Health Psychology Research 2014; volume 2:1582

Generationing, stealthing, barebacking MSM are referred to as bug chasers and gift givers. Bug chasers are HIV- Correspondence: Hugh Klein, Kensington and gift giving: the intentional negative men who actively seek unprotected Research Institute, 401 Schuyler Road, Silver transmission of HIV by sex with HIV-positive partners, so that they Spring, MD 20910, USA. HIV-positive men to their themselves can become HIV-infected. Their Tel.: +1.301.588.8875 - Fax: +1.443.885.8262. HIV-negative sex partners active pursuit (chasing) of the HIV virus (bug) E-mail: [email protected]; [email protected] gives rise to their moniker. Bug chasers’ coun- Key words: men who have sex with men, HIV risk terparts are known as gift givers: HIV-positive Hugh Klein practices, Internet, gift giving, HIV transmission, men who seek unprotected sex with HIV-nega- generationing. Kensington Research Institute, Silver tive partners, so that they can seroconvert Spring, MD, USA their partners to being HIV-positive. The term Acknowledgments: this research was supported gift giver derives from the notion that HIV-pos- by a grant from the National Institute on Drug itive men have something special that can be Abuse (5R24DA019805). The author wishes to cherished (the gift) that they can transmit to acknowledge, with gratitude, the contributions other men (giving). The existence of these made by Thomas Lambing to the data collection, Abstract subgroups within the MSM barebacker culture data entry, and data cleaning efforts done for this has led some authors to conclude that bug study. Gift giving is the process by which an HIV- chasers (and presumably gift givers as well) positive person purposely infects an HIV-nega- constitute an actual subculture within the Conflict of interests: the authors declare no potential conflict of interests. tive person with HIV, usually with that person’s broader grouping of barebacking men.1 knowledge and consent. Little has been written Little has been written in the scientific liter- Received for publication: 17 April 2014. about this HIV transmission practice. In this ature about bug chasers, and even less has Revision received: 31 July 2014. paper, two specific types of gift giving – gener- been documented with regard to gift givers. Accepted for publication: 4 August 2014. ationing and stealthing – are explained and The latter is the focus of the present article. introduced to the scientific literature. Both subgroups appear to be relatively small, This work is licensed under a Creative Commons Generationing is a type of gift giving in which comprising a total (bug chasers + gift givers) Attributiononly NonCommercial 3.0 License (CC BY- one gift giver successfully infects a previously- of anywhere from 1.0% to 9.7% of the overall NC 3.0). uninfected man with HIV, and then the two population of barebacking MSM.2-4 Bug ©Copyright H. Klein, 2014 men collaborate in an effort to seroconvert chasers appear to outnumber gift givers by Licensee PAGEPress, Italy another man, and so forth. Stealthing is anoth- approximately 3:2; but limited research makesuseHealth Psychology Research 2014; 2:1582 er type of gift giving in which an HIV-positive this ratio difficult to confirm. If a distinction is doi:10.4081/hpr.2014.1582 man actively tries to infect an HIV-negative made between committed or ardent gift givers man with HIV, without the latter’s knowledge – that is, those who are seeking to have sex or consent. The present study reports on the only with confirmed HIV-negative sex partners engage in stealth infections (what those prevalence of gift giving (4.6%) in a population – and passive or opportunistic gift givers – that authors called sneaking) of HIV-negative men. of men who use the Internet specifically to is, those who wish to have sex with HIV-nega- Those authors acknowledged that scientists identify partners for unprotected sex. The tive partners and/or with those whose HIV have documented little about the extent to research is based on a national random sample serostatus is unknown and unconfirmable – which gift givers are (or are not) the mirror of 332 men who have sex with men, identified then the prevalence of gift givers in the bare- image of bug chasers – the proverbial yin to from 16 websites. Data were collected via tele- backing population rises to 23-26%.2,4 Recent phone interviews conducted between January evidence suggests that both bug chasing and the bug chasers’ yang. In the present report, 2008 and May 2009. The paper concludes with giftcommercial giving are increasing in prevalence. 2,4 the prevalence of gift giving in a sample of a discussion of the implications of these find- The increasing use of the Internet to find Internet-using barebacking men is examined. ings for HIV prevention and intervention sex partners for barebacking is usually attrib- In addition, two phenomena that appear to be efforts. Most notably, to the extent that genera- uted to this rise.4 Some scholars have claimed unique to the gift giving experience – namely, tioning, stealthing, and gift giving occur among that medical advances that make HIV infection generationing and stealthing – are discussed. MSM, they represent a very high riskNon of HIV a chronic manageable disease rather than a The purpose of this article is to shed some transmission. More work needs to be done to condition that is likely to lead to short-term light on these particular gift giving-related understand these behaviors, the factors that death have contributed to increases in bug practices, and to discuss their implications for underlie them, and to determine how prevalent chasing