Archives of Sexual Behavior

, Volume 38, Issue 5, pp 754–764

Barebacking: A Review of the Literature

Original Paper

Abstract

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.

Keywords

Barebacking Homosexuality HIV/AIDS 

References

  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.PubMedCrossRefGoogle Scholar
  3. Berg, R. C. (2008). Barebacking among MSM Internet users. AIDS and Behavior, 12, 822–833.PubMedCrossRefGoogle Scholar
  4. Bimbi, D. S., & Parsons, J. T. (2005). Barebacking among Internet based male sex workers. Journal of Gay & Lesbian Psychotherapy, 9, 85–105.CrossRefGoogle Scholar
  5. Blechner, M. J. (2002). Intimacy, pleasure, risk, and safety: Discussion of Cheuvront’s ‘High-risk sexual behavior in the treatment of HIV-negative patients’. Journal of Gay & Lesbian Psychotherapy, 6, 27–33.CrossRefGoogle Scholar
  6. Bolding, G., Davis, M., Sherr, L., Hart, G., & Elford, J. (2004). Use of gay Internet sites and views about online health promotion among men who have sex with men. AIDS Care, 16, 993–1001.PubMedCrossRefGoogle Scholar
  7. Bull, S. S., McFarlane, M., & King, D. (2001). Barriers to HIV/STD prevention on the Internet. Health Education Research, 16, 661–670.PubMedCrossRefGoogle Scholar
  8. Carballo-Diéguez, A. (2001). HIV, barebacking, and gay men’s sexuality, circa 2001. Journal of Sex Education and Therapy, 26, 225–233.Google Scholar
  9. Carballo-Diéguez, 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
  10. Carballo-Diéguez, A., Dowsett, G. W., Ventuneac, A., Remien, R. H., Balan, I., Dolezal, C., et al. (2006). Cybercartography of popular internet sites used by New York City men who have sex with men interested in bareback sex. AIDS Education and Prevention, 18, 475–489.PubMedCrossRefGoogle Scholar
  11. Centers for Disease Control and Prevention (CDC). (2001). HIV/AIDS surveillance report, 13, 1–4.Google Scholar
  12. CDC. (2007, May). HIV/AIDS among men who have sex with men. Retrieved June 5, 2007 from http://www.cdc.gov/hiv/topics/msm/resources/factsheets/msm.htm.
  13. Cheuvront, J. P. (2002). High-risk sexual behavior in the treatment of HIV-negative patients. Journal of Gay & Lesbian Psychotherapy, 6, 7–25.CrossRefGoogle Scholar
  14. Cole, G. W. (2007). Barebacking: Transformations, dissociations, and the theatre of countertransference. Studies in Gender and Sexuality, 8, 49–68.Google Scholar
  15. Crossley, M. L. (2002). The perils of health promotion and the ‘barebacking’ backlash. Health, 6, 47–68.Google Scholar
  16. 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
  17. Dawson, A. G., Ross, M. W., Henry, D., & Freeman, A. (2005). Evidence of HIV transmission risk in barebacking men-who-have-sex-with-men: Cases from the Internet. Journal of Gay & Lesbian Psychotherapy, 9, 73–83.CrossRefGoogle Scholar
  18. Drescher, J. (2002). Barebacking: Psychotherapeutic and public health considerations. Journal of Gay & Lesbian Psychotherapy, 6, 1–5.CrossRefGoogle Scholar
  19. Elford, J., Bolding, G., Davis, M., Sherr, L., & Hart, G. (2007). Barebacking among HIV-positive gay men in London. Sexually Transmitted Diseases, 34, 93–98.PubMedCrossRefGoogle Scholar
  20. Forstein, M. (2002). Commentary on Cheuvront’s ‘High-risk sexual behavior in the treatment of HIV-negative patients’. Journal of Gay & Lesbian Psychotherapy, 6, 35–43.CrossRefGoogle Scholar
  21. Gauthier, D. K., & Forsyth, C. J. (1999). Bareback sex, bug chasers, and the gift of death. Deviant Behavior, 20, 85–100.CrossRefGoogle Scholar
  22. 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, 6, 29–36.CrossRefGoogle Scholar
  23. Graydon, M. (2007). Don’t bother to wrap it: Online giftgiver and bugchaser newsgroups, the social impact of gift exchanges and the ‘carnivalesque’. Culture, Health & Sexuality, 9, 277–292.CrossRefGoogle Scholar
  24. 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
