Sociodemographic characteristics and attitudes of men buying sex in Finland

49203SJP470.77/4034948349203E. Regushevskaya et al.sociodemographic characteristics and attitudes of men buying sex in Finland 203 Scandinavian Journal of Public Health, 203; 4: 729 736 Original Article Sociodemographic characteristics and attitudes of men buying sex in Finland ELENA REGUSHEVSKAYA, ELINA HAAVIO-MANNILA 2 & ELINA HEMMINKI National Institute for Health and Welfare, Helsinki, Finland, and 2 Department of Sociology, University of Helsinki, Helsinki, Finland Abstract Aim: To study the sociodemographic characteristics and attitudes associated with buying sex among Finnish men residing in different areas of Finland. Methods: A population-based questionnaire survey among 8 74-year-old Finns in 999 with a response rate among men of 38%. The data on 575 men were analysed with descriptive statistics and logistic regression. Results: The overall proportion of men ever having bought sex was 4%. Men who at the time of the survey were in the age group 30 39, aged 50 or over, with 3 5 years of educational study, entrepreneurs, and with high income, were more likely to have ever bought sex. Being married and living with a partner at the time of the study lowered the odds of ever having bought sex. The differences between the groups were mostly the same in all residential areas, though the strength and statistical significance varied. The exception was the association with education, which occurred only in small towns. The effect of attitudes to buying sex was strong and did not differ by area of residence. Conclusions: Many men with different sociodemographic characteristics reported having bought sex. There was no noticeable variation in the sociodemographic characteristics and attitudes of men having bought sex by the area of residence. More current research is needed on the motives and health consciousness of men buying sex. Key Words: area of residence, men, prostitution, sociodemographic characteristics, survey Introduction It has been reported that paying for sex has increased during recent decades in Western Europe [ 3]. However, it is difficult to estimate the number of clients of sex workers [,4]. Changes in the economic situation [5,6], acceptance of liberal sexual attitudes [7] and globalization [6] are assumed to relate to the rate of growth of prostitution. National surveys in Europe and Australia have shown that 8% 7% of men have ever paid for sex [,4,8 2]. The public health concerns of prostitution include sexually transmitted infections and HIV, physical and sexual violence, drug abuse and increased needs for social services. Most research has focused on sex workers [3 7], while much less is known about their customers. The sensitive nature of being engaged in sex with a prostitute and difficulties in finding those who pay for sex may have contributed to this. Existing research on customers of prostitution is mostly based on those imprisoned [8,9] or convenience samples [9,20 22], while the number of population-based studies analysing background characteristics and attitudes is low. In an Australian population-based survey in 2002, men who pay for sex were more likely to be over 30 years old, single and have low education [8]. In Britain, men who bought sex were more often in the age 25 34 years, never married and lived in London than other men []. They were more likely to have multiple sexual partners, report STIs and bought sex abroad. In a Norwegian study conducted in 2002, the men were more likely to be single, started having sex early (had had first intercourse before age 6) and had had multiple sexual partners [3]. In Finland a considerable change in the prostitution market occurred in the beginning of the 990s. Social changes in the neighbouring countries of Correspondence: Elena Regushevskaya, National Institute for Health and Welfare, P.O. Box, Helsinki, 0027, Finland. E-mail: elena.regushevskaya@thl.fi (Accepted 7 May 203) 203 the Nordic Societies of Public Health DOI: 0.77/4034948349203

