography and the de- mand for male sex workers in Cambodian society. Farley notes that nearly 1 in 5 men in the study had viewed pornography depicting adults having sex with boys. Of that 19%, 5% had seen boys under the age of 5, 36% had seen boys age 6-12, and 85% had seen boys aged 13-17 (2010, p. 26). Drawing from Farley's conclu- sions on the links between hardcore, heterosexual pornography and the abuse of Cambodian women in the sex industry, it may be also useful to ask what impact hardcore, homosexual pornography has on Cambodian male sex workers and men who have sex with men in Cambodian society. Little has been written about the lives of men used in gay male pornography and its impact on prostituted males. In fact, contrasted to similar discourse on heterosex- ual pornography, gay male pornography is often viewed as harm-free and even a source of gay male liberation and identity formation (Kendall & Funk, 2003). Chris- topher Kendall argues that gay male pornography and its implications for men who have sex with men (MSM) is just as harmful as heterosexual pornography and its effects on women. Kendall cites a 1985 study which exposes the emotional vulner- ability of young men in this industry and discusses the strong, adverse, and some- times fatal effects that such depictions have on the actors self-identities. The result is that feminine, soft, or "bottom" men are degraded as "queer" and "faggots" and are dehumanized in the same ways as a woman who is degraded as "bitch", "cunt", or "whore" (2003, p. 95). A Matter of Choice Vs. Victimization
Another consideration within present research is the terminology used to discuss males and females in prostitution. The term "prostitute" was preferred in 66% of the studies dealing with women and only 25% of the studies pertaining to men. On the other hand, "Sex Worker" was the term of choice for 75% of the studies dealing with men in the sex industry (Dennis, p. 19). In the cited study, it is believed that the term "prostitute" implies coercion and degradation, whereas "sex worker" im- plies more of an active choice of participation. This seems to imply that women are forced to participate in sexual exchanges, whereas males are not. Female sex work is thought of as degrading and dangerous, whereas male sex work is not (Dennis, p. 19). Does this preclude, then, that females in the sex trade are in need of action and activism, whereas their male counterparts are not? Noted feminist, Andrea Dworkin encapsulates the gender-exclusive view of prostitu- tion in a speech entitled "Prostitution and Male Supremacy." She says, "Prostitution: what is it? It is the use of a woman's body for sex by a man, he pays money, he does what he wants. The minute you move away from what it really is, you move away from prostitution into the world of ideas (Dworkin, In this framework, prostitution is exclusively understood as a male's abuse of a fe- male. Throughout this, and narratives of its kind, males and females seem to be di- chotomized as predator and prey. While this may be true in a number of cases, this kind of discussion is unhelpful and may lead to a greater neglect of males who also suffer from abuse and exploitation. MSM and Sexual Identity in Cambodia
In Cambodia, there is a significant level of denial that sex between men takes place (Sovannara & Ward, 2004, p.4). Male to male sexuality is often an issue of great shame and discrimination. A 2004 USAID report notes that stigma and discrimina- tion against men who have sex with men in Cambodia cause them to "hide their face" (2004, p.5). The report states that consequences of being known as a MSM included violence, ostracism, rejection, and dismissal from employment. Thus, many of these groups are forced to remain underground (2004, p. 12).
Discussions on sexual identity in Cambodian society are often difficult to have. Sexual identity is a more recent concept coming out of western thought and schol- arship (Tarr, 1996, p. 27). In Cambodia, concepts of heterosexual and homosexual are still not common distinctions to be made. Tarr notes that most Cambodians "do not consciously reflect on their sexual identity, but rather on themselves as females and males living in Cambodian society"  (1996, p.3). Men who have sex with men are commonly divided into two categories, MSM "Short Hair" and MSM "Long Hair". MSM Short hair are men who identify as men and display common mascu- line characteristics and appearances, whereas MSM "Long Hair" are men who dis- play more feminine characteristics and who may sometimes fall into a western "transgender" category (Sovannara & Ward, iv). A 2008 UNESCO Ethnography of Cambodian male-to-male sexuality notes that the sexual identity of a man in Cam- bodian society is not based upon sexual behavior, but rather on his having a mas- culine or feminine character (UNESCO, 2008). Thus, it can be possible for a man to have sexual attractions and even sexual relations with other men, however still not categorize himself with the western concept of "homosexual". The Cambodian Male Sex Industry
In Phnom Penh, there are reported to be hundreds of ‘massage' parlors featuring female masseurs who provide sexual services for male clientele. However, there is a growing number of similar services in which young males provide similar sexual services for male clientele (Miles and Blanch, Unpublished, 5). A 2011 study, con- ducted in Phnom Penh focuses on male masseurs working in the male to male sex industry. As a precursor to the present study, this report aims to provide an initial understanding of the vulnerabilities, demographics, and potential resiliences of the young men in this industry (Unpublished, p. 9). Of the respondents interviewed, 42.8% have had sex with multiple clients at the same time. 2.2% said that they did this often, or 6-10 times, and 6.7% reported that they do this frequently, or more than 10 times (Miles and Blanch, 2011, 15). Additionally, out of the 45 masseurs interviewed, 5 report that they have "occasionally" been forced to have sex and one stated that he was "sometimes" forced to have sex. (Unpublished, p. 9) A 2004 Cambodian POLICY report suggests that indirect sex workers are more common in Phnom Penh than direct sex workers due to discrimination mitigated by direct sex work. An indirect (male) sex worker is a male who will not openly solicit sex but will usually ask for money after sex (Sovannara & Ward, 19). These kinds of sex workers may be found in restaurants, parks, or other public areas. They are re- ported to find clients by striking up conversations which usually lead to the subject Male Sexual Abuse
Recent studies have indicated the need for further research into the connection be- tween male sexual abuse and the male sex industry. A Canadian study of male sex workers (2005) reports that 70% of the male sex workers studied had a history of sexual abuse prior to entering the industry. Additionally, over 75% had been physi- cally violated and witnessed aggression during childhood (McIntyre, 2005). While the sexual abuse of girls has been given much attention in research, studies concerning boys and male sexual abuse are limited. Holmes and Slap claim, "The sexual abuse of boys is common, underreported, under recognized, and under treated" (Holmes and Slap, 1998, p. 1855). Research in North America indicates that the sexual abuse of boys is less likely to be reported due to fear of punishment, loss of independence, and homosexual labeling (1998, p. 1860). Depending upon what group is studied, prevalence of male childhood sexual abuse in North America ranges from 4%-16% (1998, p. 1856). A 2005 study of Health Management Or- ganization (HMO) members in San Diego, California found that 16% of males had been sexually abused before the age of 18 (Dube et al., p. 434). A number of studies document negative effects of sexual abuse on male psycho- logical development. David Lisak, in a content analysis of 26 male survivors of sex- ual abuse, reports that victims experienced common feelings of worthlessness, emptiness, and inferiority which tended to worsen with time to become deeply in- grained negative identities (Lisak, 544). A 2005 literature review on the psychologi- cal consequences of male sexual abuse reports disrupted development of gender identity, self-esteem, and self-concept as common effects of male sexual abuse (Valente, 2005, p. 10). Males are reported to cope with the trauma of sexual abuse through denial, self-hypnosis, dissociation, and self-mutilation (2005, p. 11).
