Results of a large
European internet-based survey show that 8% of gay and other men who have sex with men
(MSM) in Europe paid for sex in the previous twelve months, and that 5% were
paid for sex during the same period.
A number of
characteristics were associated with buying or selling sex, including age,
sexual identity and drug use. The investigators stress that buying and selling
sex does not automatically involve an increased risk of HIV. Nevertheless, they
suggest that individuals with characteristics associated with the purchase or
sale of sex should be targeted with health promotion interventions.
180,000 participants from 38 European countries completed the European
Men-Who-Have-Sex-with-Men Internet Survey (EMIS) in 2010. This is the largest international study of men who have sex with men ever conducted.
gathered a large amount of data on the demographics, sexual behaviour and drug
use of MSM. Participants were
asked if they had bought or sold sex and, if so, on how many occasions.
Overall, 8% of men
had bought sex in the previous year. The countries with the highest proportion
of men buying sex were Switzerland (13%), Cyprus (13%), Russia (11%) and
Most of the men
(60%) who reported buying sex had done so on one or two occasions only, but
10% had paid for sex on more than ten occasions.
Selling sex in the
previous year was reported by 5% of men. Countries with the highest proportion
of men selling sex were the former Yugoslav Republic of Macedonia (11%), Turkey
(8%), Italy (8%) and Moldova (8%).
Over half (52%) of
men who had sold sex did so on only one or two occasions.
“Having been paid
for sex does not necessarily indicate that a person is a sex worker,” write
the authors. “Many men who had sold sex in the last year had done so only once
or twice, suggesting that these were opportunistic exchanges.”
Despite this, 10%
of men selling sex had had done on ten or more occasions.
A number of
factors were associated with having bought sex. Men aged over 40 were almost
ten times more likely to have reported buying sex than men aged under 25 (AOR =
9.68; 95% CI, 8.73-10.7).
bisexual (AOR = 1.10; 95% 1.03-1.17) was also associated with buying sex, as
was being out as gay to only a few people (AOR = 1.28; 95% CI, 1.22-1.35). Men who reported
being lonely were also more likely to buy sex (AOR = 1.18; 95% CI, 1.10-1.25).
A large number of sex partners in the previous year (above 50: AOR = 4.50; 95%
CI, 5.00-5.06), use of crack or heroin (AOR = 2.08; 95% CI, 1.60-2.70) and
recent use of drugs such as Viagra
(AOR = 1.56; 95% CI, 1.46-1.66) were associated with the purchase of sex.
“The profile of
men who paid for sex suggests that many are older and have a hidden or
clandestine sexuality,” comment the authors.
with selling sex were younger age (below 25: AOR = 8.23; 95% CI, 7.44-9.11; between 25 and 40 years: AOR = 3.00; 95% CI, 2.73-3.29), lower educational attainment (AOR =
1.81; 95% CI, 1.71-1.92), being unemployed (AOR = 1.60; 95% CI, 1.45-1.77),
identifying as bisexual (AOR = 1.99; 95% CI, 1.86-2.14), loneliness (AOR =
1.09; 95% CI, 1.01-1.18), recreational drug use (AOR = 1.69; 95% CI, 1.58-1.81)
and use of crack or heroin (AOR = 2.41; 95% CI, 2.04-2.85).
Men with larger
number of sexual partners were also more likely to report selling sex (above
50: AOR = 13.83; 95% CI, 12.24-15.62). Unprotected anal intercourse (UAI) with
a steady male partner (AOR = 1.25; 95% CI, 1.16-1.35) and casual male partners
(AOR = 1.26; 95%, 1.18-1.33) was also associated with the selling of sex.
The report also
showed that men selling sex were more likely to have been newly diagnosed with
a sexually transmitted infection (AOR = 1.32; 95% CI, 1.28-1.45) or to have
been diagnosed with HIV (AOR = 1.22; 95% CI, 1.05-1.40).
“Men who have been
paid for sex are an important at-risk population because they are more likely
to engage in certain risk behaviour (drug use, large numbers of non-steady
partners and UAI with both steady and non-steady partners),” note the
“As men who buy
sex are an important at-risk population, further analyses are needed to address
their needs and explore prevention strategies,” the authors conclude. “Specific
strategies should be designed to reach older men and those whose sexuality is