Abstract
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.
Similar content being viewed by others
References
Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2006. Vol. 18. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2008.
Berg RC. Barebacking among MSM Internet users. AIDS Behav. 2008;12:822–833.
Grov C, DeBusk JA, Bimbi DS, Golub SA, Nanin JE, Parsons JT. Barebacking, the Internet, and harm reduction: an intercept survey with gay and bisexual men in Los Angeles and New York City. AIDS Behav. 2007;11:527–536 doi:10.1007/s10461-007-9234-7.
Halkitis PN. Behavioral patterns, identity, and health characteristics of self-identified barebackers: implications for HIV prevention and intervention. J LGBT Health Res. 2007;3:37–48 doi:10.1300/J463v03n01_05.
Halkitis PN, Parsons JT, Wilton L. Barebacking among gay and bisexual men in New York City: explanations for the emergence of intentional unsafe behavior. Arch Sex Behav. 2003;32:351–357 doi:10.1023/A:1024095016181.
Mansergh G, Marks G, Colfax GN, Guzman R, Radar M, Buchbinder S. “Barebacking” in a diverse sample of men who have sex with men. AIDS. 2002;16:653–659 doi:10.1097/00002030-200203080-00018.
Halkitis PN, Parsons JT. Intentional unsafe sex (barebacking) among HIV-positive gay men who seek sexual partners on the Internet. AIDS Care. 2003;15:367–378 doi:10.1080/0954012031000105423.
Halkitis PN, Wilton L, Wolitsky RJ, Parsons JT, Hoff CC, Bimbi DS. Barebacking identity among HIV-positive gay and bisexual men: demographic, psychological, and behavioral correlates. AIDS. 2005;19:s27–s35.
Kippax S, Race K. Sustaining safer sex practice: twenty years on. Soc Sci Med. 2003;51:2–12.
Van de Ven P, Kippax S, Crawford J, Rawstorne P, Prestage G, Grulich A, et al. In a minority of gay men, sexual risk practice indicates strategic positioning for perceived risk reduction rather than unbridled sex. AIDS Care. 2002;14:471–480 doi:10.1080/09540120208629666.
Wolitski RJ. The emergence of barebacking among gay and bisexual men in the United States: a public health perspective. J Gay Lesbian Psychother. 2005;9:9–34 doi:10.1300/J236v09n03_02.
Parsons JT, Bimbi DS. Intentional unprotected anal intercourse among men who have sex with men: barebacking—from behavior to identity. AIDS Behav. 2007;11:277–287 doi:10.1007/s10461-006-9135-1.
Heckathorn D. Respondent-driven sampling: a new approach to the study of hidden populations. Soc Probl. 1997;44:174–199 doi:10.1525/sp.1997.44.2.03x0221m.
Mimiaga MJ, Goldhammer H, Belanoff C, Tetu AM, Mayer KH. Men who have sex with men: perceptions about sexual risk, HIV and sexually transmitted disease testing, and provider communication. Sex Transm Dis. 2007;34:113–119 doi:10.1097/01.olq.0000225327.13214.bf.
Sanchez T, Finlayson T, Drake A, Behel S, Cribbin M, Dinenno E, et al. Human Immunodeficiency Virus (HIV) risk, prevention, and testing behaviors—United States, National HIV Behavioral Surveillance System: men who have sex with men, November 2003-April 2005. MMWR Surveill Summ. 2006;55:1–16.
Ewing JA. Detecting alcoholism. The CAGE questionnaire. JAMA. 1984;252:1905–1907 doi:10.1001/jama.252.14.1905.
Knowlton R, McCusker J, Stoddard A, Zapka J, Mayer K. The use of the CAGE questionnaire in a cohort of homosexually active men. J Stud Alcohol. 1994;55:692–694.
Mayfield D, McLeod G, Hall P. The CAGE questionnaire: validation of a new alcoholism screening instrument. Am J Psychiatry. 1974;131:1121–1123.
U.S. Department of Health and Human Services. CES-D Scale. Bethesda, MD: Department of Health and Human Services & National Institute of Health; 2004.
Van de Ven P, Crawford J, Kippax S, Knox S, Prestage G. A scale of optimism-skepticism in the context of HIV treatments. AIDS Care. 2000;12:171–176 doi:10.1080/09540120050001841.
Catania JA, Coates TJ, Kegeles S. A test of the AIDS Risk Reduction Model: psychosocial correlates of condom use in the AMEN Cohort Survey. Health Psychol. 1994;13:548–555 doi:10.1037/0278-6133.13.6.548.
Afifi AA, Clark V, May S. Computer-Aided Multivariate Analysis, Fourth Edition. New York: Chapman and Hall/CRC; 2004.
Crossley ML. Making sense of ‘barebacking’: gay men’s narratives, unsafe sex and the ‘resistance habitus’. Br J Soc Psychol. 2004;43:225–244 doi:10.1348/0144666041501679.
Weeks J. Invented Moralities: Sexual Values in an Age of Uncertainty. New York: Columbia University Press; 1995.
