Male commercial sex clients in the U.S.: Who are they?

Most research focused on commercial sex is among sex workers (SWs). Most research among sex clients has been conducted outside the U.S. and/or relies on SW reports of client characteristics and behavior. We describe correlates of ever purchasing sex among 1249 men aged 18-70 without STDs, HIV, or a history of penile or anal cancer recruited in Central Florida. The mean age was 29.0, 72.8% white, 15.6% Hispanic, 17.4% black and 7.8% were MSM. Overall, 4.9% were ever sex clients and 13 (1.0%) were clients in the last 3 months. Clients were significantly older (mean age 42.0 vs. 28.4), married/cohabitating vs. single/divorced/widowed (9.6% vs. 3.8%), had <12 years (15.0%) or ≥17 years of education (13.2%) vs. 12-16 years (3.9%), and had sex with women and men (18.0%) vs. women only (4.6%) or men only (none) as compared to men who never purchased sex. Clients also initiated sex later (mean age 17.9 vs. 16.6, p=0.021) and had more lifetime female sex partners (median 28 vs. 6, p<0.001). Among recent clients, ten paid women, one paid men, and one paid men and women. On average, men paid for sex twice in the last three months. Eleven paid for vaginal sex, seven for oral sex, and none for anal sex. Most (77%) reported always using condoms when they paid for sex. This is one of the first studies to examine purchasing sex among U.S. men. Prevalence appears low, but is likely subject to under-reporting. Additional research is needed to further explore this phenomenon.