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Who Are the Men Who Pay for Sex in Mozambique? Results from the National HIV/AIDS Indicator Survey 2015

Abstract

Mozambique has one of the highest burdens of HIV in the world, where the prevalence is estimated at 13.2% among adults aged 15–49 years. Men who pay for sex (MPS) are considered a bridging population for HIV infection. However, the characteristics of MPS in Mozambique are poorly understood. The objective of this study was to estimate the prevalence of paid sex among men 15–49 years and investigate risk factors associated with paid sex. We analyzed data collected from 4724 men, aged 15–49 years, as part of the 2015 Mozambique AIDS Indicator Survey. Chi-squared tests and logistic regression models accounting for survey design were used to assess the associations between paying for sex and demographic characteristics and the number of lifetime and recent sex partners, condom use at last sex, and self-reported sexually transmitted infection symptoms. The prevalence of paid sex in the last 12 months was 10.4% (95% CI 9.0–12.1), with Cabo Delgado province having the highest prevalence (38.8%). MPS in the last 12 months were most frequently between the ages of 20–24 years (13.5%), not in a relationship (17.8%), had a primary education (11.9%), from poor households (14.0%), had more than three sexual partners excluding their spouse in the last 12 months (44.7%), and self-reported a STI in the past 12 months (44.2%). HIV prevalence was higher among men who ever paid for sex compared with men who did not (13.1% vs. 9.4%, p = .02). Men who reported 10+ lifetime partner (aOR 7.7; 95% CI 4.5–13.0; p < .001), from Cabo Delgado (aOR 4.0; 95% CI 2.2–7.4; p < .001), who reported STI symptoms in the past 12 months (aOR 2.7; 95% CI 1.7–4.2; p < .001), and HIV positive (aOR 1.6; 95% CI 1.0–3.7; p = .05) were more likely to have paid for sex in the last 12 months. These findings present the HIV prevalence among Mozambican MPS and highlight the need for a comprehensive behavioral, structural, and biomedical approach to interventions to reduce the risks of commercial and transactional sex.

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Acknowledgements

The study was supported by the Presidents Emergency Program for AIDS Relief through the Centers for Disease Control and Prevention (CDC), Cooperative Agreement 5U2GGH000080-05. CDC provided grand founding to the National Institute of Health. The authors gratefully acknowledge the Mozambique Government, research team, partners, implementation team and specially all participants involved on the IMASIDA 2015. The findings and conclusions in this report are those of the author(s) and do not necessarily reflect the official position of the Centers for Disease Control and Prevention or the Mozambique National Institute of Health.

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Correspondence to Cynthia Semá Baltazar.

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The authors declare that they have no competing interests.

Ethical Approval

The protocol was approved by the ICF’s Internal Review Board, the Mozambique National Committee on Bioethics for Health, and the Division of Global HIV/AIDS at the US Centers for Disease Control and Prevention, where the survey was classified as an activity involving human beings, but in which involvement did not constitute “engagement in human subjects research.”

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Informed consent was obtained from all individual participants included in the study.

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Semá Baltazar, C., Mehta, N., Juga, A. et al. Who Are the Men Who Pay for Sex in Mozambique? Results from the National HIV/AIDS Indicator Survey 2015. Arch Sex Behav 50, 2057–2065 (2021). https://doi.org/10.1007/s10508-020-01892-8

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  • DOI: https://doi.org/10.1007/s10508-020-01892-8

Keywords

  • Men
  • Paid sex
  • Mozambique
  • HIV prevalence
  • AIDS Indicator Survey
  • IMASIDA