Prevalence and Understanding of Sexual Abuse in Asia
In Asian societies, issues of male sexual abuse has also been given little attention. In South Asia, young boys are assumed to be capable of protecting themselves. The existence of male sexual abuse and even male-to-male sexuality is often ig- nored or denied. This traditional narrative seems to preclude that males are not at risk of abuse or exploitation (Frederick, 2010, p. 6). Thus, societies are less vigilant, cases of abuse are less likely to be reported, and boys may be placed at greater risk of abuse and/or exploitation. These prevalent conceptions of male invulnerabil- ity further complicate the issue of male exploitation and abuse because they rein- force the idea that males are "stronger" and thus more psychologically resilient, able to readily protect themselves, and more easily recover from trauma than ado- lescent girls (2010, p. 15).
In Cambodian society, there is an adage which states that women are like cloth and males are like gold. When a cloth is soiled, it is no longer useful, however, if gold is soiled it only needs to be polished again. Based upon this belief, girls and young women are seen as unrecoverable, and are therefore carefully protected, whereas much less vigilance is afforded to boys and young men and they are thought to not require any serious follow-up in cases of abuse (Unpublished, 5).
Male Sexual Abuse in Cambodia
In 2008, Hilton and associates published a qualitative study of 40 Cambodian boys and young men who had been victims of sexual abuse and interviewed 100 staff members from a range of NGO's about their experiences of working with male vic- tims of sexual abuse (Hilton et al, 2008). This was the first study of its kind.
Several risk factors emerged from this study, including poverty, loss of a parent and/ or siblings and experiences of domestic violence. Most had very low levels of edu- cation and commonly described drug and alcohol abuse within their home lives (Hil- ton et al, 2008, p. 8). Cambodian males who had been victims of sexual abuse commonly described mockery, jokes and further discrimination from people within their communities when they were discovered to be victims of sexual abuse, which resulted in further isolation and marginalization (2008, p. 9). Additionally, a number of older boys who identified as men who have sex with men (MSM) described a number of violent accounts of sexual abuse and even gang rape (2008, p.10).
In Cambodia, more is known about boys who are abused by foreigners in urban and tourist locales (Renault, 2006; Hilton et al, 2008, p. 8). This is due to current child protection initiatives which focus on such incidents. Stories featuring Khmer per- petrators of sexual abuse against boys are rarely featured. (2008, p. 8) However, Action Pour Les Enfants (APLE) reports that child sexual exploitation is more often committed by Cambodian nationals than foreigners (Renault, 2006). Some cultural factors can complicate research seeking to understand the preva- lence of male sexual abuse. In Cambodian society, it is common to soothe or show affection to very young male children by touching or kissing the genitals (Hilton et al, 2008; Miles and Sun, 2006). A 2005 report studied Cambodian boys ages 12-15 and asked about sexual touching before and after the age of 9. The research found that 18.9% of Cambodian boys aged 12-15 admit to being sexually touched on the genitals after the age of 9 and 15.7 admit to being sexually touched before the age of 9 (Miles and Sun, 2005). In July and August 2012, a questionnaire-based survey was conducted of male masseurs employed in male to male massage and other establishments (e.g. Barber Shops) in Siem Reap, Cambodia. The survey used for this study was previously used in a similar study of male mas- seurs conducted in Phnom Penh, Cambodia (Miles & Blanch, 2011). This survey was adapted from a similar survey instrument developed by Jasmir Thakur (Samab- havana Society) and used with male masseurs in Mumbai, India (Miles & Thakur, 2011). Adaptations were made by the researchers to make the survey more contex- tually relevant for the cultural and economic context of Cambodia. The survey was a combination of multiple choice and open-ended questions and covered the following areas: demographic details; family background and income; issues of prejudice, stigma and discrimination; migration; sexual identity and sexual history; sexual health; substance abuse; sexual violence and abuse; income gen- eration; spirituality; dignity; and future planning. Massage Establishments and Respondent Recruitment
A total number of 20 massage, spa, and other establishments employing male mas- seurs (ie. barbershops, hotels) were included in the study. Field research methodol- ogy with purposeful and snowball sampling methods (Scheyvens & Storey, 2003; Nichols, 1991) were used to identify the male masseur respondents working within the following types of massage establishments within an approximate one kilometer radius of the Siem Reap town centre: • Massage establishments advertising massage for males by male masseurs; • Massage establishments that included both male and female masseurs ad- vertising to the general public; • Other places of employment that include massage services by male mas- seurs (e.g. Barber Shops, hotels).
The locations of the massage establishments were determined through identifying available websites and advertisements; general in-person enquiries at massage es- tablishments; and follow-up on referrals provided through previous interviews with participants (also referred to as ‘snowball/referral sampling' (Nichols, 1991). Contact was made either with managers/owners of the establishments and permis- sion granted for surveys to be conducted with employees during off-peak hours, or through contact with individual masseurs who were informed of the research and invited to participate at a time and venue convenient for them. Care was taken to schedule and conduct interviews with respondents during off-peak hours of work or before or after work hours. All survey interviews were conducted in a quiet and pri- vate area within the respective massage establishments or at a quiet café/ restaurant, seeking to avoid/limit interruption and ensure that others did not over- hear the interview. Where survey interviews were conducted away from the respon- dent's place of employment, drinks and/or snacks were provided. Respondents were not compensated for their participation in the study. No images were recorded during the survey interview process.
There were a total of 50 surveys completed. Survey interviews were conducted by two local Cambodians and one expatriate. Interviewers were provided with training to ensure they provided respondents with respect and used culturally appropriate language before, during and after the survey interview process. Survey interviews were conducted in pairs to ensure safety and accountability, with each interviewer accompanied by an expatriate researcher, who observed the interview and made notes where appropriate. All survey interviews were conducted in the local Khmer language without the assistance of a translator. Interviewers also sought to estab- lish rapport with respondents prior to the survey, providing each respondent with information concerning: an explanation of the research and its purpose; assurance of anonymity and confidentiality; information regarding the personal nature of sev- eral questions to be asked of them; and their right to choose not to answer any question and/or stop the survey and/or withdraw from the study at anytime. Two potential respondents declined the invitation to participate in the study. No respon- dents chose to stop the survey, withdraw from the study, or refrained from answer- ing questions.
Data Preparation and Analysis
Descriptive analyses of the survey results were undertaken using SPSS 20.0 (SPSS Inc). Thematic analysis was used to explore the responses to open-ended ques- tions included in the survey, with key features of this data coded and sorted in a systematic manner to reflect patterns in the data and inform themes and sub- themes relevant to the questions used in the survey (Boyatzis, 1998). Ethical guidelines were adhered to throughout the research process (Ennew, et al., 2009; UNIAP, 2008). The respondents were informed about the purpose of the sur- vey before giving consent to participate. The respondents were informed prior to engaging in the survey that they could choose not to answer any question and could choose to stop the survey at any time. Interviewers visited the locations in pairs to ensure safety and accountability. Interviewers sought to establish a rapport with respondents explaining the research and its purpose. Care was taken to en- sure that others did not overhear the interviews. All surveys were kept confidential. Respondents were informed that their individual responses would not be given to their employers. No visitors were allowed during the interview process and no im- ages were taken during the process.
The ages of the respondents had a range of 14 years, the youngest reporting to be 18 and the oldest 32. The median age of respondents was 23.5 years. A few mas- seurs appeared to be very young, however all respondents reported to be at least 18 years old at the time of the interviews. The ages at which respondents reported beginning their work as masseurs ranged 16 years, 30 being the oldest age to start working as a masseur and 14 being the youngest. The median age for the mas- seurs interviewed was 21 years. A total of nine masseurs indicated beginning working as a masseur before the age of 18. Eight of these started as masseurs be- tween the ages of 15 and 17, and one reported starting at the age of 14. A similar study conducted in Mumbai, India of 77 male masseurs found that 9% of young men surveyed were aged 10-12 years old and 55% were aged 13-15 years old (Miles & Thakur, 2011). At what age did you begin work as a masseur? A significant number of respondents indicated that they had only recently come into the massage industry. Of the 50 respondents in the study, 33 (66%) had been working as a masseur for less than three years--nearly a third of which (10 people) had been working for only a matter of months (less than one year). This seems to suggest a high turnover rate among males in the massage industry. Throughout the interviews, a number of respondents seemed to indicate seeing massage work as a source of quick and/or easy income, many citing tips as an incentive for coming into the industry. In addition to these figures, nine respondents (18%) report that they had been working as a masseur for 3-5 years, and eight (16%) had been work- ing for more than six years.
