Is 'bareback' a useful construct in primary HIV-prevention? Definitions, identity and research

[Discourses about condom use and non-use among gay, bisexual men, and other men who have sex with men in two colombian cities.]

OBJECTIVE

The HIV increase cases raises concern worldwide. This phenomenon is related, among other things, to sexual practices where condom use is limited. To achieve the eradication of AIDS, international organizations have been interested in analyzing and understanding the sexual practices of certain population groups, within these men who have sex with other men. In this sense, the objective of this study was to analyze the discourses on the use and non-use of condoms held by a group of gay, bisexual and other men who have sex with men (GBHSH) men from two cities in Colombia.

METHODS

A qualitative study was carried out with data analysis through the iterative process, from the interpretation of the Information, Motivation and Behavioral Skills (IMB) model. The collection of information was carried out between 2020 and 2021 through in-depth interviews, virtually and in person, with a sample of 20 GBHSH from Colombia from the cities of Cali and Medellín.

RESULTS

In the Information component, it was identified that traditional sexual education had a negative impact and was very focused on a cisheterosexual and reproductive perspective. Regarding Motivational, it was highlighted that the majority were oriented towards not using condoms and that perceiving a low risk of contracting an STI was the main motivation for not using condoms. Regarding Behavioral Skills, it was analyzed that distrust towards the sexual partner promoted its use, but the intensification of pleasure, added to the consumption of alcohol and drugs, caused its use to decrease. It was also evidenced that the use of drugs such as PreP or PEP discouraged condom use in relationships.

CONCLUSIONS

The information on condom use revolves around cisheteronormative practices, leaving aside the care related to STIs. The motivation for not using condoms revolves around misinformation, pleasure and trust in the couple, while the motivation for condom use revolves around health care. The behavior regarding the non-use of condoms is related to the previous points, while misinformation and pleasure in non-use predominate.

Acceptability of an existing online sexually transmitted and blood-borne infection testing model among gay, bisexual and other men who have sex with men in Ontario, Canada

Objectives

Gay, bisexual and other men who have sex with men (GBM) are disproportionately affected by sexually transmitted and blood-borne infections (STBBI) due to stigma and other factors such as structural barriers, which delay STBBI testing in this population. Understanding acceptability of online testing is useful in expanding access in this population, thus we examined barriers to clinic-based testing, acceptability of a potential online testing model, and factors associated with acceptability among GBM living in Ontario.

Methods

Sex Now 2019 was a community-based, online, bilingual survey of GBM aged ≥15. Prevalence ratios (PR) and 95% confidence intervals (95%CI) were calculated using modified Poisson regression with robust variances. Multivariable modelling was conducted using the Hosmer-Lemeshow-Sturdivant approach.

Results

Among 1369 participants, many delayed STBBI testing due to being too busy (31%) or inconvenient clinic hours (29%). Acceptability for online testing was high (80%), with saving time (67%) as the most common benefit, and privacy concerns the most common drawback (38%). Statistically significant predictors of acceptability for online testing were younger age (PR  =  0.993; 95%CI: 0.991-0.996); a greater number of different sexual behaviours associated with STBBI transmission (PR  =  1.031; 95%CI: 1.018-1.044); identifying as an Indigenous immigrant (PR  =  1.427; 95%CI: 1.276-1.596) or immigrant of colour (PR  = 1.158; 95%CI: 1.086-1.235) compared with white non-immigrants; and currently using HIV pre-exposure prophylaxis (PrEP) compared to not currently using PrEP (PR  =  0.894; 95%CI: 0.828-0.965).

Conclusions

Acceptability of online testing was high among GBM in Ontario. Implementing online STBBI testing may expand access for certain subpopulations of GBM facing barriers to current in-person testing.

Consumption of sexually explicit media and unprotected anal sex in men who have sex with men

This study aimed to evaluate the influence of bareback sexually explicit media (SEM) consumption on anal sex without a condom by men who have sex with men (MSM). To this end, a page was created on the Facebook® social network with a link that directed interested parties to a questionnaire. Cisgender men, aged 18 years and over, who had sex with other men in the last 12 months, were included. Data were collected in 2017 and analyzed using univariate and bivariate inferential statistics and multivariate logistic regression. A total of 2,248 MSM participated in the research, with a mean age of 24.4 years and a mean number of 3.9 partners in the last 30 days. Having multiple sexual partners (ORa: 9.4; 95% CI 3.9-22.4), preferring movies with bareback scenes (ORa: 2.6; 95% CI 1.5-4.6), considering this practice a fetish and realizing it (ORa: 3.52; 95% CI 2.3-5.4), having casual partnerships (ORa: 1.8; 95% CI 1.5-1.9) and being aware of the partner's negative serological status for HIV (ORa: 1.4; 95% CI 1.1-2.3) were factors that increased the likelihood of engaging in anal sex without a condom. Thus, we found an association between the consumption of bareback SEM and sex without a condom among MSM.

