Paid sex among men in sub-Saharan Africa: Analysis of the demographic and health survey

BACKGROUND: Paying for sex is regarded as a risky sexual behavior (RSB) among heterosexual men. Men paying for sex are considered to be a bridging population for sexually transmitted infections (STIs). Despite the link between paid sex and sexual and reproductive health outcomes such as STIs, little is known about the prevalence and factors associated with paid sex among men in sub-Saharan Africa. This study examined the prevalence of paid sex and the socio-demographic factors associated with it among men in sub-Saharan Africa. METHODS: The study made use of pooled data from the Demographic and Health Surveys (DHS) conducted from January 1, 2010 to December 3, 2016 in 27 countries in sub-Saharan Africa. Binary and multivariable logistic regression models were used to investigate the relationship between the explanatory and the outcome variables. RESULTS: The results of the study showed that of the 139,427 men who participated in the study, 4.3% reported they had paid for sex in the 12 months preceding the survey. Men in Mozambique had the highest proportion (13.6%) of paying for sex in the 12 months preceding the survey. The results of the multivariable analysis indicated that men from DR Congo [AOR = 9.74; 95% CI = 7.45–12.73], men who had completed only primary level of education [AOR = 1.31; 95% CI = 1.18–1.45], men aged 25–34 years [AOR = 2.84; 95% CI = 2.26–3.56], men belonging to “other” religious groups [AOR = 1.20; 95% CI = 1.09–1.32] and men who were employed [AOR = 1.73; 95% CI = 1.58–1.90] had higher odds of paying for sex. Men who were divorced [AOR = 4.52; 95% = 3.89–5.25], men who read newspaper/magazine almost every day [AOR = 1.34; 95% CI = 1.12–1.63], men who listened to radio almost every day [AOR = 1.19; 95% CI = 1.05–1.36] and men who watched television at least once a week [AOR = 1.10; 95% CI = 1.01–1.19] also had higher odds of paying for sex. On the other hand, men in rural areas [AOR = 0.88; 95%CI = 0.82–0.95], men in the richest wealth quintile [AOR = 0.83; 95%CI = 0.74–0.93] and those with tertiary level of education [AOR = 0.77; 95% CI = 0.65–0.90] had lower odds of paying for sex. CONCLUSION: The odds of paid sex were high among men with only primary level of education, men aged 25–34, men who professed ‘other’ religious affiliation, men who are employed and men who are divorced. However, paid sex was low among men in the richest wealth quintile, men with tertiary level of education and men living in rural areas. This means that the decision to pay for sex is influenced by several social and demographic factors. Hence, these factors should be taken into consideration for sexual and reproductive health interventions and services. Policy and interventional measures should aim at reducing high-risk behavior of men who pay for sex.