Some research on barebacking

[bbckresearch]

As some of you are interested in looking at some research on barebacking, I'm posting some of these (mainly from epidemiological, public health, psycho-social, sociological perspectives). This is not an exhaustive list. The literature presented below do not include research published recently (2012 and 2013). The summaries and commentaries are all mine. I shall post some of the literature on bugchasing/giftgiving next time.

Adam, B., W. Husbands, J. Murray, & J. Maxwell. 2005. ‘AIDS Optimism, Condom Fatigue, or Self-Esteem? Explaining Unsafe Sex among Gay and Bisexual Men.’ The Journal of Sex Research 42(3):238-48. The Journal of Sex Research 42(3):238-48.

The authors examine major explanations for unsafe sex and contrast it with in-depth interviews with 102 high-risk gay and bisexual men in Toronto to see how well these explanations fit with their accounts. They found that there is an inadequate fit between some of the leading explanations and the discursive accounts provided by high-risk men themselves.

Unprotected sex arises in a variety of different circumstances: as a resolution to condoms and erectile difficulties, through momentary lapses and trade-offs, out of personal turmoil and depression, and as a by-product of strategies of disclosure and intuiting safety. Most of these men are well-informed and sophisticated calculators of risk. There is no average gay man nor average factor determining unsafe sex.

Adam, B., W. Husbands, J. Murray, & J. Maxwell. 2008. “Circuits, Networks, and HIV Risk Management.” AIDS Education and Prevention 20(5):420-34.

Much of the study on barebacking revolves around individualist presumptions and this study sought to move away from the assumption that risk is a tendency that lies within individuals. This study seeks to delineate characteristics of men who report that they like to participate in the ‘bareback scene’ and cruise ‘bareback Websites’ by comparing them with men who had casual male partners during the last 6 months but do not report an interest in bareback scenes or websites.

Based on their findings, barebackers show a distinct profile. They are more likely to be:

• Found in particular set of bars, baths, parks, and websites
  
• ‘Sexually adventurous’ that is, involved in poz, fisting, bear, SM, leather, and ‘party and play’ scenes
  
• Have a distinctive belief that justifies these practices grounded in a nation of the rational, informed, consenting, responsible masculine actor (i.e., they “show consistency with the neoliberal discourse widely propagated by government and business today that constructs everyone as self-interested […] who must take responsibility for himself in a marketplace of risks” (Adam 2005 in 430).
  
• Are more likely to have had five or more partners in the last 6 months compared with non-barebacker men who have casual partners.
  

Bauermeister, J., A. Carballo-Dieguez, A. Ventuneac, C. Dolezal. 2009. “Assessing Motivations to Engage in Intentional Condomless Anal Intercourse in HIV Risk Contextes (‘Bareback Sex’) Among Men who have sex with Men.” AIDS Education and Prevention 21(2):156-68.

The authors in this article look at the underlying factors that may motivate behaviours, to help create individual-level behaviour change programs.

Findings:

• Decisional balance to bareback seems to be motivated by two factors: sex as a way of coping with social vulnerabilities and sex as a way to connect and to experience pleasure with other men.
  
• Sexual intimacy and pleasure is strongly linked to their desire to cope with social stressors such as racism, loneliness, and homophobia.
  
• HIV-positive men were more likely to associate gains with bareback sex as a way of coping with social vulnerabilities than HIV-negative men.
  
• Their findings are consistent with Halkitis, et al. (2003) and Carballo-Dieguez & Bauermeister’s (2004) arguments that bareback sex is an intentional act providing sexual and emotional rewards that may not be present when using condoms.
  

Carballo-Dieguez, A., et al. 2010. “‘Bareback’— definitions and identity: Constructs’ limitation for HIV-Prevention research.” Pp. 202-12 in Routledge Handbook of Sexuality, Health and Rights, ed. by P. Aggleton & R. Parker. New York: Routledge.

This article explores the meaning of ‘bareback’ from the perspective of men who report engaging in bareback sex. Respondents were in broad agreement that bareback refers to intercourse without condoms; however, there was no single definition embraced by all men. Lack of condom use was often the first and only element mentioned. Intention not to use condoms is also a required element. Bareback as an identity is also inconsistent with the participants: about 1/3 labelled themselves as such, but about ¼ rejected labelling themselves as barebackers because of the stigma attached to the behaviour, particularly for HIV-negative men.

Carballo-Dieguez, A., A. Ventuneac, G. Dowsett, I. Balan, J. Bauermeister, R. Remien, C. Dolezal, R. Guguere, M. Mabragana. 2011. “Sexual Pleasure and Intimacy Among men Who Engage in ‘Bareback Sex.’” AIDS Behavior 15:S57-S65.