730 E. Regushevskaya et al. Estonia and Russia, large income differences between the countries and open borders with Estonia made commercial sex more easily accessible to Finnish men. The information on those who buy sex services and the differences by area of residence is limited in Finland. In a 992 population-based study in Finland overall % of men had bought sex, and of them 72% had done so abroad [23]. In a study in 2004 among reproductive-aged women in St. Petersburg, 3% of women had been offered money for sex [24]. In a 995 study in Finland [2], managers and entrepreneurs and men living in the capital more often had paid for sex. Thus, we set out to re-analyse an existing population-based sex survey from 999 to study the characteristics and attitudes associated with buying sex among Finnish men residing in different areas; there are no more recent population-based data. Finland is an affluent Nordic welfare country with a population of 5.3 million. In Finland, selling and buying sex services is not in general punishable by law. But it is illegal to buy sexual services from a person under the age of 8 years [25] and since 2006 from a victim of human trafficking [25]. A foreigner can be refused to enter Finland and to be deported from Finland if he/she is assumed to sell sex-related services [26]. Brothel ownership, procuring and pandering are illegal [25]. Until 2003, municipalities could prohibit street prostitution under their by-laws. Later local ordinances were substituted by the Public Order Act [27] which prohibits purchasing sexual services or offering sexual services against payment in a public place. Methods We re-analysed a population-based postal survey on human relationships, sexual attitudes and sexual lifestyles in Finland conducted in 999; the data on prostitution have not been analysed previously. A random sample of all Finns aged 8 74 years was taken from the central population register. The overall response rate was 52%, and for men, it was 38%. For a detailed description, see a previous publication [7]. Of the 624 male respondents, 49 did not provide information on their age, leaving 575 for analysis. The survey was not handled by a research ethics committee, as anonymous surveys in Finland are not customarily reviewed by ethics committees. Measures The survey contained questions on sociodemographic characteristics and attitudes and beliefs relating to sexual life, sexual behaviour and buying/paying for sex. Paying for sex was asked about with the question Have you ever offered money or similar economic advantages in exchange for intercourse? The origin of the prostitute and the country where sex was bought was asked with the question The person who you paid for sexual intercourse was?, with the alternatives: a foreigner abroad, a foreigner in Finland, a Finn in Finland, a Finn abroad. Marital status was asked with the question Are you at present: single; married, living with spouse; married, not living with spouse; divorced; widowed. Education was measured by the total number of study years; they were categorized into 0 years or less, 2 years, 3 5 years and 6 years or more. Sociodemographic status was asked with the question Based on your current occupation, which of the following social groups best describe you?, with the alternatives: white-collar employee in a leading position; other white-collar employee; blue-collar worker; farmer; entrepreneur; not employed. Income was elicited with the question What is your total monthly income after taxes? ; income was classified into quartiles. Number of children was asked about, as: Do you have your own children, how many? The areas of residence were classified into three groups by the size of population: big towns (over 00,000 inhabitants), small towns (less than 00,000 inhabitants), rural centres or rural areas. Attitudes were measured by the following statements Sexual intercourse without love is wrong, Men are by nature polygamous, I could maintain sexual relationships with many people at the same time, I have nothing against people selling sex, I approve of state-regulated brothels. The answer options were I agree absolutely, I agree somewhat, Hard to say, I disagree slightly and I disagree entirely. In the logistic regression analysis the first two answers were combined into I agree and two last were combined into I disagree. Statistical analysis The data were first analysed by cross-tabulation to examine bivariate associations between sociodemographic characteristics or attitudes and paying for sex, comparing men who bought and men who did not buy sex. A t test was used to test statistical differences. Logistic regression analyses adjusting for age and marital status were done separately for each independent variable, producing adjusted odds ratios and 95% confidence intervals. Analyses were first done for all men and then by area of residence. All analyses were conducted with PASW Statistics version 8.

