Journal of Urban Health

, Volume 90, Issue 6, pp 1166–1180 | Cite as

Men Who Purchase Sex, Who Are They? An Interurban Comparison

  • Danielle C. OmpadEmail author
  • David L. Bell
  • Silvia Amesty
  • Alan G. Nyitray
  • Mary Papenfuss
  • Eduardo Lazcano-Ponce
  • Luisa L. Villa
  • Anna R. Giuliano


Most research concerning clients of commercial sex workers (CSWs) relies upon CSW reports of client characteristics and behavior. We describe correlates of ever purchasing sex among 3,829 men from three cities: São Paulo, Brazil; Cuernavaca, Mexico; and Tampa, USA. A computer-assisted self-interview collected data on demographics and sexual behavior. There were significant site differences—26.5 % paid for sex in São Paulo, 10.4 % in Cuernavaca, and 4.9 % in Tampa. In all cities, men who had sex with men and women (versus sex with women only) were more likely to have ever paid for sex. In São Paulo and Cuernavaca, CSW clients were older, had higher educational attainment, and were less likely to be married. In Tampa, older age was associated with being a CSW client but not education and marital status. In São Paulo and Cuernavaca, CSW clients had more partners than men who had never paid for sex. In São Paulo, CSW clients initiated vaginal sex at an earlier age, while in Cuernavaca they were more likely to self-report a sexually transmitted infection. CSW clients varied with respect to demographics across the three cities while the association between paying for sex and risky sexual behavior seems to be somewhat conserved. These findings suggest that interventions among CSW clients should focus on condom use with commercial and non-commercial partners as these men may be at increased risk for transmitting and acquiring sexually transmitted infections to and from their sex partners. Better understanding of client characteristics is needed for targeting interventions and creating culturally appropriate content.


Commercial sex workers Men Clients Brazil Mexico United States Interurban 



The authors would like thank the men who provided personal information for the study. This study was supported by the National Cancer Institute (1R03CA134204 and RO1CA098803 (ARG)).