Nearly half (42%) of respondents reported to have come from the Siem Reap area, either from within the city or just outside of it. Another significant number of re- spondents came from Kampong Cham (six people or 12%) and Takeo (5 people or 10%) provinces. Four respondents (8%) came from other cities (two from Battam- bang, one from Phnom Penh, and one from Shianoukville).

Reason for Immigration Work/Earning Money Visiting a Relative The remaining respondents came from various provincial areas.
Over three-fourths of respondents had immigrated to Siem Reap. A predominant number of these respondents (29 people or 78.4%) had immigrated to Siem Reap for the purpose of finding work or earning money. This is about 20% higher than was found among masseurs working in Phnom Penh. Furthermore, only three masseurs in Siem Reap (8.1% of respondents) had come to Siem Reap for the pur- pose of their studies, which is nearly 20% lower than those working in Phnom Penh. In addition, five masseurs in Siem Reap (or 13.6% of respondents) report immigrating to Siem Reap for the purpose of staying with friends or relatives. In regards to living arrangements, 32.7% of respondents were presently living with immediate family members and 12.2% reported living with distant relatives. Slightly more than one-fifth (20.4%) of respondents lived with friends and nearly one-fourth (24.5%) lived alone. A predominant number of masseurs had immigrated to the Siem Reap area. Among this group, slightly under one-fourth lived with friends and the same amount lived alone, and one-third of immigrants lived with relatives, either immediate or distant. For those native to Siem Reap, over half lived with immediate family members, nearly 11% lived alone and 6.5% lived with friends. The educational levels of respondents were diverse. Well-over one-fourth (32%) of respondents had completed the 11th grade. A predominant number, 40% of re- spondents, had a 7th to 10th grade education, 20% had a 5th to 7th grade educa- tion, 4% had completed up to the 4th grade, and another 4% had no schooling at all. These figures are somewhat lower than what was found in Phnom Penh where nearly 50% completed the 11th grade; however, they are still slightly higher than national average. Entering the Massage Industry
The means through which the respondents had come into the massage industry were diverse. The largest group, 40%, state that they came into the massage in- dustry through a friend. Another 24% said that a member of their family, either im- mediate or distant, were responsible for their being in the massage industry. A slightly smaller group, 22% of respondents, say that they came into the massage industry after seeing an advertisement. Some respondents cite having friends or family members already working in the massage industry who provided them with free training. A number of others also cite receiving free training at the massage es- Respondents were asked why they became a masseur instead of taking another profession. As with the Phnom Penh study, low education and lack of skill remains the predominant reason cited for becoming a masseur. Nearly half of respondents cite that they lacked the education or skills necessary for other employment. A significant portion of these respondents also cite inabilities in speaking english as a factor in entering the massage industry instead of other employment in Siem Reap since massage does not require a great deal of verbal interaction with clients. More than one-fourth of respondents specifically cite financial benefits in being a mas- seur. Nearly half of those citing financial benefits specify that they came into the massage industry because they can earn tips as a masseur. Lastly, three respon- dents indicated that they wanted to become a masseur and another three state that they came into the industry because it is "easy work".
Income in the Past Three Months (USD $) Income and debt are significant considerations for young men working in this pro- fession. Reported incomes for the last three months ranged from $25 to $3000 with a median income of $300. The mean income over the past three months was $409.59. The largest portion of incomes over the past three months ranged from $25 to $300. A total of 29 people or 60.4% of respondents reported to be within this range. Of this group, 18 respondents or 37.5% of total respondents reported incomes between $151 and $300 for the past three months. This would indicate average incomes to be between $50 and $100 a month. Additionally, 11 respon- dents or 22.9% of respondents earn between $25 and $150. There were 6 re- spondents who reported three-month earnings of less than $100. Of those who earn less than $100 in three months, four lived with either immediate family or rela- tives and the remaining two had sources of secondary income. Additionally, 13 people (27.1%) reported earnings between $301 and $600, four people (8.4%) re- ported earnings between $601 and $900, and two reported earning more than $900 over a three-month period. The incomes most frequently reported over a three- month period were $300 and $600, respectively. The range of incomes for the past three months was $2,975. This large number seems to be due to a few respondents who reported significantly higher incomes than others. One respondent, 22, from a male to male oriented establishment, re- ported a 3-month income of $1,000. This is $700 greater than the average income for this sampling. Another respondent, 24, also from a male to male oriented es- tablishment, reported a 3-month income of $3,000, which is $2,700 greater than the average. Each of these respondents reported that they had met clients for sex. Within the past week, they reported meeting with 6 and 20 clients for sex, respec- Likelihood to Take Alterative Employment at $80/Mo. The average income for an unskilled laborer (in Phnom Penh) was determined to be 80USD a month, which is about 20 USD less than the average monthly income for masseurs in this study. Respondents in this study were asked if they would be in- terested to take another job which offered only 80USD a month, if it were offered to them. Nearly half of respondents (45%) indicated that they would "definitely" be interested in taking such a job and over one-fourth (28.3%) stated that they might be interested. Overall, nearly three-fourths would definitely, or would consider, tak- ing a job that pays 80 USD a month as an alternative to their present employment. Savings and Debts
Respondents were asked about their savings. If they saved money, they were asked where they kept it. 25 respondents, or 51% reported that they did not save any money. Of those who did save, 11 respondents or 22.4% kept their money in a bank; five respondents or 10.2% gave it to a family member for safe keeping; and one masseur kept his money it with his peers. Additionally, nearly half of the mas- seurs interviewed came from families who had debts to repay. Among the 16 re- spondents who disclosed amounts, their families' debts ranged from $100 to $2000. The average debt owed was $737 and the median was $700. In comparison with male masseurs in Phnom Penh, male masseurs in Siem Reap appeared to be less likely to save money. Three-fourths of male masseurs in Phnom Penh were reported to have some form of savings, whereas less than half in Siem Reap were able to save. The median debt in Siem Reap was was somewhat higher than the median debt found in Phnom Penh ($700 compared to $625); how- ever, the range of debt in Phnom Penh ranged from $200 to $20,000, which is much greater than reported by masseurs in Siem Reap.
Six masseurs or 12% of respondents indicated that they were the only member of their family who had income. Nearly half of masseurs indicated that they were earning money along with at least one sibling, another six or 12% indicated that they were earning along with one parent and ten or 20% reported that all members of their family were earning money.
Effects on Relationships
Respondents were asked a series of questions regarding their personal relation- ships and whether others in their communities were aware that they were working as masseurs. Nearly half of respondents (51.1%) indicated that the people in their communities where not aware that they were working as a masseur. A number of reasons given for this. Nine respondents indicated having shame in telling people that they are working as a masseur. One indicates that people in his community do not like male masseurs, because they are associated with prostitutes. Another states that he doesn't tell his family, or even his roommates, because he doesn't want them to talk badly about him. Another cites fears of mockery and laughter if he is found out to be a male masseur. Four respondents indicate that they lie to their families about their profession, or would lie to them if they were asked about it. A number cite half-truths such as telling family members that they are working at a hotel, but not sharing that they are providing massage services. One respondent states that he doesn't tell people of his work because it is "not a good job".
