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Sex Purchasing and Associations With HIV/STI Among a Clinic-Based Sample of US Men

Decker, Michele R ScD*; Raj, Anita PhD; Gupta, Jhumka ScD*‡; Silverman, Jay G PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: July 1st, 2008 - Volume 48 - Issue 3 - p 355-360
doi: 10.1097/QAI.0b013e3181775939
Epidemiology and Social Sciences

Background: Despite high rates of human immunodeficiency virus/sexually transmitted infection (HIV/STI) among commercial sex workers and international concern that male clients may constitute a critical bridge population for HIV/STI transmission, little empirical data exist within the United States to characterize men who purchase sex or to assess their sexual risk and HIV/STI infection.

Methods: The study involves the analysis of a community-based survey of men aged 18-35 years attending urban health centers (n = 1515) to assess the prevalence of engagement in sex purchasing during the past year and to evaluate relations with self-reported HIV/STI diagnosis and symptoms across this same period.

Results: More than 1 in 12 (8.7%) men reported exchanging drugs, money, or a place to stay for sex with a female partner in the past year. Such behavior was associated with additional sexual risk taking and emerged as an independent predictor of self-reported HIV/STI diagnosis [adjusted odds ratio (ORadj) = 2.99; 95% confidence interval (CI): 1.51 to 5.94] and STI symptoms (ORadj = 2.57; 95% CI: 1.57 to 4.22) in the past year in analyses adjusted for alternate HIV/STI risk sources.

Conclusions: Sex purchasing is a common form of HIV/STI risk among the population sampled. Men engaging in such behavior are more likely to be HIV/STI infected and, thus, represent a risk to the sexual health of both commercial and noncommercial sex partners. Further research is needed to inform interventions targeted toward male clients of prostituted women.

From the *Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA; †Department of Social and Behavioral Sciences, Boston University of Public Health, Boston, MA; and ‡Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT.

Received for publication November 20, 2007; accepted March 27, 2008.

Correspondence to: Michele R. Decker, ScD, Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA (e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.