Laying It Bare: Gay Men and Unprotected Sex in the Age of HIV/AIDS
June 23, 2010
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Language and Homophobia: What Are We Talking About When We Talk About "Barebacking"?
fogcityjohn: OK. Now, before we get to the main portion of our topic, I'd like to just ask you all briefly about the issue of language. I'm a lawyer by profession, so language is important to me. And I just wanted to ask all of you if there were what you would call appropriate ways to discuss this topic, appropriate terms that we should use.
I ask this because I did a recent post on this topic at TheBody.com, and someone objected to the use of the term "barebacking." So I'd like to ask you what you thought. How should we talk about this?
Walt Odets, Ph.D., a longtime psychotherapist who has written extensively on HIV prevention and the psychological and social issues facing gay men
Walt Odets: I'd like to respond to that. This is Walt. I think that what we're after here is helping people to think about behaviors that transmit HIV, not about specific sexual behaviors. And the term "barebacking" implies that any unprotected anal sex poses a risk for transmitting HIV. So that would be my objection to it. We're pathologizing behaviors, rather than helping people think about when HIV might be transmitted. And that's one of those broad terms that I think encourages that confusion.
fogcityjohn: Indeed. Rashad Burgess, any thoughts from you?
Rashad Burgess: Well, I think, having clarity around what is it we're talking about is actually important. What I would say is that when you look at the science to mean, on one hand, you have "barebacking" used very broadly to describe any unprotected anal intercourse. And usually it's used in the context of gay men.
And then on the other side, you have "barebacking" used to really identify those that identify themselves as folks that bareback, or identify as a particular group of people who identify as a subculture of barebackers.
So I would argue that we should probably be as broad as possible in the use of the language "barebackers," and those being, individuals who partake in unprotected anal intercourse, irrespective of whether or not they themselves identify as a barebacker.
fogcityjohn: Jeff Parsons? Any thoughts from you on this topic?
Jeffrey Parsons, Ph.D., a professor of psychology and co-director of the City University of New York's Center for HIV/AIDS Educational Studies and Training
Jeffrey Parsons: Yeah. I completely agree about the need to keep a barebacking identity separate from what we might construe as barebacking behavior or simply unprotected anal sex that poses a risk. I also think that intentionality gets pulled into this a lot, and that "barebacking" is often used as a term to refer to intentional unprotected anal sex. Whereas, unprotected sex that happened because the condom broke, or the person had every intention of using a condom, but somehow, one was not used, that doesn't get classified as "barebacking."
So I agree with Walt that, in some respects, there is a bit of pathologizing of it as a behavior. But I do think it's important to recognize that some gay men do identify themselves as barebackers, and have integrated that into a part of who they are, and part of their community.
fogcityjohn: Well, then, I think what I'll try to do, and maybe we should try to do in this discussion, is simply discuss this as unprotected anal sex, and we can talk about issues of intentionality, as well. But I'm going to try, just for purposes of today, to stay away from the term "barebacking."
Prevalence: How Widespread Is Unprotected Sex Among Gay Men?
With that understanding, I would like to get to what I think is probably the heart of the matter. First of all, what do we know about how widespread the practice of unprotected anal sex is among men who have sex with men? Because I think that a lot of HIV education seems to assume that the default setting is that guys are having protected sex. And I'd like to ask you all: Is that a reasonable assumption? Is that true? Or, what do we know?
Walt Odets: I think it's an erroneous assumption. I'd like to back up just for an instant, if I could? "Barebacking" is a term that's widely used and recognized to identify high-risk sex. And if two men, neither of whom has HIV, there is no risk of HIV transmission there. I think I'm saying more succinctly what I said before.
But certainly there's a tremendous amount of unprotected anal sex, and I do think that in this context that we have to make distinctions between negative men, positive men, knowledge of HIV status, and so on.
fogcityjohn: That's an excellent distinction that I probably should have made myself. Because I think we're probably not concerned with, say, two HIV-negative men in a relationship, who have negotiated safety, if you will. What we should probably be focusing on are men who either are negative, or don't know their status, and who are, despite the risk of HIV transmission, continuing to engage in unprotected anal sex with men whose status they may not know. Would that be fair?
Walt Odets: Yes, I think so.