The majority of respondents, 86.5%, state that they have a best friend. A signifi- cant portion of this group, 61%, state that their best friend is another masseur. 9.8% indicate that their best friend in another boy or girl in their village and nearly 30% indicate that their best friend is someone else. Effect on Intimate Personal Relationships Lastly, masseurs were asked the extent to which being a masseur effects their inti- mate, personal relationships. A majority of respondents, 68.8%, indicated that be- ing a masseur did not have an effect on their intimate personal relationships. Eight people or 16% indicated that massage has "little effect"; five people or 10.4% and two people (4.2%) said that being a masseur had "very much" effect on their inti- mate, personal relationships. Those who indicated that being a masseur did effect their intimate personal relationships, interviewers asked them in what ways that their relationships were affected. Of those who offered responses, six masseur cited discrimination. They report that friends and teachers often discriminate against them and cite criticism from other villagers. Five masseurs cite that stigma against male masseurs effects their relationships. Of those citing stigma, a number of common themes arise from their descriptions, particularly associated with being a man who has sex other men, as well as with being likened to prostitutes. One masseur mentioned that he is mocked and laughed at by some people in his com- munity because of his work as a masseur. While it is true that a majority of the masseurs interviewed state that their jobs have little effect on their intimate personal relationships, it is important to consider that over half of the respondents have not disclosed to their families that they are work- ing as masseurs. Additionally, of those masseurs whose friends and families do know that they are working as masseurs a number of them cite sigma and discrimi- nation. We do not have enough information to understand this fully, however, it is possible that if their friends and families did know of their professions, masseurs might have stated that their profession had a greater effect on their relationships. It also may be important to consider that well over half of the masseurs who had a best friend indicated that their best friend was also a masseur. If their intimate, per- sonal relationships are with others in the massage industry, it might not be likely that being a masseur would hinder these particular relationships. Sexual Orientation Both Men and Women Man who likes to have sex with menMan who likes to have sex with womenMan who likes to have sex with men and womenMan who likes to have sex with ladyboys The respondents were asked to identify the gender(s) of people with whom the pre- ferred to have sex. Over one-third, or 40% of respondents (18 people) identified themselves as a "man who likes to have sex with men" (MSM), while 47% (21 peo- ple) identified as a "man who likes to have sex with women" (MSW). Additionally, 11% of respondents (five people) indicated that they liked to have sex with both men and women (bisexual) and one indicated that he liked to have sex with lady- boys (transgendered males). In comparison with data from masseurs in Phnom Penh (Miles & Blanch, 2011), there is a much higher number of masseurs in Siem Reap who self-identify as MSM. In the Phnom Penh study, only 16.3% of masseurs identified as MSM, while 58.1% identified as men who like to have sex with women, and 20.9% reported liking to have sex with both men and women. It may be interesting to note that there are a greater number of respondents self-identifying as MSM, even though only half of the Siem Reap respondents were from MSM establishments, compared to 100% in the Phnom Penh study.
Gender of First Sexual Partner Masseurs were asked a number of questions regarding their first sexual experience. The ages at which respondents report having their first sexual experiences ranged from 15 to 32 years old, the median age being 19.5 years old. Seven masseurs, or slightly less than 20% of those responding, report having their first sexual experi- ence between the ages of 15 and 17. Nearly half of those responding, 44.5% or 16 people, say that they where within the 18 to 20 year age-range years old when they had their first sexual experience; and nearly one fourth (22.2%) say that they had their first sexual experience within the age-range of 21 to 23 years old. Less than half of respondents, or 43.5%, stated that their first sexual experience was with a male. Of this number, exactly half stated that the male was a friend (or boyfriend) and over one-third, or 37.5%, say that the male was a client. Two mas- seurs in this category reported that their first experience was with a neighbor. Over half, or 57.5%, stated that their first sexual experience was with a female. Of this number, three-fourths state that the female was a friend (or girlfriend), three (15%) state that their first partner was with a sex worker, and one states that his first sex- ual experience with a female client.
The respondents were asked if their first sexual experience was coerced or consen- sual. Four masseurs indicate that their first sexual experience had been coerced and in all of these cases the sexual experience had been with another male. All re- spondents stating that their first sexual experience had been with a female state that the sex had been consensual. This differs greatly from the Phnom Penh study, in which 31.1% of total respondents reported that their first sexual experience had been coerced. Masseurs reported coercion 80% of the time if their partner was male and 17% of if their partner was female. Over three-fourths (76.2%) of those immigrating to Siem Reap report that their first sexual experience happened in Siem Reap. Including all respondents, a total of 81.8% report having their first sexual experience in Siem Reap. Of those remaining, three, or 9.1%of total respondents, stated having their first sexual experience in the village and one stated that his first experience was in Phnom Penh. It should be noted that the masseur's first sexual experience are assumed to mean their first experience of sexual intercourse. The research instrument did not specify other sorts of sexual experiences, encounters, or even abuse that might have hap- pened throughout the respondent's childhood. For future studies, questions such as this might be useful in order to better understand the complexities of the sexual histories of the men working in this industry.
Respondents were asked if they had visited a prostituted female within the past three months. Very few indicated that they had. Of the 50 respondents interviewed, four masseurs (8.2%) stated that they had and 45 indicated that they had not. One masseur declined to answer this question. This is significantly different from the numbers reported among masseurs in Phnom Penh (Miles & Blanch, 2011) which found 31% of respondents having visited a female sex worker in the past three months. Although a larger sampling would be needed to determine a conclusive pattern from this dataset, it is interesting to note that not all of those visiting a fe- male sex working within the past three months self-identified as a man who likes to have sex with women. This was a pattern suggested in the study on male mas- seurs in Phnom Penh. In the study, 28.5% of respondents self-identifying as homo- sexual (or exclusively MSM) had also visited a female sex worker in the past three months. Miles and Blanch question whether there could be other reasons for visit- ing a prostituted female other than pleasure. More research is needed to determine what these alternative reasons could be. For example, might it be possible that some MSM masseurs felt a need to affirm their masculinity to themselves or their male friends by visiting a prostituted female? Sexual Experiences as a Masseur
Respondents were asked a series of questions regarding their sexual experiences with clients. Kinds and frequencies of experiences were diverse. Masseurs were asked the number of clients that they had met last week for sex. Responses ranged from 0 to 20 clients within the past week. The median number of clients was 1.2. Of those who had sex with clients within the past week, three masseurs had sex with only one client, five had sex with two to four clients, four masseurs had sex with five to seven clients, and one masseur (noted above) reports having sex with 20 clients. Nearly three-fourths of masseurs indicated that they had not had sex with their cli- ents within the past week. It is important to note, however, that within this context, the question of having sex with clients implies just that: penetrative sexual inter- course. A number of masseurs who deny having sex with their clients within the past week also mention providing other sexual services, such as masturbation, which would typically be done following the massage. There was a strong contrast between masseurs working in male to male oriented massage establishments and masseurs working in mixed gender massage estab- lishments. Over half of respondents working within male to male-male oriented es- tablishments, or 12 people, report having sex with clients in the past week. Con- versely, only 3% of those coming from mixed gender massage establishments re- port having sex with clients in the past week. Similarly, respondents were asked the number of clients they met for sex within the past day. Six people, or 12% of total respondents, report having sex with clients in the past day. All of the respondents were from male to male oriented massage establishments. Respondents were also asked how often they had sex with multiple clients within the past three months. Eight people