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Intentional Unprotected Anal Intercourse among Sex Who have Sex with Men: Barebacking—from Behavior to Identity

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Abstract

Unprotected sex among gay/bisexual men throughout the AIDS epidemic has usually been described as unintentional due to a relapse from safer sex behavior. The term “barebacking” emerged among HIV-positive men explicitly seeking unprotected sex with seroconcordant partners, but has come into use in the larger gay community to simply mean condomless sex. Some men have also taken on the identity as a “barebacker.” The present study assessed prevalence and predictors of bareback identity in a sample 687 gay/bisexual men attending community events. Barebackers reported significantly more use of crystal methamphetamine and higher peer norms for unprotected sex; HIV-negative barebackers were higher in sexual compulsivity while HIV-positive barebackers were higher in romantic obsession as well as drug/alcohol influenced sexual expectancies. HIV prevention efforts targeting barebackers and barebacking must be carefully developed if programs and campaigns are to be effective given the open debates about this phenomenon in the gay community.

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References

  • Adam, B. D. (2005). Constructing the neoliberal sexual actor: Responsibility and care of the self in the discourse of barebackers. Culture, Health & Sexuality, 7, 333–346.

    Article  Google Scholar 

  • Adam, B. D., Husbands, W., Murray, J., & Maxwell, J. (2005). AIDS optimism, condom fatigue or self esteem? Explaining unsafe sex among gay and bisexual men. Journal of Sex Research, 42, 238–248.

    PubMed  Google Scholar 

  • Adib, S. M., Joseph, J. G., Ostrow, D. G., & James, S. A. (1991a). Predictors of relapse in sexual practices among homosexual men. AIDS Education and Prevention, 3, 293–304.

    CAS  Google Scholar 

  • Adib, S. M., Joseph, J. G., Ostrow, D. G., Tal, M., & Schwartz, S. A. (1991b). Relapse in sexual behavior among homosexual men: A 2 year follow up from the Chicago MACS/CCS cohort. AIDS, 5, 757–760.

    Article  CAS  Google Scholar 

  • Adib, S. M., & Ostrow, D. G. (1991). Trends in HIV behavioral research among homosexual and bisexual men in the United States: 1981–1991. AIDS Care, 3, 281–288.

    Article  PubMed  CAS  Google Scholar 

  • Adib, S. M., & Ostrow, D. G. (1995). Stages sexual behavior change to reduce the risk of HIV/AIDS: The Chicago MACS/CCS cohort. Journal of Psychology and Human Sexuality, 7, 121–133.

    Article  Google Scholar 

  • Bancroft, J. (2000). Individual differences in sexual risk taking: A biopsychosocial theoretical approach. In J. Bancroft (Ed.), The role of theory in sex research (pp. 175–212). Bloomington, IN: Indiana University Press.

    Google Scholar 

  • Benotsch, E. G., Kalichman, S. C., & Kelly, J. A. (1999). Sexual compulsivity and substance use in HIV-seropositive men who have sex with men: Prevalence and predictors of high-risk behaviors. Addictive Behaviors, 24(6), 857–868.

    Article  PubMed  CAS  Google Scholar 

  • Beren, S. E., Hayden, H. A., Wilfley, D. E., & Grilo, C. M. (1996). The influence of sexual orientation on body dissatisfaction in adult men and women. The International Journal of Eating Disorders, 20, 135–141.

    Article  PubMed  CAS  Google Scholar 

  • Bimbi, D. S., & Parsons, J. T. (2004, August). Intentional unsafe sex: Reframing the theory of reasoned action to include “unreasonable” intentions. Paper presented at the annual meeting of the American Psychological Association, Honolulu, HI.

  • Bimbi, D. S., & Parsons, J. T. (2005). Barebacking among Internet-based male sex workers. Journal of Gay and Lesbian Psychotherapy, 9(3/4), 89–110.

