Sex purchasing and associations with HIV/STI among a clinic-based sample of US men.
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.
Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA. mdecker@hsph.harvard.edu
Michele R
MR
Decker
Anita
A
Raj
Jhumka
J
Gupta
Jay G
JG
Silverman
D000293:Adolescent; D000328:Adult; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D008297:Male; D012309:Risk-Taking; D011477:Sex Work; D012725:Sexual Behavior; D015229:Sexually Transmitted Diseases, Viral / Q000453:epidemiology*; D014481:United States