title: The prevalence of, and factors associated with, paying for sex among men resident in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).
abstract: OBJECTIVE
  Men who pay for sex (MPS) are considered a bridging population for sexually transmitted infections (STI). However, the extent, characteristics and role of MPS in transmission is poorly understood. We investigate these questions using data from Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).
  
  
  METHODS
  We performed complex survey analyses of data from 6293 men aged 16-74 years resident in Britain who completed Natsal-3, a probability sample survey undertaken during 2010-2012, using computer-assisted personal interviewing and computer-assisted self-interview.
  
  
  RESULTS
  11.0% (95% CI10.1% to 11.9%) of all men reported ever paying for sex. Among MPS, 18.4% (95% CI 18.2% to 18.7%) of their lifetime sexual partners were paid. 3.6% (95% CI 3.1% to 4.2%) of men had paid for sex in the past 5 years. Partners of MPS constitute 14.7% of all reported partners and MPS report 15.6% of all reported STI diagnoses in the past 5 years. Paying for sex in the past 5 years was strongly associated with reporting larger numbers of sexual partners (adjusted OR, AOR for 5+ partners, past 5 years, 31.50, 95% CI 18.69 to 53.09). After adjusting for partner numbers, paying for sex remained strongly associated with reporting new foreign partners outside the UK (AOR 7.96; 95% CI 4.97 to 12.73) and STI diagnosis/es (AOR 2.34; 95% CI 1.44 to 3.81), all in the past 5 years. Among men ever paying for sex, 62.6% (95% CI 58.3% to 66.8%) reported paying for sex outside the UK, most often in Europe and Asia.
  
  
  CONCLUSIONS
  MPS in Britain remain at greater risk of STI acquisition and onward transmission than men who do not. They report high numbers of partners, but the minority are paid partners. They are an important core group in STI transmission.
authors.affiliation: Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK.
authors.forename: Kyle G
authors.initials: KG
authors.lastname: Jones
authors.affiliation: Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Johnson
authors.affiliation: Department of Social and Environmental Research, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Kaye
authors.initials: K
authors.lastname: Wellings
authors.affiliation: Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK.
authors.forename: Pam
authors.initials: P
authors.lastname: Sonnenberg
authors.affiliation: Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Field
authors.affiliation: Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Tanton
authors.affiliation: Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Bob
authors.initials: B
authors.lastname: Erens
authors.affiliation: Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK NatCen Social Research, London, UK.
authors.forename: Soazig
authors.initials: S
authors.lastname: Clifton
authors.affiliation: Department of Social and Environmental Research, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Jessica
authors.initials: J
authors.lastname: Datta
authors.affiliation: Department of Social and Environmental Research, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Kirstin R
authors.initials: KR
authors.lastname: Mitchell
authors.affiliation: Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK.
authors.forename: Phillip
authors.initials: P
authors.lastname: Prah
authors.affiliation: Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK.
authors.forename: Catherine H
authors.initials: CH
authors.lastname: Mercer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006801:Humans; D007407:Interviews as Topic; D008019:Life Style; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012725:Sexual Behavior / Q000502:physiology*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000635:transmission; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: Sexual Behaviour; Sexual Health; Social Science