and gift giving behaviors, because HIV prevention and intervention. they are in the bare-backing population of some do not perceive HIV infection in them- MSM. selves or their sex partners to be particularly problematic anymore.5 Gift giving, as with bug chasing, may be attributable, at least in part, to Materials and Methods a desire for excitement, thrills, and rule break- Introduction ing, which many people find sexually This paper draws from data that were col- arousing.5 lected between January 2008 and May 2009 for Barebacking is a practice in which people Very little has been written in the scientific The Bareback Project. The study sample con- purposely engage in unprotected . literature about the practices involved in gift sisted of men who use the Internet specifically Although the prevalence of barebacking is giving or how gift givers feel about engaging in to find other men with whom they can engage unknown among men who have sex with other these practices. Recently, Moskowitz and in unprotected sex. Some of the 16 websites men (MSM), this behavior is linked closely to Roloff spoke of gaps in our scientific knowl- from which the sample of 332 men were the transmission of HIV in this population. edge regarding gift givers,6 specifically in recruited catered exclusively to unprotected Two subgroups of the larger population of terms of whether or not these individuals sex (e.g., Bareback.com, RawLoads.com).

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These sites accounted for 50.9% of the men viewed the profile names of all men meeting ny the quantitative interviews for nearly three- subsequently recruited into the study. The those criteria who had logged onto that site quarters of the study participants (n=246). other websites used did not cater to unprotect- within the previous 24 hours. Recruiters then The qualitative data took the form of post- ed sex exclusively but did make it possible for reviewed the profiles of potentially-eligible interview narrative summaries (what qualita- site users to identify which men were looking men the letter/numeral match described above tive researchers often refer to as memos, or for unprotected sex (e.g., Men4SexNow.com, for men who were online at the time that memoing),7,8 in which the interviewers Squirt.org). These sites supplied 49.1% of the recruiters were working. recorded personal observations and thoughts, men for the sample. Recruitment efforts were undertaken seven direct quotes from the participants them- days a week, during all hours of the day and selves, and contextual information that the Recruitment nighttime, variable from week to week interviewers believed would help to place the A nationwide sample of men was derived, throughout the duration of the project. This quantitative interview data into proper per- with random selection of participants being was done to maximize the representativeness spective. Each of the qualitative narrative sum- based on a combination of the first letter of the of the final research sample, in recognition of maries was anywhere from one-half of one person’s online username, his race/ethnicity the fact that different people use the Internet page to three pages in length, depending upon (as listed in his profile), and the day of recruit- at different times. how talkative the study participant was during ment. Each day, members of the research staff Participation and/or after the interview, and upon how much working on recruitment had three letters or useful information the interviewer felt should Initially, men were approached for participa- numerals assigned to them for their use that be recorded at the interview’s conclusion. The tion either via instant message or email day. These letters and numerals were assigned idea underlying the memoing process was to (much more commonly via email), depending randomly. The first letter/numeral was restrict- capture information that otherwise would have upon the website used. Potential participants ed for use for recruiting Caucasian men only; been lost if the study had relied solely upon the were provided with a brief overview of the the last two letters/numerals were to be used quantitative information contained in the sur- study and informed consent-related informa- exclusively for recruiting men of color. (This vey instrument –information that, hopefully, tion, and they were given the opportunity to oversampling technique for racial minority could be used to illuminate and inform major ask questions about the study before deciding group men was adopted so as to compensate study findings. It was from these qualitative whether or not to participate. Interested men for the fact that men of color, especially dataonly that the constructs of generationing and were scheduled for an interview soon after African-American men, are more difficult to stealthing discussed below were identified. recruit into research studies than their they expressed an interest in taking part in the Caucasian counterparts are.) In order for a study, typically within a few days. To maximize Measures used particular person to be approached and asked convenience for participants, interviewsuse were HIV serostatus is based on men’s self- to participate in the study, these letters/numer- conducted during all hours of the day and reports. The desired HIV serostatus of their als had to correspond to the first letter/numer- night, seven days a week, based on interviewer sex partners was ascertained by asking men: al of that individual’s profile and that person’s availability and participants’ preferences. When you are looking to meet someone online race/ethnicity, as stated in