Intentional Unprotected Anal Intercourse Research Articles

Personality among sexually compulsive men who practice intentional unsafe sex in São Paulo, Brazil.

There is evidence of an association between the practice of intentional unsafe sex among men who have sex with men (MSM) and sensation seeking and impulsivity. However, other aspects of personality have been less frequently investigated. This study aims to investigate the association between the practice of intentional unsafe sex and personality traits in individuals who sought treatment and met the criteria for compulsive sexual behavior in São Paulo, Brazil. The sample consisted of 69 sexually compulsive MSM. The participants underwent psychiatric evaluation and an interview to define intentional condomless sex and completed self-report instruments. The participants completed the following measures: the Temperament and Character Inventory and the Sexual Compulsivity Scale. Twenty-five participants (36%) reported intentional unsafe sex with casual partners, of whom 84% were gay and 16% bisexual (P<0.05). Fifteen (22%) individuals reported being HIV positive, and 11 (73%) of them practiced intentional unprotected anal intercourse (P<0.05). The mean of sexual compulsivity was associated with men who engaged in intentional unsafe sex (P=0.01). Men who reported intentional unsafe sex scored significantly higher on the novelty seeking temperament dimension (P<0.05) and scored significantly lower on the self-directedness character dimension (P<0.001). However, self-directedness predicted intentional unsafe sex in the multiple logistic regression (P=0.001). Sexually compulsive individuals who practiced intentional unsafe sex presented lower self-directedness than the group who did not engage in intentional unsafe sex, which suggests less autonomy regarding life itself. To the best of our knowledge, this is the first study to consider intentional unsafe sex in sexually compulsive men.

The Ethics of Barebacking: Implications of gay Men's Concepts of Right and Wrong in the Context of HIV

ABSTRACT. Recent compelling evidence that HIV medication may decrease the chances of HIV transmission and acquisition bring to light once again the issue of ethical responsibilities of those infected and uninfected when engaging in sexual intercourse. Using data collected in New York City from 120 gay men who engaged in “barebacking” (operationalized as intentional unprotected anal intercourse in an HIV-risk context), we analyzed participants’ attributions of responsibility to self and/or others and how these attributions varied by HIV status. Nearly all participants concurred that ethical judgments were involved and frequently offered a two-tiered response based on the right to individual decision-making and recognition of one's responsibility not to harm others. However, respondents merged the imperative for ethical action with an implicit requirement for communication, and their descriptions of sexual negotiations suggested ambiguities and conflicting assumptions. The result was a frequent tendency to shift the ethical burden to the partner rather than oneself in the context of diminished community dialogue about HIV. New scientific knowledge about HIV transmission offers opportunities for community discussions of sexual fulfillment, rights and responsibilities.

Inner Contradictions Among Men Who Bareback

Barebacking, or intentional unprotected anal intercourse when HIV transmission can occur, emerged as a descriptive term in the 1990s, and marked greater acceptance by gay and bisexual men of dispensing with condom use under certain circumstances. In an exploratory study of men who used Internet sites to meet partners and reported recent episodes of barebacking, respondents outlined numerous strategies they deployed to avoid HIV infection instead of universal condom use. However, in interviews many participants acknowledged uneasiness with the flaws in their chosen strategies, and the contradiction between their urgent desire to remain HIV-free and their sexual practices. For some, the dissonance between the conflicting cognitions could be resolved through self-justification, mental compartmentalization, or invincibility beliefs so that barebacking could continue. For this subpopulation, continued reiteration of cognitive-based prevention messages has the potential to reinforce rather than undermine their attachment to inadequate strategies for disease avoidance.

