Gay men who engage in sex work may be at increased risk through risk behaviour outside the context of sex work. Among participants in the Health in Men (HIM) cohort of HIV-seronegative gay men in Sydney, 19.7% had ever engaged in sex work. Five percent reported being paid for sex in a six-month period during the study (2001-2006); a minority (18.3%) of these current sex workers reported unprotected anal intercourse (UAI) with clients and 62.0% reported UAI with any casual partners. The practice of sex work itself may not represent increased risk for HIV transmission but sex workers in this study were, nonetheless, at markedly increased risk in other aspects of their lives.