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Hooked Up: Exploring HIV Disclosure Online

September 28, 2013

Some hook-up sites for gay men make it easy to discuss HIV status; others just muddy the waters. But how reliable is the data for deciding what sex to have, with whom and how safely? And how does barebacking fit in? Bob Leahy looks at two popular sites and arrives at some surprising conclusions.

How much do we know about disclosure on the internet? Not much if we look for published research on how guys communicate for sex in 2013 or how frequently they reveal their HIV status in a meaningful way or even how guys use their profiles to get what they are looking for.

And how often does reliance on the efficacy of profiles put negative guys at risk? We just don't know. But in an age where HIV researchers have seemingly studied virtually everything that moves, the most popular way in which gays hook up and its sexual health implications seems largely overlooked. So we must rely a lot on what we observe ourselves and on other empirical evidence.

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While online has become an important venue for disclosure for those brave enough to do so, and in fact some sites make that easier to do, disclosure doesn't take place only here. After all, some of these discussions are left to when men meet. But hook-up sites can provide opportunities to select partners by HIV status (serosort) and in fact appear to be used extensively for this purpose. Not that serosorting in this manner doesn't rule out all the pitfalls involved in questionable assumptions, ambiguous language or the possibility of poz guys in particular encountering stigma or hurtful behavior. But at their best the sites offer opportunities for sex free of worries about status issues, the absence of which many would argue makes for hot sex indeed.

In any event, to gain a broader perspective, I looked at how disclosure issues play out on two busy sites popular with gay men -- Squirt.org. and BarebackRT.com. Both have tens of thousands of users, are free for the basic service but charge $13 or so a month for a package of more advanced features which make hooking up smoother.

I decided to look at a manageable 32 random profiles from each site, using in each case a Toronto-based sample, in part because the rate of HIV infections, and arguably propensity for disclosure, is high in gay men there. It is also a place where the chance of poz and neg guys interacting sexually is higher. The result is a survey which lacks scientific rigor but nevertheless sheds some light on how we tackle disclosure online and whether that process appears effective.


Sampling Squirt

Squirt.com

Squirt is owned by the same folks that bring you the LGBT paper and website Xtra! Based in Toronto, it's got a huge number of members from around the world, and includes lots of video content that users have provided of themselves in action, plus the usual stack of photo images. Some of these are locked and access has to be requested directly from the user. Thus the identity of a user can be well protected unless he chooses to identify himself by way of face pictures and the like.

Camming is also popular on Squirt.

A key problem with Squirt from a sexual health point of view is that it does not have a field which permits users to state their HIV status: instead it asks members to indicate whether they practice safer sex always, usually, never or rather not say. None of this, of course, is particularly helpful.

On to who is on it. Of the sample of 32 Toronto-based members whose profile was reviewed, no less than 25 indicated they "always" practiced safer sex. Does that jive with what we know about how often men who have sex with men dispense with condoms? Not at all; statements like these may be pure window dressing or more charitably, reflect men's intentions rather than their actual practices. In any event, of the seven who indicated they did not always practice safer sex, five indicated a specific interest in barebacking. One member of the 32 indicated he never practiced safer sex.

But how do you define safer sex?

Only two out of the 32 (both checked "usually" have safer sex) mentioned poz guys in the list of the kind of men they preferred. There was some stigmatizing language throughout the profiles of those who "always" practiced safer sex, with more than a few instances of men seeking "clean" partners. Many poz men find the use of that word derogatory.

It's not surprising that in this kind of environment it is not hard to find examples of both stigma and lack of sexual health education. One Squirt member provided evidence of both in this exchange between a positive top (him) and a supposedly negative bottom.

Top: Check out my private photos. Click here to see them.

Bottom: Yes, I would love to swallow your cum

Top: love to have that happen but I'm poz/undetectable. It's safe but is my status a problem for you?

Bottom: Maybe you can just suck me then. I am almost 7 cut, clean and safe.

Oy vey! Poz guys require a thick skin if they are to declare their status in chat once contact has been made. The general consensus is that outright rejection after a negative man has initially shown interest is in the range of 50%, however safe the sex contemplated.

Searching for something special? Squirt can help you. While Squirt is hardly a bareback site, but leans perhaps towards the vanilla, poz users can search for others seeking poz guys or those looking for barebacking, as an example.

And barebacking certainly seems popular. A search of all Toronto member profiles indicates no less than 2,017 members seeking barebacking opportunities. Given we do not know their status, it's hard to know whether these are mostly poz guys seeking poz guys, neg guys seeking poz guys or perhaps includes neg guys on PrEP who consider themselves not at risk.

All this speaks to a minefield, where the status of one's Squirt partner may well be a mystery until further online or in-person discussions occur, if at all. For poz guys wishing to serosort, though, there are opportunities to do so but the site is not particularly well suited to it. It thus may well be that such poz guys are better suited to a site geared to barebacking, if this activity is sought, one that handles disclosure of one's status a little bit less enigmatically than Squirt would. So ...