  1. 1.
    Sanders T. Paying for Pleasure: Men Who Buy Sex. Portland, OR: Willan; 2008.Google Scholar
  2. 2.
    Monto MA. Prostitutes' customers: motives and misconceptions. In: Weitzer R, ed. Sex for sale: prostitution, pornography, and the sex industry. 2nd ed. New York, NY: Routledge; 2010: 233–254.Google Scholar
  3. 3.
    Ward H, Mercer CH, Wellings K, et al. Who pays for sex? An analysis of the increasing prevalence of female commercial sex contacts among men in Britain. Sex Transm Infect. 2005; 81: 467–471.PubMedCrossRefGoogle Scholar
  4. 4.
    Schei B, Stigum H. A study of men who pay for sex, based on the Norwegian national sex surveys. Scand J Public Health. 2010; 38: 135–140.PubMedCrossRefGoogle Scholar
  5. 5.
    Melbye M, Biggar RJ. Interactions between persons at risk for AIDS and the general population in Denmark. Am J Epidemiol. 1992; 135: 593–602.PubMedGoogle Scholar
  6. 6.
    Belza MJ, de la Fuente L, Suarez M, et al. Men who pay for sex in Spain and condom use: prevalence and correlates in a representative sample of the general population. Sex Transm Infect. 2008; 84: 207–211.PubMedCrossRefGoogle Scholar
  7. 7.
    South SJ, Trent K. Imbalanced sex ratios, men's sexual behavior, and risk of sexually transmitted infection in China. J Health Soc Behav. 2010; 51: 376–390.PubMedCrossRefGoogle Scholar
  8. 8.
    Huang ZJ, Wang W, Martin MC, Nehl EJ, Smith BD, Wong FY. "Bridge population": sex workers or their clients?—STI prevalence and risk behaviors of clients of female sex workers in China. AIDS Care. 2011; 23(Suppl 1): 45–53.PubMedCrossRefGoogle Scholar
  9. 9.
    Shutt JE, Barnes JC, Beaver KM, Higgins GE, Tewksbury R. Does biology underlie the oldest profession? Prostitution and sex disparities in john behavior. Biodemography Soc Biol. 2011; 57: 155–170.PubMedCrossRefGoogle Scholar
  10. 10.
    Brewer DD, Roberts JM Jr, Muth SQ, Potterat JJ. Prevalence of male clients of street prostitute women in the United States. Hum Organ. 2008; 67: 346–356.Google Scholar
  11. 11.
    U.S.Department of State. 2008 Country reports on human rights practices. [serial online] 2009; Accessed April 22, 2011.
  12. 12.
    Della Giusta M, Di Tommaso ML, Shima I, Strom S. What money buys: clients of street sex workers in the US. Appl Econ. 2009; 41: 2261–2277.CrossRefGoogle Scholar
  13. 13.
    Giuliano AR, Lee JH, Fulp W, et al. Incidence and clearance of genital human papillomavirus infection in men (HIM): a cohort study. Lancet. 2011; 377: 932–940.PubMedCrossRefGoogle Scholar
  14. 14.
    Giuliano AR, Lazcano E, Villa LL, et al. Circumcision and sexual behavior: factors independently associated with human papillomavirus detection among men in the HIM study. Int J Cancer. 2009; 124: 1251–1257.PubMedCrossRefGoogle Scholar
  15. 15.
    State of Florida. Prostitution. Title XLVI, Chapter 796. 2011. 9-28-2011.
  16. 16.
    MEASURE DHS. HIV/AIDS Survey indicators database. [serial online] 2011; Accessed October 19, 2011.
  17. 17.
    Rodrigues MT. O sistema de justiça criminal ea prostituição no Brasil contemporâneo: administração de conflictos, discriminação e exclusão. Soc estando. 2004; 19: 151–172.CrossRefGoogle Scholar
  18. 18.
    Conde-Glez CJ, Calderón E, Juárez-Figueroa L, Hernández-Avila M. Historical account of venereal diseases in Mexico. Genitourin Med. 1993; 69: 462–466.PubMedGoogle Scholar
  19. 19.
    Bliss K. The science of redemption: syphilis, sexual promiscuity, and reformism in revolutionary Mexico City. Hisp Am Hist Rev. 1999; 79: 1–40.PubMedGoogle Scholar
  20. 20.
    Bliss KE. Compromised Positions: Prostitution, Public Health and Gender Politics in Revolutionary Mexico City. University Park, PA: Pennsylvania State University Press; 2001.Google Scholar
  21. 21.
    Statutory Revision Department. Florida statutes 1949. Tallahassee, Florida: State of Florida; 1949.Google Scholar
  22. 22.
    State of Florida. Prohibiting prostitution, etc.; evidence; penalties. §796.07. 1949.Google Scholar
  23. 23.
    Galvan FH, Ortiz DJ, Martinez V, Bing EG. The use of female commercial sex workers' services by Latino day laborers. Hisp J Behav Sci. 2009; 31: 553–575.PubMedCrossRefGoogle Scholar
  24. 24.
    Monto MA, McRee JN. A comparison of the male customers of female street prostitutes with national samples of men. Int J Offender Ther. 2011; 49: 505–529.CrossRefGoogle Scholar
  25. 25.
    Parrado EA, Flippen C. Community attachment, neighborhood context, and sex worker use among Hispanic migrants in Durham, North Carolina, USA. Soc Sci Med. 2010; 70: 1059–1069.PubMedCrossRefGoogle Scholar
  26. 26.
    Pitts MK, Smith AM, Grierson J, O'Brien M, Misson S. Who pays for sex and why? An analysis of social and motivational factors associated with male clients of sex workers. Arch Sex Behav. 2004; 33: 353–358.PubMedCrossRefGoogle Scholar
  27. 27.
    Xantidis L, McCabe MP. Personality characteristics of male clients of female commercial sex workers in Australia. Arch Sex Behav. 2000; 29: 165–176.PubMedCrossRefGoogle Scholar
  28. 28.
    Treas J. How cohorts, education, and ideology shaped a new sexual revolution on American attitudes toward nonmarital sex, 1972–1998. Sociol Perspect. 2002; 45: 267–283.CrossRefGoogle Scholar
  29. 29.
    Wellings K, Field J, Johnson AM, Wadsworth J. Sexual behaviour in Britain. London: Penguin; 1994.Google Scholar
  30. 30.
    Dew BJ, Chaney MP. The relationship among sexual compulsivity, internalized homophobia, and HIV at-risk sexual behavior in gay and bisexual male users of internet chat rooms. Sexual Addiction & Compulsivity. 2005; 12: 259–273.CrossRefGoogle Scholar
  31. 31.
    Rosario M, Hunter J, Maguen S, Gwadz M, Smith R. The coming-out process and its adaptational and health-related associations among gay, lesbian, and bisexual youths: stipulation and exploration of a model. Am J Community Psychol. 2001; 29: 133–160.PubMedCrossRefGoogle Scholar
  32. 32.
    Newcomb ME, Mustanski B. Moderators of the relationship between internalized homophobia and risky sexual behavior in men who have sex with men: a meta-analysis. Arch Sex Behav. 2011; 40: 189–199.PubMedCrossRefGoogle Scholar
  33. 33.
    Smolenski DJ, Stigler MH, Ross MW, Rosser BR. Direct and indirect associations between internalized homonegativity and high-risk sex. Arch Sex Behav. 2011; 40: 785–792.PubMedCrossRefGoogle Scholar
  34. 34.
    Young RM, Meyer IH. The trouble with "MSM" and "WSW": erasure of the sexual-minority person in public health discourse. Am J Public Health. 2005; 95: 1144–1149.PubMedCrossRefGoogle Scholar
  35. 35.
    Semple SJ, Strathdee SA, Gallardo CM, Robertson A, Goldenberg S, Patterson TL. Psychosexual and social-cognitive correlates of sexual risk behavior among male clients of female sex workers in Tijuana, Mexico. AIDS Care. 2010; 22: 1473–1480.PubMedCrossRefGoogle Scholar
  36. 36.
    Kalichman SC, Cain D. The relationship between indicators of sexual compulsivity and high risk sexual practices among men and women receiving services from a sexually transmitted infection clinic. J Sex Res. 2004; 41: 235–241.PubMedCrossRefGoogle Scholar
  37. 37.
    Seal DW, Agostinelli G. Individual differences associated with high-risk sexual behaviour: implications for intervention programmes. AIDS Care. 1994; 6: 393–397.PubMedCrossRefGoogle Scholar
  38. 38.
    Ostovich JM, Sabini J. How are sociosexuality, sex drive, and lifetime number of sexual partners related? Pers Soc Psychol Bull. 2004; 30: 1255–1266.PubMedCrossRefGoogle Scholar
  39. 39.
    Kinsey A, Pomeroy W, Martin C. Sexual Behavior in the Human Male. Philadelphia, PA: Saunders; 1948.Google Scholar
  40. 40.
    Kinsey A, Pomeroy W, Martin C, Gebhart P. Sexual Behavior in the Human Female. Philadelphia, PA: Saunders; 1953.Google Scholar
  41. 41.
    Hewett PC, Mensch BS, Ribeiro MC, et al. Using sexually transmitted infection biomarkers to validate reporting of sexual behavior within a randomized, experimental evaluation of interviewing methods. Am J Epidemiol. 2008; 168: 202–211.PubMedCrossRefGoogle Scholar
  42. 42.
    Simoes AA, Bastos FI, Moreira RI, Lynch KG, Metzger DS. A randomized trial of audio computer and in-person interview to assess HIV risk among drug and alcohol users in Rio De Janeiro, Brazil. J Subst Abuse Treat. 2006; 30: 237–243.PubMedCrossRefGoogle Scholar
  43. 43.
    Ghanem KG, Hutton HE, Zenilman JM, Zimba R, Erbelding EJ. Audio computer assisted self interview and face to face interview modes in assessing response bias among STD clinic patients. Sex Transm Infect. 2005; 81: 421–425.PubMedCrossRefGoogle Scholar
  44. 44.
    Kurth AE, Martin DP, Golden MR, et al. A comparison between audio computer-assisted self-interviews and clinician interviews for obtaining the sexual history. Sex Transm Dis. 2004; 31: 719–726.PubMedCrossRefGoogle Scholar

