Transactional Sex: Supply and Demand Among European Men Who have Sex with Men (MSM) in the Context of Local Laws

Figures & data

Table 1. Sociodemographic Characteristics of EMIS Participants, Total and Grouped by Prostitution Law Group Countries (Groups A–D)

	Total	Group A	Group B	Group C	Group D
Status of transactional sex:		Legal, regulated	Legal, not regulated	Illegal; clients criminally prosecuted	Illegal; sellers criminally prosecuted	Pearson's Chi-square (two-sided p value)
Countries included (by country code top-level domain):		AT, CH, DE, GR, HU, LV, NL, TK	BE, BG, CY, CZ, DK, EE, ES, FI, FR, IE, IT, LU, MT, PL, PT, SI, SK, UK	NO, SE	BA, BY, HR, LT, MD, MK, RO, RS, RU, UA
	N (%)	N (%)	N (%)	N (%)	N (%)
Sum	174,209 (100.0)	74,813 (100.0)	82,126 (100.0)	5,228 (100.0)	12,042 (100.0)
Sellers
Has frequently been paid for sex in country of residence^a	1,650 (1.0)	683 (1.0)	829 (1.1)	19 (0.4)	119 (1.1)	X^2 = 21.9 p < .001
Has been paid for last sex abroad	632 (1.5)	234 (1.5)	322 (1.5)	11 (0.7)	65 (3.0)	X^2 = 39.2 p < .001
Buyers
Has frequently paid for sex in country of residence^b	4,910 (3.1)	2,246 (3.3)	2,286 (3.0)	40 (0.9)	338 (3.1)	X^2 = 87.8 p < .001
Has paid for last sex abroad	1,970 (4.7)	810 (5.2)	943 (4.2)	81 (5.1)	136 (6.2)	X^2 = 31.7 p < .001
Age
< 25 years	40,673 (23.3)	16,990 (22.7)	18,855 (23.0)	1,205 (23.0)	3,623 (30.1)	X^2 = 1,965.4 p < .001
25–39 years	85,193 (48.9)	35,174 (47.0)	40,609 (49.4)	2,340 (44.8)	7,070 (58.7)
40+ years	48,343 (27.8)	22,649 (30.3)	22,662 (27.6)	1,683 (32.2)	1,349 (11.2)
Education^c
ISCED 1	1,904 (1.2)	709 (1.0)	1,183 (1.5)	18 (0.3)	84 (0.7)	X^2 = 18,237.8 p < .001
ISCED 2	12,006 (6.9)	5,722 (7.7)	5,730 (7.0)	254 (4.9)	300 (2.5)
ISCED 3	33,205 (19.2)	21,087 (28.4)	9,508 (11.7)	1,096 (21.1)	1,1514 (12.7)
ISCED 4	39,394 (22.8)	18,859 (25.4)	17,663 (21.7)	836 (16.1)	2,036 (17.0)
ISCED 5	44,496 (25.7)	11,351 (15.3)	23,926 (29.3)	2,393 (46.0)	6,826 (57.1)
ISCED 6	41,773 (24.2)	16,457 (22.2)	23,517 (28.8)	609 (11.7)	1,190 (10.0)
Occupation
Employed full-time	93,575 (53.7)	41,481 (55.4)	42,131 (51.3)	2,916 (55.8)	7,047 (58.5)	X^2 = 1,661.7 p < .001
Employed part-time	9,671 (5.6)	4,222 (5.6)	4,192 (5.1)	357 (6.8)	900 (7.5)
Unemployed	10,457 (6.0)	3,947 (5.3)	5,614 (6.8)	260 (5.0)	636 (5.3)
Self-employed	20,196 (11.6)	8,578 (11.5)	10,285 (12.5)	397 (7.6)	936 (7.8)
Student	26,978 (15.5)	10,066 (13.5)	14,158 (17.2)	895 (17.1)	1,859 (15.4)
Retired	6,488 (3.7)	3,045 (4.1)	3,046 (3.7)	273 (5.2)	124 (1.0)
Other	6,844 (3.9)	3,474 (4.6)	2,700 (3.3)	130 (2.5)	540 (4.5)
Settlement size
< 500,000	92,363 (54.4)	41,747 (57.2)	43,680 (54.5)	2,691 (52.5)	4,245 (36.4)	X^2 = 1,768.5 p < .001
≥ 500,000	77,539 (44.5)	31,208 (42.8)	36,478 (45.5)	2,430 (47.5)	7,423 (63.6)
Region of origin^d
Born in country of residence	146,311 (86.2)	64,798 (89.1)	66,533 (83.1)	4,321 (84.6)	10,659 (90.7)
EMIS regions^e (Europe)
West Europe	4,160 (2.5)	1,096 (1.5)	2,963 (3.7)	63 (1.2)	39 (0.3)	X^2 = 9,196.4 p < .001
Northwest Europe	578 (0.3)	140 (0.2)	268 (0.3)	167 (3.3)	3 (0.0)
Central Europe (West)	2,926 (1.7)	1,458 (2.0)	1,312 (1.6)	90 (1.8)	66 (0.6)
Southwest Europe	2,367 (1.4)	866 (1.2)	1,431 (1.8)	46 (0.9)	24 (0.2)
Northeast Europe	273 (0.2)	45 (0.1)	166 (0.2)	21 (0.4)	41 (0.3)
Central Europe (East)	1,623 (1.0)	794 (1.1)	745 (0.9)	53 (1.0)	31 (0.3)
Southeast Europe (European Union)^g	855 (0.5)	422 (0.6)	405 (0.5)	22 (0.4)	6 (0.1)
Southeast Europe (non-European Union)^h	913 (0.5)	472 (0.6)	254 (0.3)	32 (0.6)	155 (1.3)
East Europe	1,434 (0.8)	493 (0.7)	267 (0.3)	23 (0.5)	651 (5.5)
WHO regions^f (outside Europe)
United States/Canada	1,411 (0.8)	637 (0.9)	720 (0.9)	36 (0.7)	18 (0.2)
Latin America/Caribbean^i	3,806 (2.2)	725 (1.0)	2,967 (3.7)	98 (1.9)	16 (0.1)
Eastern Mediterranean Region^j	597 (0.4)	178 (0.2)	378 (0.5)	33 (0.6)	8 (0.1)
African Region^k	974 (0.6)	160 (0.2)	794 (1.0)	10 (0.2)	10 (0.1)
South East Asia^l	412 (0.2)	166 (0.2)	205 (0.3)	36 (0.7)	5 (0.0)
Australia, New Zealand	425 (0.3)	74 (0.1)	336 (0.4)	12 (0.2)	3 (0.0)
Western Pacific Region^m	617 (0.4)	205 (0.3)	353 (0.4)	42 (0.8)	17 (0.1)