Results The sociodemographic characteristics of men who had and had not bought sex are presented in Table I. There were several differences in the characteristics between the two groups. Those who bought sex were less often in the age group 8 29 and more often in the age group 30 39 at the time of the survey than those who have not bought sex. They were less often married and more often separated at the time of the survey. They had more often studied for 3 5 years, were currently entrepreneurs, and were currently in the highest income quartile than men who had never bought sex. There were no differences in regard to area of residence and having or not having children. For the most part, the adjustment for age, marital status, and area of residence did not markedly change the difference in the sociodemographic characteristics of men having and not having bought sex (Table I). An exception was found for age: after adjustment men in the age group 50 and older were more likely to buy sex than the youngest ones. Among the 8 men who had ever bought sex, only 8 answered the question on the origin of the prostitute and the country in which sex was bought. Among them, 2 had sex with a foreigner abroad, three with a foreigner in Finland and two men had said the prostitute was a Finnish woman in Finland. Similar proportions of men had bought sex in different areas of residence (Table II). Table III compares men who had ever bought sex to men who had not bought sex by area of residence, adjusting for age and marital status. The differences found in the whole sample (Table I) were mostly found also in the analysis by area of residence. However, most of the differences were statistically non-significant, possibly because of the small sample sizes of each group. But the association of buying sex with having 3 5 years of education was found only in small towns. Men were asked to respond to five statements reflecting their attitudes to sexual relationships, including those which indirectly might explain how they see prostitution (Table IV). Responses to all five statements showed that men who had bought sex had more liberal attitudes to sexual relationships: they more often disagreed that sexual intercourse without love is wrong, more often agreed that men are by nature polygamous, that they could maintain a sexual relationships with many people at the same time, were not against people selling sex, and approved of state-regulated brothels. Adjusting for age, marital status and area of residence did not change these results. Table V compares the attitudes of men who had and had not bought sex by the area of residence, Sociodemographic characteristics 73 adjusting for age and marital status. The attitudinal differences did not differ by area of residence. Discussion Prior to this study there was only one representative study available in Finland on the characteristics or sex-related attitudes of men who pay for sex [2]. In qualitative studies among customers of prostitutes, convenience samples have been used and the emphasis has been on the transnational nature of prostitution and sex buyers attitudes to prostitution [6,22]. Thus, we believe that the results of this study make a useful contribution to prostitution research. The main findings of our study were that many men (4%) in Finland had at some time bought sex and the proportion did not vary by type of residential area. Having ever bought sex was more common in the group being aged 30 39 years at the time of the survey, and was more commonly associated with having ever bought sex; further, it was not influenced by having children but was associated with currently being single, having a high education, currently being an entrepreneur, and currently having a high income. The differences between groups were similar in all areas of residence. Adjusting for age, marital status and area of residence did not markedly change the findings of the descriptive analysis. The proportion of men ever having bought sex in our study is comparable to population-based studies in Denmark [28], a survey in Norway [3], a population-based telephone survey in Australia [8] and two studies in Sweden [0,]. In these studies, 8% 7% of men have ever paid for sex. Furthermore, the proportion of men buying sex in our study was similar to the result in a population-based Finnish