PHOTO: Rick & Steve character Chuck, an older HIV-positive gay character, defines bareback in an AIDS prevention class for young gay men: Battling Aids Requires Education Bring A Condom Kiddo. (See previous posts Dustin Lance Black bareback unsafe sex (6/15/09), Bareback stealthing and other stuff (4/27/09), Gay bareback sex, wishful thinking (3/19/09) and Rick & Steve define bareback (1/15/09))
The long held theories of AID educators are challenged in the ethnographic study by Dave Holmes, et al., "Bareback Sex: A Conflation of Risk and Masculinity," International Journal of Men's Health, Summer 2008, p. 171-191 DOI: 10.3149/jmh.0702.171.
(abstract) From a healthcare perspective, there is an underlying assumption that most gay and bisexual men do not intentionally seek to have unprotected anal sex. This paper presents the results of a qualitative investigation conducted in three Canadian gay bathhouses regarding unprotected anal sex among men. It is our contention that much epidemiological research, though helpful, obfuscates essential factors in the practice of bareback sex. Consequently, the paper addresses two themes: the identification from the participants' perspective of the risk factors involved in the practice of bareback sex and the identification of specific risk-reduction strategies used by barebackers. Our research results indicate that the majority of the participants were informed about health risks and took steps to avoid harmful practices even when engaging in high-risk sexual activities. Many participants, regardless of their HIV status, used risk-reduction strategies because the majority wanted to protect both their partners and themselves. . .
(p. 179) In contrast to public health claims that bareback sex usually occurs because of ignorance or due to the influence of drugs, it is essential to emphasize that the participants in this research project were well aware of the associated risks. We believe that the misguided public health assumption is highly problematic because it incorrectly frames several educational and prevention campaigns. For example, an HIV-negative participant who practices bareback sex as well as oral sex without condom states: "For me, it's the state of my oral hygiene, "Did I brush my teeth before I went out?" Yes . . . then no oral sex is going to happen . . . . That's in case someone has a lot of pre-cum, because pre-cum can be very heavy with HIV." . .
Despite the fact that this participant practices barebakcing, he seems more concerned about the risk associated with oral sex if the mucosa is not intact. It is interesting to note that this participant's knowledge of the term "super seminal shedder" is in fact superior to the knowledge of many HIV clinicians and researchers who are unaware of the concept. The same interviewee was explicit in his description of the potential risk of HIV transmission via oral sexual contact: "Sucking is as safe as the cock you're sucking and the state of your mouth . . . people just doesn't [sic] understand the dangerous place for a potentially HIV-infected cum is actually your mouth. I mean, the obvious thing is to not let someone come in your mouth but if it does happen . . . well, get it out of your mouth, so if that swallowing it, then swallow it, if it's spitting it out, then spit it out, but get it out. That's where the important potential risk of infection is, it's actually in your oral cavity." . . .
While the language used by this participant is not euphemized with medical jargon, an in-depth knowledge of risk is definitely present. In fact, this quotation illustrates an understanding of the location of possible infection (the oral cavity) and is aware that the likelihood of infection increases as the length of time of exposure increases. . .
(p.181) The next category that emerged from our data was the representation of risk. Although it could be interpreted as barebackers exhibiting ignorance about sexual practices, in our view, this category represents a personal integration of knowledge of risk from a variety of sources. At a time when even organizations such as the CDC and Health Canada are unable to provide coherent and matching definitions of risk and transmission, it is an internalization of a variety of sources on the topic of HIV transmission rather than a recitation of all possible risk sources.
(p. 182) "As a top, barebacking is to me not a particularly risky activity, that's my own personal line that I've drawn. As a bottom, it's a very risky activity. The rationalization that I've come to in that decision is, I'll let someone suck me without a condom and it doesn't matter... I don't ask whether they're HIV positive or not, to me that's an acceptable risk in my world. I've talked to a lot of people, and eventually came to the conclusion for myself that to be a top, all things being equal, the state of my penis is healthy, then to me it's as risky as oral sex. It's the same level of risk, and if I've made that rationalization for oral sex, then what's the difference for anal sex?" . . . Another participant adds: I bareback because we all die from the time we pop out. And I feel like I'm a little more spiritually evolved, than I was before. I believe that death is just an extension or a continuation of life. . .
