In the 35 countries analyzed, paying for sex is prevalent, and a 50% more likelihood to be living with HIV was observed in men who ever paid for sex than other men. There is a need for further prevention efforts, including improved access to HIV testing and condom use initiatives. Recognizing men who pay for sex as a priority population for HIV prevention is suggested.

• By conducting meta-analyses of 87 population-based surveys from sub-Saharan Africa (2000–2020), researchers sought to estimate pooled proportions of men who ever paid for sex, condom use during paid sex, HIV prevalence, and HIV prevention and treatment outcomes.

• In these surveys, ever paying for sex was admitted by up to 1 in 10 sexually active men, and condom use during paid sex has continued to be suboptimal, at 68% over the last decade.

• Reporting ever paying for sex was more likely in men living in urban areas vs those in rural areas, and there was more likelihood of having paid for sex in the past 12 months among younger men (15–24 years).

• Men who ever paid for sex had a higher prevalence of HIV than those who did not.