Jeffrey Parsons: To be honest, I would be a little concerned about the first part of that -- this notion that two HIV-negative men in a relationship with negotiated safety and not having concerns. The epidemiological data is increasingly showing that a significant number of new infections are happening in the context of main partner relationships. And I think we sometimes make the mistake of assuming that when somebody is confident in their knowledge that they are HIV negative that may not be the fact.
And so I do think that we have to recognize that we can't just assume that for two people who believe themselves to be negative in a relationship that unprotected anal sex does not pose a risk.
Walt Odets: Yes. But that goes to, I think, more the issue of whether or not their knowledge is accurate; their assumptions are accurate.
Rashad Burgess, chief of the Capacity Building Branch of the Division of HIV/AIDS at the U.S. Centers for Disease Control and Prevention
Rashad Burgess: This is actually a very important issue, particularly in the context of gay men, where, because the background prevalence of HIV is respectively so high, so many gay men are unaware of their HIV status, even though there's a considerable frequency of testing. Individuals will believe that they are HIV negative, and have an operating assumption that they are negative, and enter into relationships assuming that they are negative when they actually are not.
And so one of the challenges we face in having this discussion is having a different perspective for those that we believe to be negative; oftentimes, that belief is not held true. And we have study after study where individuals who thought they were HIV negative, after being tested during the entry point into study, found out that they actually weren't negative.
fogcityjohn: OK. So obviously, having accurate information on that point is clearly quite difficult. But that leads to my original question. Do we have some sense of how many? What percentage of men do in fact adhere only to protected sex? And how many, some or all of the time, are having unprotected sex?
Rashad Burgess: I don't think we have a definitive answer to the proportion of gay men who have sex with men who definitely only have unprotected anal course, or primarily have unprotected anal intercourse. I mean, you look at studies; it ranges significantly.
I pulled some data up, and it ranges from 12 to about 46 percent. So it's a considerable range. It's specific to region of the country; the city, particularly; some differences in terms of race/ethnicity; differences in terms of age; differences in terms of HIV status. So I think that it's difficult to make a broad statement about the proportion of gay men that are partaking in unprotected anal intercourse, because it does vary significantly.
Walt Odets: John?
fogcityjohn: Yes, Walt?
Walt Odets: Just to go back to part of the original question: You used the term "negotiated safety." This is something that originated in Australia about 15 years ago. And it refers to two men that enter in a relationship who have presumably determined HIV status and determined the kinds of sexual behaviors that would occur outside the relationship, if any, and have found a way to have unprotected sex.
I agree with Rashad and Jeff. This is something that often has failed. But we have almost entirely in the United States failed in prevention efforts to educate men in that process. We simply pathologized the behavior and prohibited intervention, and don't discuss it, and don't help them to think about it, help them to understand how they can make that determination.
I see this in psychotherapy patients all the time, very sophisticated people, who really don't know how to go about that.
fogcityjohn: Well, what I'd like to ask you to do, Walt, is, if you could hold that thought for a little later on when we talk about some interventions. Because I think that's a really interesting and important issue. But I would like to get there a little later.
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This article was provided by TheBody.com.
Comment by: Reese
Sat., Oct. 2, 2010 at 5:13 pm EDT
I have been told that one could become reinfected going bare back wether male & female or male & male sex. I have met men on the HIV + sites who come to me with that lame excuse of well we are both positive what have you got to loose? In my opinion a whole lot. In loving myself where it all starts and respect for one self speaks volumes. Bare back should always be a no no. Why do you think we are in this position of being + in the first place.
Comment by: Ben
Fri., Oct. 1, 2010 at 7:49 am EDT
The statement "Many men turn off their thinking brains when they want to f*** or get f***ed" is absolutely correct.
You HAVE TO turn off your brain when you're having sex. You HAVE TO let the primal and the animal in you take control. If you read any decent guide to sex written prior to the AIDS epidemic you will find that message spelt out time and time again. Every sex therapist urged it. Problems that couples had in the bedroom and in relationships, whether straight or gay, could often be boiled down to an inability to give the inner animal free reign and enjoy natural sex.
The problem for us all now is that to enjoy natural human sex in this way is to dice with being sentenced to life with HIV!