or 16% of total respondents, indicated that they have had sex with multiple clients at the same time. Three respondents indi- cated that they did this "often" and others gave specific numbers. One masseur, who did this with some frequency, indicated that he had done this about 45 times in the past three months and another indicated that he had sex with multiple clients 10 times within the past three months. Once again, there was a significant difference between the male to male and mixed gender massage establishments. All respon- dents reporting to have sex with multiple clients at the same time were from male to male oriented massage establishments and no respondents from mixed gender massage establishments indicated having sex with multiple clients at the same Additionally, respondents were questioned about how often they and another male masseur have had sex with one client at the same time in the past three months. About 80% of respondents indicated that they had never done this. One masseur, from a mixed gender massage establishment indicated that his manager does not allow the masseurs to do this, however, if arrangements are made with the client, they can provide this service in another location. A total of eight respondents indi- cated that they and another male masseur have had sex with a client at the same time within the past three months. Four masseurs indicate that this has happened 1-2 times and another four indicate that this has happened 3-5 times. Once again, all of the masseurs reporting to have provided this kind of service within the past three months were from male to male massage establishments. There were a number of masseurs who state that they have never had any sexual experiences with their clients. While this may be true for many respondents, it is also important to note that some of these figures may be inaccurate for a couple of reasons. It is possible that, due to the nature of the services provided and poten- tial pressures from management, some masseurs may choose to leave some parts of their work undisclosed. Additionally, there seems to have been some confusion among a number of respondents as to what is meant by "sex" or "sexual experi- ences". Towards the end of data-collection, it was noted that a number of mas- seurs interpreted "sexual experiences" and/or "sex" to mean exclusively penetrative intercourse. Interviewers found that a number of masseurs denied having any sex- ual experiences at all; however, when this term was broadened to include fallacio ("oral sex") and masturbation a number of masseurs then responded in the affirma- tive. Interviewers are uncertain the extent to which this confusion occurred or if it could have had an effect on the figures reflected in this and other variables dealing with "sex" and "sexual experiences". Sexual Education and Health
Respondents were asked to name a few of the modes of transmission for HIV. This was to determine if the the masseurs recognized the connection between sexual relations and HIV/AIDS. Nearly all respondents 98% cited "sex" or "sex without a condom" as a mode of HIV transmission and one respondent cited "semen" as a mode of transmission. 26 respondents (56.5%) specifically mentioned "sex without a condom" and one mentioned "sex", with the exclusion of oral sex, as a mode of HIV transmission. A large number of respondents also cited "blood" and "shared needles" as additional modes of HIV transmission. This is somewhat better than the national average. A 2009 UNICEF report states that 45% of Cambodian youth aged 15-24 are able to correctly identify the major modes of HIV transmission. Slightly more than one-third of respondents (16 people or 34.8%) stated that they knew someone who was presently living with HIV/AIDS. HIV/AIDS has a 0.5% preva- lence rate in Cambodia with an estimated 63,000 people presently living with the disease (UNICEF, 2009). Of the masseurs interviewed for this study, 17 people or 34% state that they know someone who is presently living with HIV/AIDS. In addition to their knowledge of HIV transmission, respondents were asked about their usage of condoms. Nearly three-fourths (72.9%) of those interviewed, or 35 persons, indicated that had previously used a condom. However, accounting for the fact that 3 masseurs reported to have not yet had sexual relations, slightly over three-fourths of of those reporting to have had sexual relations (77.8%) state that they have used a condom. Of this same group, 63.9% state that they have used a condom in the past week, and 54.5% had a condom with them at the time of the While those who report to use protection are in a majority, nevertheless nearly one- fourth of respondents state that they have never used a condom. A number of this group also reports having experienced coercive sex, and one of this group reports having rashes, ulcerations, or lumps in his anal/genital area within the past six Masseurs were also asked about their use of addictive drugs and alcohol. Only one respondents gave verbal indication of using any addictive drugs. The only illegal drug that was acknowledged to be use was "ice" or crystal methamphetamines. It is probable that a number of respondents were not comfortable with sharing details of drug usage, particularly without having stronger rapport built between the re- spondent and interviewer. For example, in one interview, a respondent arrived with glossy, red eyes and other notable indicators of drug usage; however, when ques- tioned about drug usage, the respondent denied any previous experience of addic- tive substances, apart from alcohol. Additionally, no masseurs indicated using Viagra or poppers while having sex with clients. Some, however, admitted to using alcohol during sex with their clients. Among respondents from male To male establishments, two respondents said that they "sometimes" used alcohol during sex with clients and one said that they "oc- casionally" did. Among those from Mix massage establishments, one "occasion- ally" mixed alcohol and sex with clients and one did this "sometimes." Experiences of Violence
Respondents were asked a series of questions regarding experiences of violence from police, bullies in the community, and their clients. Of these three groups expe- riences of violence from clients was the greatest. Only one respondent indicates that, within the past three months, he has "sometimes" experienced violence from police. Additionally, two respondents indicated that they have experienced vio- lence from bullies in their communities within the past three months; one indicates that this has happened "sometimes" and the other indicates that this has happened "very often" within the past three months. Only one respondent stated that he has "occasionally" experienced violence from clients within the past three months. However, with regards to sexual violence from clients overall, the frequencies were Have you ever been forced to have sex? Respondents were asked about previous experiences of sexual violence from cli- ents. Nearly half (43.7%) of the respondents report times in which they had been forced to have sex with clients. Six respondents indicate that this happened "sometimes" (between 1-5 times); 11 respondents indicate that this happened "oc- casionally" (between 5-10 times); three indicated that this happened "very often"; and one reports that when sex has happened with clients, it has always been against his wishes. Ten of the 21 masseurs who report having sex against their wishes state that they attempted to refuse their clients' sexual advances. A number of masseurs cite cli- ents "having strong sexual urges" and becoming angry when the masseurs did not cooperate with the clients' sexual advances. One masseur recounts having a client pull his hair in order to force the masseur to provide sexual services; another cites being striped of his clothes and having fallacio performed on him against his wishes. A number of respondents cite instances in which they were only forced to masturbate clients or to provide oral sex, while others indicate full-on sex against their wishes. One masseur reports that some clients ask him for sex, while others simply force him to have sex. Others indicate bribes or other offers given to mas- seurs for their compliance. One respondent recounts a job offer, made by two for- eign clients demanding sex, to work in a foreign country in what resembled an at- tempt at human trafficking.
While nearly half of the respondents report being forced to have sex, when asked if they were aware of other young men in the massage industry who were being forced to have sex against their wishes, only one-fourth of respondents, or 11 peo- ple, indicated that they were aware of this. This may be due to the fact that these young men are working in a closed working environment, where sexual acts may happen and masseurs may even be paid for sexual acts performed; however, all of these services fall under "massage" and further services may not be openly ac- knowledged as such. These figures are strongly contrasted with a similar survey conducted in Mumbai, India with street-based masseurs (as opposed to the parlor- based masseurs in this study). In the Indian study, nearly all of the masseurs inter- viewed had faced violence by police, 47 percent by gangs, 42 percent by clients, and violence from members of their communities was almost unanimous (Miles & Thakur, 2011).
Faith and Dignity
Respondents were asked if they had a faith or system of beliefs. Nearly all respon- dents (96%) reported to be Buddhist and one stated that he was a believer of both Christianity and Mormonism. Two respondents reported initially to be buddhists, but then added that they were followers or at least partial-believers in the doctrines of Christianity as well.
