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Men who Pay for Sex: Prevalence and Sexual Health-Results from the German Health and Sexuality Survey (GeSiD).

BACKGROUND
Men who pay for sex (MPS) are a vulnerable bridging population for spreading sexually transmitted infections (STI). However, their prevalence and sexual health are unknown in Germany.


METHODS
We analyzed data from 2336 men aged 18-75 years resident in Germany who completed the German Health and Sexuality Survey (GeSiD), a population-based probability sample survey undertaken 2018-2019, using face-to-face interviews (participation rate: 30.2%).


RESULTS
26.9% (95% confidence interval [24.7; 29.2]) of all men reported ever paying for sex. On average, MPS had M = 19.9 [16.8; 22.9] lifetime sexual partners, among them M = 7.3 [5.3; 9.4] paid partners. MPS described their paid sex predominantly as vaginal intercourse in domestic brothels. Regarding sociodemographic characteristics, MPS differed from men not paying for sex (MNPS) in terms of age, immigration status, and sex education. Compared to MNPS, MPS reported significantly more HIV/STI risk-taking, including multiple sex partners in the past year (OR adjusted for age, immigration status, sex education; AOR 3.55) and STI diagnosis in the past 5 years (AOR 1.96) as well as more prevention behaviors (e.g., condom use in the past year: AOR 3.13).


CONCLUSION
The prevalence of MPS suggests physicians should address the topic with their patients to protect and improve the sexual health of MPS and their paid and unpaid partners.