Article Text

Download PDFPDF
Clients of sex workers in different regions of the world: hard to count
  1. M Carael1,
  2. E Slaymaker2,
  3. R Lyerla3,
  4. S Sarkar3
  1. 1Free University of Brussels, Brussels, Belgium
  2. 2London School of Hygiene and Tropical Medicine, London, UK
  3. 3UNAIDS, Switzerland and Thailand
  1. Correspondence to:
 Dr M Carael
 Free University of Brussels, Brussels, Belgium; caraelm{at}


Objectives: To estimate the proportion of the male population that reports having paid for sex in different regions.

Methods: Clients of sex workers were identified from representative samples of men asked in face-to-face interviews whether they had had sex in exchange for money or whether they had paid for sex, in the last 12 months. A total of 78 national household surveys and nine city based surveys were selected for inclusion. Where such surveys were not available, results of behavioural surveillance surveys and of research studies were also used. Using national estimates, a median percentage of men who reported paying for sex was calculated for each region.

Results: The median percentage of men who exchanged sex for money in the last 12 months in all regions was around 9–10%, with estimates from 13% to 15% in Central African region, 10 to 11% in Eastern and southern Africa, and 5–7% in Asia and Latin America. Estimates for men who paid sex were much lower at around 2–3% with ranges from 7% in the South African region to 1% in Asia and West Africa.

Conclusions: Although errors of measurement and critical issues of definitions and interpretation exist, this compilation represents a first attempt to obtain reasonably coherent estimates of the proportion of men who were clients of sex workers at regional level. Large discrepancies between regions were found. Further improvements in national estimates will be critical to monitor coverage of HIV prevention programmes for sex workers and clients, and to improve estimates of national HIV infection prevalence levels in low and concentrated HIV epidemics.

  • BSS, Behavioral Surveillance Surveys
  • DHS, Demographic and Health Surveys
  • GPA, Global Program on AIDS
  • IDU, injecting drug user
  • MSM, men who have sex with men
  • NEM, New Encounter Module
  • UNAIDS, Joint United Nations Programme on HIV/AIDS
  • WHO, World Health Organization
  • clients of sex workers
  • HIV epidemic
  • sex workers
  • sexual behaviour
  • size estimates

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Edited by Peter Ghys, Neff Walker, Helen Ward and Rob Miller