(p.183) All the barebackers we interviewed knew the risks associated with unsafe anal sex and the majority of them were practicing bareback sex with a harm reduction mindset. M were able to outline risk reduction strategies that they used with their partners; for example: (1) sero-selection of partners, (2) physical appearance of partners, (3) use of coitus interruptus, (4) pre-anal intercourse preparation, (5) self-awareness, and (6) decreased number of partners. . .
(p. 187) According to the Centre for Disease Control, the number of gay men who reported not using condoms with multiple anonymous partners increased from 24 to 45 percent between 1994 and 1999, and the statistics for other Western countries reveal that this phenomenon is not limited to North America. In a survey of more than 14,000 gay males conducted in the UK (Sigma Research, 2003), up to 60 percent of respondents reported having practiced bareback sex. Studies in Russia and in the cities of Budapest, Melbourne and Sydney have all reported increases in barebacking (Shernoff, 2006). An increase in the efficacy of anti-retroviral drug treatments has been suggested as a factor in this resurgence in high-risk behaviour (Halkitis & Parsons, 2003; Ridge, 2004); however, none of our participants offered this as a reason for engaging in barebacking. The relevance to men who have sex with men of public health discourses regarding HIV/AIDS awareness was also questioned, suggesting a rift between the dominant discourse and personal narratives (Ridge). When personal motivations for practicing bareback sex were explored (Holmes & Warner, 2005), reasons such as connectedness through skin to skin sex contact, the spontaneity and naturalness of barebacking, and a sense of completion (including semen exchange) were offered. . .
(Quoted from Dave Holmes, et al., "Bareback Sex: A Conflation of Risk and Masculinity," International Journal of Men's Health, Summer 2008, p. 171-191 DOI: 10.3149/jmh.0702.171 )
The authors said "In analyzing the data, we drew on the insights risk offered by poststructuralist theorists." This was a new term to me and a quick reading of Post-structuralism (Wikipedia) tells me that the definition used by the author may be unclear.
The authors' thesis is that bareback sex participants in many cases are making decisions to take a risk not based on ignorance. However, in my opinion most gay men are taking risks based on folklore instead of scientifically proven data. I do not blame them because no study has been able to collect a sample size large enough to calculate risks with any precision. Therefore risk is being decided by an informal Delphi method (Wikipedia).
In my experience, this type of group consensus on risk can be surprisingly more accurate than any scientific study. For example, the lower risks of HIV were first determined by gay men long before any scientists agreed. However, consensus or "group thinking" can often perpetuate misinformation that might not be challenged for decades. For example, the real symptoms of physical disorders, such as multiple sclerosis, were long thought to be psychosomatic until medical tests were invented that show what was physically wrong. Multiple sclerosis victims were often dismissed as mentally ill until brain MRI images showed they had a real problem. I bet many other so-called "mental disorders" will in the future be reclassified as organic as medical science advances.
I was glad to see the authors acknowledged the fact that the CDC and Health Canada have inconsistent messages about HIV risk. I still hear young gay men confused by these messages. As a result, many take a fatalistic approach and decide to take more risk. In my opinion there is a fine line between being fatalistic versus depressive or suicidal.
The authors quote one bareback participant (p. 181-182) who describes his algorithm of how to decide if to use a condom or not. As a top, he says nothing and leaves it up to the bottom. Other factors are mentioned, such as always using a condom in a bathhouse. The authors' examples confirm my belief that the old 1980s "condom code of using a condom every time" is no longer practiced by young gay men. I am also disturbed by how many young gay men think it is impossible to talk about condoms and therefore leave it up to heat of the moment decisions.
Once again, I don't blame young gay men because the decision to bareback is complicated by all of the methods of harm reduction. For example, one participant told the authors, "I don't mostly cum inside. Because I like the feeling of seeing cum. I Like cumming on someone's chest. Mostly people like to see cum. That's what sex is about. Sex is about the cum. People are always curious... they just want to see it." (p. 184)
Another risk reduction method noted by the authors: "Our results show that some barebackers insist on a preparation ritual to prepare the anus for sexual activity, thus reducing the risk of damage to anal tissue such as abrasions and open lesions. For some participants, extended foreplay constitutes part this preparation and, as such, involves oral-anal stimulation, digital dilation of the sphincter, and the use of a substantial amount of lubricant."
Right or wrong, gay folklore is being used by gay men to decide on the risks they take and methods they use to avoid harm from sexually transmitted infections. Sadly, science has been unable to provide gay men with any better advice.