his profile, had to Participants in the study completed a one- for a possible sexual hook-up, which of the fol- be a match for the Caucasian-versus-racial- time, confidential telephone interview lowing statements is most true for you: 1) He addressing a wide array of topics, including minority-group-member designation on the must be HIV-negative, 2) You would prefer that degree of outness, perceived discrimination daily randomization listing. On recruitment he is HIV-negative, 3) It does not matter to you based on , general health sites where it was possible to know who was whether he is HIV-positive or HIV-negative, 4) practices, HIV testing history and serostatus, online at the time the recruiter was working, You would prefer that he is HIV-positive, or 5) sexual practices (protected and unprotected) selection of potential study participants came He must be HIV-positive. Thus, one way of with partners met online and offline, risk- from the pool of men who happened to be defining gift givers is to focus on the HIV-pos- related preferences, risk-related hypothetical logged onto the site at the time when the itive men, and identify which ones responded commercialsituations, substance use, drug-related prob- recruiter was working. All men who were with #1 or #2. This is a way of defining active lems, Internet usage, psychological function- online at that time and whose profile name gift giving (what other researchers have ing, childhood maltreatment experiences, began with the appropriate letter/numeral termed ardent or committed gift giving). HIV/AIDS knowledge, and basic demographic were eligible to be approached. On recruitment Passive gift giving (what other researchers information. The questionnaire that was used sites where it was not possible toNon know who have termed opportunistic gift giving) can be was developed specifically for The Bareback was online at the time the recruiter was work- defined by including HIV-positive men who Project. Many parts of the survey instrument ing, ZIP codes were used to narrow down the responded #1, #2, or #3 to this question. were derived from standardized scales previ- pool of men who could be approached. To do ously used and validated by other researchers. Elsewhere in the questionnaire, men were this, in addition to the daily three Interviews lasted an average of 69 minutes posed a series of questions about hypothetical letters/numerals that were assigned to each (median: 63, SD=20.1, range: 30-210). sexual situations in which sex with an HIV- recruiter throughout the study, each day, ten Participants who completed the interview were serodiscordant partner might occur. The sce- five-digit numbers were also assigned to each offered $35. Approval of the research protocol narios were identical other than in the types of recruiter (five to be used for Caucasian men, was given by the institutional review boards at sex that were posed (insertive anal sex, recep- five to be used for men of color). These five- Morgan State University, where the principal tive anal sex, insertive , receptive oral digit numbers were random number combina- investigator and one of the research assistants sex). In each scenario, men were asked what tions and they were used in this study as prox- were affiliated, and George Mason University, they thought they would be most likely to do. ies for ZIP codes. Recruiters entered the first where the other research assistant was locat- HIV-positive men were asked to indicate five-digit number into the website’s ZIP code ed. whether they would tell the would-be sex part- search field (which site users typically utilized ner (1) that they were HIV-positive, (2) that to identify potential sex partners who resided Qualitative data they were HIV-negative, (3) nothing whatsoev- within a specified radius from their resi- Although the Bareback Project was primarily er about their HIV serostatus, or (4) that they dence), selected a five-mile radius, and then a quantitative study, qualitative data accompa- were HIV-positive only if the person specifical-

[Health Psychology Research 2014; 2:1582] [page 55] Article ly asked about that. These items lead to anoth- one person who is HIV-positive intentionally ongoing practice after his relocation. One plan er way of defining gift giving –namely, by men infects someone who is HIV-negative, most was for all of the men to meet in his current who responded #2 or #3 (active gift giving) or commonly via unprotected anal sex involving (soon-to-be ex) city of residence two or three #2, #3, or #4 (passive gift giving). internal . In most situations, the times a year and convene a bareback sex party unprotected anal sex is repeated a few times in which there would be additional opportuni- during a particular sex session, so that the ties to proceed with creating new HIV genera- chances of infecting the HIV-negative partner tions. Another plan the men were contemplat- Results are increased. Commenting on this experi- ing entailed having all of the men fly to some ence, R986 remarked: I find it incredibly sensu- locale together once or twice a year, and treat Sample characteristics al to think of having my DNA inside of another that as a generationing-focused vacation. In total, 332 men participated in the study. man, who then can pass it on to other men for They ranged in age from 18 to 72 (mean: 43.7, me. . . . The more they want my poz charged Stealthing SD=11.2, median: 43.2). Racially, the sample is cum, the more I want to give it to them – the Stealthing is a practice in which an HIV-pos- a fairly close approximation of the American more I need to give it to them. itive man intentionally tries to