The authors in this article sought to find out what led participants to have their first bareback experience as well as continue with the behaviour. Their qualitative analysis suggests that sexual pleasure and intimacy have a pivotal role and drives for sexual satisfaction, adventure, intimacy, and love overpower health concerns and condom use recommendations.

Although they were unable to identify distinct typologies or patterns of factors, the issue of pleasure and intimacy experienced having condomless sex is a potent force men could not or did not want to control. Thus, they suggest that the power of the libido should be acknowledged in prevention approaches.

Grov, C., J. Debusk, D. Bimbi, S. Golub, J. Nanin, & J. Parsons. 2007. “Barebacking, the Internet, and Harm Reduction: An Intercept Survey with Gay and Bisexual Men in Los Angeles and New York City.” AIDS Behavior 11:527-36.

The authors focus on the internet as a vehicle for MSM to look for intentional unprotected anal intercourse (UAI). They argue that there is a clear link between behaviour and identity because men who identify as barebackers are more willing to engage in a planned and unplanned barebacking. They say that the internet plays an important role in exposing individuals to ‘risky sexual behaviours’ and ‘risky sexual partners’ (533-4).

In the end, they suggest that mutual monogamy between partners of the same HIV serostatus is ‘possibly the most effective strategy to eliminate HIV transmission risks’ (534).

Halkitis, P. & Parsons, J. 2003. “Recreational Drug Use and HIV-Risk Sexual Behavior Among Men Frequenting Gay Social Venues.” Journal of Gay & Lesbian Social Services 14(4):19-38.

The purpose of this study was to assess the extent of non-injection recreational drug use among gay and bisexual men frequenting gay social venues, assess recent initiation to ‘club drugs’, and document the interaction between drug use and risky sexual practices.

They found that, consistent with other studies, there is a high rate of recreational drug use. The most commonly used drugs were alcohol, marijuana, inhalant nitrates, cocaine, and ecstasy. Further, participation in gay social venues (bars, clubs, and bath houses) was found to be significantly related to substance use. In turn, this was associated with risky sexual behaviours, suggesting the interaction between gay social venues, drug use, and unsafe sex. It should be noted that inhalant nitrates and alcohol were the critical predictors of unprotected sex under the influence.

Inhalant nitrates use was related to three unprotected sexual behaviours (unprotected oral insertive, unprotected oral receptive, and unprotected anal receptive), suggesting that the use of inhalant nitrates is particularly problematic for HIV prevention (32). They suggest that the relationship between risky sex and inhalant use may result from personality variables, such as a propensity for risk-taking or sensation seeking, and a need to ‘escape’. Further, inhalant nitrates have the pharmacological impact of relaxing the anal muscles, making anal sex less painful. Thus, this drug is related to receptive anal intercourse but not to insertive anal intercourse. There may be an association between HIV status and sexual risk behaviours under the influence of recreational drugs, especially among HIV-positive men.

Halkitis, P., Wilton, L., and P. Galatowitsch. 2005. “What’s in a Term? How Gay and Bisexual Men Understand Barebacking.” JGLP 9(3/4):35-48.

In this article, the authors examine the conceptual understandings, definitions, and practices of barebacking in a sample of 227 gay and bisexual men in New York metropolitan area.

Their findings suggest that gay and bisexual men are familiar with the term ‘barebacking’, but it is inconsistently defined. For the majority of their participants, they defined barebacking simply as anal intercourse without a condom, even if unintended (43). Some men include unprotected oral sex as barebacking and that it was more common among HIV-positive men, particularly with their HIV-positive partners.

It is found that HIV-negative men understand barebacking as an act that fellow HIV-ngeative men engage in. Among these men, barebacking is understood as insertive. For HIV-positive men, barebackers include all HIV-positive and HIV-negative men and could either be receptive or insertive.

Parsons, J., & Bimbi, D. 2007. “Intentional Unprotected Anal Intercourse among Sex Who have Sex With Men: Barebacking—from Behavior to Identity.” AIDS Behavior 11:277-87.

The purpose of their study was to assess the prevalence of gay and bisexual men (both HIV positive and negative) identifying themselves as barebackers and to determine factors related to having a barebacker identity.

They found that HIV-positive men were more likely to identify as barebacker than HIV-negative men. Further, they found a link between the use of crystal meth and barebacking identity. Barebackers were also higher in drug and alcohol related sexual experiences. Moreover, barebackers were significantly higher in sexual compulsivity and romantic obsession.