survey from 992 [23] and from the Habitus Study in 995 [2]. In those surveys, % of men had ever paid for sex. An increasing trend in the proportion of men buying sex has been reported in other European countries [,3,29], but not in Sweden [0]. The increase may relate to liberal sexual attitudes and greater acceptance of commercial sex services over time. Other reasons may also exist. Our data were from 999 and it would be of great interest to explore the proportion of those who buy sex in Finland nowadays, given the many social and political changes that have occurred since then. They include the opening of borders with Estonia in 2004 following the joining of Estonia with the European Union, easier access and increased travel to and from the regions of Northwest Russia. Finland has increasingly become a transit and destination country for human trafficking [22]. Unfortunately, our data did not have complete information on the nationality of

732 E. Regushevskaya et al. Table I. Comparison of the sociodemographic characteristics of men who had and had not bought sex, Finland 999, distributions (%) and adjusted odds ratios (OR and 95% CI). Total % Not bought sex % Bought sex % OR (95% CI) (n = 575) (n = 494) (n = 8) (n = 575) Age group 8 29 20.7 22. 2.3*.00 30 39 9.3 7.4 30.9** 4.42 (.93 0.3) 40 49 22.3 22.9 8.5 2.24 (0.9 5.50) 50+ 37.7 37.6 38.3 2.80 (.7 6.72) Marital status single 29.4 28. 37.0.00 married, living with spouse 53.9 56.6 38.3** 0.37 (0.20 0.68) separated 2..4 6.2** 2.24 (0.62 8.0) divorced, widowed 0. 9.3 4.8 0.90 (0.38 2.0) missing 4.5 4.6 3.7 Residential area big towns with over 30.6 30.6 30.9 00,000 inhabitants small towns with less than 37.2 36.8 39.5 00,000 inhabitants rural centres or rural areas 32.2 32.6 29.6 Education 0 or less 36.2 37.7 27.2.00 2 22.4 22.5 22.2.44 (0.69 3.0) 3 5 20.0 8.4 29.6* 2.55 (.26 5.9) 6+ 7.6 7.6 7.3.52 (0.69 3.33) missing 3.8 3.8 3.7 Occupation white collar employee in a 3.2 3.8 9.9.00 leading position other white collar employee 5.5 5.0 8.5 0.95 (0.40 2.26) blue-collar worker 33.0 33.6 29.6.62 (0.79 3.32) farmer 5.6 5.7 4.9.4 (0.35 3.69) entrepreneur 0.8 9. 2.0*** 2.55 (.23 5.3) not employed 20.7 2.6 4.9 0.68 (0.3.46) missing.2.2.2 Income quartiles first (lowest) 5.3 5.6 3.6.00 second 30.6 3.6 24.7.0 (0.45 2.29) third 23.7 24.5 8.5.0 (0.47 2.60) forth (highest) 27.7 25.9 38.3* 2.6 (.6 5.85) missing 2.7 2.4 4.9 Children no children 35.7 34.8 40.7.00 3.4 3.2 4.8. (0.50 2.46) 2 28.3 28.5 27.2 3 5.5 6.2. 4+ Total 7. 00 7.3 00 6.2 00 Adjusted for age, marital status and area of residence *p value < 0.05, **p value < 0.0, ***p value < 0.00 comparing men who bought sex with men who had not bought sex

Table II. Buying sex by residence, men in Finland in 999, proportions (%) of men. Sociodemographic characteristics 733 N Total Big towns Small towns Rural 8 29 years (9, 49, 44, 26) 8.4 4..4.5 30 39 years (, 34, 43, 34) 22.5 23.5 25.6 7.6 40 49 years (28, 33, 49, 46).7 9. 4.3 0.9 50+ years (27, 60, 78, 79) 4.3 20.0.5 2.7 Total (575, 76, 24,85) 4. 4.2 5.0 3.0 the number in each area Table III. The likelihood of buying sex by background characteristics and by residence, adjusted odds ratios (OR and 95% CI), men in Finland, 999. Big towns Small towns Rural (n = 76) (n = 24) (n = 85) Age group 8 29.00.00.00 30 39 9.5 (.74 5.89) 5.6 (.57 20.09).77 (0.38 8.22) 40 49 2.55 (0.38 6.98) 2.98 (0.76.66).33 (0.26 6.85) 50+ 5.70 (0.98 33.33) 2.69 (0.66 0.95).62 (0.35 7.47) Marital status single.00.00.00 married, living with spouse 0.57 (0.8.74) 0.5 (0.05 0.44) 0.53 (0.8.58) separated.60 (0.2 2.83).67 (0.29 9.64) 3.77 (0.20 69.63) divorced, widowed 2.73 (0.60 2.34) 0.50 (0.2 2.07) 0.39 (0.07 2.30) Education 0 or less.00.00.00 2 0.65 (0.4 2.96) 4.87 (.20 9.8) 0.67 (0.8 2.52) 3 5.7 (0.30 4.56) 2.68 (3.38 47.62) 0.64 (0.6 2.56) 6+.67 (0.52 5.36).29 (0.2 7.92) 0.63 (0. 3.52) Occupation blue-collar worker.00.00.00 white collar employee in a leading position 0.79 (0.9 3.24) 0.75 (0.4 3.94) 2.44 (0.39 5.23) other white collar employee.23 (0.33 4.57) 2.06 (0.62 6.85) 2.7 (0.54 8.8) farmer 2.23 (0.5 33.07).04 (0.23 4.67) entrepreneur 4.80 (.8 9.46).96 (0.54 7.06) 2.38 (0.60 9.44) not employed 0.5 (0. 2.40).5 (0.38 3.49) 0.37 (0.06 2.7) Income quartiles first (lowest).00.00.00 second.38 (0.22 8.69).04 (0.30 3.52) 0.82 (0.8 3.82) third 2.47 (0.40 5.) 