infect an HIV- population,9 with 74.1% being Caucasian, 9.0% When the receptive partner seroconverts negative man without the latter’s knowledge or each being African American and Latino, 5.1% (proof of which, typically in the form of printed consent. This practice goes by other names a self-identifying as biracial or multiracial, 2.4% HIV lab test results, is usually required before well, the most common of which appear to be being Asian, and 0.3% being Native American. the gift giver considers the process of genera- sneaking and stealth fucking.6 Depending upon The large majority of the men (89.5%) consid- tioning to have been successful), he becomes the gift giver in question, stealthing takes ered themselves to be gay and almost all of the the original HIV-positive man’s HIV son –that numerous forms, some of which are more rest (10.2%) said they were bisexual. On bal- is, his first HIV-infected generation. Having overtly aggressively gift giving in nature and ance, men participating in The Bareback successfully seroconverted one person, the some of which are more passively gift giving in Project were fairly well-educated. About 1 man first man then coordinates with that newly- their implementation. in 7 (14.5%) had completed no more than high infected man to find another man whom they One especially active manifestation of school; 34.3% had some college experience are certain is HIV-negative, and together they stealthing takes the form of a process named without earning a college degree; 28.9% had a arrange a sex session in which both men try to bootyonly bumping, in which an HIV-positive man bachelor’s degree; and 22.3% were educated infect person #3 via unprotected sex (especial- packs the foreskin of his penis with a drug, beyond the bachelor’s level. Consistent with ly, but not necessarily exclusively, unprotected usually methamphetamine (occasionally pow- the demography of the U.S. population,10 28.0% anal sex). According to R986, he and his son der cocaine), and then engages in insertive of the men lived in rural or low-density popula- take turns engaging in insertive unprotecteduseunprotected anal sex with a man who is HIV- tion areas (fewer than 500 persons per square anal sex with man #3, with each man taking negative. Booty bumping gets its name from mile), 23.5% lived in urban or higher-density turns ejaculating inside of #3’s anus a few the physical locale of the sex on the body, refer- population areas (more than 5000 persons per times. When they have successfully infected ring to the anus (booty), and the way of square mile). Slightly more than one-half of this third person, he becomes the HIV grand- enhancing the drug-related high (bumping). It the men (59.0%) reported being HIV-positive; son of the original man – that is, his HIV- should be noted that not all booty bumping most of the rest (38.6%) were HIV-negative. infected second generation. Subsequently, the entails the transmission – intentional or unin- Prevalence of gift giving three men (original HIV-infected man, son, tentional – of HIV, as the behavior is also prac- ticed by men who simply like to get high as Using the first definition of gift giving (self- and grandson) work together to find a new per- part of their sex acts. (An excellent, ongoing reported HIV serostatus combined with son who is HIV-negative, whom all three of discussion of this practice among MSM may be expressed preference for HIV serostatus of sex them can, as a group, try to infect. In so doing, found online, in the Sex with Drugs section of partners), 2.1% of the HIV-positive men could they create generations of HIV progeny. Living the http://tribes.tribe.net website.) As a type of be construed as active/committed gift givers in commercialan urban area that has many MSM makes stealthing, however, booty bumping ordinarily and 30.3% could be construed as passive/oppor- the process of generationing much easier to entails a discussion whereby the two partners tunistic gift givers. Using the second defini- undertake, as there are more men who are agree to engage in anal sex, without the recep- tion of gift giving (self-reported HIV serostatus willing to (if not downright interested in) par- tive partner being aware of the exact manner combined with HIV serostatus disclosureNon prac- ticipate in group sex sessions involving the tices to sex partners in hypothetical sexual sit- intentional transmission of HIV to one or more in which it is going to be done to him. For uations), 2.6% of the HIV-positive men could of the participants. At the time of his study example, the insertive partner may tell the be construed as active/committed gift givers interview, R986 – who was an articulate, well- receptive partner that he will be wearing a con- and 21.1% could be construed as passive/oppor- educated man whose involvement in genera- dom, and then get the man into a position for tunistic gift givers. When the variables are tioning was a well-thought-out, carefully-engi- anal sex in which the receptive partner cannot recomputed such that either of the criteria for neered practice executed over the course of see whether or not the insertive partner is, defining active/committed gift giving and pas- several years of his adult life – had managed to indeed, wearing a . Packing his unpro- sive/opportunistic gift giving is met, 4.6% of establish a link of eight generations. Indeed, tected penis’ foreskin with his drug of choice, the HIV-positive men participating in this he expressed disappointment at having to relo- he then inserts his penis, condomless, into the study can be construed as active/committed cate to a new city in the near future, comment- receptive