Are HIV-Negative Men Who Have Sex with Men and Who Bareback Concerned About HIV Infection? Implications for HIV Risk Reduction Interventions

The emergence of barebacking (intentional unprotected anal intercourse in situations where there is risk of HIV infection) among men who have sex with men (MSM) has been partially attributed to a decrease in HIV-related concerns due to improved anti-retroviral treatment. It is important to understand the level of concern these men have regarding HIV infection because it can affect their interest in risk reduction behaviors as well as their possible engagement in risk reduction interventions. As part of a study on MSM who use the Internet to seek sexual partners, 89 ethnic and racially diverse men who reported never having an HIV-positive test result completed an in-depth qualitative interview and a computer-based quantitative assessment. Of the 82 men who were asked about concerns of HIV infection during the qualitative interviews, 30 expressed "significant concern" about acquiring HIV, 42 expressed "moderate concern," and 10 expressed "minimal concern." Themes that emerged across the different levels of concern were their perceptions of the severity of HIV infection, having friends who were HIV positive, and their own vulnerability to HIV infection. However, these themes differed depending on the level of concern. Among the most frequently mentioned approaches to decrease risk of HIV infection, participants mentioned avoiding HIV-positive sex partners, limiting the number of partners with whom they barebacked, and not allowing partners to ejaculate inside their rectum. Findings suggest that many MSM who bareback would be amenable to HIV prevention efforts that do not depend solely on condom use.

Perceived Risks and Protective Strategies Employed by Young Men Who Have Sex With Men (YMSM) When Seeking Online Sexual Partners

This study examined the perceptions of risk by young men who have sex with men (YMSM) regarding meeting sexual partners through the Internet. Fifty-four YMSM ages 18–29 who reported engaging in bareback sex (“intentional unprotected anal intercourse in high-risk contexts”) completed a structured assessment and a face-to-face interview. Participants reported using the Internet to meet sexual partners at least once per week, having had multiple sexual partners in the past 2 months (M = 10.50, SD = 9.25), and engaging in occasions of unprotected receptive (M = 5.35, SD = 6.76) and insertive (M = 5.06, SD = 10.11) anal intercourse. A third of the sample reported having had unprotected sex with a partner who was serodiscordant or of unknown serostatus. Despite the obvious HIV risks, the most commonly perceived risks included threats to physical safety and difficulties trusting a stranger. Risk reduction strategies included leaving information about partner and whereabouts with a friend, meeting in a public place, and screening partner through online chatting. Those YMSM who meet partners online may be at risk for physical violence in addition to HIV or sexually transmitted infections (STIs). Public health campaigns should increase awareness of safety concerns when meeting sexual partners online and support YMSM's self-protective actions.

Barebacking: A Review of the Literature

This article synthesizes the peer-reviewed literature about barebacking, an HIV risk behavior that is generally understood as intentional unprotected anal intercourse between men where HIV transmission is a possibility. Of the 42 academic reports identified in the Anglophone literature, the greatest attention is given to U.S. publications and empirical projects. The variable nomenclature about barebacking is recognized and it is concluded that although epidemiological data suggest prevalence of barebacking varies across regions, time, and serostatus, the majority of men who have sex with men (MSM) do not intentionally seek out condomless anal sex. Findings show that macro-, meso-, interpersonal-, and intrapersonal level factors, such as homonegativity, community norms, partner intimacy, and drug use, converge to influence the likelihood that an individual will bareback. A conceptual framework to examine the reciprocal and dynamic relationships sustaining barebacking is proposed. In examining the theoretical and methodological limitations of the research about barebacking, the atheoretical nature of the studies, failure to report analyses conducted, and suboptimal measures are included among the study constraints. Furthermore, in research to date, the majority of participants have been white, urban, and gay-identified; thus, more research is needed to capture the viewpoints of diverse MSM communities. There has also been an overly individualistic focus on barebacking which needs to be tempered by greater consideration of the impact of macro- and meso-level factors upon MSM's behavior. With respect to programmatic responses, more culturally bound strategies are called for.

Predictors of identifying as a barebacker among high-risk New England HIV seronegative men who have sex with men.

