Men who pay for sex at higher risk of acquiring STIs

1. The most common subgroups of men who pay for sex were aged above 24 years, more likely to be without a steady partner, and more likely to be drug users.

2. Men who pay for sex were at higher risk of acquiring STIs and could be targeted in sexual health interventions.

Evidence Rating Level: 3 (Average)

Study Rundown: Men who pay for sex (MPS) are at high risk of having sexually transmitted infections (STIs) because of the high risk that their paid partners carry STIs. The purpose of this study was to determine the prevalence of paying for sex in British men and how this behavior would vary with sociodemographic variables and self-reported STI diagnoses. Of over 6,000 surveyed men, 11% reported ever paying for sex. These men also had more than twice as many partners over their lifetime compared to the average for the male population. Factors associated with paying for sex included being above age 24, having no current steady partner, having managerial or professional occupations, and binge drinking or using drugs. Additionally, MPS reported greater rates of STIs and testing for HIV. The most common geographic locations for pursuance of this behavior were in Europe and Asia.

This study benefited from the use of a nationwide survey that allowed for population-based estimates on various variables associated with paying for sex. Additionally, the results are largely generalizable to the British population. This was, however, a cross-sectional study in which no definitive link could be determined between paying for sex and health-seeking behaviors. Finally, as the data were based on survey results, with questions such as number of lifetime partners, recall bias is a concern. Overall, this study suggests that MPS are at higher risk of acquiring STIs and could be targeted in sexual health interventions.

Click to read the study, published today in Sexually Transmitted Infections

Click to read an accompanying editorial in Sexually Transmitted Infections

Relevant Reading: Who pays for sex? An analysis of the increasing prevalence of female commercial sex contacts among men in Britain

In-Depth [cross-sectional study]: This study investigated 6,108 men in Natsal-3, a nationwide survey in Britain between 2010 and 2012. 11% (CI_95% 10.1% to 11.9%) of men reported every paying for sex. This rate was lowest in men aged 16-24 years and three times higher in men aged 25-34 years. Compared to a male population average of 13.6 lifetime partners, MPS had on average 31.6 lifetime partners. After adjustment, men without a steady partner had 2.58-fold (CI_95% 1.84 to 3.62) higher rate of paying for sex and men using drugs other than cannabis in the past year had a 5.01-fold (CI_95% 3.38 to 7.42) higher rate of paying for sex. Importantly, MPS were 2.34 (CI_95% 1.44 to 3.81) times more likely to report STI diagnoses and 2.20 (CI_95% 1.53 to 3.17) times more likely to be tested for HIV.

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