Brace Yourself for BarebackRT.com

BarebackRT.com

A quick look at BarebackRT.com (BBRT, the world's largest and busiest site for gay men seeking bareback sex) reveals it's both more detailed in terms of describing each of its members and what each member is seeking in others. From a sexual health perspective, as well as a measure of how effective a site is in connecting like-minded guys, that isn't a bad thing.

It's also very raunchy. Combined with a clean design and nice functionality, the site is an impressive one.

One anonymous poz member told me:

The thing I like best about BBRT as a hook-up site is not necessarily the most obvious one -- a place to meet guys into bareback sex. Rather, for me, it's a place where, as a person living with HIV, I can serosort and find other poz guys to have sex with without the stigma and discrimination I find on other hookup sites or apps like Grindr and Scruff.

I think it's great that I can identify my status as either "positive" or "undetectable" on BBRT and say whether or not I'm looking for other positive/undetectable guys.

The same member added: "I also think it would be great place for HIV negative guys, for whom condoms don't work, and who want to lessen their chances of getting HIV by hooking up with poz guys with undetectable viral loads. Counter-intuitive, I know, until one remembers that someone with an undetectable viral load (and who doesn't have any STIs) is unlikely to pass on HIV to their sexual partners."

BBRT members, as the name implies, are almost exclusively seeking men willing to bareback. The site helps men narrow down the field; rather than merely specifying you are a top or a bottom, for instance BBRT will let you say whether you give and/or receive loads orally and give and/or receive loads anally. It will allow you to indicate your preference as to the HIV status of your partner and that of yourself. And as the above member says, you are able to check that you are undetectable and/or looking for undetectable partners. That, incidentally, is a well used option.

So on to the survey. Sampling 32 Toronto-based randomly chosen BBRT profiles can be distracting. BBRT profiles are frequently explicit and so are the user pics accompanying them. Nevertheless we soldiered on ...

Looking at HIV status, of the 32 profiles sampled, 13 members indicated they were undetectable, another three indicated they were positive. Twelve did not specify and five indicated they were negative. (Negative?)

Why, one might ask, unless they wish to seroconvert, and that's generally deemed rare, are negative men looking for bareback sex on a site like this? Four explanations come to mind: a) they are on PrEP and feel this provides adequate protection, b) they are neg and seeking other neg guys, by any measure a risky harm-reduction strategy, c) they don't mind if they ultimately seroconvert, or d) they are savvy neg guys seeking out poz guys with undetectable viral loads, who many deem incapable of transmitting the virus.

Superficially, it does seem that more than a few neg BBRT members want to be "seeded" or to be "bred," barebacking language sometimes indicating a wish to seroconvert at the hands of a poz top. How much of this is fantasy has always been a matter for academic debate. Clearly most men here though, poz or neg, are looking for condomless sex, plain and simple. For most, we know, they do so because it feels better. Research shows us in fact that most poz barebackers have no interest in infecting others. (For a detailed exploration of barebacking culture, refer to my interview with Unlimited Intimacy author and barebacking expert Tim Dean.

Notable too is that stigmatizing language, other than it relates to age/body-type preferences, seems virtually absent from BBRT. There is no "I'm clean, UB 2" here or the much hated term "DDF." A further plus is that in enabling poz members to record their status on the site, this feature reduces the possibility of subsequent prosecution for nondisclosure.


Conclusions: Vanilla vs. Hardcore

It's hard not to argue that sites which facilitate guys sharing who they are and what they are into, including serostatus, represent a healthier environment than where that information is handled in a circumspect manner, relying in part on mutual assumptions of status which can often be flawed. Having said that, online banter is not the be all and end all of opportunities for disclosure; many will feel more comfortable doing so, if at all, at other times and places.

At the same time it's inevitable that HIV stigma prevents many gay men from comfortably disclosing their status on their profiles, even where there is considerable licence to do so. There is no doubt too that some poz members, at least on the vanilla sites, will see and experience stigma on these sites through unkind words and rejection. There is also evidence of ignorance of what is safe and what is not, as in the conversation I quoted on Squirt.

It may be the case that online sites can make risky sex more available, but hot sex more available too. As one neg man who uses BBRT, talking about seroconversion, told me "If it happens, it happens. But I'm thinking that's not very likely if a guy tells me he's undetectable -- and he's not lying."

And there's the rub. While disclosure on profiles can work well in making more informed risk decisions, it's not without its flaws. How does a negative guy know he is really negative? And how does a negative guy know his "negative" partner isn't positive? The system is by no means perfect.