'It's like getting an Uber for sex': social networking apps as spaces of risk and opportunity in the Philippines among men who have sex with men

The HIV epidemic in the Philippines has been expanding rapidly, with most newly diagnosed cases occurring among 'men who have sex with men' (MSM). New social contexts of HIV are evident in the evolving phenomenon of more MSM seeking partners online via social networking applications ('apps'). This study examines findings from a virtual ethnography of app use among MSM, focus group discussions with community-based healthcare workers, and key informant interviews with healthcare workers, policymakers and researchers in Metro Manila. We argue that participants viewed the expanding epidemic and apps as intimately linked, regarding the apps as 'risky spaces' for 'risky behaviour'. However, such narratives neglected the agentive capabilities of the apps and how they have transformed sexual practice, creating new ways of being as sexual subjects, while perpetuating old imaginaries among healthcare workers of 'hard-to-reach' populations. Such narratives of 'risk' have led to new interventions by healthcare workers on the apps, viewing these technologies as opportunities to reach more MSM for health promotion. However, the interventions have created new complexities by reconfiguring boundaries with target populations. By conducting community-based outreach through encouraging behaviour change in one-to-one interactions with app users, the potential impact of these interventions is limited.

Scenes as Micro-Cultures: Examining Heterogeneity of HIV Risk Behavior Among Gay, Bisexual, and Other Men Who Have Sex with Men in Toronto, Canada

Using latent class analysis (LCA), we examined patterns of participation in multiple scenes, how sexual risk practices vary by scene, and psychosocial factors associated with these patterns among 470 gay, bisexual, and other men who have sex with men (GBM) recruited from Toronto. We calculated posterior probability of being in a class from participation in nine separate scenes. We used Entropy, the Bayesian information criterion and the Lo-Mendel-Rubin likelihood ratio test to identify the best fit model. Fit indices suggested a four-class solution. Half (50%) of the GBM reported no or minimal participation in any scene, 28% reported participating in the dance club scene, 16% reported participating in the BDSM, bear, and leather scenes, and 6% reported participating in circuit, party and play, and sex party scenes. Compared to GBM who did not participate in scenes, GBM participating in the BDSM-Bear-Leather scene were more likely to be older, white, to report higher sexual self-esteem, and to engage in condomless anal sex; Party and Play scene members were more likely to be of Asian origin, and to use drugs before and during sex, whereas Dance Club scene members were more likely to be younger and to report lower self-esteem but higher hope. LCA allowed us to identify distinct social niches or micro-cultures and factors characterizing these micro-cultures. GBM differ in their risk for HIV and STIs according to characteristics associated with participation in distinct micro-cultures associated with scenes. Tailored interventions may be needed that focus on reducing HIV risk and promoting sexual health in specific contexts such as the BDSM-Bear-Leather and Party and Play.

Correlates and Racial/Ethnic Differences in Bareback Sex Among Men Who Have Sex with Men with Unknown or Negative HIV Serostatus

Men who have sex with men (MSM), particularly racial/ethnic minority MSM, are disproportionately affected by HIV in the United States and Texas. Bareback sex or condomless anal intercourse (CAI) can be a high HIV risk behavior. Despite this, a majority of MSM continues to engage in barebacking. Research suggests racial/ethnic differences in barebacking exist; however, these conclusions remain unclear due to insufficient sample sizes to compare racial/ethnic groups. Our cross-sectional correlational design explores barebacking correlates (substance use during sex, safe sex fatigue, and optimistic HIV treatment beliefs) within and between racial/ethnic groups among 366 MSM. Regression models are significant for Latino and African-American MSM alone and for all MSM combined, though not significant for European-American and Other Race/Ethnicity MSM alone. Our findings suggest motivations and behaviors underlying barebacking among MSM vary by racial/ethnic membership with clinical implications for informing culturally sensitive HIV interventions and prevention programs for target racial/ethnic groups.

Risk behaviours of an interrelated syphilis-infected sexual network of men who have sex with men

AIMS AND OBJECTIVES

We examined the risk behaviours in an interrelated sexual network of 33 syphilis-infected men who have sex with men on the use of condoms, substances and websites to meet sexual partners. Our study used a descriptive exploratory design to investigate co-occurring high-risk behaviours in this interrelated sexual network to inform future health interventions and research directions.

BACKGROUND

Although the risk behaviours for human immunodeficiency virus transmission in men who have sex with men have been studied, few have studied the high-risk population of men who already have syphilis, and even fewer have studied the risk behaviours in sexual networks of syphilis-infected men who have sex with men who were identified using contact tracing.

