European gay men more likely to buy or sell sex if they have large numbers of sex partners, are lonely and use drugs

Internet survey identifies targets for health promotion
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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.

Approximately 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.


adjusted odds ratio (AOR)

Comparing one group with another, expresses differences in the odds of something happening. An odds ratio above 1 means something is more likely to happen in the group of interest; an odds ratio below 1 means it is less likely to happen. Similar to ‘relative risk’. 

unprotected anal intercourse (UAI)

In relation to sex, a term previously used to describe sex without condoms. However, we now know that protection from HIV can be achieved by taking PrEP or the HIV-positive partner having an undetectable viral load, without condoms being required. The term has fallen out of favour due to its ambiguity.

risky behaviour

In HIV, refers to any behaviour or action that increases an individual’s probability of acquiring or transmitting HIV, such as having unprotected sex, having multiple partners or sharing drug injection equipment.

The survey 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 Belgium (10%).

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).

Identifying as 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.

Factors associated 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 investigators.

“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 hidden.”


EMIS 2010: The European men-who-have-sex-with-men internet survey. Findings from 38 Countries. Click here to download.