They contend that the ‘current social climate of the gay community may be facilitating and sustaining barebacking behaviors and the development of barebacker identity’ (284). For them, the current social climate is where gay men are feeling pressured by peers to bareback and that websites developed to barebacking have proliferated.

Pollock, J. & Halkitis, P. 2009. “Environmental Factors in Relation to Unprotected Sexual Behavior Among Gay, Bisexual, and other MSM.” AIDS Education& Prevention 21(4):340-55.

This study also moves away from the individual-based analyses of sexual risk and HIV by considering the broader social context in which individuals function. They argue that understanding sexual risk through ‘rational’ cognitively based models tend to forget that sex and sexuality are non-rational and emotional in nature (342).

Findings:

• The venue cited most often for making an initial contact with casual sex partners was the internet; however, this does not suggest that men who use the internet do not use other venues.
  
• The best predictor of men engaged in UIAI and URAI with casual partners of all serostatuses (except URAI with negative casual partners) is attending bareback sex parties.
  
  • Although frequenting bathhouses/sex clubs predict a greater number of casual sex partners, engagement at these venues does not predict unprotected sexual behaviours as bareback sex parties do.
    
  • However, men who attend bareback sex parties also meet their partners at bathhouses and sex clubs.
    

Reisner, S., M. Mimiaga, P. Case, C. Johnson, S. Safren, & K. Mayer. 2007. “Predictors of Identifying as a Barebacker among High-Risk New England HIV Seronegative Men Who Have Sex with Men.” Journal of Urban Health 86(2):250-62.

This article seeks to understand the sociocultural phenomenon of barebacking by measuring the demographics, psychosocial, and behavioural predictors of barebacker ‘identity’ among HIV-negative men. They argue that most studies have focused on behaviour but these do not necessarily provide insights into barebacking as an identity.

They found that almost 1/3 of participants identified as barebackers. According to them, men with less education are more likely to identify as barebackers (in particular, men who have completed highschool or below). Further, men who identified as barebackers were more likely to screen for alcohol abuse, having higher levels of HIV treatment optimism, and more likely to have engaged in serodiscordant unprotected insertive anal sex. However, the link between barebacking behaviour and meeting sexual partners online was not seen in this study. They contend that due to the fact that a relatively high number of participants are less-educated, their lack of education contributed to the infrequency of their use of the internet.

Shernoff, Michael. 2006. “Condomless Sex: Gay Men, Barebacking, and Harm Reduction.” Social Work 51(2):106-13.

This article summarizes current research findings on sexual risk-taking among gay men, discusses psychosocial issues that contribute to barebacking, and suggests a harm-reduction approach to clinical work with gay men who bareback as an effective method of addressing the behaviour.

• Combination therapy and barebacking: having high-risk sex has been linked to the advent of HAART. It is important for social workers to use psychoeducational interventions ensuring that clients understand the difference between a chronic illness and a mild or unimportant medical condition.
  
• Generational differences: According to this author, for many young gay men, a sense of impractical romanticism has developed about how wonderful and liberating sex used to be ‘in the good old days’. However, no evidence is provided to prove this point.
  
• Barebacking and the internet: a major factor in contributing to barebacking is the Internet.
  
• Drug use and barebacking: ‘party drugs’ have spawned the increase in barebacking.
  
• Intrapsychic motivations for barebacking: According to him, gay men grow up in a culture where their desires and even their existence are marginalized. As such, these factors help to strengthen and reinforce internalized homophobia in an individual’s psyche. This helps to explain why some self-actualized, out, and proud gay men are not doing everything possible to prevent themselves and their partners from becoming infected.
  
  • For some, barebacking is not just an act of sensual pleasure but an assertion of sexual freedom, rebellion, and empowerment (Crossley 2002).
    

  [*]Barebacking in pursuit of interpersonal needs: Mansergh, et al. (2002) suggest that men intentionally put themselves and others at risk to meet important human needs such as physical stimulation and emotional connection.

  [*]Barebacking and AIDS Anxiety: one rationalization for barebacking is the belief that getting HIV might lessen worry about becoming infected.

Stein, D., R. Silvera, R. Hagerty, & M. Marmor. 2012. “Viewing Pornography Depicting Unprotected Anal Intercourse: Are There Implications for HIV Prevention Among Men Who Have Sex with Men?” Archives of Sexual Behavior 41:411-19.

The authors used an internet-based questionnaire to investigate whether viewing pornography depicting UAI was associated with engaging in UAI in a sample of 821 non-monogamous MSM. They found that viewing pornography depicting UAI and engaging in UAI are correlated. For them, UAI and ‘barebacking’ are synonymous. Inhalant nitrates were also found to be associated with UAI.