DESIGN/METHODS

The data were collected from semi-structured, individual interviews at a not-for-profit lesbian, gay, bisexual and transgender health centre in a large city in the Midwestern USA.

RESULTS

Inconsistent condom use was substantial during both insertive (92%) and receptive (88%) anal intercourse. Most participants (97%) reported using one or more substances prior to or during anal intercourse, and Internet websites were the most common place to meet sexual partners (88%).

CONCLUSIONS

High-risk behaviours were significant within this syphilis-infected sexual network of men who have sex with men. The majority of our 33 participants were non-Hispanic Whites (n = 27, 82%), possessed a baccalaureate degree or higher (n = 23, 70%), and actively sought out unprotected anal intercourse [21 participants (64%) used BareBackRT.com, a website to seek out unprotected anal intercourse].

RELEVANCE TO CLINICAL PRACTICE

Nurses should be more informed about the risk factors of a high-risk sexual network of syphilis-infected men who have sex with men. Interrelated sexual networks have high levels of similarity among participants' high-risk behaviours; contact tracing may be used to identify individual participants for relevant risk-reduction interventions.

HIV risk and sense of community: French gay male discourses on barebacking

This paper analyses the use of the concept of 'barebacking' as a risk category in the discourses of French gay men. It discusses how the rise and spread of the term barebacking contributes to reframing gay men's personal experiences of HIV prevention and their sense of belonging (or a lack thereof) to a gay community. The study is based on 30 qualitative interviews with French gay men conducted between 2005 and 2008. An import from the USA, the term barebacking emerged publicly in France in the late-1990s and was first used to describe intentionally unprotected sexual practices. Debates surrounding this risk category were marked by violent controversy over its use and its definition among HIV prevention actors. There remains a general lack of consensus on the definition of the term, despite its use by activists, in porn culture and in the daily discourses of gay men. By focusing on the relational roots of risk perception, I consider how uses of the term barebacking invoke a moral framework around risk taking.

Prevalence and risk factors of HIV and syphilis, and knowledge and risk behaviors related to HIV/AIDS among men who have sex with men in Chongqing, China

High HIV prevalence and incidence burdens have been reported in men who have sex with men (MSM) in Chongqing, China. We aimed to estimate the prevalence of HIV and other sexually transmitted infections (STIs), to appraise the knowledge and risk behaviors related to HIV/AIDS among MSM, and to analyze the possible causes of deviation between behavior and knowledge to make better strategies. We recruited 617 MSM from February to July in 2008 by using a respondent-driven sampling (RDS) method in Chongqing, China. Through the collection of questionnaire-based data and biological testing results from all objects, we launched a cross-sectional survey. STATA/SE was used for data analysis by frequency, ANOVA, rank sum test and logistic regression models. MSM with syphilis (OR=4.16, 95%CI: 2.35-7.33, P<0.0001) were more likely to be HIV infected. Being a company employee (OR=3.64, 95%CI: 1.22-10.08, P<0.0001) and having bought male for sex (OR=3.52, 95%CI: 1.10-11.32, P < 0.034) were associated with a higher probability of syphilis. MSM with younger age, higher education and greater monthly income had a higher mean knowledge score. MSM who had HIV testing had a higher mean knowledge score than those who never had. Students, venues for finding sex partners by Internet and homosexuals in MSM had a higher mean knowledge score compared to other occupations, venues for finding sex partners and sexual orientation. There is an urgent need for delivery of barrier and biomedical interventions with coordinated behavioral and structural strategies to improve the effect of HIV interventions among MSM.

Comportamentos sexuais de risco e preventivos masculinos: resultados de uma amostra recolhida através da internet em Portugal

Pretendeu-se com a pesquisa realizada estudar e comparar padrões de testagem em relação ao VIH; resultados do teste para o VIH; e comportamentos sexuais preventivos de homens homo, hetero e bissexuais. Os dados foram recolhidos através de um questionário on-line. A amostra foi constituída por 732 participantes com idade média de 32,2 anos, dos quais 53,7% identificaram-se como homossexual/gay; 27,4%, como heterossexual; e 18,3%, como bissexual, refletindo a divulgação privilegiada do estudo junto a organizações de lésbicas, gays, bissexuais e transgênero (LGBT). Nunca tinham realizado o teste para o VIH 26,6% dos participantes; 7,2% indicaram ser portadores do HIV. Homens gays apresentaram níveis significativamente mais elevados de testagem para o VIH e de soropositividade, quando comparados com os restantes. No geral, verificou-se ainda que homens gays indicaram ter mais comportamentos preventivos. Todos os grupos estudados apresentaram padrões comportamentais específicos e diferenciados em relação ao VIH. Conclui-se que são de grande importância intervenções comportamentais desenhadas à medida das necessidades dos diferentes grupos estudados, em particular junto aos homens heterossexuais e gays.