This is part of the tragedy of this monstrous virus.
We must see things as they are. We must detest the virus and NOT detest natural human sex.
And, of course, the sooner our armies of scientists find a cure for the detestable virus, the sooner we may all switch our brains off once again and fully enjoy natural sex.
Comment by: Ken
Thu., Sep. 30, 2010 at 6:00 pm EDT
I would just like to say that I have heard everything mentioned but the simple fact that gay men strive to be fulfilled. I can remember when I was curious and walked inside of a video arcade in San Francisco. When I went into the arcade inside the booth and seen the hole in the wall, someone stuck their mouth up to the hole and said let me suck it. I think that I had the hardest dick I had ever had, in my whole life. I couldn't believe how much of a sexually deviate I was. I loved dialouge, licking,and the condoms were used at first but then slowly faded away after maybe five or six years. I wasn't diagnosed until 30 but have had the behavior for almost seven to eight years. When my condom would break in the heat of the moment, it would feel so good and I wouldn't wanna stop. I liked it, and would return to those same places time and time again looking for that same satisfaction that I could only get from barebacking. Now I'm positive and I know that it is wrong to spread it so I am different and responsible, even if it means I need to masturbate thinking about one of my raw encounters from the past, I can almost get the same satisfaction. This is me, but some actions of gay men today can simply prove that desire can supersede everything, even morals. It's sad but very true!
Comment by: Shannon M.
Thu., Sep. 30, 2010 at 4:43 pm EDT
I would like to go back to the very beginning of the discussion where Walt is supporting the objection of the term "barebacking". Let's not make this an argument of theory or rhetoric. Let's call it what it is. Whether or not you label yourself a "barebacker" or you just prefer to engage in bareback sex is not the main issue and to even give that relevance is ridiculous. The issue that everyone should be focused upon is if you are having multiple random sex partners and engaging in unprotected sex, then you are more at risk for getting HIV. If you are in a monogamous relationship, and you and your partner do not use protection then I don't consider that "bareback" behavior. It is more the norm. If you are HIV+ like myself and you disclose your status to your partner and you proceed to engage in consensual "bareback" sex, again I do not see the issue. The main issue at hand is to ensure everyone is aware of how to take preventative measures from becoming HIV and being educated about HIV. That should be the main issue. Just my opinion.
Comment by: Tommy Dukeur
Thu., Sep. 30, 2010 at 2:13 pm EDT
Sex is a primal need. I prefer to bareback. It's the natural way we get off. Nothings going to change that. A cure and vaccine needs to be found, period. I am pos 24 years, doing well, thank you. Raw sex is therapy for me, something I seem to need in my limited world. My partners have no problem with this, pos OR neg. Everyone is doing it. This is the reality of the gay male in the U.S. and the reason HIV rates are increasing.
Comment by: Brian E.
Mon., Sep. 6, 2010 at 4:13 am EDT
I have to agree with the bloggers who say that sex is primal behavior. Intellectual discussions about barebacking completely miss this very important fact. Many men do not use their brains when they have the oppertunity to get laid. It is that simple and that tragic. No amount of talking about barebacking from an intellectual perspective will alter the fact that many men turn off their thinking brains when they want to f*** or get f***ed. When AIDS first emerged and it was thought to be sexually transmitted many gay men replied "I'd rather die than use condoms" and in fact many gay men did die. What we have learned from this tragedy is that safer sex can save your life and barebacking is like playing a sexual version of Russian roulette. Yet many men choose to play this deadly game because just like in the early days of AIDS they would rather die than use condoms.
Comment by: Mandy
Tue., Aug. 17, 2010 at 8:31 am EDT
In the wake of new treatment, living longer and more active lives for HIV+ people, it seems that we are losing sight of the main focus in this epidemic. We can't cure emotional, physical and spiritual issues with sex. I am not a gay or bisexual woman but a hetrosexual who found herself in relationship with someone who was in a sexual conflict. He did not admit to his sexual desires for men and often lied about his HIV status. With that said, I do believe that it is the responsibility of both parties to know their status and protect themselves. I also have to say that the greater burden should rest with the one who is infected. I have been in relationships since the one mentioned where the guys knew my status and still wanted to have unprotected sex. Be it reasons related to emotional issues, feelings of rejection or a physical disconnect, I will not contribute to the spread of any disease by knowingly transmitting it. To me this behaviour is criminal. Herpes may not be life-threatening, but who do you know likes having it once they are left to deal on a daily basis. Likewise, when the heat of the moment subsides and you have been intimate with someone who is HIV+, you are still left with the realities of HIV disease. That passion last 5-10 seconds while HIV can last a lifetime...it is not worth it. I tell people all the time to find a partner, get tested and even then protect yourshelf! You never know who needs to feel an emotional connection with someone else and decide to go "raw" while bringing home some disease!
