HIV Risk and Sexual Behavior among Male Sex Workers
Summary
Male sex workers (MSWs) represent a key population for HIV prevention due to a convergence of behavioural, structural and biological risk factors. Prevalence estimates vary widely by region, with some urban settings reporting HIV rates exceeding 30 per cent. Patterns of condomless intercourse with both paying clients and non-paying partners are shaped by economic incentives, power dynamics and social stigma. Barriers to service engagement include criminalisation, limited access to tailored health services and low levels of peer support. Recent research has highlighted the importance of combination strategies—behavioural counselling, economic incentives, digital outreach and biomedical prophylaxis—to reduce new infections. Understanding the interplay between risk behaviours, service uptake and enabling policies is essential for designing effective public health interventions and for informing global HIV epidemic control efforts.
Research from Nature Portfolio
An agent-based modelling study examined the impact of targeted pre-exposure prophylaxis (PrEP) among cisgender MSWs within a broader population of men who have sex with men. Simulations projected that prioritising MSWs for PrEP initiation could reduce new HIV infections by more than half over a decade and achieve cost-effectiveness thresholds per quality-adjusted life-year gained. These findings underscore the value of focused PrEP expansion to high-risk subgroups as a strategy for maximising population-level reductions in HIV incidence.
HIV Risk and Sexual Behavior among Male Sex Workers publication trend
The graph below shows the total number of articles in hiv risk and sexual behavior among male sex workers across all publications each year (not limited to Nature Index journals).
Technical terms
Male sex worker: Cisgender man who receives money, goods or other items of value in exchange for sexual services.
Pre-exposure prophylaxis (PrEP): Use of antiretroviral medications by HIV-negative individuals to prevent acquisition of HIV.
Sexually transmitted infection (STI): Infection transmitted through sexual contact, including bacterial and viral pathogens.
Condomless sex: Sexual intercourse without use of a barrier contraceptive device, elevating the risk of HIV and STI transmission.
Agent-based model: Computational simulation in which individual entities and their interactions are used to estimate population-level outcomes.
References
- Study protocol of a randomized controlled trial to assess the efficacy of the “PrEPare for Work” intervention to enhance PrEP uptake and optimize adherence for HIV prevention among male sex workers in the U.S.. BMC Public Health (2024).
- Incidence and time-varying predictors of HIV and sexually transmitted infections among male sex workers in Mexico City. Infectious Diseases of Poverty (2021).
- Global Burden of HIV among Men Who Engage in Transactional Sex: A Systematic Review and Meta-Analysis. PLOS ONE (2014).
- Barriers and facilitators to pre-exposure prophylaxis uptake among male sex workers in Mexico: an application of the RE-AIM framework. BMC Public Health (2021).
- Potential Impact of Targeted HIV Pre-Exposure Prophylaxis Uptake Among Male Sex Workers. Scientific Reports (2020).
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