Personality among sexually compulsive men who practice intentional unsafe sex in São Paulo, Brazil

INTRODUCTION

There is evidence of an association between the practice of intentional unsafe sex among men who have sex with men (MSM) and sensation seeking and impulsivity. However, other aspects of personality have been less frequently investigated.

AIMS

This study aims to investigate the association between the practice of intentional unsafe sex and personality traits in individuals who sought treatment and met the criteria for compulsive sexual behavior in São Paulo, Brazil.

METHODS

The sample consisted of 69 sexually compulsive MSM. The participants underwent psychiatric evaluation and an interview to define intentional condomless sex and completed self-report instruments.

MAIN OUTCOME MEASURES

The participants completed the following measures: the Temperament and Character Inventory and the Sexual Compulsivity Scale.

RESULTS

Twenty-five participants (36%) reported intentional unsafe sex with casual partners, of whom 84% were gay and 16% bisexual (P<0.05). Fifteen (22%) individuals reported being HIV positive, and 11 (73%) of them practiced intentional unprotected anal intercourse (P<0.05). The mean of sexual compulsivity was associated with men who engaged in intentional unsafe sex (P=0.01). Men who reported intentional unsafe sex scored significantly higher on the novelty seeking temperament dimension (P<0.05) and scored significantly lower on the self-directedness character dimension (P<0.001). However, self-directedness predicted intentional unsafe sex in the multiple logistic regression (P=0.001).

CONCLUSIONS

Sexually compulsive individuals who practiced intentional unsafe sex presented lower self-directedness than the group who did not engage in intentional unsafe sex, which suggests less autonomy regarding life itself. To the best of our knowledge, this is the first study to consider intentional unsafe sex in sexually compulsive men.

HIV knowledge and related sexual practices among Portuguese men who have sex with men

Qualitative studies of the sexual risk practices of Portuguese men who have sex with men (MSM) are scarce, as have been campaigns to target this group despite high HIV infection rates. This study investigates the concepts and practices of safer sex of a group of 36 Portuguese self-identified gay men (age: x = 34.4, SD = 9.1) who have met sexual partners online; two identified as HIV positive. Thematic analysis of interviews showed that our participants were aware of HIV transmission risks and tended to protect themselves in most sexual practices. Oral sex and steady relationships, however, did not always include safer practices. Participants tended to rely on indirect sources of information when assessing their partners’ HIV status, such as their physical characteristics or the information available in online profiles. Contrasting HIV positive and negative men’s sexual expectations and practices indicated that communication shortcomings might be putting some at risk. Findings suggest that safe sex is a relational practice which can only be understood and addressed within the context in which it occurs.

Os jovens homossexuais masculinos e sua saúde: uma revisão sistemática

Com o objetivo de analisar a literatura acadêmica de abordagem sociocultural acerca da relação entre os temas homossexualidade masculina, homem jovem e saúde, realizou-se uma revisão baseada na análise de conteúdo temática de 37 artigos selecionados, nas bases de dados Medline e Lilacs, entre 2004 e 2013. A escassez de literatura na perspectiva sociocultural apontou para obstáculos e desafios, relacionados à promoção de saúde, que vão desde a qualidade da informação, passando por valores simbólicos inconscientes, até a efetivação de propostas de gestores de saúde. Concluiu-se que a hegemonia heterossexual encontra-se presente nas estruturas inconscientes da construção da homossexualidade, contribuindo para a perpetuação do habitus heteronormativo. Estudos que valorizam o encontro do saber técnico com o conhecimento que cada um produz, referido a seus valores pessoais e culturais, podem servir de subsídio para o maior aprofundamento dessa discussão.

Beyond prevention: containment rhetoric in the case of bug chasing

Bug chasing, the practice of pursuing HIV positive sexual partners in order to acquire HIV, presents multiple dilemmas for health affiliates in terms of how to address discourses and practices that challenge widely held beliefs about health and medicine. In order to examine how researchers respond to controversial counterpublic rhetorics, this essay chronicles the construction of "bug chasing" in published social science literature. Guided by a theory of containment rhetoric, I analyze how bug chasers are configured in the language of social science used to describe and explain them. I find that social scientific coverage of bug chasing often addresses the behavior using a recipe of rhetorical containment: first, authors gaze upon bug chasers via distanced descriptions of the community; second, authors characterize the behavior as exhibiting an idealistic naiveté; and, third, authors stress the inconceivable, and therefore reproachable, sacrifice that bug chasing ultimately demands of its onlookers and participants. In closing, I evaluate the consequences of this containment rhetoric and offer three rhetorical maneuvers to aid future scholarship that examines the discourses and communities that counter dominant health ideologies.