    Article  Google Scholar 

  • Boily, M., Godin, G., Hogben, M., Sherr, L., & Bastos, F. I. (2005). The impact of the transmission dynamics of the HIV/AIDS epidemic on sexual behavior: A new hypothesis to explain recent increases in risk taking behavior among men who have sex with men. Medical Hypotheses, 65, 215–226.

    Article  PubMed  Google Scholar 

  • Cadwell, S. (1991). Twice removed: The stigma suffered by gay men with AIDS. Smith College Studies in Social Work, 61, 236–246.

    Google Scholar 

  • Carballo-Dieguez, A., Stein, Z., Saez, H., Dolezal, C., Nieves-Rosa, L., & Diaz, F. (2000). Frequent use of lubricants for anal sex among men who have sex with men: The HIV prevention potential of a microbicidal gel. American Journal of Public Health, 90, 1117–1120.

    Article  PubMed  CAS  Google Scholar 

  • Carballo-Dieguez, A. (2001). HIV, barebacking, and gay men’s sexuality, Circa 2001. Journal of Sex Education and Therapy, 26, 225–233.

    Google Scholar 

  • Carballo-Dieguez, A., & Bauermeister, J. (2004). “Barebacking”: Intentional condomless anal sex in HIV-risk contexts reasons for and against it. Journal of Homosexuality, 47, 1–16.

    Article  PubMed  Google Scholar 

  • Clark, M. (1993). From gay men’s lives: Toward a more inclusive ecological vision. Journal of Men’s Studies, 1, 347–358.

    Article  Google Scholar 

  • Colfax, G. N., Buchbinder, S. P., Cornelisse, P. G., Vittinghoff, E., Mayer, K., & Celum, C. (2002). Sexual risk behaviors and implications for secondary HIV transmission during and after HIV seroconversion. AIDS, 16, 1529–1535.

    Article  PubMed  Google Scholar 

  • Colfax, G., Coates, T. J., Husnik, M. J., Huang, Y., Buchbinder, S., Koblin, B., Chesney, M., & Vittinghoff, E. (2005). Longitudinal patterns of methamphetamine, popper (amyl nitrite), and cocaine use and high-risk sexual behavior among a cohort of San Francisco men who have sex with men. Journal of Urban Health, 82, 62–70.

    Google Scholar 

  • Cox, J., Beauchemin, J., & Allard, R. (2004). HIV status of sexual partners is more important than antiretroviral treatment related perceptions for risk taking by HIV positive MSM in Montreal, Canada. Sexually Transmitted Infections, 80, 518–523.

    Article  PubMed  CAS  Google Scholar 

  • Crossley, M. L. (2004). Making sense of ‘barebacking’: Gay men’s narratives, unsafe sex and the ‘resistance habitus’. British Journal of Social Psychology, 43, 225–244.

    Article  PubMed  Google Scholar 

  • Davis, M. (2002). HIV prevention rationalities and serostatus in the risk narratives of gay men. Sexualities, 5, 281–299.

    Article  Google Scholar 

  • Doll, L. S., Judson, F. N., Ostrow, D. G., O’Malley, P. M., Darrow, W. W., Hadler, S. C. et al. (1990). Sexual behavior before AIDS: The hepatitis B studies of homosexual and bisexual men. AIDS, 4(11), 1067–1073.

    Article  PubMed  CAS  Google Scholar 

  • Ekstrand, M. L. (1992). Safer sex maintenance among gay men: Are we making any progress? AIDS, 6, 875–877.

    Article  PubMed  CAS  Google Scholar 

  • Fordham, S., & Ogbu, J. (1986). Black students’ school success: Coping with the burden of acting white. The Urban Review, 18, 176–206.

    Article  Google Scholar 

  • Gatter, P. (1995). One of us, one of them, or on of those? The construction of identity and sexuality in relation to HIV/AIDS. In P. Aggleton & P. Davies (Eds.), AIDS: Safety, sexuality and risk (pp. 159–171). Philadelphia, PA: Taylor and Francis.