Having said all that, a site like BBRT, though likely frowned upon by many -- barebacking remains highly stigmatized whatever the circumstances -- arguably serves a valuable purpose in helping men who would otherwise have difficulty in disclosing do so in a protective environment which (mostly) preserves their confidentiality, helps to reduce risk of transmission and facilitates more worry-free and unencumbered sexual encounters. Thus while the more vanilla of the two sites referred to here, Squirt, seems relatively innocuous and BBRT the place for risky, raunchy sex, one could argue that it is features in the second of the two that contributes to fewer new HIV infections.

Said one profile-savvy negative guy who uses both sites, "I prefer the way BBRT handles HIV disclosure issues; I like the straightforward specificity of their profile form. It makes it much easier to assess any risk factor. There's nothing vague about it ... I respond to honesty in people and I'm much more likely to respond to the profile of someone I feel is being straight up with me and I think BBRT has made that easier for people to do."

Barebacking, like it or not, has come of age at this stage of the HIV epidemic -- more and more people are doing it and many of them pretty safely. Sites which contribute to the safety of an activity which many find irresistible -- not to mention extremely hot -- can only be applauded.

This article is adapted from a piece that originally appeared on PositiveLite.com.

Follow Bob on Twitter @ruraltweeter.

Send Bob an e-mail.

Read Bob's blog, Northern Lights.

Get e-mail notifications every time Bob's blog is updated.


Related Stories

Why We Need to Re-Assess Barebacking, Stop the Stigma and Be Honest About the Risk
Barebacking, Unbridled: Thoughts From the HIV Community on Unprotected Sex
This PrEP-ed Life: Damon Jacobs on Sex and Dating in a New Era of HIV Prevention
More on Sex, Dating & HIV for Gay Men


This article was provided by TheBody.com.
 

Reader Comments:

Comment by: John (Austin, TX) Mon., Jul. 7, 2014 at 5:09 pm EDT
I agree with John-Manuel Andriote. The HIV prevention strategies should take a look at human health behavior research and see that people do stuff they're told not to do and it makes it that much hotter. You can see this with religious people getting off in ways they were told are sinful. Remove the stigma, and it's not quite as fun anymore. I agree with others that say DDF and Clean fuel the rise in seroconversion due to the stigma, and that the main issues with self-esteem and depression and mens' emotional health are not being addressed. OBVIOUSLY, anyone who is negative and chooses to put themselves at risk is not making a rational, logical decision. What motivates them to be at risk is an emotional, nonsensical reason, which is the hope of finding someone to love, which makes the harsh world go away. Having to worry about a condom when you get into the escapism of sex makes even educated, productive members of society make poor choices in the moment. Guys are NOT meeting each other traditionally and building trust and a non-sexual relationship first, and that's what they really crave minus the fact they get horny frequently due to biology (just like women menstruate once a month, whether they like it or not, men have our thing too). MOST guys aren't even in touch with what they are feeling and cannot engage in any sort of vulnerable relationship these days. These are the people who are online that health prevention does not understand because it isn't rational.

I agree that it is nice that there are websites for those who have come to terms with their choice for bare sex, but most of the conversions probably come from those who AREN'T coming to terms with it and make poor decisions in the moment due to depression, low self-esteem as a gay/bi man (or whatever is the cause), and who are on sites in a fantasy to trust another's status for what they say it is, even though they have no reason to yet not knowing the guy or how many loads he took last week
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Comment by: C (Atlanta) Mon., Oct. 21, 2013 at 11:02 am EDT
A very thought provoking article. It certainly has me pondering questions that would be interesting to have answers to. Such as how did age play into those ratios, ethnicity, HIV IQ, etc. would they remain stable across multiple regions or would they spike for certain groups in different areas. Also what would be the social, economic, and psychological drivers. Would those diversify according to region.

I have many more, but you are correct. The fight against HIV has severely overlooked the valuable insight into the HIV epidemic by ignoring the places where it starts in 2013. Nicely done to draw attention to it.
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Comment by: Bob Leahy (Toronto) Wed., Oct. 23, 2013 at 6:42 am EDT
Thanks. Another way of putting it is that there seems to be a disconnect between the research/prevention community and gay men in the trenches having the kind of sex they want. Huge missed opportunities here.


Comment by: Mark (NYV) Fri., Oct. 11, 2013 at 2:19 pm EDT
"But at their best the sites offer opportunities for sex free of worries about status issues."

Howzat? By trusting what a hookup reports is his serostatus? I think that's what is driving the upswing in HIV among MSM - guys relying on reported serostatus of strangers to made decisions about hookups.

"The general consensus is that outright rejection after a negative man has initially shown interest is in the range of 50%"

The genral consensus? Where does that come from? My friends tell me it's more like 95% say no if you tell them you're positive. If you say you're negative, it's bareback city, if you say you're positive, it's "Thanks, but I'd rather not play with you."

Trusting complete strangers to know their serostatus (they could have seroconverted last week and not know) is simply stupid.