Nearly two-thirds of respondents, or 29 people, state that they pray or worship every day. When asked how they feel after visiting their place(s) of worship, nearly half of the respondents stated that they felt "happy". Slightly over one-fourth of re- spondents stated that visiting their place(s) of worship made them feel "refreshed", others mention feeling "relaxed" and eight stated that they just felt "normal". Though most masseurs Some additional comments seem to give some insight into the understanding or function of faith in the lives of some of the respondents. One masseur adds that visiting his place of worship makes him feel that he is "looked after". Others indicate a desire for future blessings. One respondent states that he hope to earn good merits, and another says that he would be willing to offer sacri- fices if God would be able to help him.
Interviewers asked the masseurs what the word "respect" meant to them. There were no answer choices given and respondents could respond however they wished. This question often took a bit more time to process than the other ques- tions in the survey. Several respondents did not provide a response and four re- sponded that they did not know. Of those who did respond, a few themes became apparent. Nearly 60% of those responding described respect in terms of words and actions that others might show to them. A very common response was that respect means that being respected means that they are valued or shown value. Others cite facial expressions and being politeness in speech. Over 10% of those responding cited listening and being understood as a way of being shown respect. A number of respondents cite love and acceptance and a few single out non- discrimination and being provided with opportunities and assistance to better Lastly, respondents were asked what they could do to increase their sense of value or self-confidence. Once again there were no answer choices given and respon- dents were free to respond however they wished. Over one-third of responses to this question where along the theme of getting a better or more respectable job, getting an education, or learning specific skills. More than one-fifth of responses had to do with being a good person, being nice, or generally doing good in life. Nine respondents, or slightly less than one-fifth, mentioned needing to have respect for themselves and/or others to increase their sense of value as a person. Some respondents indirectly cite the need to development a sense of self-respect by communicating their insecurities. One states that he wants to show people that he is a "real man" and not katuey (lady-boy) and that this would help him to increase his sense of self-confidence, while another cites wanting avoid having a girly atti- tude and behaviors. Further qualitative research on the self-identity and self- respect of people in this industry may be needed to further understand issues of shame or discrimination that may be compounded in within the somewhat enig- matic self-evaluations such as these.
Present Skills, Future Plans
The masseurs were asked a series of questions regarding their present skill-sets, future goals, and plans for reaching those goals. These questions were primarily asked in order to help NGOs do develop more focused initiatives for young men in these contexts to find alternative and sustainable employment. Respondents were asked if they presently had a second job or another source of income. 14 respon- dents described a variety of jobs that they undertook to supplement their income. Jobs were quite diverse. Three respondents described supplementary incomes having to do with their work as a masseur. One states that he sleeps with custom- ers as a way of supplementing his income, another is "on call" providing massage services for hotels and the third states that he teaches others how to do massage. Some other responses included two respondents working as moto-taxi drivers, cleaning houses, and making small animals out of clay (presumably to be sold). When asked about the time spent working these secondary jobs in the previous week, only seven of the initial 14 indicated that they had worked at all.
Skills Desired to Learn Learning a Language20% Mechanical Skills13% Learning a Language Mechanical Skills Respondents were then asked what skills that they would like to learn, if they were given the opportunity. The respondents were given no choices and were free to answer with any skills that they wished. Their answers were diverse and many re- spondents gave multiple answers. Most commonly, respondents wished to be able to learn another language. Of the 12 people who responded in this way, nine stated that they wanted to learn English. Additionally, two people wanted to learn Chinese, two wanted to learn Thai, one wished to learn Korean, and one wished to learn Japanese. Learning computer skills was the second most common skill that respondents desired to learn, followed by mechanical and business skills each hav- ing eight responses. Following this was electronics (seven people), hairstyling/ cosmetics (six people), design (five people), cooking (three people), and lastly farm- ing was a desired skill having two responses.
More than one-fourth of respondents indicated that they see themselves in some type of business within two years time, either as an owner or manager. Three re- spondents or six people saw themselves as a hairstylist or makeup artist. Other re- sponses included NGO work, farming, tour guiding, and repair/mechanical work. Two people indicated that they saw themselves leaving Cambodia within the next two years. Lastly, 10% of respondents indicated that they didn't really know what the future held. One states that he has never really thought about the future. An- other states that he doesn't want to make wishes about what is to come because they are only dreams.
Divergent Markets: ‘Male for Male' Massage vs ‘Mixed Gender' Massage
There is a clear distinction between "Male to Male" and "Mixed Gender" massage establishments in this study. Each category seems to cater to its own particular market and similarly seems to recruit a slightly different demographic of young men to work as masseurs. Respondents from each setting were found to have their own unique sets of vulnerabilities which should be considered.
Within male to male massage establish- ments, sexual services are implied and masseurs are often overtly sexualized. In some establishments, masseurs stand shirtless behind a glass showcase, iden- tifiable by number, as clients browse for the masseur of their choice. Entrances to these establishments are often dis- creet or covered to allow clients to enter and exit without being easily noticed. Phallic symbols are often ubiquitous within these establishments, found in the artwork on the walls and as trinkets deco- rating shelves and tables of the business. A primary symbol that is common to these establishments is the lingha (pictured above), which has been interpreted as a religious symbol of male creative energy or a phallus. This symbol carries particular relevance to the Siem Reap area and has been commonly found among the historic ruins of the nearby Angkor Wat temples which lie only three kilometers north of the modern city of Siem Reap. Male to male massage establishments are usually well- connected and commonly known within LGBT circles and are advertised within lo- cal LGBT bars and restaurants.
Mixed Gender massage establishments do not overtly sexualize their masseurs, or imply sexual services directly. These businesses typically advertise by having their masseurs stand outside of the establishment calling to potential clients passing on the street, often handing out fliers that detail the services that they can provide. Inside the establishment, simple massage services, such as foot and hand mas- sage, are often provided in an open area in the front part of the business. Other types of service, such as full-body, back, and oil massages are provided in the back or upstairs portion of the building, often in private or semi-private, air-conditioned quarters. While masseurs from mixed gender establishments report providing sex- ual services to clients, as well as having penetrative sex with clients, these services seem to be less frequent and do not seem to be acknowledged or even implied within the establishments. While there are particular vulnerabilities and concerns that can be raised with each type of massage establishment, there are several factors which seem to indicate greater distress and vulnerability among male masseurs working in "mixed gender massage" establishments. Frequency of Sex with Clients (Past Week) Forced (or Coerced) Sex Upon analysis of the research data, respondents from mixed gender massage es- tablishments report significantly lower occurrences of sexual intercourse with cli- ents; however, they were far more likely to have been forced to have sex against their wishes. While 12 masseurs (54% of male to male masseurs) from male to male establishments report having sex with at least one client within the past week, only one masseur from a mixed massage establishment reported the same within the past week. On the other hand, 15 masseurs from mixed gender establishments (62% of the mixed gender category) report times in which they were forced (or co- erced) to have sex against their wishes and only 6 masseurs from male to male es- tablishments (28% of male to male masseurs) report the same.
Similarly, those reporting that massage work has a great effect on their intimate, personal relationships, all came from mixed gender massage establishments. Some indicate physical violence such as the pulling of hair and many indicate bribes or other compensation in exchange for sexual services. A predominant number of masseurs in mixed gender massage establishments report to have been forced to have sex against their wishes also report that the had tried to reject the clients sexual advances. This resistance does not seem as prevalent among mas- seurs from male-to-male massage establishments. Presumably, since sexual serv- ices are implied, sex with clients is not unexpected or uncommon.