Comment by: Mandy
Tue., Aug. 17, 2010 at 7:42 am EDT
I am not a gay man...but a hetrosexual woman who found herself in a relationship with someone who was in a sexual conflict and hid his status from me. While I know that it is the responsibility of both parties to know their status and protect themselves, I must say there should be a greater burden on the person infected. I have been in relationships with men who knew my status and would still want to have unprotected sex. Obviously, there is something wrong with this behaviour. Be it feelings of rejection, a physical disconnect, or whatever the case; sex would not be the answer to begin with. These inner wounds or feelings of acceptance needs to be address foremost. In the same vein, I can not knowingly transmit anything to anyone in good conscious. To me this behaviour is criminal whether my partner desires it or not. Because when the heat of the moment subsides, you are left with the reality of HIV disease.
Comment by: fogcityjohn
(San Francisco, CA)
Sun., Aug. 8, 2010 at 11:21 pm EDT
@ lfivepoints69 (San Francisco): You bring up some very valid points. One thing I'd note, though, is that where alcohol and drugs are concerned, they're not always the reason for unprotected sex. Some men actually get drunk or high to lower their inhibitions so that they can engage in unprotected sex. In other words, drug or alcohol use isn't the cause at all. It's that men are using them to facilitate behavior that they wouldn't engage in if sober.
@ MoreAnon (SoFlo): Sorry, but I don't believe that HIV is or should be God's plan for anyone. Maybe it's because I was raised Roman Catholic, and thus indoctrinated in the concept of free will, but I think this is something that we can have control over. We are all capable of protecting ourselves for HIV and other STIs. I don't think anyone should entrust this issue to God. If you think it's all in God's hands, you may think God will protect you from HIV no matter what you do. That would be a very serious mistake.
@ vbelew (Atlanta): You're absolutely right that sex isn't about logical choices. If it were, we wouldn't have an HIV epidemic. That's why I think it's important to understand the emotional factors that lead men to have unprotected sex. I think you're right that we'll never eliminate it entirely, but we do need to try to help men make intelligent choices about how to reduce their risk. The only way we can do that is if we understand why men take risks in the first place. This podcast is an attempt to illuminate that question.
Thanks to all for listening and reading.
Comment by: lfivepoints69
Tue., Aug. 3, 2010 at 10:05 pm EDT
I believe all of the reasons that you mentioned, both the well-known and more shocking ones, are reasons that, even today, some non-monogamous gay mean are having unprotected anal intercourse. I think there are three critical ones that I have seen - 1) People who have sex with a partner of unknown HIV status under the influence of alcohol or other drugs. Even guys who would never have unsafe sex sober often do so when under the influence. 2) People often underestimate the risk of infection from a single or occasion instance of unprotected sex. 3) People who are in Generation X and Millennials don't know many people who are openly HIV-positive. As a result, they feel invincible and that either a) they will never catch the virus or b) that catching it is no big deal due to modern medical treatments.
Comment by: MoreAnon
Mon., Jul. 26, 2010 at 2:38 pm EDT
Thank you for creating a forum that facilitates open dialogue about the issues that plague modern society fogcityjohn. I thoroughly enjoyed some of the highlights, and before reading this, I didn't even consider that many people [heterosexuals included] may just be plain fatigued AND jaded by trying to stay negative.
I also did not consider fatalism and the psychodynamics that come into play here. For me, fatalism would conflict with my belief that God has great plans in store for me, which may not involve having a debilitating virus. However, I do see where it still falls in line with my Christian principles that everything done in this life is and was predestined and preordained to occur.