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Comment by: Bob Leahy (Toronto) Mon., Oct. 14, 2013 at 6:36 pm EDT
Agreed, sites like BBRT.com don't work well in terms of safety for "negative" guys to meet other "negative" guys for barebacking. But neither does the sexual marketplace in general. Where sites like this do score points though is for "negative" guys wishing to meet poz guys who are undetectable and engage in relativly safe barebacking, or for poz guys to meet poz guys, where the risk is limited to STIs.

As for the incidence of poz guys being rejected for their status, my 50% figure was admittely unscientific but is based on personal experience and that of other poz guys I've talked to. We can say definitively that in a large city, it's not uncommon, where HIV prevalence rates in gay men are in the 25-30% range, for the respondent to be poz himself and therefore rejection through status disclosure isn't an issue. And anecdotal evidence (and personal exeperience) suggests negative guys are increasingly barebacking with undetectable poz guys, or hooking up when the type of sex (e.g. oral or anal with a condom) doesn't put them at risk. Using a rejection rate of 95% strikes me as wild exageration and unnecesarily adds to the stigma that poz guys can face, including that we impose upon ourselves.


Comment by: Mark (NYC) Thu., Oct. 10, 2013 at 5:31 pm EDT
Say what? "The sites offer opportunities for sex free of worries about status issues" and "sites which facilitate guys sharing who they are and what they are into, including serostatus, represent a healthier environment"?

So you're telling guys to trust the declared status of a guy who checks "Negative" at a hook-up site?? My god. I think this is one of the drivers of the latest upswing in MSM infections: guys relying on stated serostatus of partners. It's absurd to put any weight on what a hookup says about being negative - chances are he recently seroconverted and doesn't know it.

And this ststement - "outright rejection after a negative man has initially shown interest is in the range of 50%"? More like 95% from what I've heard from guys.

Far too many young gay men think any kind of sex with a positive guy is too risky and turn them down flat. Only if you "reassure" them that you're negative and tested recently will they hook up.

The BS of serosorting for negative guys has to stop - it will never work and is actually fueling the epidemic.
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Comment by: trey (bastrop) Thu., Oct. 10, 2013 at 3:48 pm EDT
What point should you disclose? Before a kiss?
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Comment by: Bob Leahy (Toronto) Mon., Oct. 14, 2013 at 6:16 pm EDT
Sorry, but that's a very individual decision; there is no one-size-fits-all answer. Even the legal requirement varies by jurisdiction.


Comment by: robert perez (Kansas city,Missouri) Tue., Oct. 1, 2013 at 7:40 pm EDT
Hmmm,I guess its what ones happy with what with all the moriality and stuff?Still,it would be nice if one found a "cure",for 2013!
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Replies to this comment:
Comment by: Bob Leahy (Toronto) Fri., Oct. 4, 2013 at 8:58 am EDT
Agreed on the cure!


Comment by: John-Manuel Andriote (Norwich, CT) Tue., Oct. 1, 2013 at 6:20 pm EDT
The less overtly stigmatizing ability to disclose one's HIV status in BarebackRT.com is surely a step up from the "DDF" and "clean" stigmata that besmirch so many online gay male cruise site profiles. But from an HIV prevention point of view, we're still failing to ask the most fundamental questions: What drives a man to have unprotected anal intercourse, the highest risk behavior for HIV and other STIs, with strangers? What impels a man to open the interior of his body, put his health and potentially his life, in the hands of someone he doesn't know? I don't buy that it's only about the intensified pleasure of condom-free sex, especially from the point of view of the bottom guy. As for the intimacy? Let's get real: How much real intimacy can there be with a stranger? We need to address the underlying drivers of behavior--the depression, drug abuse, sexual abuse, etc., far more prevalent in gay men than non-gay men. Once we have done all we can to support gay men's resilience and strength, then let's see if quite so many are willing to risk it all for the momentary pleasure of a rubberless boink with someone they may never see again.
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Replies to this comment:
Comment by: Bob Leahy (Toronto) Fri., Oct. 4, 2013 at 8:57 am EDT
Not sure I'm 100% with you. Agreed there are many factors that influence risk behaviours, but I thnk we sometimes overestimate the social drivers and underestimate the ones you mention, like the search for pleasure and intimacy when all we offer is condoms as an alternative. And as for intimacy with strangers? I think its undeniable that intimacy of the best kind can and does occur outside relationships. In fact that is the exactly the kind of intimacy many men are seeking.

I'd also argue that bareback culture is full of strong resilient gay men free of "depression, drug abuse, sexual abuse, etc" who choose condomless sex because the risk of infection does not loom large, for one reason or another, who do not get on with condoms or who are just plain pleasure driven. I think a harm reduction approach probably works better here than analyzing them to death and trying to address whatever flaws the prevention community sees in them.


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