0.63 (0.6 2.49).26 (0.26 6.9) forth (highest) 3.72 (0.68 20.40).73 (0.47 6.3) 3.59 (0.74 7.46) Children at least one child.00.00.00 no children 2.40 (0.54 0.64).30 (0.29 5.9) 0.54 (0.6.83) Adjusted for age and marital status the prostitutes, with the question on the person from whom sex was bought was poorly answered. However, our limited data and the results of the study in 995 [2] suggest that prostitution abroad or with a foreigner in Finland is common. This is in accordance with the 2007 [0] and 20 [] surveys in Sweden showing that of those who had bought sex most had done it abroad. In addition, men in Sweden who had ever bought sex were more often travelling than those who had not bought sex []. Being married and living with a partner lowered the odds of ever having bought sex, which has also been the case in the UK [], Australia [8] and Norway [3]. Unlike in other studies [,3,8], we found an association between current occupation and having ever bought sex. Entrepreneurs had higher odds of ever having bought sex than blue-collar employees. This is in line with the result of the Finnish study in 995 [2]. There is no clear explanation for this but it might be that entrepreneurs have money and more

734 E. Regushevskaya et al. Table IV. Comparison of attitudes to sexual relationships of men who had and had not bought sex in Finland in 999, distributions (%) and adjusted odds ratios (OR and 95% CI). Total Not bought sex Bought sex OR (95% CI) (n = 575) (n = 494) (n = 8) (n = 575) Sexual intercourse without love is wrong Agree 28.2 3.6 7.4***.00 Hard to say 7.9 9.2 9.9* 2.24 (0.74 6.75) Disagree 53.9 49.2 82.7*** 7.75 (3.9 8.83) Men are by nature polygamous Agree 3.9 2.3 23.5**.00 Hard to say 20.7 20.9 9.8 0.4 (0.9 0.89) Disagree 65.4 66.8 56.7 0.37 (0.20 0.70) I could maintain a sexual relationships with many people at the same time Agree 28.0 22.8 59.3***.00 Hard to say 3.9 3.8 4.8 0.46 (0.33 0.95) Disagree 58. 63.4 25.9*** 0.5 (0.09 0.28) Not against people selling sex Agree 63.3 59.8 85.2***.00 Hard to say.3 2. 6.2 0.32 (0.2 0.84) Disagree 25.4 28. 8.6** 0.22 (0.0 0.5) I approve of state-regulated brothels Agree 59.5 55. 86.4***.00 Hard to say 5.3 6.8 6.2 0.2 (0.08 0.55) Disagree 25.2 28. 7.4*** 0.8 (0.08 0.44) Adjusted for age, marital status and area *p value < 0.05, **p value < 0.0, ***p value < 0.00 comparing men who bought sex with men who had not bought sex Table V. The likelihood of buying sex by attitudes and by residence, adjusted odds ratios (OR and 95% CI), men in Finland 999. Big towns Small towns Rural (n = 76) (n = 24) (n = 85) Sexual intercourse without love is wrong I agree.00.00.00 Hard to say 3.8 (0.36 40.70).54 (0.2 9.27) 2.0 (0.43 0.7) I disagree 5.09 (.63 2.68) 8.96 (.98 40.62) 6.54 (.69 25.26) Men are by nature polygamous I agree.00.00.00 Hard to say 0.24 (0.05.08) 0.47 (0. 2.02) 0.45 (0.3.64) I disagree 0.38 (0.3.4) 0.55 (0.5.95) 0.9 (0.06 0.62) I could maintain a sexual relationships with many people at the same time I agree.00.00.00 Hard to say 0.2 (0.05 0.87) 0.47 (0.4.57) 0.76 (0.20 2.89) I disagree 0.05 (0.0 0.2) 0.4 (0.05 0.39) 0.29 (0.0 0.78) Not against people selling sex I agree.00.00.00 Hard to say 0.20 (0.02.68) 0.5 (0.3 2.00) 0.6 (0.02.55) I disagree 0.49 (0.5.62) 0.0 (0.0 0.76) 0.4 (0.03 0.67) I approve state-regulated brothels I agree.00.00.00 Hard to say 0.38 (0.09.56) 0.0 (0.0 0.88) 0.2 (0.02 0.94) I disagree 0.0 (0.0 0.77) 0.43 (0.4.34) 0.07 (0.0 0.59) Adjusted for age and marital status

freedom to travel. Being away from home may provide a different situation for behaviour, such as buying sex [6]. It may also be possible that entrepreneurs value less the modern gender-equality society [6]. On the other hand, entrepreneurs in Finland are a very heterogeneous group and include people with different characteristics. A more detailed breakdown would need a study with a larger sample size so as to provide more reliable conclusions. We were surprised to find that men in the smaller towns with higher education (3 5 years) were more likely to report buying sex than lower educated men. A study in Europe [] did not find an association between education and buying sex. A study in Australia found that it was related to low education [8]. We have no clear explanations for our results but it might relate to the fact that educated men from small towns may travel more