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Who pays for sex? An analysis of the increasing prevalence of female commercial sex contacts among men in Britain
  1. H Ward1,
  2. C H Mercer2,
  3. K Wellings3,
  4. K Fenton2,
  5. B Erens4,
  6. A Copas2,
  7. A M Johnson2
  1. 1Department of Infectious Disease Epidemiology, Imperial College London, UK
  2. 2Department of Primary Care and Population Sciences, University College London, UK
  3. 3Centre for Reproductive and Sexual Health, London School of Hygiene and Tropical Medicine, UK
  4. 4National Centre for Social Research, UK
  1. Correspondence to:
 Helen Ward
 DIDE, Imperial College London, Norfolk Place, London W2 1PG, UK; h.ward{at}


Background: In the United Kingdom the incidence of sexually transmitted infections (STI) and risky sexual behaviours is increasing. The role of commercial sex in this trend is poorly understood. Little is known about the men who pay for sex. We examined the epidemiology of female commercial sex contacts reported by men in 1990 and 2000.

Methods: National probability sample surveys of sexual attitudes and lifestyles (Natsal) of men aged 16–44 resident in Britain in 1990 (n = 6000) and 2000 (n = 4762).

Results: The proportion of men who reported paying women for sex in the previous 5 years increased from 2.0% (95% CI 1.6 to 2.5) in 1990 to 4.2% in 2000 (95% CI 3.6 to 4.9). In both surveys, paying for sex was more frequent in men aged between 25 years and 34 years, who were never or previously married, and who lived in London. There was no association with ethnicity, social class, homosexual contact, or injecting drug use. Men who paid for sex were more likely to report 10 or more sexual partners in the previous 5 years; only a minority of their lifetime sexual partners (19.3%) were commercial. They were more likely to meet partners abroad and to report previous STI. Only 15% reported having had an HIV test.

Conclusion: The proportion of men who reported paying for heterosexual sex has increased, and these men have multiple commercial and non-commercial partners. Their higher rates of STI and low level of HIV testing suggest the need for prevention interventions for clients as well as sex workers.

  • CASI, computer assisted self interview
  • STD, sexually transmitted diseases
  • STI, sexually transmitted infections
  • prostitution
  • sex work
  • men
  • Britain
  • population survey

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  • Conflicts of interest: none.

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