Masculinity and Barebacker Identification in Men who have Sex with Men

Purpose:

Barebacking is a term that is used to refer to intentional involvement in unprotected anal sex. This paper examines the relationship between masculinity and self-identification as a barebacker, and how these factors related to HIV risk practices in a sample of men who have sex with other men (MSM).

Method:

As part of the Men4Men Study, a brief Internet-based survey was completed in 2007 with English-speaking MSM aged 18+ who were not involved in a marital/romantic relationship at the time of interview. 886 participants were recruited by placing electronic postings and banner advertisements on Weblogs, social and sexual networking sites, and listservs frequented by MSM.

Results:

A number of factors differentiated men who self-identified as barebackers from those who did not, and barebacking identity was linked with greater involvement in HIV risk practices. Multivariate analysis revealed that having a high level of masculinity was associated with a greater likelihood of self-identifying as a barebacker.

Conclusions:

HIV prevention and intervention efforts targeting MSM ought to address issues of self-identification as a barebacker as well as the extent to which men adhere to a masculine ideology.

Gay and bisexual men's use of the Internet: research from the 1990s through 2013

We document the historical and cultural shifts in how gay and bisexual men have used the Internet for sexuality between the 1990s and 2013-including shifting technology as well as research methods to study gay and bisexual men online. Gay and bisexual men have rapidly taken to using the Internet for sexual purposes: for health information seeking, finding sex partners, dating, cybersex, and pornography. Men have adapted to the ever-evolving technological advances that have been made in connecting users to the Internet-from logging on via dial-up modem on a desktop computer to geo-social-sexual networking via handheld devices. In kind, researchers have adapted to the Internet to study gay and bisexual men. Studies have carefully considered the ethics, feasibility, and acceptability of using the Internet to conduct research and interventions. Much of this work has been grounded in models of disease prevention, largely as a result of the ongoing HIV/AIDS epidemic. The need to reduce HIV in this population has been a driving force to develop innovative research and Internet-based intervention methodologies. The Internet, and specifically mobile technology, is an environment gay and bisexual men are using for sexual purposes. These innovative technologies represent powerful resources for researchers to study and provide outreach.

Sex, HIV, and the Internet: Exploring Variations in the Online Profiles of MSM in the United States

With the increasing pervasiveness of social media, the Internet has become an important venue for dating and sex. Not only does the Internet introduce a unique array of opportunities and risks for men who have sex with men (MSM), it also presents a valuable means through which to study sexual behavior. In this study, data on what men report in their online profiles were collected from two dating/hookup websites to explore possible geographical differences in men's sexual preferences and expectations (N = 5,588). Across the 15 selected cities, significant differences emerged in reported HIV status and stated preference for safer sex (condom use). These patterns suggest important contextual and demographic variations and point to a need for targeted, population-specific interventions and further research to identify the underlying social and psychological constructs. With a better understanding of the local factors driving risky sexual behavior, health communication messages and tailored online interventions could be developed to address the needs and concerns of specific groups.

Why rectal douches may be acceptable rectal-microbicide delivery vehicles for men who have sex with men

RATIONALE

To explore age of onset of rectal douching among men who have sex with men (MSM) and reasons leading to and maintaining douching behavior; and to consider whether rectal douches containing microbicidal agents might be acceptable for men at HIV risk.

METHODS

In stage 1, we used qualitative methods to explore douching behavior in a sample of 20 MSM. Subsequently, we developed a structured questionnaire that was administered in stage 2 to 105 MSM.

RESULTS

More than half of participants who completed stage 1 douched during the trial despite having been advised not to do so. Of the 105 human immunodeficiency virus uninfected participants in stage 2, 51% reported using rectal douches in the prior 6 months; 47% douched before and 25% after anal intercourse. Most participants reported douching frequently or always. On average, men reported douching about 2 hours before or 1 hour following intercourse. Average age of onset was late 20s. Most men who douched wanted to be clean or were encouraged to douche by their partners. Some men thought douching after sex could prevent sexually transmitted infections.

CONCLUSION

Rectal douching appears to be a popular behavior among men who have receptive anal intercourse. It is necessary to identify harmless douches. If human immunodeficiency virus or sexually transmitted infections preventive douches can be developed, rectal douching before or following sexual intercourse could become an important additional prevention tool. To reshape an existing behavior to which some men strongly adhere, like douching, by suggesting use of 1 type of douche over another may be more successful than trying to convince MSM to engage in behaviors they never practiced before or those they resist (e.g., condom use).

