Harm Reduction for Barebacking?

by Rafael Madrid, PhD - for ACRIA

I came to New York City, like many other gay men, looking for a place where I could be myself and escape the repressive, conservative, and homophobic society of my native Chile, where you can't talk about sex, period. What I actually found - in the city where the Stonewall Riots happened and the gay rights movement began - was an only slightly less homophobic society. I found a city facing the same problems as other societies that preach abstinence or perfect behavior as the only way to deal with the complicated issue of human sexuality.

After living here awhile and working in the HIV and LGBT fields, I began to hear people talking about "condom fatigue" and the rise of "barebacking" among gay man, including the use of websites as a way to practice it. I learned about concepts like "PNP" (Party and Play - mixing recreational drugs and sex) and the reality of burnout and the tiredness of old prevention campaigns.

To get a sense about how other gay men felt about this, I registered at one of the most popular sex websites in New York City. I contacted 69 guys on the site with an invitation to bareback, and 48 responded. Surprisingly, 26 of them were open to the idea; 15 of those 26 were partying, mainly with crystal methamphetamine.

What is barebacking?

Barebacking is gay slang for intentional unprotected anal intercourse. Different from just skipping the condom in the heat of passion, barebacking means making a deliberate decision before sex to not use one. (The term "barebacking" may not be acknowledged by all men who practice this behavior - some men use the terms "raw" or "natural" instead. Health professionals who are tailoring programs toward barebackers must recognize this in order to design effective prevention services.)

Internalized homophobia can be an important stressor that contributes to barebacking. According to Michael Shernoff, it creates an "an unconscious sense that a gay man is unimportant and undervalued, thus increasing his sense that he is expendable, and so too are the men with whom he has sex and from whom he seeks love and validation."

Research conducted in New York has shown that use of crystal meth correlates directly with barebacking among white, black, and Latino (but not Asian) gay men. A study of gay meth users in New York City suggested that men with certain psychological profiles are attracted to methamphetamine, use it in environments and contexts that are sexually charged, and as a result are more likely to engage in barebacking. Whether men use the drug intentionally as a way to facilitate barebacking or whether barebacking is a byproduct of methamphetamine use - or some combination of the two - are issues that need further exploration.

Read the rest.

And please leave a comment on the blog whether you agree with Rafael, disagree or simply want to continue the conversation around the notion of harm reduction and natural - "bareback" - sex.