Prevalence and associated factors of selling sex among men who have sex with men (MSM) in Latin America: results from the Latin American MSM Internet Survey in 18 countries (LAMIS-2018)

Introduction Selling sex has been associated with negative social and health outcomes, but most studies have been limited geographically and have not distinguished between selling and buying sex. This study assesses prevalence and factors associated with selling sex in the last 12 months among men who have sex with men (MSM) in 18 Latin American countries.Methods Data were collected in 2018 through the Latin American MSM Internet Survey, a cross-sectional online survey. Of 64 655 participants, 9585 were excluded due to data inconsistencies on age and partner status, and 1728 due to missing outcome data, yielding an analytic sample of 53 342. Multivariable logistic regression was used for analysis.Results Overall, 6.9% (10.3% among MSM aged 18-24) reported selling sex in the previous year. Higher odds of selling sex were associated with younger age, low education, being born abroad, low financial coping, substance use, potential alcohol dependency, early sexual debut with a male partner, low sexual agency and sex with women. High educational level and having a steady male partner were associated with lower odds.Conclusions Key factors associated with selling sex among MSM in Latin America include socioeconomic, behavioural and relational variables. Harm reduction and preventive interventions may be particularly needed among younger MSM. Codeveloping these interventions with the MSM community can ensure sustainability, relevance and strengthen providers' ability to offer individualised, respectful care. Longitudinal and qualitative studies are needed to monitor long-term health and tailor interventions to individual needs.