Studies have found that between 14% and 46% of US men who have sex with men (MSM) consistently report "barebacking" behavior (i.e., intentional unprotected anal intercourse) with other men. This is of public health significance because MSM continue to constitute more than 50% of new HIV infections in the USA. Men who self-identify as barebackers may represent a different and unique subset of MSM with distinct HIV prevention needs. In 2007, 227 HIV seronegative MSM recruited through modified respondent-driven sampling completed an interviewer-administered survey which assessed barebacker identity (i.e., personally identifying with the barebacker scene), demographics, sexual risk behaviors, psychosocial variables, and drug/alcohol use. Bivariate and multivariable logistic regression procedures were used to examine predictors of barebacker identity in relation to HIV risk behavior. Overall, 31% of participants identified as a barebacker. In bivariate analyses, lower education (OR = 1.76; 95% CI = 0.99-3.13; p < 0.05), a current drinking problem (OR = 2.34, 95% CI = 1.29-4.23; p < 0.01), higher levels of HIV treatment optimism (OR = 1.06; 95% CI = 1.01-1.12; p < 0.05), meeting sexual partners at private sex parties (OR = 2.47; 95% CI = 1.28-4.74; p < 0.01) or at bars/cubs (OR = 1.97; 95% CI = 1.10-3.52; p < 0.05), and engaging in serodiscordant unprotected insertive anal sex (OR = 3.42; 95% CI = 1.27-9.21; p < 0.01) significantly predicted barebacker identification compared to those with no barebacker identification. In a multivariable model, barebackers were more likely to screen in for alcohol abuse (adjusted OR = 2.16; 95% CI = 1.09-4.27; p < 0.05) and engage in serodiscordant unprotected insertive anal sex (adjusted OR = 3.17; 95% CI = 1.09-9.20; p < 0.05) compared to their non-barebacker counterparts. No significant differences were found in serodiscordant unprotected receptive anal sex between barebackers and non-barebackers. These findings suggest that barebacker identity is related to intentional HIV sexual risk taking and alcohol abuse. Furthermore, strategic positioning (i.e., engaging in insertive rather than receptive sex) might be associated with barebacker identification and may indicate a harm-reduction strategy being used among some HIV-uninfected MSM to reduce their risk of becoming infected. Additional research is warranted to understand the social identity of barebacking among MSM in order to develop more nuanced prevention strategies.

The existence of a bug chasing subculture

This study attempted to authenticate the existence of a controversial subculture of gay men, the ‘bug chasers’, whose main attribute is an active desire to voluntarily contract the human immunodeficiency virus (HIV), and examine the tenacity with which this subculture actually searches for seroconversion. Using a quasi‐randomized survey of personal profiles, bug chasers were compared against barebackers, a culture of gay men that practice intentional unprotected anal intercourse. Bug chasers were authenticated as an observable subculture of barebackers where most reported apathy to the serostatus of their partner or an active want of a serodiscordant partner, and a preference towards practicing unprotected anal intercourse. As anticipated, two subgroups with varying tenacities were found within the sample of bug chasers. Apathetic chasers were found only to be in search of partners with sero‐ambiguous status. Ardent chasers were found only to be in search of certifiably serodiscordant partners.

Barebacking, the Internet, and Harm Reduction: An Intercept Survey with Gay and Bisexual Men in Los Angeles and New York City

Researchers have suggested that intentional unprotected anal intercourse (UAI) among gay and bisexual men (colloquially called barebacking), is on the rise. Further, they have linked this increase in barebacking to the growth of the Internet as a medium for men to meet sex partners. Data were used from large-scale gay, lesbian, and bisexual (GLB) community events in New York and Los Angeles collected between 2003 and 2004. In total 1178 men who have sex with men (MSM) responded to questions about the use of the Internet, willingness to have unplanned UAI, intentions toward planned UAI, and "barebacker identity." Compared to nonbarebackers, barebackers spent significantly more time on the Internet looking for sex and looking for dates. Further, HIV-positive barebackers specifically spent the most time online looking for dates. Further analyses of willingness and intentions to have UAI, and the specific sexual behaviors of self-identified barebackers, found evidence of strategic positioning and serosorting, both harm reduction strategies. These data suggest both HIV-positive and HIV-negative barebackers may be engaged in efforts to reduce the risk of HIV transmission when engaged in unprotected sex.