Copyright information

© The New York Academy of Medicine 2013

Authors and Affiliations

  • Danielle C. Ompad
    • 1
    Email author
  • David L. Bell
    • 2
    • 3
    • 4
  • Silvia Amesty
    • 3
    • 4
  • Alan G. Nyitray
    • 5
  • Mary Papenfuss
    • 6
  • Eduardo Lazcano-Ponce
    • 7
  • Luisa L. Villa
    • 8
    • 9
  • Anna R. Giuliano
    • 6
  1. 1.Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS) and Department of Nutrition, Food Studies and Public Health, Steinhardt School of Culture, Education and Human DevelopmentNew York UniversityNew YorkUSA
  2. 2.Department of PediatricsCollege of Physicians and SurgeonsColumbia UniversityNew YorkUSA
  3. 3.Department of Population and Family HealthColumbia University Mailman School of Public HealthNew YorkUSA
  4. 4.Center for Family and Community MedicineColumbia University College of Physicians and SurgeonsNew YorkUSA
  5. 5.Center for Infectious DiseasesThe University of Texas School of Public Health at HoustonHoustonUSA
  6. 6.Center for Infection Research in Cancer (CIRC)H. Lee Moffitt Cancer Center and Research InstituteTampaUSA
  7. 7.Instituto Nacional de Salud PúblicaCuernavacaMexico
  8. 8.School of MedicineUniversity of São PauloSão PauloBrazil
  9. 9.School of Medical SciencesSanta Casa de São PauloSão PauloBrazil

Personalised recommendations