Note. EMIS = European Men who have sex with men Internet Survey; WHO = World Health Organization.

^aHaving frequently been paid for sex was operationalized as having been paid by a man to have sex 11 or more times in the previous 12 months.

^bHaving frequently paid for sex was operationalized as having paid a man to have sex three or more times in the previous 12 months.

^cISCED = International Classification of Education (from 1997), where ISCED 1 is primary education and ISCED 6 is the second stage of tertiary education (e.g., Ph.D.).

^dRegion of origin refers to those who were not born in their current country of residence (reference group) and can thus be regarded as migrants.

^eEuropean countries of origin were grouped into nine European subregions (see http://www.emis-project.eu/sub-regions). Expressed by country code top-level domain, these are: West Europe = BE, FR, IE, NL, UK; Northwest Europe = DK, FI, NO, SE; Central Europe (West) = AT, CH, DE, LU; Southwest Europe = ES, GR, IT, PT; Northeast Europe = EE, LT, LV; Central Europe (East) = CZ, HU, SI, SL, PL; Southeast Europe (EU) = BG, CY, MT, RO; Southeast Europe (non-European Union) = BA, HR, MK, RS, TR; East Europe = BY, MD, RU, UA.

^fNon-European countries of origin were grouped into non-European WHO regions (http://www.who.int/about/regions); the WHO region of the Americas was split into United States/Canada versus all others, and the WHO Western Pacific region was split into Australia/New Zealand versus all others.

^gMigrant men who have sex with men (MSM) from Southeast Europe (European Union) were predominantly from Romania (n = 533) and Bulgaria (n = 217).

^hMigrant MSM from Southeast Europe (non-European Union) were predominantly from Turkey (n = 198), Croatia (n = 177), Serbia (n = 244), and Bosnia (n = 161). Migrant MSM from East Europe were predominantly from Russia (n = 563), Ukraine (n = 259), and Kazakhstan (n = 215).