Crossley ML. The perils of health promotion and the ‘barebacking’ backlash. Health. 2002;6:47–68.
Vincke J, Bolton R, De Vleeschouwer P. The cognitive structure of the domain of safe and unsafe gay sexual behaviour in Belgium. AIDS Care. 2001;13:57–70 doi:10.1080/09540120020018189.
Hogg MA, Abrams D. Social Identifications: A Social Psychology of Intergroup Relations and Group Processes. New York: Routledge; 1988.
Tajfel H, Turner J. The social identity theory of intergroup behavior. In: Worchel S, Austin W, eds. Psychology of Intergroup Relations. Chicago: Nelson-Hall; 1986:7–24.
Koblin BA, Husnik MJ, Colfax G, Huang Y, Madison M, Mayer K, et al. Risk factors for HIV infection among men who have sex with men. AIDS. 2006;20:731–739 doi:10.1097/01.aids.0000216374.61442.55.
Stall R, Paul PJ, Greenwwod G, et al. Alcohol use, drug use and alcohol-related problems among men who have sex with men: the Urban Men’s Health Study. Addiction. 2001;96:1589–1601 doi:10.1046/j.1360-0443.2001.961115896.x.
Clatts MC, Goldsamt LA, Yi H. An emerging HIV risk environment: a preliminary epidemiological profile of an MSM POZ Party in New York City. Sex Transm Infect. 2005;81:373–376 doi:10.1136/sti.2005.014894.
Dilley JW, Wood WJ, McFarland W. Are advances in treatment changing views about high-risk sex. N Engl J Med. 1997;337:501–502 doi:10.1056/NEJM199708143370715.
Kalichman SC, Nachimson D, Cherry C, Williams E. AIDS treatment advances and behavioral prevention setbacks: preliminary assessment of reduced perceived threat of HIV-AIDS. Health Psychol. 1998;17:546–550 doi:10.1037/0278-6133.17.6.546.
Kelly JA, Otto-Salaj LL, Sikkema KJ, Pinkerton SD, Bloom FR. Implications of HIV treatment for behavioral research on AIDS: protease inhibitors and new challenges in HIV secondary prevention. Health Psychol. 1998;17:310–319 doi:10.1037/0278-6133.17.4.310.
Vanable PA, Ostrow DG, McKirnan DJ, Taywaditep KJ, Hope BA. Impact of combination therapies on HIV risk perceptions and sexual risk among HIV-positive and HIV-negative gay and bisexual men. Health Psychol. 2000;19:134–145 doi:10.1037/0278-6133.19.2.134.
Suarez T, Miller J. 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. Arch Sex Behav. 2001;30:287–300 doi:10.1023/A:1002700130455.
Carballo-Diegez A, Stein Z, Saez H, Dolezal C, Nieves-Rosa L, Diaz F. Frequent use of lubricants for anal sex among men who have sex with men: the HIV prevention potential of a microbicidal gel. Am J Public Health. 2000;90:1117–1120.
Marks G, Mansergh G, Crepaz N, Murphy S, Miller LC, Appleby PR. Future HIV prevention options for men who have sex with men: intention to use a potential microbicide during anal intercourse. AIDS Behav. 2000;4:279–286 doi:10.1023/A:1009572919712.
Liu AY, Hittredge PV, Vittinghoff E, Raymond HF, Ahrens K, Matheson T, et al. Limited knowledge and use of HIV-post- and pre-exposure prophylaxis among gay and bisexual men. J Acquir Immune Defic Syndr. 2008;47:241–247.
Mimiaga MJ, Case P, Johnson CV, Safren SA, Mayer KH. Pre-exposure antiretroviral prophylaxis (PrEP) attitudes in high risk Boston area MSM: limited knowledge and experience, but potential for increased utilization after education. J Acquir Immune Defic Syndr 2008; in press.
Voetsch AC, Heffelfinger JD, Begley EB, Jafa-Bhushan K, Sullivan PS. Knowledge and use of preexposure and postexposure prophylaxis among attendees of minority gay pride events, 2005 through 2006. J Acquir Immune Defic Syndr. 2007;46:378–380.
Nodin N, Carballo-Diegez A, Ventuneac AM, Balan IC, Remien R. Knowledge and acceptability of alternative HIV prevention bio-medical products among MSM who bareback. AIDS Care. 2008;20:106–115 doi:10.1080/09540120701449096.
Acknowledgments
Support for this manuscript came from an Office of AIDS Research supplement to grant number R01MH068746 from the National Institute of Mental Health and from the Lifespan/Tufts/Brown University Center for AIDS Research grant NIH P30 AI42853.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Reisner, S.L., Mimiaga, M.J., Case, P. et al. Predictors of Identifying as a Barebacker among High-Risk New England HIV Seronegative Men Who Have Sex with Men. J Urban Health 86, 250–262 (2009). https://doi.org/10.1007/s11524-008-9333-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11524-008-9333-4