Finally, I like Pete SF's gumption when he stated "I do regret that I am HIV-positive, and I am not offended by the idea that my particular condition is something that is best avoided." I cannot agree with you more on that point [I somehow channel teenage pregnancy issues when I re-read this quote]. Nuff said 'bout that.
Best to all.
Comment by: vbelew
Sun., Jul. 25, 2010 at 9:02 am EDT
I Don't think sex has ever been a logical choice. Sexual attraction is impulsive and breaks all the rules. While it makes perfect sense to advise people to use condoms for safe sex, since part of the excitement of sexual behavior is often found in risktaking, it is unlikely barebacking will ever cease to exist, dangerous or not. It is still a good move to encourage safe sex practices as harm reduction strategies, but from a realistic standpoint, the rules will all be broken during the impulsive, exciting risk taking adventurous charge that is sex itself. Thanks for all you do to teach, warn, and encourage.
Comment by: raugos
(st Petersburg, Florida)
Thu., Jul. 8, 2010 at 8:46 am EDT
There is no way we can keep risking our own lives and still be pointed as bad guys in our communities . Safe sex is a guarantee that we will growing stronger and healtier. Condon is our best tool.... keep this in mind.
Comment by: fogcityjohn
(San Francisco, CA)
Thu., Jul. 8, 2010 at 2:08 am EDT
@ Matt in CO: Thanks for your honest comment. You make a lot of good points about some of the reasons guys have a hard time adhering to safer sex practices. Fatalism is certainly one of them.
@ don warner saklad: I've seen you post this hypothetical question more than once here on this site. I really must ask what your point is. No, if two people who are uninfected with HIV have unprotected sex, there is no risk of HIV transmission. How many times do you need that confirmed?
I'm very glad that you are doing well, but it would be a mistake to assume that your experience with HIV and HAART is necessarily typical. I've had a lot of problems because of this virus, even though my numbers have always been pretty good. I discovered I was positive within months of seroconverting and have had good health care since then. Despite all this, HIV has taken quite a toll on me. Be thankful for your good fortune, but I wouldn't want anyone to think that having HIV is always so easy to deal with.
Comment by: Matt
Wed., Jul. 7, 2010 at 4:29 am EDT
Let me start by saying I have HIV and I prefer to bareback.
I came out in a major city around 1990 when I was 19 and I didn't really have sex before then. I certainly was never abused, and my family has always been supportive.
I also didn't know a lot about AIDS when I was coming to terms with being gay, but I sure did know that gay men were dropping like flies and I was convinced that I wouldn't live to see my 30th birthday.
When I did start having sex, the safe sex thing was constantly pounded into my head. Despite some token efforts to make putting on the condom part of the fun, the message was very much "Use a condom or die."
There were the inevitable slip-ups, followed by months of guilt and fear while frantically getting tested outside of the 90 day window to see if I'd dodged the bullet. At that point, lacking better information, I assumed that HIV was transmitted extremely easily during sex. So I had this idea in the back of my head that being gay automatically led to HIV while I consciously assumed that barebacking once with a guy who had HIV guaranteed that I'd get HIV too.
After a bit, a sense of fatalism crept in. I figured that becoming infected at some point was pretty much unavoidable, so I stopped trying to avoid it and started enjoying my sex life.
Discovering that I wasn't alone in hating condoms and lube did help things along immensely (online, in porn, etc.). But I don't see how you can put that cat back in the bag. Banning bareback porn from IML doesn't do anything now but draw more attention to bareback porn.
And now, HAART has really undercut the safe sex message. I'm approaching 40, ten years more than that young kid I used to be thought he'd ever have. My doctor says there's no reason I shouldn't live into my 70s. I look perfectly healthy.
I'm pretty open about my status. So I'm sure that there are some guys who draw the conclusion that barebacking is OK even if you get HIV based on the simple fact that I exist.
Comment by: don warner saklad
Tue., Jul. 6, 2010 at 1:44 pm EDT
Why haven't more people tried the strategy?... of "BEFORE we have sex let's get tested TOGETHER for A VARIETY of STDs."