    Google Scholar 

  • Gauthier, D. K., & Forsyth, C. J. (1999). Bareback sex, bug chasers, and the gift of death. Deviant Behavior, 20, 85–100.

    Article  Google Scholar 

  • Gendin, S. (1997, June). Riding bareback: Skin-on-skin sex been there, done that, want more. POZ, 64–65.

  • Gendin, S. (1999, February). They shoot barebackers don’t they? Poz, 50.

  • Gerrard, M., Gibbons, F. X., & Bushman, B. J. (1996). Relation between perceived vulnerability to HIV and precautionary sexual behavior. Psychological Bulletin, 119, 390–409.

    Article  PubMed  CAS  Google Scholar 

  • Goodroad, B. K., Kirksey, K. M., & Butensky, E. (2000). Bareback sex and gay men: An HIV prevention failure. Journal of the Association of Nurses in AIDS Care, 11(6), 29–36.

    Article  PubMed  CAS  Google Scholar 

  • Gross, M., Buchbinder, S., Celum, C., Heagerty, P., & Seage, G. (1998). Rectal microbicides for U.S. gay men: Are clinical trials needed? Are they feasible? Sexually Transmitted Diseases, 25, 296–302.

    Article  CAS  Google Scholar 

  • Grov, C. (2004). “make me your death slave”: Men who have sex with men and use the internet to intentionally spread HIV. Deviant Behavior, 25, 329–349.

    Article  Google Scholar 

  • Halkitis, P. N., & Parsons, J. T. (2003). Intentional unsafe sex (barebacking) among HIV-positive gay men who seek sexual partners on the Internet. AIDS Care, 15(3), 367–378.

    Article  PubMed  CAS  Google Scholar 

  • Halkitis, P. N., Parsons, J. T., & Stirratt, M. J. (2001). A double epidemic: Crystal methamphetamine use in relation to HIV transmission among gay men. Journal of Homosexuality, 41, 17–35.

    Article  PubMed  CAS  Google Scholar 

  • Halkitis, P. N., Parsons, J. T., & Wilton, L. (2003). Barebacking among gay and bisexual men in New York City: Explanations for the emergence of intentional unsafe behavior. Archives of Sexual Behavior, 32(4), 351–357.

    Article  PubMed  Google Scholar 

  • Halkitis, P. N., Wilton, L., Wolitski, R. J., Parsons, J. T., Hoff, C. C., & Bimbi, D. (2005). Barebacking identity among HIV-positive gay and bisexual men: Demographic, psychological, and behavioral correlates. AIDS, 19(S1), 27–36.

    Google Scholar 

  • HIV/AIDS Surveillance Project Group (2004). High-risk sexual behavior by HIV-positive men who have sex with men—16 sites, United States, 2000–2002. JAMA, 292, 2333–2334.

    Article  Google Scholar 

  • Holmes, D., & Warner, D. (2005). The anatomy of forbidden desire: Men, penetration and semen exchange. Nursing Inquiry, 12, 10–20.

    Article  PubMed  Google Scholar 

  • Huebner, D. M., Proescholdbell, R. J., & Nemeroff, C. J. (2004, August). Do gay and bisexual men share researchers’ definitions of barebacking? Poster presented at the Annual Meeting of the American Psychological Association, Honolulu, HI.

  • Irwin, T. W., Morgenstern, J., Parsons, J. T., Wainberg, M., & Labouvie, E. (in press). Alcohol and sexual HIV risk behavior among problem drinking men who have sex with men: An event level analysis of timeline followback data. AIDS and Behavior.

  • Joseph, K. M., Adib, S. M., Joseph, J. G., & Tal, M. (1991). Gay identity and risky sexual behavior related to the AIDS threat. Journal of Community Health, 16, 287–297.

    Article  PubMed  CAS  Google Scholar 

  • Junge, B. (2002). Bareback sex, risk, and eroticism: Anthropological themes (re-)surfacing in the post-AIDS Era. In W. L. E. Lewin (Ed.), Out in theory: The emergence of Lesbian and Gay anthropology (pp. 186–221). Chicago: University of Illinois Press.

