Background Men who have purchased sex from sex workers (“clients”) have been associated with an increased risk of acquiring STIs including HIV and in influencing the spread of infection in the population. To date, only a few reports on behavioural risk correlates and infection history of male clients have been documented in the United States, mainly drawn from populations in central cities and at high-risk for HIV. This study examines STIs/HIV behavioural risks and screening history correlates of male clients in the general population and whether the prevalence of male clients differs by urbanisation level.

Methods Data from the 1999–2000 National STD and Behavioral Measurement Study, a cross-sectional telephone-based probability sample of the non-institutionalised population aged 18 to 45 years old, was linked to the National Center Health Statistics Urban Rural Classification Scheme for Counties. The analysis is restricted to men aged 26 to 45 years old (N = 469). F-statistic that accounted for survey design effects and Poisson regression for weighted data were used.

Results The overall prevalence of clients was 14.5 (95% CI 11.5–18.1) and did not statistically differ between men residing in central cities of large metropolitan areas (MA) and men residing in large metropolitan suburbs, MAs of less than one million people, or non-metropolitan subdivisions (P = 0.5655). Compared to non-clients, clients had a significantly higher prevalence of an array of other high-risk behaviours in their lifetime and more recently including history of same-sex partners (Adjusted prevalence ratio (Adj.PR) = 2.5, 95% CI, 1.5–4.1), sold sex (Adj.PR = 3.6, 95% CI, 2.2–6.1), multiple partners in the past year (Adj.PR = 2.6, 95% CI, 1.6–4.0), as well as a history of STIs (Adj.PR = 2.5 95% CI 1.5–4.4).

Conclusion Male clients are ubiquitous. The risk-taking behaviour of clients in the general population is important to develop more comprehensive prevention measures for STIs/HIV.