AIDS and Behavior

, Volume 11, Issue 2, pp 277–287 | Cite as

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

  • Jeffrey T. ParsonsEmail author
  • David S. Bimbi
Original Paper


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.


Bareback Identity Sexual compulsivity Substance use Peer norms 



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.


  1. 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.CrossRefGoogle Scholar
  2. 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.PubMedGoogle Scholar
  3. 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.Google Scholar
  4. 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.CrossRefGoogle Scholar
  5. 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.PubMedCrossRefGoogle Scholar
  6. 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.CrossRefGoogle Scholar
  7. 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
  8. 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.PubMedCrossRefGoogle Scholar
  9. 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.PubMedCrossRefGoogle Scholar
  10. 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.Google Scholar
  11. 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.CrossRefGoogle Scholar
  12. 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.PubMedCrossRefGoogle Scholar
  13. Cadwell, S. (1991). Twice removed: The stigma suffered by gay men with AIDS. Smith College Studies in Social Work, 61, 236–246.Google Scholar
  14. 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.PubMedCrossRefGoogle Scholar
  15. Carballo-Dieguez, A. (2001). HIV, barebacking, and gay men’s sexuality, Circa 2001. Journal of Sex Education and Therapy, 26, 225–233.Google Scholar
  16. 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.PubMedCrossRefGoogle Scholar
  17. Clark, M. (1993). From gay men’s lives: Toward a more inclusive ecological vision. Journal of Men’s Studies, 1, 347–358.CrossRefGoogle Scholar
  18. 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.PubMedCrossRefGoogle Scholar
  19. 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
  20. 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.PubMedCrossRefGoogle Scholar
  21. 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.PubMedCrossRefGoogle Scholar
  22. Davis, M. (2002). HIV prevention rationalities and serostatus in the risk narratives of gay men. Sexualities, 5, 281–299.CrossRefGoogle Scholar
  23. 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.PubMedCrossRefGoogle Scholar
  24. Ekstrand, M. L. (1992). Safer sex maintenance among gay men: Are we making any progress? AIDS, 6, 875–877.PubMedCrossRefGoogle Scholar
  25. Fordham, S., & Ogbu, J. (1986). Black students’ school success: Coping with the burden of acting white. The Urban Review, 18, 176–206.CrossRefGoogle Scholar
  26. 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
  27. Gauthier, D. K., & Forsyth, C. J. (1999). Bareback sex, bug chasers, and the gift of death. Deviant Behavior, 20, 85–100.CrossRefGoogle Scholar
  28. Gendin, S. (1997, June). Riding bareback: Skin-on-skin sex been there, done that, want more. POZ, 64–65.Google Scholar
  29. Gendin, S. (1999, February). They shoot barebackers don’t they? Poz, 50.Google Scholar
  30. Gerrard, M., Gibbons, F. X., & Bushman, B. J. (1996). Relation between perceived vulnerability to HIV and precautionary sexual behavior. Psychological Bulletin, 119, 390–409.PubMedCrossRefGoogle Scholar
  31. 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.PubMedCrossRefGoogle Scholar
  32. 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.CrossRefGoogle Scholar
  33. 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.CrossRefGoogle Scholar
  34. 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.PubMedCrossRefGoogle Scholar
  35. 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.PubMedCrossRefGoogle Scholar
  36. 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.PubMedCrossRefGoogle Scholar
  37. 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
  38. 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.CrossRefGoogle Scholar
  39. Holmes, D., & Warner, D. (2005). The anatomy of forbidden desire: Men, penetration and semen exchange. Nursing Inquiry, 12, 10–20.PubMedCrossRefGoogle Scholar
  40. 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.Google Scholar
  41. 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.Google Scholar
  42. 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.PubMedCrossRefGoogle Scholar
  43. 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
  44. 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.PubMedCrossRefGoogle Scholar
  45. 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.PubMedCrossRefGoogle Scholar
  46. 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.PubMedCrossRefGoogle Scholar
  47. 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
  48. 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.PubMedCrossRefGoogle Scholar
  49. 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.PubMedCrossRefGoogle Scholar
  50. 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.CrossRefGoogle Scholar
  51. 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.PubMedCrossRefGoogle Scholar
  52. 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.PubMedCrossRefGoogle Scholar
  53. Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). Guilford Press: New York.Google Scholar
  54. 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.CrossRefGoogle Scholar
  55. 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.PubMedCrossRefGoogle Scholar
  56. Morton, T. A., & Duck, J. M. (2000, August). Social identity and media dependency in the Gay community. Communication Research, 27, 438–461.Google Scholar
  57. Muench, F., & Parsons, J. T. (2004). Sexual compulsivity and HIV: Identification and treatment. Focus, 19, 1–4.PubMedGoogle Scholar
  58. 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.CrossRefGoogle Scholar
  59. 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
  60. Parsons, J. T. (2005b). Motivating the unmotivated: A treatment model for barebackers. Journal of Gay and Lesbian Psychotherapy, 9(3/4), 133–152.CrossRefGoogle Scholar
  61. 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.PubMedCrossRefGoogle Scholar
  62. 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
  63. 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
  64. 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.PubMedCrossRefGoogle Scholar
  65. 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.CrossRefGoogle Scholar
  66. 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.PubMedCrossRefGoogle Scholar
  67. 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.CrossRefGoogle Scholar
  68. Ridge, D. T., Plummer, D. C., & Minichiello, V. (1994). Young gay men and HIV: Running the risk? AIDS Care, 6, 371–378.PubMedCrossRefGoogle Scholar
  69. 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.PubMedGoogle Scholar
  70. 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.PubMedGoogle Scholar
  71. 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
  72. 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.CrossRefGoogle Scholar
  73. Seibt, A. C., & Ross, M. W. (1995). Relationship between safe sex and acculturation into the gay subculture. AIDS Care, 7, 85–88.CrossRefGoogle Scholar
  74. Shoptaw, S., & Frosch, D. (2000). Substance abuse treatment as HIV prevention for men who have sex with men. AIDS and Behavior, 4, 193–203.CrossRefGoogle Scholar
  75. 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.PubMedCrossRefGoogle Scholar
  76. Silverstein, C., & Picano, F. (2003). Barebacking. In The joy of gay sex (3rd ed., pp. 1–2). New York: Harper Collins.Google Scholar
  77. 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
  78. Strub, S. (1997, June). Talking about sex in an intelligent way is tough. POZ, 16.Google Scholar
  79. 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.PubMedGoogle Scholar
  80. 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.PubMedCrossRefGoogle Scholar
  81. 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.CrossRefGoogle Scholar
  82. 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.PubMedCrossRefGoogle Scholar
  83. 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.CrossRefGoogle Scholar
  84. 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.CrossRefGoogle Scholar
  85. 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.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  1. 1.Department of Psychology, Hunter CollegeCity University of New YorkNew YorkUSA
  2. 2.Sub-program in Social/Personality Psychology, The Graduate CenterCity University of New YorkNew YorkUSA
  3. 3.Center for HIV/AIDS Educational Studies and Training (CHEST), Hunter CollegeCity University of New YorkNew YorkUSA

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