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To estimate the proportion of the male population that reports having paid for sex in different regions. A total of 78 national household surveys and nine city based surveys were selected for inclusion. Where such surveys were not available, results of behavioural surveillance surveys and of research studies were also used. Using national estimates, a median percentage of men who reported paying for sex was calculated for each region.
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, and to improve estimates of national HIV infection prevalence levels in low and concentrated HIV epidemics.
The role of commercial sex in facilitating the spread of HIV depends among other things on the proportion of the male population who have unprotected sex with female sex workers as well as the number and characteristics of the other sexual partners of these clients. The literature describes the large national or regional variations in these proportions. Several methods have previously been used to study the potential role of male clients in spreading HIV to large sexual networks.
The first involves interviewing known clients of female sex workers about the number and types of their sexual partners. Secondly, one can estimate the proportion of men who are clients of sex workers based on the number of clients reported by female sex workers.
This method is potentially biased by assumptions about the number and characteristics of sex workers. A third method is to use survey data from both sex workers average number of clients per week and clients average number of visits to sex worker. Where such surveys were not available, especially in low and concentrated HIV epidemics, results of behavioural surveillance surveys and of published and unpublished research studies were also used. The criteria used to select the surveys for this analysis were: Surveys with clean and documented data files were preferred.