In Reply

We appreciate the interest in our original article “Men who pay for sex: Prevalence and sexual health” (1). Based on the population study GeSiD (the German Health and Sexuality Survey; www.gesid.eu), we were able to report reliable prevalence data of paying for sex by men and related factors in Germany for the first time. The lifetime prevalence was 26.9%, and the 12-month prevalence was 4.0%. Among other things, we found that men who pay for sex (MPS) differ significantly in their HIV/STI-related risk and prevention behavior from men who are not paying for sex (MNPS). Compared to MNPS, MPS also state significantly more often that they want to talk to a physician about HIV/STI. Therefore, our article in Deutsches Ärzteblatt International advocates towards creating conditions that enable MPS to receive medical care that makes sense. This promotion of the sexual health of MPS also protects the relatively large number of their paid and unpaid sexual partners. Similar arguments were made in the context of the British population study Natsal (British National Survey of Sexual Attitudes and Lifestyles; www.natsal.ac.uk, [2]). Statements about women who pay for sex were not possible due to the small number of cases in the sample of the GeSiD study (n = 3).

Paid sex is a gender-specific, complex, and morally and politically controversial field of occupation (1). Hence, it is important to treat the facts in a differentiated manner. In particular, forced prostitution, which is a criminal offense like any other form of sexual violence, must be distinguished from voluntary sex work. Likewise, evaluation results on different forms of regulation of voluntary sex work should be taken into account. These results have associated the criminalization of voluntary sex work due to a ban on buying sex with a predominantly negative effects for sex workers (e.g. [3, 4]).

The three letters we received disagree with this classification. The authors see men who pay for sex as “perpetrators”, call for their criminalization, and claim that the criminalization of buying sex could prevent violence against women or abolish paying for sex. These claims are not evidence-based, as the letters make clear:

• Dr.-Ing. Valentin Klöppel tries to reinterpret the sources we quoted.

• Barbara Schmid, M.A., presents statistics for which there is no scientific evidence.

• Dr. phil. Ingeborg Kraus makes apodictic statements about men and women in the context of prostitution. As peer-reviewed evidence for this, she uses self-citations that present two individual cases: a human trafficking victim and a former client.

Our work is based on population-representative data, builds on the international state of research, and uses sources that are as reliable as possible. For instance, a meta-analysis in PLoS Medicine shows that criminalization and the related stigmatization of voluntary sex work are associated with negative effects, such as increased violence and reduced condom use (4).