ⁱMigrant MSM from Latin America were predominantly from Brazil (n = 1,184), Mexico (n = 435), Colombia (n = 422), Venezuela (n = 385), and Argentina (n = 379).

^jMigrant MSM from the Eastern Mediterranean region were predominantly from Morocco (n = 102), Iran (n = 77), and Lebanon (n = 73).

^kMigrant MSM from the African region were predominantly from South Africa (n = 358), Mozambique (n = 92), and Angola (n = 90).

^lMigrant MSM from South East Asia were predominantly from India (n = 315) and Thailand (n = 80).

^mMigrant MSM from the Western Pacific region were predominantly from China (n = 159), Malaysia (n = 122), and the Philippines (n = 97).

FIGURE 1. Transactional sex in the last 12 months among men who have sex with men (MSM) in Europe, by age group.

Table 2. Multivariable Regression Analyses of Having Been Paid for Sex (‘Sellers’) in the Last 12 Months and Having Been Paid for Sex at Last Sex Abroad

	Has Frequently Been Paid for Sex in Country of Residence^a		Has Been Paid for Last Sex Abroad
	N (%)	AOR [95% CI]	N (%)	AOR [95% CI]
Group A: legal, regulated	683 (1.0)	Ref.	234 (1.5)	Ref.
Group B: legal, not regulated	829 (1.1)	1.01 [0.91, 1.13]	322 (1.5)	0.93 [0.78, 1.12]
Group C: paying for sex is illegal	19 (0.4)	0.42 [0.26, 0.68]	11 (0.7)	0.54 [0.29, 0.99]
Group D: being paid for sex is illegal	119 (1.1)	0.94 [0.76, 1.17]	65 (3.0)	1.59 [1.17, 2.14]
Sum	1,650 (1.0)		632 (1.5)
Age
< 25 years	639 (1.8)	Ref.	264 (4.6)	Ref.
25–39 years	818 (1.0)	0.57 [0.51, 0.65]	306 (1.4)	0.33 [0.27, 0.40]
40+ years	193 (0.4)	0.21 [0.18, 0.26]	62 (0.4)	0.09 [0.06, 0.12]
Education^b
ISCED 1	67 (3.9)	Ref.	33 (9.7)	Ref.
ISCED 2	229 (2.1)	0.63 [0.47, 0.84]	64 (3.9)	0.53 [0.32, 0.80]
ISCED 3	355 (1.2)	0.39 [0.29, 0.51]	121 (2.2)	0.31 [0.20, 0.48]
ISCED 4	408 (1.1)	0.32 [0.24, 0.43]	138 (1.9)	0.22 [0.14, 0.34]
ISCED 5	355 (0.9)	0.24 [0.18, 0.32]	153 (1.3)	0.17 [0.11, 0.26]
ISCED 6	213 (0.5)	0.16 [0.12, 0.21]	118 (0.8)	0.13 [0.09, 0.21]
Occupation
Employed full-time	492 (0.6)	Ref.	184 (0.8)	Ref.
Employed part-time	134 (1.5)	2.10 [1.71, 2.56]	44 (2.1)	2.07 [1.47, 2.92]
Unemployed	226 (2.4)	2.95 [2.49, 3.50]	68 (3.6)	3.12 [2.32, 4.21]
Self-employed	358 (1.9)	3.79 [3.28, 4.39]	146 (2.3)	3.44 [2.73, 4.32]
Student	262 (1.1)	1.12 [0.96, 1.34]	110 (2.4)	1.20 [0.91, 1.58]
Retired	45 (0.8)	2.46 [1.78, 3.40]	16 (1.1)	2.90 [1.65, 5.09]
Other	133 (2.4)	2.76 [2.22, 3.43]	64 (5.3)	4.82 [3.51, 6.63]
Settlement size
< 500,000	616 (0.7)	Ref.	246 (1.4)	Ref.
≥ 500,000	975 (1.3)	2.02 [1.81, 2.25]	364 (1.6)	1.26 [1.07, 1.50]
Region of origin^c/destination^d	Born in country of residence	1,189 (0.9)	Ref.	n.a.
EMIS regions^e (Europe)
West Europe	27 (0.7)	1.04 [0.71, 1.53]	99 (1.3)
Northwest Europe	2 (0.4)	0.47 [0.12, 1.89]	19 (1.6)
Central Europe (West)	22 (0.8)	1.10 [0.72, 1.68]	156 (2.5)
Southwest Europe	22 (1.0)	0.98 [0.62, 1.55]	108 (1.1)
Northeast Europe	2 (0.8)	0.76 [0.19, 3.09]	1 (0.5)	Not included
Central Europe (East)	35 (2.3)	2.60 [1.84, 3.68]	18 (1.1)
Southeast Europe (European Union)	36 (4.5)	3.99 [2.80, 5.68]	8 (1.4)
Southeast Europe (non-European Union)	21 (2.4)	2.62 [1.68, 4.09]	20 (1.4)
WHO regions^f (outside Europe)
East Europe	17 (1.3)	1.40 [0.86, 2.29]	8 (1.7)
United States/Canada	12 (0.9)	1.15 [0.61, 2.17]	26 (0.9)
Latin America/Caribbean	189 (5.2)	4.96 [4.17, 5.90]	31 (1.5)
Eastern Mediterranean Region	13 (2.4)	2.69 [1.49, 4.84]	21 (2.0)
African Region	18 (2.0)	2.57 [1.57, 4.21]	10 (2.4)	Not included
Southeast Asia	4 (1.0)	1.42 [0.52, 3.83]	5 (0.3)
Australia, New Zealand	4 (1.0)	1.43 [0.53, 3.88]	6 (1.1)
Western Pacific Region	3 (0.5)	0.72 [0.23, 2.25]	6 (0.7)	<