When 'raw sex' turns to a 'raw deal' … taking the opportunity to think about sex? Interviews with HIV-positive gay men diagnosed with acute hepatitis C

Since 2001, cases of hepatitis C virus (HCV) sexual transmission have been reported in France, among HIV-positive gay men who do not inject drugs. An earlier study focused on the incidence of acute hepatitis C and risk factors associated with HCV transmission. The present study, based on in-depth interviews, aimed to highlight the biography, the sexual practices and the experiences of gay men infected with HCV. Beyond an apparent uniformity, the group of interviewees illustrates a variety of situations, life stories and health pathways, depending on their age. These well-adjusted gay men were used to engaging in unprotected sexual practices, but before their diagnosis they largely ignored HCV-transmission risk, which was associated in their mind with a pejorative drug addict image. Once diagnosed with acute hepatitis C, they experienced a critical and emotional period during which they were open to discuss their sexual practices and reconsider risk-reduction procedures, without being willing to give up on their satisfying sex life. Health educators should consider labelling hepatitis C as an STI in order to disrupt its negative image and to help HIV-positive gay man raise their awareness of HCV-transmission risks and implement better risk-reduction strategies.

Are HIV-negative men who have sex with men and who bareback concerned about HIV infection? Implications for HIV risk reduction interventions

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.

Depressive symptoms among MSM who engage in bareback sex: does mood matter?

Much research has examined the relationship between depressive symptoms and unprotected sex among men who have sex with men (MSM), but little is known about how depression is related to the sexual behavior of men who intentionally engage in unprotected anal intercourse, or bareback sex. In this study, we explored the extent to which depressive symptoms were associated with rates of unprotected sex among barebackers, and whether this relationship was dependent upon HIV serostatus. Using a sample of 120 MSM who engage in intentional condomless sex, we found that for HIV-negative participants, depressive symptoms were associated with the overall frequency of unprotected anal intercourse as well as unprotected anal intercourse with a serodiscordant partner. For HIV-positive participants, depressive symptoms were not associated unprotected intercourse. Additional research is needed to better understand depression among men who bareback and how interventions could be designed to address depression and reduce sexual risk behaviors.

Sex and the community: the implications of neighbourhoods and social networks for sexual risk behaviours among urban gay men

Gay neighbourhoods have historically served as vital places for gay socialising, and gay social networks are important sources of social support. Yet, few studies have examined the influence of these forms of community on sexual health. Informed by theoretical frameworks on neighbourhoods and networks, we employ multi-level modelling to test hypotheses concerning whether gay neighbourhoods and social network factors are associated with five sexual risk behaviours: receptive and insertive unprotected anal intercourse (UAI), barebacking identity, recent internet use for finding sexual partners, and 'Party and Play' (PnP). Our analyses of a community-based sample of gay men in New York City reveal little evidence for the direct effect of gay enclaves on sexual risk with the exception of PnP, which was more likely among gay enclave residents. Having a network composed predominantly of other gay men was associated with insertive UAI, PnP, and internet use for meeting sexual partners. This network type also mediated the association between gay neighbourhoods and higher odds of insertive UAI as well as PnP. Our findings highlight the sexual health implications of two important facets of gay community and, in doing so, indicate the need to better contextualise the sexual health risks faced by gay men.

Spectrums of love: examining the relationship between romantic motivations and sexual risk among young gay and bisexual men

We examined the association between HIV/AIDS risk behaviors and romantic feelings among single, young gay and bisexual men (YGBM). Romantic feelings may have positive (romantic ideation) and negative (romantic obsession) connotations. Consequently, we hypothesized that YGBM would report greater risks if they reported having obsessive thoughts about their relationship desires; conversely, we hypothesized that YGBM who envision a romantic relationship would report fewer unprotected partners. Using cross-sectional data from a study examining YGBM's online dating experiences (N = 376; ages 18-24), we found a positive association between romantic obsession and number of partners for unprotected receptive (URAI) and insertive (UIAI) anal intercourse. Conversely, we found a negative association between romantic ideation and number of partners for URAI and UIAI. Is love risky or protective? Our results indicate support for both perspectives. We discuss the implications of our findings, highlighting the importance of addressing romantic pursuits into existing HIV prevention interventions for YGBM.

Inner contradictions among men who bareback

Barebacking, or intentional unprotected anal intercourse when HIV transmission can occur, emerged as a descriptive term in the 1990s, and marked greater acceptance by gay and bisexual men of dispensing with condom use under certain circumstances. In an exploratory study of men who used Internet sites to meet partners and reported recent episodes of barebacking, respondents outlined numerous strategies they deployed to avoid HIV infection instead of universal condom use. However, in interviews many participants acknowledged uneasiness with the flaws in their chosen strategies, and the contradiction between their urgent desire to remain HIV-free and their sexual practices. For some, the dissonance between the conflicting cognitions could be resolved through self-justification, mental compartmentalization, or invincibility beliefs so that barebacking could continue. For this subpopulation, continued reiteration of cognitive-based prevention messages has the potential to reinforce rather than undermine their attachment to inadequate strategies for disease avoidance.

