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.
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Abdool Karim, Q., Abdool Karim, S. S., Frohlich, J. A., Grobler, A. C., Baxter, C., Mansoor, L. E., … The CAPRISA 004 Trial Group. (2010). Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science, 329, 1168–1174.
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.
Berg, R. C. (2008). Barebacking among MSM internet users. AIDS and Behavior, 12, 822–833.
Berg, R. C. (2009). Barebacking: A review of the literature. Archives of Sexual Behavior, 38, 754–764.
Berry, M., Raymond, H. F., Kellogg, T., & McFarland, W. (2008). The Internet, HIV serosorting and transmission risk among men who have sex with men, San Francisco. AIDS, 22, 787–789.
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.
Carballo-Diéguez, A., Dowsett, G. W., Ventuneac, A., Remien, R. H., Balán, I., Dolezal, C., … Lin, P. (2006). Cybercartography of popular Internet sites used by New York City MSM interested in bareback sex. AIDS Education and Prevention, 18, 475–489.
Carballo-Diéguez, A., Frasca, T., Dolezal, C., & Balan, I. (2012). Will gay and bisexually active men at high risk of infection use over-the-counter rapid HIV tests to screen sexual partners? Journal of Sex Research. doi:10.1080/00224499.2011.647117.
Carballo-Diéguez, A., Ventuneac, A., Bauermeister, J., Dowsett, G. W., Dolezal, C., Remien, R. H., … Rowe, M. S. (2009). Is “bareback” a useful construct from a primary HIV-prevention perspective? Definitions, identity, and research. Culture, Health & Sexuality, 11, 51–65.
Carballo-Diéguez, A., Ventuneac, A., Dowsett, G. W., Balán, I. C., Bauermeister, J., Remien, R. H., … Mabragaña, M. (2011). Sexual pleasure and intimacy among men who engage in “bareback sex”. AIDS and Behavior, 15, S57–S65.
Cassels, S., Menza, T. W., Goodreau, S. M., & Golden, M. R. (2009). HIV serosorting as a harm reduction strategy: Evidence from Seattle, Washington. AIDS, 23, 2497–2506.
Cheuvront, J. P. (2002). High-risk sexual behavior in the treatment of HIV-negative patients. Journal of Gay & Lesbian Psychotherapy, 6, 7–25.
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.
Davis, M., Hart, G., Bolding, G., Sherr, L., & Elford, J. (2006). Sex and the Internet: Gay men, risk reduction, and serostatus. Culture, Health, & Sexuality, 8, 161–174.
Eaton, L. A., Kalichman, S. C., O’Connell, D. A., & Karchner, W. D. (2009). A strategy for selecting sexual partners believed to pose little/no risks for HIV: Serosorting and its implications for HIV transmission. AIDS Care, 21, 1279–1288.
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.
Fisher, J. D., & Fisher, W. A. (2000). Theoretical approaches to individual-level change in HIV risk behavior. In J. Peterson & R. DiClimente (Eds.), Handbook of HIV prevention (pp. 1–55). New York: Kluwer/Plenum.
Frost, D. M., Stirratt, M. J., & Ouellette, S. C. (2008). Understanding why gay men seek HIV-seroconcordant partners: Intimacy and risk reduction motivations. Culture, Health & Sexuality, 10, 513–527.
Gauthier, D. K., & Forsyth, C. J. (1999). Bareback sex, bug chasers, and the gift of death. Deviant Behavior, 20, 85–100.
Gold, R. S., & Skinner, M. J. (1996). Judging a book by its cover: Gay men’s use of perceptible characteristics to infer antibody status. International Journal of STD and AIDS, 7, 39–43.
Gold, R. S., Skinner, M. J., & Hinchy, J. (1999). Gay men’s stereotypes about who is HIV infected: A further study. International Journal of STD and AIDS, 10, 600–605.
Grant, R. M., Lama, J. R., Anderson, P. L., McMahan, V., Liu, A. Y., Vargas, L., … The iPrex Study Team. (2010). Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. New England Journal of Medicine, 363, 2587–2599.
Grov, C. (2006). Barebacking websites: Electronic environments for reducing or inducing HIV risk. AIDS Care, 18, 990–997.
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.
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.
Halkitis, P. N., Parsons, J. T., & Stirrat, M. (2001). A double epidemic: Crystal methamphetamine drug use in relation to HIV transmission among gay men. Journal of Homosexuality, 41, 17–35.
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, 351–357.
Halkitis, P. N., Wilton, L., & Galatowitsch, P. (2005). What’s in a term? How gay and bisexual men understand barebacking. Journal of Gay & Lesbian Psychotherapy, 9, 35–48.
Hruschka, D. J., Schwartz, D., John, St. D., Picone-Decaro, E., Jenkins, R. A., & Carey, J. W. (2004). Reliability in coding open-ended data: Lessons learned from HIV behavioral research. Field Methods, 16, 307–331.
Huebner, D. M., Proescholdbell, R. J., & Nemeroff, C. J. (2006). Do gay and bisexual men share researchers’ definitions of barebacking? Journal of Psychology & Human Sexuality, 18, 67–77.
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.