    Google Scholar 

  • Kalichman, S. C., Johnson, J. R., Adair, V., Rompa, D., Multhauf, K., & Kelly, J. A. (1994). Sexual sensation seeking: Scale development and predicting AIDS risk behavior among homosexually active men. Journal of Personality Assessment, 62, 385–397.

    Article  PubMed  CAS  Google Scholar 

  • Kalichman, S. C., & Rompa, D. (1995). Sexual sensation seeking and sexual compulsivity scales: Reliability, validity, and predicting HIV risk behavior. Journal of Personality Assessment, 65, 586–601.

    Article  PubMed  CAS  Google Scholar 

  • Kalichman, S. C., & Rompa, D. (2001). The sexual compulsivity scale: Further development and use with HIV-positive persons. Journal of Personality Assessment, 76, 379–395.

    Article  PubMed  CAS  Google Scholar 

  • Kippax, S. (2002). Negotiated safety agreements among gay men. In A. O’Leary (Ed.), Beyond condoms: Alternative approaches to HIV prevention (pp. 1–15). New York: Kluwer.

    Google Scholar 

  • Kurtz, S. P. (2005). Post-circuit blues: Motivations and consequences of crystal meth use among gay men in Miami. AIDS and Behavior, 9, 63–72.

    Article  PubMed  Google Scholar 

  • Mansergh, G., Marks, G., Colfax, G., Guzman, R., Rader, M., & Buchbinder, S. (2002). Barebacking in a diverse sample of men who have sex with men. AIDS, 16, 653–659.

    Article  PubMed  Google Scholar 

  • Marks, G., Mansergh, G., Crepaz, N., Murphy, S., Miller, L., & Appleby, P. (2000). Future HIV prevention options for men who have sex with men: Intention to use a potential microbicide during anal intercourse. AIDS and Behavior, 4, 279–286.

    Article  Google Scholar 

  • Mckirnan, D. J., Ostrow, D. G., & Hope, B. (1996). Sex, drugs and escape: A psychological model of HIV-risk sexual behaviors. AIDS Care, 8, 655–669.

    Article  PubMed  CAS  Google Scholar 

  • McKirnan, D. J., Vanable, P. A., Ostrow, D. G., & Hope, B. (2001). Expectancies of sexual “escape” and sexual risk among drug and alcohol-involved gay and bisexual men. Journal of Substance Abuse, 13, 137–154.

    Article  PubMed  CAS  Google Scholar 

  • Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). Guilford Press: New York.

    Google Scholar 

  • Missildine, W., Feldstein, G., Punzalan, J. C., & Parsons, J. T. (2005). S/he loves me, s/he loves me not: Questioning heterosexist assumptions of gender and romantic attraction. Sexual Addiction and Compulsivity, 12, 1–11.

    Article  Google Scholar 

  • Morin, S. F., Vernon, K., Harcourt, J., Steward, W. T., Volk, J., Riess, T. H., Neilands, T. B., McLaughlin, M., & Coates, T. J. (2003). Why HIV infections have increased among men who have sex with men and what to do about it: Findings from California focus groups. AIDS and Behavior, 7, 353–362.

    Article  PubMed  Google Scholar 

  • Morton, T. A., & Duck, J. M. (2000, August). Social identity and media dependency in the Gay community. Communication Research, 27, 438–461.

    Google Scholar 

  • Muench, F., & Parsons, J. T. (2004). Sexual compulsivity and HIV: Identification and treatment. Focus, 19, 1–4.

    PubMed  Google Scholar 

  • Nanin, J. E., & Parsons, J. T. (2006). Club drug use and risky sex among gay and bisexual men in New York City. Journal of Gay and Lesbian Psychotherapy, 10, 111–122.

    Article  Google Scholar 

  • Parsons, J. T. (2005a). HIV-positive gay and bisexual men. In S. C. Kalichman (Ed.), Positive prevention: Reducing HIV transmission among people living with HIV/AIDS (pp. 99–133). New York: Kluwer.