The findings of this research suggests that reduced viewing of certain types of pornography may facilitate adherence to safer sex guides, based on the ‘Theory of Reasoned Action’ where behavioural intentions can be altered by changing attitudes of subjective norms.

It seems to me that this correlation is taken too simplistically and/or generally. The relationship between the consumption of pornography depicting barebacking and the translation to behaviour cannot be that simple.

Suarez, T. & Miller, J. 2001. “Negotiating Risks in Context: A Perspective on Unprotected Anal Intercourse and Barebacking Among Men Who Have Sex with Men—Where Do We Go From Here?” Archives of Sexual Behavior 30(3):287-300.

These authors offer a review of the scientific literature on risk behaviours, popular literature, and websites to delineate the many contextual factors influence the decision to engage in unprotected anal intercourse. Barebacking is recognized as a “highly dangerous” form of unprotected anal intercourse. For them, barebacking refers to “UAI between casual and anonymous partners, but may also encompass oral sex with swallowing of semen, and gloveless fisting” (288).

For the purposes of the present review, contextual issues include the cognitive, behavioural, and environmental factors motivating one toward or away from AIDS preventive behaviour. They present a (hypothetical) typology including four groups of gay/bisexual men who engage in UAI who differ on level of negotiated risk and predominate contextual issues.

• Seroconcordant couples: UAI in this group appears to be motivated by feelings of love and desire to express emotional intimacy. Because these relationships are monogamous, the risk of introducing HIV, hepatitis, or other STDs is infinitesimal. Behaviour in this group is highly unlikely.
  
• Rational risk takers: in this group, there is a real possibility of HIV, hepatitis, or other STDs. However, the risks may be reduced because of harm reduction activities: non-monogamous couples with negotiated safety-like agreements, HIV-negative individuals whose only UAI is insertive, and serosorting . These men view UAI as a calculated risk. The underlying contextual issues appear to be the weighing of scientific data on infectivity, reinforcement value of UAI, and possibly AIDS burnout.
  
• Irrational risk takers: these include individuals denying their own risk or who use non-scientific or irrational information when making decisions regarding UAI. These men engage in UAI with anonymous partners and also individuals using faulty information such as physical appearance to guess their partner’s HIV status. The logic of this group appears to be convoluted and/or obscured by the heat of the moment, pure pleasure, intimacy issues, and sensation-seeking. Alcohol and drug use also heavily influence risk takers in this group.
  
• Young MSM: their lack of experience with the devastation of AIDS and their pessimistic view of the future may lead to risky behaviours. Only societal interventions aimed at reducing homophobia and promoting healthy and dynamic gay role models will help reduce fatalistic thinking in this group.
  

Wolitski, R. 2005. “The Emergence of Barebacking Among Gay and Bisexual Men in the United States: A Public Health Perspective.” JGLP 9 (3/4):9-34.

In this article, the author presents a review of the literature to identify reasons why some men engage in unprotected sex. He discusses them as: improvements in HIV treatment, more complex sexual-decision making, the internet, substance use, safe-sex fatigue, and changes in HIV prevention programs. The author argues that barebacking may be considerd as a symptom as a result of HAART, changes in how prevention programs are conducted, and changes in gay communities in general. It may also be a cause for increased risk-taking by providing the tools for a social identity for men who enjoy condomless sex and the environment conducive for its existence such as establishing social networks.

[numbersgame]

How serendipitous! I am presenting my thesis proposal this Friday at 9:30 a.m. and this is amazing! I was talking to my professor about how I still need some more literature and TADA! Thank you so much for this! I will definitely hit you up sometime so we can discuss this further and any feedback you have my topic.

I want to use a website for hooking up and do a content analysis of profiles. I want to explore how undetectable and PrEP are talked about in profiles. I have a proposal to do, then I have to do an IRB. I will have to contact the webmaster of the website, as well. I am very nervous about the potential road blocks. But, as a sociologist I am trained in ethics and I want to make sure that I am protecting and giving voices to the subjects.

You are a gift and so is this post you did! :-D

[ffoz]

I found the above to be of very interesting reading. I mainly read both Australian and Swiss studies. HIV has increased by 11% in the year 2011-2012. Also, Hep C and various STI's are on the increase. Thanks for posting.

[Blueyedsoul]

This is an excellent annotated bibliography of some good research/literature. I may have a few you would like to add to the list. I will definitely get back to this one when there's more time.