Barebacking websites: electronic environments for reducing or inducing HIV risk

Barebacking, or intentional unprotected anal intercourse (UAI), among men who have sex with men (MSM) has been a growing concern for the public health community because of UAIs link to HIV incidence and sexually transmitted infections (STIs). Men who bareback have created online spaces through websites that host thousands of profiles throughout the US and world. Adapting two domains from person-environment theory, this study contrasted the health messages surrounding the risks of UAI within two mainstream US-based barebacking websites. One website developed intensive systems to promote harm reduction, such as encouraging frequent HIV-testing, discussing STIs with partners, and limiting the number of partners. In contrast, the other site analysed negated the seriousness of HIV and STIs, which can have clear negative outcomes for patrons whom relied on this information. This analysis implicates the need to explore electronic environments as viable tools for HIV prevention and programme development.

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

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.

An Exploratory Study of Barebacking, Club Drug Use, and Meanings of Sex in Black and Latino Gay and Bisexual Men in the Age of AIDS

SUMMARY Current epidemiological trends demonstrate that Black and Latino men-who-have-sex-with-men (MSM) have increasingly disproportionate rates of HIV. The emergence of barebacking (intentional unprotected anal intercourse) and club drug use (cocaine, methamphetamine, GHB, ecstasy, ketamine) have posed a significant public health threat for MSM. This formative, behavioral multi-method investigation aims to examine barebacking, club drug use, and meanings of sex in Black and Latino gay and bisexual (BLGB) men. The data were drawn from the baseline assessment of a larger-scale longitudinal investigation (N = 450) of club drug use in gay and bisexual men from the New York Metropolitan area recruited from mainstream gay venues, AIDS service organizations, and public/commercial sex environments. Findings demonstrated that Black and Latino men were more likely to report an HIV-positive serostatus and identify as bisexual. Significant racial/ethnic differences were demonstrated in the use of club drugs. HIV-positive men reported significantly more frequent barebacking with HIV-positive partners. Latino men of HIV unknown status perceived greater benefits of barebacking. The qualitative data suggested specific cultural and phenomenological meanings ascribed to the act of bareback sex, club drug use, and the intersection of these behaviors.

Masculinity, Body Image, and Sexual Behavior in HIV-Seropositive Gay Men: A Two-Phase Formative Behavioral Investigation Using the Internet

The purpose of this study was to understand the synergistic relationships between conceptions of masculinity, body image, and sexual behavior in HIV-positive gay men. The data were drawn from a two-phase formative behavioral mixed methodologies investigation with the use of the Internet. Findings demonstrated that conceptions of masculinity were intimately linked to body image and sexual adventurism, such that men defined their masculinity by their physical appearance and sexual behavior. Further, the data support high levels of risk taking, including steroid use and intentional unprotected anal intercourse (barebacking), which correlated with the participants’ conception of physical masculinity. Clinical implications suggest that it is critical to examine the interaction that occurs between the individual’s gay, masculine, and HIV-positive identities as these appear to be overlapping realities that have an impact on the decisions and behaviors in which these men engage.

Barebacking among gay and bisexual men in New York City: explanations for the emergence of intentional unsafe behavior.

This study was undertaken to assess the frequency with which gay and bisexual men in New York City engage in intentional unprotected anal sex, or "barebacking," and to examine explanations about the emergence of barebacking. A total of 518 men completed a brief intercept survey. Of the 448 men who were familiar with the term "barebacking" 204 (45.5%) reported bareback sex in the past 3 months prior to assessment. HIV seropositive men were significantly more likely than HIV seronegative men to report this behavior and reported significantly more sexual partners with which they had engaged in intentional unprotected anal intercourse. Participants reported significantly more acts of seroconcordant bareback sex (intentional unprotected anal intercourse with a partner of the same HIV status) than those of serodiscordant bareback sex. Men who reported barebacking also reported significantly more benefits associated with this behavior. The Internet and the availability of sexually oriented chat rooms, HIV treatment advances, emotional fatigue regarding HIV, and the increased popularity of "club" drugs were commonly cited as reasons for the barebacking phenomenon.