A thought experiment http://en.wikipedia.org/wiki/Thought_experiment
Two uninfected men are barebacking, is it true or false one or both could get HIV/AIDS human immunodeficiency virus acquired immune deficiency syndrome?... True [ ] False [ ]
"tested together" alerts
Comment by: Eddy
Thu., Jul. 1, 2010 at 12:06 am EDT
I read your interview and I think You did a fantastic job John. That was interesting, especially the part from the panel where they said that there have not been studies to fully understand why negative gay people stay healthy and live happy lives. I also believe -much like you- that what has been said here is probably the tip of the iceberg. And I mean that experts already know to a certain extent what causes gay men to become infected more easily than other groups. The next topic may be about genetics, I do believe that before gay men are exposed to the world of discrimination,trauma,isolation drugs, parental abuse at a younger age. I think they have already been defined as to who they are and how they will behave or choose in society; sexually speaking, that is. I truly believe that it has to do with their biological make up before they were exposed to the platform mentioned here, and for me to go there is like trying to defeat the virus. I just don't know how, but there is always room to learn.
Comment by: fogcityjohn
(San Francisco, CA)
Sat., Jun. 26, 2010 at 1:22 am EDT
@ Alexandro in Paris, France: I'm sorry to hear that you find a serious attempt to understand the emotional and psychological motivations behind unprotected anal sex to be nothing but "psychobabble." Certainly, as we all recognize, sex without a condom feels better, but there's obviously far more to it than that. But if the simple, physical explanation works for you, then go with it.
@ Rafael M in NYC: Thanks for the kind words. I'd like to return to this topic sometime. I found our three guests extremely informative, and we certainly need to try to understand why men are having unprotected sex when they know the risks.
Comment by: Rafael M.
(New York, NY)
Fri., Jun. 25, 2010 at 2:57 pm EDT
Thats for an intersting dialog. I found very useful and eye opening the parallel between adolelescents and adult males. Seeking out thoase who aren't infected and learning from them. Great work guys. I've been in this field since 1983 and HIV + for 23 years.
Comment by: Alexandro
Fri., Jun. 25, 2010 at 12:41 pm EDT
There are some good comments here but also one HELL of a lot of American psycho-babble! Why do people love screwing without condoms rather than with them? Because screwing with condoms, granting protection from HIV and other STDs, is just nowhere near as pleasurable as screwing bareback. Simple. No need for all the psycho-babble.
Comment by: fogcityjohn
(San Francisco, CA)
Thu., Jun. 24, 2010 at 1:48 pm EDT
@ Pete in SF: Thanks for listening and commenting. As you can see, I think all of our guests agreed that, as Rashad Burgess put it, HIV prevention must involve a holistic approach. We need to find structural interventions that will help gay men feel their lives are worth living.
And you're absolutely right. It's better to be uninfected. We have to admit something Walt Odets pointed out in 1994 -- HIV education is for HIV-negative men, and its purpose is to keep them uninfected. Some positive men may react badly to this idea, but I'm with you on this one. Being positive, and knowing how stressful it is to live with HIV, I'm determined to let negative men know that protecting their health must be a paramount concern.
Comment by: Pete
Wed., Jun. 23, 2010 at 8:11 pm EDT
Thank you, Fog City John! It is so great to see all of these emotional issues regarding anal sex, safer sex, and prevention touched upon in one place. To me, one key issue is an holistic approach to the wellness of gay men and communities that work to build individual wellness and self-esteem concurrently with the building of community to reduce isolation and increase inter-connectedness.
To that end, I have recently been spending time in a smaller city with an old friend who is very active in his local gay community, and I find myself envious of the incredibly rich and connected life he has built for himself. I've been reminded how important it is to get involved with the community in whatever way possible. I'm in a place in my life where I feel I have time to "give back" again and I'll be jumping in this summer. So I would say that while it would be ideal to have community-strengthening, holistic wellness programs already out there, if anyone is feeling isolated - find an organization and go volunteer! It was up to us when the epidemic emerged in the 80s, and it probably still is.
On a more personal note, I agree, John, that it is better to be uninfected! Maybe more of us active, healthy positive men need to acknowledge this! I know that while I do everything I can to take care of myself and maintain a positive outlook, I do regret that I am HIV-positive, and I am not offended by the idea that my particular condition is something that is best avoided.
Thanks again for the forum.
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