Note. Percentages refer to the proportion of men with the respective behavior within each category/layer.

Ref. = reference group; AOR = adjusted odds ratio; CI = confidence interval; EMIS = European Men who have sex with men Internet Survey; WHO = World Health Organization. Bold values indicate statistically significant differences; n.a. = not applicable.

^aHaving frequently been paid for sex was operationalized as having been paid by a man to have sex 11 or more times in the previous 12 months.

^bISCED = International Classification of Education (1997), where ISCED 1 is primary education and ISCED 6 is second stage of tertiary education (e.g., Ph.D.).

^cRegion of origin refers to those who were not born in their current country of residence (reference group) and can thus be regarded as migrants.

^dFor having been paid for the last sex abroad, the listed regions refer to where this occurred. Bold values indicate a higher-than-average proportion.

^eEuropean countries of origin were grouped into nine European subregions (see http://www.emis-project.eu/sub-regions).

^fNon-European countries of origin were grouped into non-European WHO regions (http://www.who.int/about/regions); the WHO region of the Americas was split into United States/Canada versus all others, and the WHO Western Pacific region was split into Australia/New Zealand versus all others.

Table 3. Multivariable Regression Analyses of Having Paid for Sex (‘Buyers’) in the Last 12 Months and at Last Sex Abroad