Ages of Respondents The masseurs coming from mixed gender establishments tended to be slightly younger than those coming from male-to-male establishments. Five masseurs, or 11%, of those coming from mixed gender massage establishments were in the 18- 20 year old range, whereas only 2%, or one masseur, from a male to male estab- lishment was in this range. Educational Level of Respondents 8th to 10th Grade 11th grade and above Masseurs from male to male massage establishments reported somewhat higher levels of education. The predominant number of masseurs coming from mixed gender massage establishments (26%) had 7th to 10th grade educations and only 11% had completed a secondary education; however, 20% of those working in male-to-male establishments had completed their secondary education. Income (past three months) Masseurs from mixed gender massage establishments indicated greater economic hardships and came from families who had greater debt. The predominant number of those coming from mixed gender massage establishments were in the $151 to $300 earnings bracket (for three months), whereas the predominant number of those coming from male-to-male massage establishments were in the $451 to $600 earnings bracket (for three months). Once again, it should be mentioned that this is potentially due to the fact that financial success in the massage industry is often contingent upon services provided and tips received. Those masseurs working in male-to-male massage establishments are statistically more likely to be providing sexual services and thus more likely to receive a greater compensation for the serv- ices that they are providing.
The communities of those coming from mixed gender massage establishments were more aware of the respondents career then those coming from male to male massage establishments. This could possibly indicate less fear of discrimination among mixed gender masseurs, one reason for this could be that these masseurs are not as strongly associated with male-to-male sex. Additionally, fewer masseurs from mixed gender establishments self-identify as homosexual, thus they could be could be less prone to discrimination from family and community members.
A number of respondents from mixed gender establishments indicate that they pro- vide sexual services, and also meet their clients for sexual intercourse; however, sexual services are not acknowledged or openly implied. Based upon discussion and qualitative data taken from interview it seems that most sexual services are ne- gotiated quietly between the client and masseur. Some masseurs indicate that they are often unsure of their client's intentions. A number of masseurs give reports of clients becoming angry when the masseurs decline to have sex.
Throughout this process, management seems to turn a blind eye. While masseurs from mixed gender establishments have indicated that sex is not allowed while they are at work, some indicate that if customers request, they can schedule to meet them later at their hotels or guesthouses for sex. This raises another concern, in that, once sexual services are taken outside of the establishment, there are little-to- no protections for the masseur. Additionally, it may be relevant to ask: could estab- lishments such as these serve as meeting points for male sex work, similar to the way KTV bars serve as meeting points for female sex work? Shame / Discrimination
While the young men working in mixed gender massage establishments appear to be the more vulnerable group, both in a demographic sense and with regard to ex- periences of sexual violence, this should not minimize the vulnerabilities of those within male-to-male massage establishments. 50% of the masseurs in male-to- male massage establishments self-identified as homosexual and 18% self-identified as bi-sexual A number of respondents indicate discrimination or an active fear of discrimination from their families and communities. One reason for this could be that male to male massage establishments have a much stronger association with male-to-male sex. Thus, masseurs in these establishments may not only deal with the social stigma of being a male masseur, but also discrimination due to their sex- ual orientation or society's perception of their sexual orientation. Respondents in these establishments were less likely to disclose their work to their families and communities, which seems to verify a stronger sense of shame and/or discrimina- tion. In a 2004 UNESCO report on the shame and discrimination of Cambodian men who have sex with men (MSM), respondents in the study indicated threats from community members, beatings within the family, and inability to find employ- ment if they are known to be MSM (UNESCO, 2004, 17). Further, qualitative re- search would be useful to better understand the social dynamics of stigma and dis- crimination among male-to-male sex workers within Cambodian society.
1 "Homosexual" and "Bisexual" are western categorizations for sexual orientation are used here as operating terms for ease of reading. The terms by which respondents self-identified were: "man who likes to have sex with other men" and "man who likes to have sex with both men and women." Lack of Skills - Lack of Job Alternatives
Many may argue (particularly of those within male-to-male establishments) that these young men are not victims of exploitation; that they have chosen to offer sex- ual services to their clients out of their own accord. However, research data seems to indicate that many careers in this industry are "structurally exploitive." That is, masseurs may not necessarily be forced to have sex with clients directly (although, more than one-fourth report that this has happened); however, the surrounding conditions of their finances, education, family debt/need, and job availability may force them to do things that they would not have otherwise chosen to do.
Upon analysis of the data, a number of notable patterns seem to emerge. Of those who had immigrated to the Siem Reap area, 78.4% state immigrating to Siem Reap in search of a job. While the education level of respondents was slightly higher than the national average, 68% had not completed an 11th grade education and nearly half indicated that they had entered the massage industry due to a lack of educa- tion and/or skills. This seems to suggest the need for more alternative non- exploitive vocational alternatives for those unskilled/low education job seekers, as well as a wider range of skills training or post-secondary options for this same demographic of people.
It is significant that nearly one-third of respondents cite that they entered the mas- sage industry because it offered them the opportunity to earn money quickly--a number of whom cite tips as a major drawing factor to the industry. Although tips are not consistently given, several respondents seem to indicate that tips are ex- pected in exchange for "special services" or for sexual favors. Upon review of in- come vs sexual activity with clients, the two highest earners had also met the most number of clients for sex with in the past week.
The authors believe this present baseline data to be a useful, but ultimately insuffi- cient, tool describing merely the "surface of the tip of an iceberg" in regards to the male sex industry in Cambodia. Much more research in this area is needed to bet- ter understand the scope and breadth of male sexual exploitation in Southeast Asia. Further qualitative research would be useful to better understand the individual nar- ratives and developments of men in this industry. Very little is known about the Childhoods and formative experiences of these young men. Research has found that many young men in the sex industry have had histories of childhood sexual abuse (McIntyre, 2005). Within Cambodia, Miles and Sun (2005) note that 18.9% of Cambodian boys between the ages of 12 and 15 reported being touched on the genitals after the age of nine. More research on childhood sexual exploitation of males within the sex industry would be useful to better understand the prevalence and implications of this kind of abuse, as well as its impact on development and its connections with the male sex industry.
Male massage is believed to be only one small piece of a much larger puzzle, in re- gards to the male sex industry. Further and more in-depth research would be useful to better understand what additional markets for male sex work exist within Cam- bodia. Anecdotal discussion with various Cambodian MSM suggests male sex work to be a thriving industry throughout Cambodia. Most of this work seems to be decentralized and often independent, largely taking place within and around bars, public parks, shopping centers and other various locales. Online forums and MSM internet sites indicate a number of public "meeting places" in Phnom Penh and Siem Reap for men looking to discreetly meet other men for sex. These locations could also serve as ideal markets for prostituted males and a number of them cor- respond to the male sex work locations indicated in discussions with Cambodian MSM. Ethnographic research into into these additional markets such as these would be greatly useful.
Perhaps a significant omission of the present study was an analysis of the clientele seeking sexual services. It is understood that Siem Reap is heavily patronized each year by international tourists. Qualitative data from a number of respondents seem to indicate that masseurs met with a diverse range of clientele, both local and for- eign. It would be helpful to better understand the demographics and backgrounds of those seeking sexual services. This would be helpful in order to better speculate as to what demographic groups and other various factors might be driving the de- mand for this industry.
A content analysis of the respondents' qualitative feedback reveals a number of patterns which may provide insight into the self-identities developed by those work- ing within this industry. A number of respondents indicate feelings of marginaliza- tion and desires to hide their work and their identities. These statements raise a number of questions about self-identity among men working within the sex industry. It may be significant for future research to ask how these young men understand themselves, and how this understanding informs how they develop as people. In addition, it should be asked to what extent sexuality and its surrounding social stigmas inform the development of self-identity among male sex workers in Cam- bodian society.