  25. Grov, C. (2006). Barebacking websites: Electronic environments for reducing or inducing HIV risk. AIDS Care, 18, 990–997.PubMedCrossRefGoogle Scholar
  26. Grov, C., DeBusk, J. A., Bimbi, D. S., Golub, S. A., Nanin, J. E., & Parsons, J. T. (2007). Barebacking, the Internet, and harm reduction: An intercept survey with gay and bisexual men in Los Angeles and New York City. AIDS and Behavior, 11, 527–536.PubMedCrossRefGoogle Scholar
  27. Grov, C., & Parsons, J. T. (2006). Bug chasing and gift giving: The potential for HIV transmission among barebackers on the Internet. AIDS Education and Prevention, 18, 490–503.PubMedCrossRefGoogle Scholar
  28. Haig, T. (2006). Bareback sex, masculinity, silence, and the dilemmas of gay health. Canadian Journal of Communication, 31, 859–877.Google Scholar
  29. Halkitis, P. N. (2007). Behavioral patterns, identity, and health characteristics of self-identified barebackers: Implications for HIV prevention and intervention. Journal of GLBT Health Research, 3, 37–48.CrossRefGoogle Scholar
  30. 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, 367–378.PubMedCrossRefGoogle Scholar
  31. 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, 351–358.PubMedCrossRefGoogle Scholar
  32. Halkitis, P. N., Wilton, L., & Drescher, J. (2005a). Introduction: Why barebacking? Journal of Gay & Lesbian Psychotherapy, 9, 1–8.CrossRefGoogle Scholar
  33. Halkitis, P. N., Wilton, L., & Drescher, J. (Eds.). (2005b). Barebacking: Psychosocial and public health approaches. New York: Haworth Medical Press.Google Scholar
  34. Halkitis, P. N., Wilton, L., & Galatowitsch, P. (2005c). What’s in a term? How gay and bisexual men understand barebacking. Journal of Gay & Lesbian Psychotherapy, 9, 35–48.CrossRefGoogle Scholar
  35. Halkitis, P. N., Wilton, L., Wolitski, R. J., Parsons, J. T., Hoff, C. C., & Bimbi, D. S. (2005d). Barebacking identity among HIV-positive gay and bisexual men: Demographic, psychological, and behavioral correlates. AIDS, 19(Suppl 1), S27–S35.PubMedGoogle Scholar
  36. Holmes, D., & O’Byrne, P. (2006). Bareback sex and the law: The difficult issue of HIV status disclosure. Journal of Psychosocial Nursing, 44(7), 26–33.Google Scholar
  37. Holmes, D., O’Byrne, P., & Gastaldo, D. (2006). Raw sex as limit experience: A Foucauldian analysis of unsafe anal sex between men. Social Theory & Health, 4, 319–333.CrossRefGoogle Scholar
  38. Holmes, D., & Warner, D. (2005). The anatomy of a forbidden desire: Men, penetration and semen exchange. Nursing Inquiry, 12, 10–20.PubMedCrossRefGoogle Scholar
  39. Huebner, D. M., Proescholdbell, R. J., & Nemeroff, C. J. (2006). Do gay and bisexual men share researchers’ definition of barebacking? Journal of Psychology & Human Sexuality, 18, 67–77.CrossRefGoogle Scholar
  40. Junge, B. (2002). Bareback sex, risk, and eroticism: Anthropological themes (re-)surfacing in the post-AIDS era. In E. Lewin & W. L. Leap (Eds.), Out in theory: The emergence of lesbian and gay anthropology (pp. 186–221). Chicago: University of Illinois Press.Google Scholar
  41. Léobon, A. (2003). Barebacking et culture de risque: Les usages sociaux d’Internet et le dévelopment d’une culture de risque u sein de la communauté homosexuelle [Barebacking and risk culture: Social uses of the Internet and development of a culture of risk within the homosexual community]. Le Journal du Sida, 155, 16.Google Scholar
  42. Mansergh, G., Marks, G., Colfax, G. N., 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
  43. Minium, E. W., King, B. M., & Bear, G. (1993). Statistical reasoning in psychology and education (3rd ed.). New York: Wiley.Google Scholar
  44. Moskowitz, D. A., & Roloff, M. E. (2007a). The existence of a bug chasing subculture. Culture, Health & Sexuality, 9, 347–357.CrossRefGoogle Scholar