for educational or work purposes and be attracted by sex advertising while travelling. In our study, we found an association between current income and ever having bought sex. Unlike in the Australian study [8], Finnish men with high income were more likely to have ever bought sex than those with the lowest income. Likewise, in a study in Sweden men who had bought sex were somewhat richer than those who had not bought sex []. Most probably having a high income gives men a better opportunity and easier access to prostitutes. On the other hand, we found a correlation between income and occupation (data not shown): the higher employment position the person had the higher the reported income. The association between liberal attitudes on sexual relationships and buying sex was strong. We found no previous study in Finland investigating this issue. The association between men s attitudes and buying sex was found in all residence types. However, not all who agreed with the statements I am not against people selling sex and I approve of statecontrolled brothels reported having bought sex, and would not necessarily be future buyers. Our findings are in line with the results of the population-based study in Sweden [] showing an association between liberal attitudes towards commercial sex and buying sex. Several limitations should be taken into account when considering the results of our study: the crosssectional design, non-respondents and self-reported information on paying for sex. In cross-sectional studies, causality cannot be definitively established. About half of the men did not respond and the nonrespondents may have had different characteristics; there may have been more or less men buying sex among the non-respondents. Sociodemographic characteristics 735 Information on sex behaviour can be obtained only by asking people. Self-reporting can underestimate buying sex or the practice of other risky behaviours. However, the survey covered human relationships and sexuality at large and was not specifically on prostitution. The study context may have facilitated honest answers. In 999, there was not much advertising of sex via the Internet. Nowadays, sexual services are widely advertised and bought through the Internet also in Finland (unpublished data from our project). It might be that men buying sex online differ in their characteristics from the men we studied. However, it may be that the Internet gives only more discrete opportunities for those who buy sex, while their sociodemographic characteristics, beliefs and attitudes may be similar to those in our study. It is possible that since the 990s, there have been significant changes in the way men buy sex, and so more recent studies on prostitution in Finland and elsewhere in Europe are needed. Furthermore, future studies in Finland could address the effect of geographical differences, such as the long border with Russia to the east and the open borders with Estonia to the south. Our results should serve as a comparison and help in formulating such studies. Conflict of interest None declared. Funding The survey was financially supported by the Academy of Finland. This paper is written as part of the research project Prostitution and health in Finland, which is supported by a Finnish Cultural Foundation grant. References [] Ward H, Mercer CH, Fenton K, et al. Who pays for sex? An analysis of the increasing prevalence of female commercial sex contacts among men in Britain. Sex Transm Infect 2005;8:467 7. [2] Marttila AM. Consuming sex Finnish male clients and Russian and Baltic prostitution. In: Gender and Power in the New Europe the 5th European Feminist Research Conference, 20 24 August 2003. [3] Schei B and Stigum H. A study of men who pay for sex, based on the Norwegian national sex surveys. Scand J Public Health 200;38:35 40. [4] Carael M, Slaymaker E, Lyerla R, et al. Clients of sex workers in different regions of the world: hard to count. Sex Transm Infect 2006 Jun;82 Suppl 3:iii26 33. [5] Holmström C and Skilbrei M (ed). Prostitution i Norden. Forskningsrapport [Prostitution in the Nordic countries. Research report]. Copenhagen: Nordiska ministerrådet, 2008. [6] Marttila AM. Desiring the other: prostitution clients on a transnational red-light district in the border area of Finland, Estonia and Russia. Gend Tech Dev 2008;2():3 5.