Beyond additional research, data from this study indicates a number of present needs for young men working in this industry. Many masseurs indicate that they wish to leave the massage industry, however they are unable due to a lack of skills and/or education. Free or low-cost vocational and life skills training programs pro- vided by NGO's or local churches would be greatly beneficial for young men work- ing in this industry. Respondents indicated that they had a diverse range of voca- tional interests. While it would be ideal for NGO's to provide specific training for an alternative careers, it is also important to allow these young men a level of choice in their own future work. Among the desired skills most highly cited by masseurs, language and computer skills rank the highest. These skills are significant in that they are often foundational to success in a broad range of careers. Having basic training provided in these areas could serve as a significant stepping-stone or for- mative base from which masseurs could seek alternative employment in a number of various fields.
This research seeks to provide a basis for understanding the vulnerability of young males who are sexually exploited in the massage industry in order to make them visible and start addressing their needs. While girls have long been viewed as vic- tims, boys are victimized as well. In the current donor climate, it is more difficult to get funding for boys' projects. Are Christian organizations afraid of being seen as pro-Gay while secular organizations are afraid of being seen as anti-Gay so that the sexual exploitation of boys falls through the gap? Not enough research has been done to determine the extent of sexual exploitation of young men and boys, which may be occurring with much greater frequency than we currently assume. For ex- ample in Cambodia there are hundreds of research studies on women and girls compared to a handful mentioning men or boys and even when studies talk of sex- ual exploitation of children it really means girls.
Christian organizations need to be at the forefront of providing holistic care for boys and young men. They are human beings with hopes and desires and vulner- abilities and needs that require better understanding in order to serve them. The best way to start doing this is to conduct thorough, careful research. □ Boyatzis, Richard E. (1998), Transforming qualitative information: Thematic analysis & code development. SAGE Publications Ltd: London, UK.
Dennis, Jeffery P. (2008), Women are Victims, Men Make Choices: The Invisibility of Men and Boys in the Global Sex Trade, Gender Issues 25:11-25, 11-12.
Dube, S. R., Anda, R. F., Whitfield, C. L., Brown, D. W., Felitti, V. J., Dong, M., & Giles, W. H. (2005). Long-term consequences of childhood sexual abuse by gender of victim. American Journal of Preventive Medicine, 28(5), 430-438.
Dworkin, Andrea (1992), from a symposium entitled "Prostitution: From Academia to Activism," sponsored by the Michigan Journal of Gender and Law at the University of Michigan Law School, October 31, 1992.] Ennew, J., Abebe, T., Bangyai, R., Karapituck, P., Kjørholt, A. T., Noonsup, T., Waterson, R. (2009). The right to be properly researched: How to do rights-based, scientific research with children. Bangkok: Black on White Publications.
Farley, Melissa, Wendy Freed, Kien Serey Phal, and Jaqueline Golding. (2010) A Thorn in the Heart: Cambodian Men Who Buy Sex. 9 Frederick, J. (2010). Sexual abuse and exploitation of boys in South Asia a review of research findings, legisla- tion, policy and programme responses. Florence: UNICEF Innocenti Research Centre. pg. 6.
Graham, Ruth. (2006). Male Rape and the Careful Construction of the Male Victim. Social and Legal Studies, Vol. 15(2), 187–208.
Hilton, A., Kong, S., Nong, S., Oung, S., Sok, C., Seoung, S., Teng, P., Long, V., & Meng, D. (2008). I thought it could never happen to boys. Phnom Penh: Hagar & World Vision.
Holmes, W. C., & Slap, G. B. (1998). Sexual abuse of boys: Definition, prevalence, correlates, sequelae, and management. Journal of the American Medical Association, 280(21), 1855-1862.
Jones, Samuel Vincent. (2010) The Invisible Man: The Conscious Neglect of Men and Boys in the War on Hu- man Trafficking. Utah Law Review, No 4. 1144.
Kendall, C. N., & Funk, R. E. (2003). Gay male pornography's 'actors': When 'fantas'y isn't. In M. Farley (Ed.), Prostitution, Trafficking, and Traumatic Stress.  (pp. 95). Binghampton: The Haworth Maltreatment & Trauma Press.
Lisak, D. (1994). The psychological impact of sexual abuse: Content analysis of interviews with male survivors. Journal of Traumatic Stress, 7(4), 525-548.
McIntyre, S. (2005). Under the radar: The sexual exploitation of young men. Calgary, Alberta, Canada.
Miles, G. M., & Sun, V. (2005). ‘Stop violence against us!': Cambodian children's perceptions of violence. Phnom Penh: Tearfund. Child Welfare Group.
Miles, G. M., & Sun, V. (2006). ‘Stop violence against us!' part 2: Cambodian children's perceptions of violence. Phnom Penh: Tearfund. Child Welfare Group.
Miles, G. M., & Thakur, J. (2011). Baseline Survey with Masseur Boys in Mumbai. (unpublished report). Love 146 & Samabhavana Society, Mumbai, India.
Miles, G., & Blanch, H. (2011). What about boys?: an initial exploration of sexually exploited boys in Cambodia. Miles, G., & Blanch, H. (Unpublished). An Initial Exploration of Young Men Who Work in the Male-to-Male Mas- sage Industry in Phnom Penh, Cambodia. Love146, Phnom Penh, Cambodia.
Nichols, P. (1991) Social survey methods: A field guide for development workers. Oxfam Publications: Oxford, Overton, J. & van Diermen, P. (2003) Using quantitative techniques in Scheyvens, R. & Storey, D. (Eds) (2003) Development Fieldwork: A practical guide. SAGE Publications Ltd: London, UK.
Renault, R. (2006). Survey on street-based child sexual exploitation in Cambodia: Overview of 7 provinces. Phnom Penh: Action Pour Les Enfants.
Sovannara, K., & Ward, C. (2004). U.S. Agency for International Development, POLICY. Men who have sex with men in Cambodia: HIV/AIDS Vulnerability, Stigma, and Discrimination. Tarr, Chou Meng (1996), Study of Contextual Factors Affecting Risk-Related Sexual Behaviour Among Young People in Cambodia.
UNICEF. (2012, August). Cambodia statistics. Retrieved from Valente, S. M. (2005). "Sexual abuse of boys." Journal of Child and Adolescent Psychiatric Nursing, 18(1), 10- Jarrett Davis, M.A., Independent Researcher. Ohio, USA / Metro Manila, Philippines. US Mobile
Phone: 1(740)304-5040 Email:
Glenn Miles, Ph.D., Asia Community Building Facilitator, Love146, P.O. Box 2654, Phnom Penh 3,
Kingdom of Cambodia.Mobile Phone: +855 (0) 89515415. Email:
. Websites:

Key Words: Young men; sexual exploitation; sexual abuse; Cambodia; Southeast Asia; Non Gov-
ernment Organizations; LGBT; Baseline Research.


Rapport de Stage De Mathieu GINESTE Maître de Stage : Michel Pucéat Equipe Cellules ES et Différenciation cardiaque CRBM CNRS FRE2593 1919 route de mende 34293 MONTPELLIER, France Sujet du Stage : Oct-4 module la spécification puis la différenciation des cellules souches embryonnaires vers un phénotype cardiaque.

Hidden devices in the school setting

in the School Setting Types of devices • Vagus nerve stimulator • Baclofen pump • Implantable defibrillator • Vascular devices • Shunt • Transcutaneous electrical nerve stimulation • Electrical muscle stimulator • Diaphragmatic pacer Vagus Nerve Stimulator Vagus Nerve Stimulator • This device is implanted under the left chest. A second incision, made along the