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.
Decker
Michele R
MR
Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA. mdecker@hsph.harvard.edu
Raj
Anita
A
Gupta
Jhumka
J
Silverman
Jay G
JG
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