    Google Scholar 

  • Parsons, J. T. (2005b). Motivating the unmotivated: A treatment model for barebackers. Journal of Gay and Lesbian Psychotherapy, 9(3/4), 133–152.

    Article  Google Scholar 

  • Parsons, J. T., Vicioso, K., Punzalan, J. C., Halkitis, P. N., Kutnick, A., & Velasquez, M. M. (2004). The impact of alcohol use on the sexual scripts of HIV + men who have sex with men. Journal of Sex Research, 41, 160–172.

    Article  PubMed  Google Scholar 

  • Parsons, J. T., Schrimshaw, E. W., Wolitski, R. J., Halkitis, P. N., Purcell, D. W., Hoff, C. C., & Gomez, C. (2005). Sexual harm reduction practices of HIV seropositive gay and bisexual men: Serosorting, strategic positioning, and withdrawal before ejaculation. AIDS, 19(S1), 13–26.

    Google Scholar 

  • Parsons, J. T., & Vicioso, K. (2005). Brief encounters: The Roles of public and commercial sex environments in the sexual lives of HIV-positive gay and bisexual men. In P. Halkitis, C. Gómez, & R. J. Wolitski (Eds.), HIV positive sex: The psychological and interpersonal dynamics of HIV-seropositive gay and bisexual men’s relationships (pp. 183–200). Washington, DC: American Psychological Association.

    Google Scholar 

  • Purcell, D. W., Parsons, J. T., Halkitis, P. N., Mizuno, Y., & Woods, W. (2001). Relationship of substance use by HIV-seropositive men who have sex with men and unprotected anal intercourse with HIV-negative and unknown serostatus partners. Journal of Substance Abuse, 13(1–2), 185–200.

    Article  PubMed  CAS  Google Scholar 

  • Purcell, D. W., Moss, S., Remien, R. H., Woods, W. J., & Parsons, J. T. (2005). Illicit substance use, sexual risk, and HIV-positive gay and bisexual men: Differences by serostatus of casual partners. AIDS, 19(S1), 37–48.

    Article  Google Scholar 

  • Rader, M., Marks, G., Mansergh, G., Crepaz, N., Miller, L., Appleby, S., & Murphy, S. (2001). Preferences about the characteristics of future HIV prevention products among men who have sex with men. AIDS Education and Prevention, 13, 149–159.

    Article  PubMed  CAS  Google Scholar 

  • Ridge, D. T. (2004). ‘It was an incredible thrill’: The social meanings and dynamics of younger gay men’s experiences of barebacking in Melbourne. Sexualities, 7, 259–279.

    Article  Google Scholar 

  • Ridge, D. T., Plummer, D. C., & Minichiello, V. (1994). Young gay men and HIV: Running the risk? AIDS Care, 6, 371–378.

    Article  PubMed  CAS  Google Scholar 

  • Robins, A. G., Dew, M. A., Kingsley, L. A., & Becker, J. T. (1997). Do homosexual and bisexual men who place others at potential risk for HIV have unique psychosocial profiles? AIDS Education and Prevention, 9, 239–251.

    PubMed  CAS  Google Scholar 

  • Roffman, R. A., Stephens, R. S., Curtin, L., Gordan, J. R., Craver, J. N., Stern, M., Beadnell, B., & Downey, L. (1998). Relapse prevention as an intervention model for HIV risk reduction in gay and bisexual men. AIDS Education and Prevention, 10, 1–18.

    PubMed  CAS  Google Scholar 

  • Rogers, E. M., & Shefner-Rodgers, C. L. (1999). Diffusion of innovations and HIV/AIDS prevention research. In W. N. Elwood (Ed.), Power in the blood: A handbook on AIDS, politics, and communication (pp. 405–414). New Jersey: Lawrence Erlbaum Associates.

    Google Scholar 

  • Schonnesson, L. N., & Clement, U. (1995). Sexual attitudinal conflict and sexual behavior changes among homosexual HIV-positive men. Journal of Psychology and Human Sexuality, 7, 41–58.

