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The role of men who pay for sex in STI transmission: current knowledge and future directions. The contribution of the third UK National Survey of Sexual Attitudes and Lifestyles (Natsal-3)
  1. Sónia Dias
  1. Correspondence to Professor Sónia Dias, Institute of Hygiene and Tropical Medicine & CMDT, Universidade Nova de Lisboa, Rua da Junqueira, 100, Lisboa 1349-008, Portugal; sfdias{at}ihmt.unl.pt

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Sexually transmitted infections (STI) remain a major cause of morbidity and mortality worldwide. Worryingly, after nearly a decade of declining rates, STI incidence appears to be increasing in several regions.1 ,2

Men who pay for sex and their paid partners have been recognised as particularly vulnerable to STIs.1 Where data on STI prevalence in sex workers (SW) exist, outbreaks of STIs have been reported among this population.1 The few studies conducted with men who pay for sex indicate a high prevalence of STIs among this group.3 ,4 Most of this information comes from one-off surveys among convenience samples or attendances at STI clinics for screening, leading to uncertainty about how well these data truly reflect the STI burden in these populations.1

As currently discussed, men who pay for sex and their paid partners can act as a potential ‘bridge’ for STI transmission to lower-risk populations.2 ,5 Critical components of bridging include high rate of partner change, concurrency, patterns of sexual mixing with different types of partners (paid, non-paid, regular, casual, etc), inconsistent condom use and high rates of STI prevalence. Some of these characteristics have been documented in men who pay for sex, as illustrated in previous studies.3 ,5 ,6 A survey conducted in Benin with 404 clients recruited at sex work venues showed that many visit female SWs regularly, on a long-term basis, and visit a different SW …

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