736 E. Regushevskaya et al. [7] Haavio-Mannila E and Kontula O. Sexual trends in the Baltic Sea area. Publications of the Population Research Institute D 4, 2003. [8] Rissel CE, Richters J, Grulich AE, et al. Sex in Australia: experiences of commercial sex in a representative sample of adults. Aust N Z J Public Health 2003;27:9 7. [9] Groom TM and Nandwani R. Characteristics of men who pay for sex: a UK sexual health clinic survey. Sex Transm Infect 2006 Oct;82:364 7. [0] Kuosmanen J. Tio år med lagen: om förhållningssätt till och erfarenheter av prostitution i Sverige [Ten years after law: Attitudes and experience of prostitution in Sweden]. In: Holmström C and Skilbrei M-L (ed) Prostitution i Norden. Copenhagen: Nordiska ministerrådet, 2008, pp. 357 83. [] Priebe G and Svedin. Sälja och köpa sex i Sverige 20. Förekomst, hälsa och attityder [Selling and buying sex in Sweden in 20. Occurrence, health and attitudes]. Linköping University Electronic Press, 202. [2] Lammi-Taskula J. Clients of the sex industry in Finland, The Habitus Study, 995. In: Keeler L and Jyrkinen M (eds) Who s Buying? The Clients of Prostitution. Ministry of Social Affairs and Heath, 999, pp. 82 8. [3] Rossler W, Koch U, Lauber C, et al. The mental health of female sex workers. Acta Psychiatr Scand 200;22:43 52. [4] Brody S, Potterat JJ, Muth SQ, et al. Psychiatric and characterological factors relevant to excess mortality in a longterm cohort of prostitute women. J Sex Marital Ther 2005; 3:97 2. [5] Burnette ML, Lucas E, Ilgen M, et al. Prevalence and health correlates of prostitution among patients entering treatment for substance use disorders. Arch Gen Psychiatry 2008;65:337 44. [6] Cohan D, Lutnick A, Davidson P, et al. Sex worker health: San Francisco style. Sex Transm Infect 2006;82:48 22. [7] Shanon K, Kerr T, Strathdee SA, et al. Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers. BMJ 2009;:b2939. [8] Kennedy MA, Gorzalka BB, Yuille JC. Men who solicit prostitutes: a demographic profile of participants in the Vancouver police department s prostitution offender program. Interim report 3, Vancouver Police Department, 2004. [9] Monto M. Clients of street prostitutes in Portland, Oregon, San Francisco and Santa Clara, California, and Las Vegas, Nevada, 996 999. ICPSR version. Portland: University of Portland, 999. [20] Pitts MK, Smith AM, Grierson J, et al. Who pays for sex and why? An analysis of social and motivational factors associated with male clients of sex workers. Arch Sex Behav 2004; 33:353 8. [2] Macleod J, Farley M, Anderson L, et al. Challenging men s demand for prostitution in Scotland. A research report based on interviews with 0 men who bought women in prostitution. Women s Support Project and Prostitution Research and Education, Glasgow, Scotland, 2008. [22] Penttinen E.Globalization, prostitution and sex trafficking: corporeal politics. London: Routledge, 2008. [23] Haavio-Mannila E and Kontula O. Single and double standards in Finland, Estonia, and St. Petersburg. J Sex Res 2003:40;36 49. [24] Kesseli K, Regushevskaya E, Doubikaytis T, et al. Reproductive health and fertility in St. Petersburg: report on a survey of 8 44 year old women in 2004. Working papers 60. Department of Sociology, University of Helsinki, 2005, www.julkari. fi/handle/0024/80450 (accessed 2 January 20). [25] The Penal Code of Finland, Chapter 20. [26] Finnish Aliens Act 22.2.99/378. [27] Public Order Act, 62/2003. [28] Melbye M and Biggar RJ. Interactions between persons at risk for AIDS and the general population in Denmark. Am J Epidemiol 992;35:593 602. [29] Johnson AM, Mercer CH, Erens B, et al. Sexual behaviour in Britain: partnerships, practices, and HIV risk behaviours. Lancet 200;358:835 42. Information for Authors Why do we ask you to transfer copyright to the Nordic Societies of Public Health?. Ownership of copyright by the Nordic Societies of Public Health ensures maximum protection against infringement of copyright protected material through breach of copyright or piracy anywhere in the world. 2. It also ensures that requests by third parties to reprint or reproduce a contribution, or part of it in any format, are handled efficiently in accordance with our general policy which encourages dissemination of knowledge inside the framework of copyright. SAGE administers the copyright and permissions for SJPH on behalf of the Nordic Societies of Public Health. For more information please go to the Author gateway: http://www.sagepub.co.uk/ journaleditors.nav