Use of a rapid HIV home test to screen sexual partners: a commentary on Ventuneac, Carballo-Diéguez, Leu et al. 2009

Previously, we estimated the HIV risk reduction that men who have sex with men could attain using a rapid HIV home test to screen sexual partners versus using condoms inconsistently. Here, we clarify the assumptions of our published formulas. Using models that more closely resemble our study population, our results show a difference from that presented in the original article in the magnitude of the relative advantage (i.e., lower risk of HIV infection) for HIV home test use versus inconsistent condom use. We present a general formula that can accommodate different types of partnerships in estimating risk of HIV infection.

The Internet profiles of men who have sex with men within bareback websites

The Internet has become a venue for men who have sex with men to search for sexual partners. Some of these men intentionally seek unprotected anal intercourse with other men ('bareback' sex). This paper focuses on the creation, use, and content of Internet personal profiles of men who have sex with men in the greater New York City metropolitan area who use bareback sites for sexual networking. We used a mixed-methods approach to examine data from a cybercartography of Internet sites conducted during the first phase of the research (199 personal profiles) and from in-depth interviews conducted during its second phase (120 men who have sex with men who sought partners online for bareback sex). Results indicate that men generally followed offline stereotypical patterns in their online profiles. However, men who disclosed being HIV-positive were more likely to include face and head pictures. Overall, the images they used were heavily sexualised in accordance with group norms perceived and reinforced by the websites' design and imagery. Bottom-identified men tended to be more explicit in the exposition of their sexual and drug use interests online. This paper highlights how certain virtual and social performances play upon and reinforce other, in the flesh, performances.

Achieving Safety: Safer Sex, Communication, and Desire among Young Gay Men

Conceptualizations of safer sex practices among young gay men (YGM) are frequently structured around communication between partners and the subsequent utilization or absence of condoms in a sexual encounter. Drawing on a sample of 34 in-depth interviews with YGM, ages 18 to 24, we explore the ways in which conceptualizations and definitions of safer sex are discussed and enacted. Placing attention on their safer sex practices, we analyze the conversations that do and do not occur among YGM and their partners, including the strategies (e.g., negotiated safety, condom communication and negotiation) that are commonly perceived as most useful by YGM. We provide recommendations regarding how to craft safer sex messages for YGM by considering their competing demands.

Predictors of reporting bareback sex among a diverse sample of MSM recruited through a Swedish website

This study aimed to understand how person, health and sexual behavior, HIV-risk cognitions, and gay community involvement relate to barebacking among 3634 men who have sex with men (MSM) recruited by way of the Swedish website QX.se. In this sample, 10% reported that they had engaged in barebacking in the past year. Variables found to be statistically significant in the bivariate analyses were incorporated into a logistic regression domain-specific model. Variables that remained significantly associated with barebacking in domain 1 were being HIV-positive and having had a sexually transmitted infection (STI) in the past year. The variable talked with someone in HIV services remained significant in domain 2, and for domain 3, the variable used the Internet to look for a bareback partner remained significant. Two variables, believing taking semen in one's mouth involves no or low risk of HIV transmission and believing that engaging in insertive unprotected anal intercourse (IUAI) involves no or low risk of HIV transmission, remained significant in domain 4. The final multivariate regression analysis included six variables (from domains 1 to 4) and had a significant fit (χ (2)(6) = 2.571, p=0.958). The likelihood of engaging in barebacking was higher for those men who reported being HIV-positive (odds ratio [OR] = 2.77), having had an STI in the past year (OR = 1.67), and having used the Internet to look for a bareback partner (OR = 12.59). This first study to explore the predictors of bareback sex among a Nordic MSM sample suggests that bareback sex among northern European MSM is less common than among other samples. The findings reconfirm that MSM who engage in bareback sex may represent a unique subset of MSM with distinct HIV prevention needs.

Sexual pleasure and intimacy among men who engage in "bareback sex"

An ethnically diverse sample of 120 mostly gay-identified men who engaged in "bareback" intercourse was recruited via the Internet in New York City. By study design three quarters of participants were HIV-uninfected and engaged in condomless receptive anal intercourse. In the course of face-to-face in-depth interviews, participants were asked what led them to have their first bareback experience as well as to continue with the behavior. Qualitative analysis identified the pivotal role that sexual pleasure and intimacy have in this population and how drives for sexual satisfaction, adventure, intimacy, and love overpower health concerns and condom use recommendations. Men interested in bareback sex use a variety of defense mechanisms to account for, justify, and exonerate their behavior. HIV-prevention interventions have paid insufficient attention to libidinal drives, a crucial element of psychological functioning.

