Risk of HIV acquisition and transmission is hgh among key populations, including sex workers. In view of the contribution of men who pay for sex to HIV transmission through sexual relationships with both sex workers and their other partners, researchers herein sought to characterize the population of men who pay for sex in sub-Saharan Africa (SSA) by analyzing population size, HIV prevalence, and use of HIV prevention and treatment.

• A total of 87 population-based surveys from sub-Saharan Africa (2000–2020) were meta-analyzed with the aim 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, up to 1 in 10 sexually active men reported ever paying for sex and there remained suboptimal condom use during paid sex, at 68% over the last decade.

• Relative to men in rural areas, those living in urban areas reported ever paying for sex more frequently, and younger men (15–24 years) more frequently reported to have paid for sex in the past 12 months.

• Men who ever paid for sex had higher HIV prevalence as compared to those who did not.

• Researchers emphasize identification of this high risk population as a priority for HIV prevention.

• Female sex workers and their clients will remain at risk of HIV acquisition, if there is no improvement in HIV prevention efforts among clients of sex workers, including improved access to HIV testing and condom use initiatives.