Marks, G., Millett, G. A., Bingham, T., Lauby, J., Murrill, C. S., & Stueve, A. (2010). Prevalence and protective value of serosorting and strategic positioning among Black and Latino men who have sex with men. Sexually Transmitted Diseases, 37, 325–327.
Marques, J. F., & McCall, C. (2005). The application of interrater reliability as a solidification instrument in a phenomenological study. The Qualitative Report, 10, 439–462.
McGowan, I. (2011). Rectal microbicides: Can we make them and will people use them? AIDS and Behavior, 15, S66–S71.
Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people to change (2nd ed.). New York: Guilford Press.
Morin, S. F., Shade, S. B., Steward, W. T., Carrico, A. W., Remien, R. H., Rotheram-Borus, M. J., … Chesney, M. A. (2008). A behavioral intervention reduces HIV transmission risk by promoting sustained serosorting practices among HIV-infected men who have sex with men. Journal of Acquired Immune Deficiency Syndromes, 49, 544–551.
Morisky, D. E., Ang, A., Colyi, A., & Tiglao, T. V. (2004). A model HIV/AIDS risk reduction program in the Philippines: A comprehensive community-based approach through participatory action research. Health Promotion International, 19, 69–76.
Morse, J. M., Barrett, M., Mayan, M., Olson, K., & Spiers, J. (2002). Verification strategies for establishing reliability and validity in qualitative research. International Journal of Qualitative Methods, 1(2), Article 2. Retrieved from http://www.ualberta.ca/~iiqm/backissues/1_2Final/html/morse.html.
Nodin, N., Carballo-Diéguez, A., Ventureac, A., Balán, I., & Remien, R. (2008). Knowledge and acceptability of alternative HIV prevention bio-medical products among MSM who bareback. AIDS Care, 20, 106–115.
Parsons, J. T. (2005). Motivating the unmotivated: A treatment model for barebackers. Journal of Gay & Lesbian Psychotherapy, 9, 129–148.
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.
Parsons, J. T., Severino, J., Nanin, J., Punzalan, J. C., von Sternberg, K., Missildine, W., & Frost, D. (2006). Positive, negative, unknown: Assumptions of HIV status among HIV-positive men who have sex with men. AIDS Education and Prevention, 18, 139–149.
Prochaska, J. O., Redding, C. A., Harlow, L. L., Rossi, J. S., & Velicer, W. F. (1994). The transtheoretical model of change and HIV prevention: A review. Health Education and Behavior, 21, 471–486.
Rhodes, S. D., Hergenrather, K. C., Duncan, J., Ramsey, B., Yee, L. J., & Wilkin, A. M. (2007). Using community-based participatory research to develop a chat room-based HIV prevention intervention for gay men. Progress in Community Health Partnerships: Research, Education, and Action, 1, 175–184.
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.
Shernoff, M. (2006). Condomless sex: Gay men, barebacking, and harm reduction. Social Work, 51, 106–113.
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.
Thompson, C., McCaughan, D., Cullum, N., Sheldon, T. A., & Raynor, P. (2004). Increasing the visibility of coding decisions in team-based qualitative research in nursing. International Journal of Nursing Studies, 41, 15–20.
Tomso, G. (2004). Bug chasing, barebacking, and the risks of care. Literature and Medicine, 23, 88–111.
Vanable, P. A., Ostrow, D. G., McKirnan, D. J., Taywaditep, K. J., & Hope, B. A. (2000). Impact of combination therapies on HIV risk perceptions and sexual risk among HIV-positive and HIV-negative gay and bisexual men. Health Psychology, 19, 134–145.
Wilson, D. P., Regan, D. G., Heymer, K. J., Jin, F., Prestage, G. P., & Grulich, A. E. (2010). Serosorting may increase the risk of HIV acquisition among men who have sex with men. Sexually Transmitted Diseases, 37, 13–17.
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.
Wohlfeiler, D., & Potterat, J. (2005). Using gay men’s sexual networks to reduce sexually transmitted disease (STD)/human immunodeficiency virus (HIV) transmission. Sexually Transmitted Diseases, 32(10), S48–S52.
Wolitski, R. J. (2005). The emergence of barebacking among gay and bisexual men in the United States: A public health perspective. Journal of Gay & Lesbian Psychotherapy, 9, 9–34.
Wolitski, R. J., & Branson, B. M. (2002). “Gray area behaviors” and partner selection strategies: Working toward a comprehensive approach to reducing the sexual transmission of HIV. In A. O’Leary (Ed.), Beyond condoms: Alternative approaches to HIV prevention (pp. 173–198). New York: Kluwer/Plenum.
This research was supported by a grant (R01 MH69333; PI: Alex Carballo-Diéguez, Ph.D.) from the United States National Institute of Mental Health (NIMH) and by a center NIMH grant (P30-MH43520; PI: Anke A. Ehrhardt, Ph.D.) to the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIMH or the NIH.
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Balán, I.C., Carballo-Diéguez, A., Ventuneac, A. et al. Are HIV-Negative Men Who Have Sex with Men and Who Bareback Concerned About HIV Infection? Implications for HIV Risk Reduction Interventions. Arch Sex Behav 42, 279–289 (2013). https://doi.org/10.1007/s10508-011-9886-2
- Gay men
- HIV prevention
- HIV concerns
- HIV optimism
- Raw sex