  45. Moskowitz, D. A., & Roloff, M. E. (2007b). The ultimate high: Sexual addiction and the bug chasing phenomenon. Sexual Addiction & Compulsivity, 14, 21–40.CrossRefGoogle Scholar
  46. O’Hara, S. (1997). Autopornography. New York: Haworth.Google Scholar
  47. Orange, D. M. (2002). High-risk behavior or high-risk systems? Discussion of Cheuvront’s ‘High-risk sexual behavior in the treatment of HIV-negative patients’. Journal of Gay & Lesbian Psychotherapy, 6, 45–50.CrossRefGoogle Scholar
  48. 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 Academic/Plenum Publishers.Google Scholar
  49. Parsons, J. T. (2005b). Motivating the unmotivated: A treatment model for barebackers. Journal of Gay & Lesbian Psychotherapy, 9, 129–148.CrossRefGoogle Scholar
  50. Parsons, J. T., & Bimbi, D. S. (2007). Intentional unprotected anal intercourse among who have sex with men: Barebacking—from behavior to identity. AIDS and Behavior, 11, 277–287.PubMedCrossRefGoogle Scholar
  51. Parsons, J. T., Schrimshaw, E. W., Wolitski, R. J., Halkitis, P. N., Purcell, D. W., Hoff, C. C., et al. (2005). Sexual harm reduction practices of HIV-seropositive gay and bisexual men: Serosorting, strategic positioning, and withdrawal before ejaculation. AIDS, 19(Suppl. 1), S13–S25.PubMedCrossRefGoogle Scholar
  52. Race, K. D. (2003). Revaluation of risk among gay men. AIDS Education and Prevention, 15, 369–381.PubMedCrossRefGoogle Scholar
  53. Rhodes, S. D. (2004). Hookups or health promotion? An exploratory study of a chat room- based HIV prevention intervention for men who have sex with men. AIDS Education and Prevention, 16, 315–327.PubMedCrossRefGoogle Scholar
  54. 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
  55. Riggs, D. W. (2006). ‘Serosameness’ or ‘serodifference’? Resisting polarized discourses of identity and rationality in the context of HIV. Sexualities, 9, 409–422.CrossRefGoogle Scholar
  56. Shernoff, M. (2004). Barebacking and challenges to therapeutic neutrality. Journal of Gay & Lesbian Social Services, 17(4), 59–68.CrossRefGoogle Scholar
  57. Shernoff, M. (2005). Without condoms: Unprotected sex, gay men and barebacking. New York: Routledge.Google Scholar
  58. Shernoff, M. (2006). Condomless sex: Gay men, barebacking, and harm reduction. Social Work, 51, 106–113.PubMedGoogle Scholar
  59. Sorrell, J. M., & Redmand, G. M. (1995). Interviews in qualitative nursing research: Differing approaches for ethnographic and phenomenological studies. Journal of Advanced Nursing, 26, 1117–1122.CrossRefGoogle Scholar
  60. 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, 287–300.PubMedCrossRefGoogle Scholar
  61. Taéron, C. (2003). Bareback: En quête de raisons et de sense [Bareback: A search for reason]. Le Journal de Sida, 155, 12–23.Google Scholar
  62. 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, 467–482.CrossRefGoogle Scholar
  63. Tewksbury, R. (2006). “Click here for HIV”: An analysis of Internet-based bug chasers and bug givers. Deviant Behavior, 27, 379–395.CrossRefGoogle Scholar
  64. Tomso, G. (2004). Bug chasing, barebacking, and the risks of care. Literature and Medicine, 23, 88–111.PubMedCrossRefGoogle Scholar
  65. Wilton, L., Halkitis, P. N., English, G., & Roberson, M. (2005). 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. Journal of Gay & Lesbian Psychotherapy, 9, 49–72.CrossRefGoogle Scholar
  66. Wolitski, R. J. (2005). The emergency of barebacking among gay and bisexual men in the United States: A public health perspective. Journal of Gay & Lesbian Psychotherapy, 9, 9–34.CrossRefGoogle Scholar
  67. Yep, G. A., Lovaas, K. E., & Pagonis, A. V. (2002). The case of riding ‘bareback’: Sexual practices and the paradoxes of identity in the era of AIDS. Journal of Homosexuality, 42, 1–14.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Norwegian Knowledge Center for the Health ServicesOsloNorway

Personalised recommendations