	Has Frequently Paid for Sex in Country of Residence^a		Has Paid for Last Sex Abroad
	N (%)	AOR [95%-CI]	N (%)	AOR [95% CI]
Group A: legal, regulated	2,246 (3.3)	Ref.	810 (5.2)	Ref.
Group B: legal, not regulated	2,286 (3.0)	0.92 [0.86, 0.98]	943 (4.2)	0.87 [0.79; 0.96)
Group C: paying for sex is illegal	40 (0.9)	0.26 [0.18, 0.35]	81 (5.1)	0.98 [0.77; 1.26)
Group D: being paid for sex is illegal	338 (3.1)	1.33 [1.17, 1.52]	136 (6.2)	1.86 [1.52; 2.28)
Sum	4,910 (3.1)		1,970 (4.7)
Age
< 25 years	150 (0.4)	Ref.	68 (1.2)	Ref.
25–39 years	1,733 (2.2)	3.37 [2.81, 4.04]	696 (3.2)	2.26 [1.71, 2.99]
40+ years	3,027 (6.7)	10.19 [8.50, 12.23]	1,206 (8.5)	5.72 [4.32, 7.58]
Education^b
ISCED 1	54 (3.1)	Ref.	20 (5.8)	Ref.
ISCED 2	286 (2.6)	0.83 [0.61, 1.14]	116 (7.1)	1.14 [0.69, 1.88]
ISCED 3	854 (2.8)	0.95 [0.70, 1.28]	282 (5.2)	0.84 [0.52, 1.36]
ISCED 4	857 (2.4)	0.99 [0.73, 1.34]	358 (4.8)	0.97 [0.60, 1.55]
ISCED 5	1,255 (3.0)	1.01 [0.75, 1.36]	567 (4.7)	0.85 [0.53, 1.36]
ISCED 6	1,582 (4.0)	1.17 [0.87, 1.57]	618 (4.2)	0.74 [0.46, 1.18]
Occupation
Employed full-time	2,863 (3.2)	Ref.	1,133 (4.7)	Ref.
Employed part-time	200 (2.2)	0.76 [0.66, 0.89]	78 (3.6)	0.82 [0.65, 1.04]
Unemployed	174 (1.8)	0.66 [0.56, 0.78]	61 (3.2)	0.79 [0.60, 1.03]
Self-employed	1,017 (5.3)	1.36 [1.26, 1.47]	382 (6.0)	1.19 [1.05, 1.35]
Student	86 (0.4)	0.34 [0.27, 0.43]	48 (1.1)	0.59 [0.36, 0.68]
Retired	396 (6.9)	1.26 [1.12, 1.42]	195 (13.6)	1.93 [1.62, 2.31]
Other	174 (3.1)	1.08 [0.91, 1.29]	73 (6.0)	1.24 [0.95, 1.61]
Settlement size
< 500,000	2,176 (2.6)	Ref.	923 (5.3)	Ref.
≥ 500,000	2,549 (3.5)	1.31 [1.24, 1.40]	969 (4.2)	0.85 [0.77, 0.93]
Region of origin^c/destination^d	Born in country of residence	4,065 (3.0)	Ref.	n.a.
EMIS regions^e (Europe)
West Europe	145 (3.7)	0.91 [0.76, 1.08]	177 (2.3)
Northwest Europe	13 (2.4)	0.82 [0.47, 1.44]	8 (0.7)
Central Europe (West)	90 (3.2)	0.90 [0.72, 1.12]	216 (3.4)
Southwest Europe	60 (2.6)	0.89 [0.68, 1.15]	267 (2.7)
Northeast Europe	3 (1.1)	0.54 [0.17, 1.69]	8 (3.8)	Not included
Central Europe (East)	20 (1.3)	0.52 [0.33, 0.81]	142 (8.9)
Southeast Europe (European Union)	12 (1.5)	0.72 [0.40, 1.27]	31 (5.6)
Southeast Europe (non-European Union)	16 (1.9)	0.73 [0.44, 1.21]	59 (4.1)
WHO regions^f (outside Europe)
East Europe	33 (2.5)	0.91 [0.64, 1.30]	14 (2.9)
USA/Canada	50 (3.7)	0.82 [0.62, 1.10]	51 (1.8)
Latin America / Caribbean	102 (2.8)	1.06 [0.86, 1.31]	203 (10.0)
Eastern Mediterranean Region	32 (5.8)	1.97 [1.36, 2.85]	173 (16.0)
African Region	37 (4.0)	1.03 [0.74, 1.45]	30 (7.0)	Not included
South East Asia	9 (2.3)	1.10 [0.56, 2.14]	402 (25.9)
Australia, New Zealand	8 (2.0)	0.51 [0.25, 1.03]	4 (0.7)
Western Pacific Region	8 (1.4)	0.51 [0.24, 1.09]	40 (4.3)

Note. Percentages refer to the proportion of men with the respective behavior within each category/layer. Ref. = reference group; AOR = adjusted odds ratio; CI = confidence interval; EMIS = European Men who have sex with men Internet Survey; WHO = World Health Organization. Bold values indicate statistically significant differences; n.a. = not applicable.

^aHaving frequently paid for sex was operationalized as having been paid by a man to have sex three or more times in the previous 12 months.

^bISCED = International Classification of Education (1997), where ISCED 1 is primary education and ISCED 6 is the second stage of tertiary education (e.g., Ph.D.).

^cRegion of origin refers to those who were not born in their current country of residence (reference group) and can thus be regarded as migrants.

^dFor having paid for the last sex abroad, the listed regions refer to where this occurred. Bold values indicate a higher-than-average proportion.

^eEuropean countries of origin were grouped into nine European subregions (see http://www.emis-project.eu/sub-regions).

^fNon-European countries of origin were grouped into non-European WHO regions (http://www.who.int/about/regions); the WHO region of the Americas was split into United States/Canada versus all others, and the WHO Western Pacific region was split into Australia/New Zealand versus all others.