Men Who Pay For Sex: Prevalence and Sexual Health

Background: Men who pay for sex (MPS) are a vulnerable bridging population for spreading sexually transmitted infections (STI). However, their prevalence and sexual health are unknown in Germany.

Methods: We analyzed data from 2336 men aged 18-75 years resident in Germany who completed the German Health and Sexuality Survey (GeSiD), a populationbased probability sample survey undertaken 2018-2019, using face-to-face interviews (participation rate: 30.2%).

Results: 26.9% (95% confidence interval [24.7; 29.2]) of all men reported ever paying for sex. On average, MPS had M = 19.9 [16.8; 22.9] lifetime sexual partners, among them M = 7.3 [5.3; 9.4] paid partners. MPS described their paid sex predominantly as vaginal intercourse in domestic brothels. Regarding socio - demographic characteristics, MPS differed from men not paying for sex (MNPS) in terms of age, immigration status, and sex education. Compared to MNPS, MPS reported significantly more HIV/STI risk-taking, including multiple sex partners in the past year (OR adjusted for age, immigration status, sex education; AOR 3.55) and STI diagnosis in the past 5 years (AOR 1.96) as well as more prevention behaviors (e.g., condom use in the past year: AOR 3.13).

Conclusion: The prevalence of MPS suggests physicians should address the topic with their patients to protect and improve the sexual health of MPS and their paid and unpaid partners.