Mr. Right and Mr. Right Now: romantic and casual partner-seeking online among young men who have sex with men

Dating is a normative behavior for youth, yet few studies have examined the relationship between romantic partner-seeking and sexual behavior among young men who have sex with men (YMSM). This omission is most notable across studies examining YMSM's partner-seeking behaviors online. In this study, we examined the relationship between sexual behaviors and online partner-seeking behaviors for casual and romantic partners in a sample of YMSM (N = 431; M = 21.49 years old, SD = 1.94) who reported using the Internet to meet other men. Using analysis of covariance (ANCOVA), we found YMSM in the High Romantic/High Casual group had more unprotected partners than YMSM in other categories. YMSM in the High Romantic/Low Casual group had fewer unprotected partners than the High Romantic/High Casual group. We discuss the implications of our findings and conclude that there is a need to further examine romantic partner-seeking among YMSM.

Sexual risk behaviour for transmission of HIV in men who have sex with men: recent findings and potential interventions

PURPOSE OF REVIEW

Men who have sex with men (MSM) remain one of the groups most at risk of HIV, particularly in countries with concentrated epidemics. Here, we review findings from behavioural research with MSM and discuss the potential of behavioural interventions.

RECENT FINDINGS

Increasing sexual risk behaviour and HIV transmission among MSM is apparent. Although risk reduction strategies, including serosorting and strategic positioning, are being widely reported, these appear to offer limited protection to HIV-negative MSM. There are emerging HIV epidemics among MSM in low-income and middle-income countries, with reported high levels of HIV and sexual risk behaviour. Studies of African MSM report higher HIV prevalence than that in the adult male general population. Evidence of effective behavioural interventions is growing. However, further trials, incorporating biological endpoints, are required.

SUMMARY

Reducing HIV transmission among MSM remains a significant challenge. Risk reduction strategies, other than condom use, could reduce the risk, but their efficacy is questionable, particularly when knowledge of HIV status may be inaccurate. Behaviour change alone is unlikely to produce the sustained reductions in HIV transmission necessary to change the course of the epidemic. 'Combination prevention', which incorporates biomedical, behavioural, social and structural interventions, should be explored further.

Perceived risks and protective strategies employed by young men who have sex with men (YMSM) when seeking online sexual partners

This study examined the perceptions of risk by young men who have sex with men (YMSM) regarding meeting sexual partners through the Internet. Fifty-four YMSM ages 18-29 who reported engaging in bareback sex ("intentional unprotected anal intercourse in high-risk contexts") completed a structured assessment and a face-to-face interview. Participants reported using the Internet to meet sexual partners at least once per week, having had multiple sexual partners in the past 2 months (M = 10.50, SD = 9.25), and engaging in occasions of unprotected receptive (M = 5.35, SD = 6.76) and insertive (M = 5.06, SD = 10.11) anal intercourse. A third of the sample reported having had unprotected sex with a partner who was serodiscordant or of unknown serostatus. Despite the obvious HIV risks, the most commonly perceived risks included threats to physical safety and difficulties trusting a stranger. Risk reduction strategies included leaving information about partner and whereabouts with a friend, meeting in a public place, and screening partner through online chatting. Those YMSM who meet partners online may be at risk for physical violence in addition to HIV or sexually transmitted infections (STIs). Public health campaigns should increase awareness of safety concerns when meeting sexual partners online and support YMSM's self-protective actions.

Stress and coping among HIV-positive barebackers

HIV-positive MSM may report high-risk behaviors-including drug use and intentional unprotected anal sex-as a means of coping. We recruited a diverse sample of HIV-positive men (n = 66) at gay community events. One third of these men self-identified as barebackers. Barebackers were more likely to report drug use and sex under the influence of drugs (i.e., PnP). Beyond this, those who identified as barebackers also tended to report greater stigma, gay-related stress, self-blame-related coping, and substance abuse coping. Providers must attend to issues of stress and coping to engage men who may not respond to traditional risk reduction efforts.

Intentional condomless anal intercourse among Latino MSM who meet sexual partners on the Internet

Data on intentional condomless anal intercourse in risky contexts, also known as "barebacking," among ethnic minority MSM, whose rates of HIV infection continue to rise, are extremely limited. In this study, 31 Latino MSM who seek barebacking partners via the Internet underwent in-depth interviews about bareback sex and its association to pleasure, substance use, HIV concerns, and cultural identity. Participants reported engaging in bareback sex owing to the physical and emotional pleasure they experience. They expressed concern about HIV infection and took steps to reduce risk of infection. Although a majority of participants reported using alcohol or drugs in the context of bareback sex, substance use did not appear to propel the behavior. Crystal methamphetamine use, prevalent only among our HIV-positive participants, was related to very high HIV risk behavior. In this sample, culture did not seem to play a large role in barebacking.