Clients of sex workers in different regions of the world: Hard to count

An article by Carael M, Slaymaker E, Lyerla R and Sarkar S in Sexually Transmitted Infections, 2006; 82:iii26-iii33. This article explored the proportion of the male population in different regions who reported having unprotected sex with female sex workers as well as the number and characteristics of their other sexual partners. The article describes the large national or regional variations in these proportions. For example it was estimated that in 1997, in Northeastern Thailand '50% of married men and 43% of single men had visited female sex workers in their life'. In contrast, in Orissa, a rural district in India, 'less than two per cent of men have had any sex encounter with sex workers'. Many studies have highlighted a great variety in the mix between commercial and non-commercial sexual contacts of clients of sex workers. The median percentage of men who exchanged sex for money in the last 12 months in all regions was around 9–10%, with estimates from 13% to 15% in Central African region, 10 to 11% in Eastern and southern Africa, and 5–7% in Asia and Latin America. Estimates for men who paid for sex were much lower at around 2–3% with ranges from 7% in the South African region to 1% in Asia and West Africa. Although errors of measurement and critical issues of definitions and interpretation exist, this compilation represents a first attempt to obtain reasonably coherent estimates of the proportion of men who were clients of sex workers at regional level. Large discrepancies between regions were found. Further improvements in national estimates will be critical to monitor coverage of HIV prevention programmes for sex workers and clients. (Summary adapted from authors)