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Original article
The prevalence of, and factors associated with, paying for sex among men resident in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)
  1. Kyle G Jones1,
  2. Anne M Johnson1,
  3. Kaye Wellings2,
  4. Pam Sonnenberg1,
  5. Nigel Field1,
  6. Clare Tanton1,
  7. Bob Erens1,3,
  8. Soazig Clifton1,4,
  9. Jessica Datta2,
  10. Kirstin R Mitchell2,
  11. Phillip Prah1,
  12. Catherine H Mercer1
  1. 1Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK
  2. 2Department of Social and Environmental Research, London School of Hygiene & Tropical Medicine, London, UK
  3. 3Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
  4. 4NatCen Social Research, London, UK
  1. Correspondence to Dr Catherine H Mercer, Centre for Sexual Health & HIV Research, University College London, Mortimer Market Centre, off Capper Street, London WC1E 6JB, UK; c.mercer{at}


Objectives Men who pay for sex (MPS) are considered a bridging population for sexually transmitted infections (STI). However, the extent, characteristics and role of MPS in transmission is poorly understood. We investigate these questions using data from Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).

Methods We performed complex survey analyses of data from 6293 men aged 16–74 years resident in Britain who completed Natsal-3, a probability sample survey undertaken during 2010–2012, using computer-assisted personal interviewing and computer-assisted self-interview.

Results 11.0% (95% CI10.1% to 11.9%) of all men reported ever paying for sex. Among MPS, 18.4% (95% CI 18.2% to 18.7%) of their lifetime sexual partners were paid. 3.6% (95% CI 3.1% to 4.2%) of men had paid for sex in the past 5 years. Partners of MPS constitute 14.7% of all reported partners and MPS report 15.6% of all reported STI diagnoses in the past 5 years. Paying for sex in the past 5 years was strongly associated with reporting larger numbers of sexual partners (adjusted OR, AOR for 5+ partners, past 5 years, 31.50, 95% CI 18.69 to 53.09). After adjusting for partner numbers, paying for sex remained strongly associated with reporting new foreign partners outside the UK (AOR 7.96; 95% CI 4.97 to 12.73) and STI diagnosis/es (AOR 2.34; 95% CI 1.44 to 3.81), all in the past 5 years. Among men ever paying for sex, 62.6% (95% CI 58.3% to 66.8%) reported paying for sex outside the UK, most often in Europe and Asia.

Conclusions MPS in Britain remain at greater risk of STI acquisition and onward transmission than men who do not. They report high numbers of partners, but the minority are paid partners. They are an important core group in STI transmission.

  • Sexual Behaviour
  • Sexual Health
  • Social Science

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