    Article  Google Scholar 

  • Seibt, A. C., & Ross, M. W. (1995). Relationship between safe sex and acculturation into the gay subculture. AIDS Care, 7, 85–88.

    Article  Google Scholar 

  • Shoptaw, S., & Frosch, D. (2000). Substance abuse treatment as HIV prevention for men who have sex with men. AIDS and Behavior, 4, 193–203.

    Article  Google Scholar 

  • Siever, M. D. (1994). Sexual orientation and gender as factors in socioculturally acquired vulnerability to body dissatisfaction and eating disorders. Journal of Consulting and Clinical Psychology, 62, 252–260.

    Article  PubMed  CAS  Google Scholar 

  • Silverstein, C., & Picano, F. (2003). Barebacking. In The joy of gay sex (3rd ed., pp. 1–2). New York: Harper Collins.

  • Stirratt, M. (2005). I have something to tell you: HIV serostatus disclosure practices of HIV-positive gay and bisexual men with sex partners. In P. N. Halkitis, C. A. Gomez, & R. J. Wolitiski (Eds.), HIV + Sex: The psychological and interpersonal dynamics of HIV-seropositive gay and bisexual men’s relationships (pp. 101–120). Washington, DC: American Psychological Association.

    Google Scholar 

  • Strub, S. (1997, June). Talking about sex in an intelligent way is tough. POZ, 16.

  • Tabet, S., Callahan, M., Mauck, C., Gai, F, Coetti, A., Profy, A., Moench, T., Sotto-Torres, L., Poindexter III, A., Frezieres, R., Walsh, T., Kelly, C., Richardson, B., van Damme, L., & Celum, C. (2003). Safety and acceptability of penile application of 2 candidate topical microbicides: Buffergel and PRO 2000 Gel. Journal of AIDS, 33, 476–483.

    PubMed  CAS  Google Scholar 

  • Tawk, H. M., Simpson, J. M., & Mindel, A. (2004). Condom use in multi-partnered males: Importance of HIV and hepatitis B status. AIDS Care, 16, 890–900.

    Article  PubMed  CAS  Google Scholar 

  • Tewksbury, R. (2003). Bareback sex and the quest for HIV: Assessing the relationship in Internet personal advertisements of men who have sex with men. Deviant Behavior, 24, 467–483.

    Article  Google Scholar 

  • van De Ven, P., Kippax, S., Crawford, J., Rawstorne, P., Prestage, G., Grulich, A., & Murphy, D. (2002). In a minority of gay men, sexual risk practice indicates strategic positioning for perceived risk reduction rather than unbridled sex. AIDS Care, 14, 471–480.

    Article  PubMed  Google Scholar 

  • Williams, M. L., Elwood, W. N., & Bowen, A. M. (2000). Escape from risk: A Qualitative exploration of relapse to unprotected anal sex among men who have sex with men. Journal of Psychology and Human Sexuality, 11, 25–49.

    Article  Google Scholar 

  • Wolitski, R. J. (2005). The emergence of barebacking among gay and bisexual men in the United States: A Public health perspective. Journal of Gay and Lesbian Psychotherapy, 9, 13–38.

    Article  Google Scholar 

  • Wood, M. J. (2004). The gay male gaze: Body image disturbance and gender oppression among gay men. Journal of Gay and Lesbian Social Services, 17, 43–63.

    Article  Google Scholar 

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Acknowledgments

This study was part of the larger ‘Sex and Love Survey’ funded by the Hunter College Center for HIV/AIDS Educational Studies and Training (CHEST). The authors would also like to recognize the hard work and input of the other members of the “Sex and Love” research team.

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Parsons, J.T., Bimbi, D.S. Intentional Unprotected Anal Intercourse among Sex Who have Sex with Men: Barebacking—from Behavior to Identity. AIDS Behav 11, 277–287 (2007). https://doi.org/10.1007/s10461-006-9135-1

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