partner’s anus and the drug gets into gift givers and 40.4% can be considered pas- ing: It [relocating] makes generationing very the receptive partner’s circulatory system sive/opportunistic gift givers. difficult, because the guys are spread so far through the anal capillaries. As the drug apart. It’s hard to get them all together to keep begins to take effect, the receptive partner not the generationing going. only becomes high, but also loses his sexual Generationing He spoke of his ongoing discussions with inhibitions regarding how the way the remain- Generationing is a term that arose initially the men comprising his eight recently-infected der of the sexual act unfolds. The qualitative in conjunction with a lengthy post-interview generations, and how, as a group, they were notes for R986, who was an avid booty bumper, discussion with R986. It is a practice by which planning to try to keep their generationing an described the process in the following manner:

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[T]he partner becomes high on methampheta- HIV serostatus to his HIV-negative sex part- giving, in which the intentional transmission mine directly through the anal sex practice, and ners even when they ask him point-blank of HIV to an unaware HIV-negative man is tak- comes to crave the sex all the more. R986 said about it. As another example of stealthing, an ing place, these Don’t ask, don’t tell practices that 8 out of 10 HIV-negative men with whom even more passive approach to gift giving may not qualify as gift giving, because the he has sex say that they are willing to try booty entails the adoption of a Don’t ask, don’t tell intent to transmit HIV is questionable. But as bumping with him, provided that he agrees not policy toward HIV serostatus disclosure. Here, noted earlier, some scholars label these prac- to ejaculate inside of them. Although he never HIV-positive men knowingly have unprotected tices as opportunistic gift giving because they plans to honor this promise, he makes the sex with other men whose HIV serostatus may entail the purposeful withholding of HIV-relat- promise so that he can be allowed to perform or may not be known to them; but the HIV-pos- ed information that, had it been disclosed to anal sex on them, with the full itive men do not disclose their HIV serostatus one’s sex partner(s) prior to engaging in sex knowledge/expectation that the majority of unless they are asked directly about it. Many of acts, might have led some of them to choose them will not insist on him withdrawing prior the men participating in the Bareback Project not to engage in risky sex with a particular to ejaculation once the methamphetamine gets reported that most of their sex partners do not individual. By knowingly engaging in sexual into their system. He said that of the 8 of 10 ask them about their HIV serostatus. Thus, practices that have a high potential for infect- men who agree to try this with him, at least 5 they are able to engage in unprotected sex, ing HIV-negative partners and then withhold- beg him not to withdraw when it actually even with HIV-negative partners, because they ing one’s HIV-positive serostatus information comes time for him to ejaculate. The other 3, he are not forced to answer questions about their from these partners (as opposed to disclosing made it a point of telling me, either say nothing serostatus. The qualitative notes for R867 it up front), Don’t ask, don’t tell stealthing may in response to his Where do you want me to illustrate this approach: To date, he has told be construed as a type of passive or oppor- cum? question (in which case he automatically very few people about his [HIV-positive] tunistic gift giving. ejaculates inside of them, by default) or ask serostatus. That includes his sex partners, to him to pull out, in which case he forces them whom he only discloses it if they ask him about down and makes them receive his any- it. He will admit to being HIV-positive if they way. ask him about his HIV serostatus; if they do not, Discussion He commented that, of the men in the latter he does not disclose it to them. Interestingly, he group, almost always, they are too high to put prefers to have sex with men who are HIV-neg- Potentialonly limitations up too much of a fight or they are so high that ative, apparently because he perceives them to As with any research study, the present they do not care that he is having his way with be less likely to be capable of transmitting sex- study has a few potential limitations. First, as them, provided that he can bring his anal sex ually transmitted infections to him. R867 is with most research data on sexual behaviors, act to completion. also unconcerned with his partners’use HIV the data in this study are based on uncorrobo- Another way in which stealthing takes place serostatus or their sexual history, and discusses rated self-reports. Therefore, it is unknown is more passive in nature, but is a gift giving neither with potential sex partners before hav- whether participants underreported or over- behavior just the same. It might be termed ing sex with them. reported their involvement in risky behaviors. convenient omission of information or answer Additional insights into the Don’t ask, don’t The study’s reliance upon self-reported data is dodging and it entails purposely failing to dis- tell practice may be found in R877’s comments: acceptable, however, as other authors of previ- close one’s HIV-positive serostatus when asked I live in a don’t ask, don’t tell world. It’s social- ous studies conducted with similar popula- a direct question about it by a sex partner. ly unacceptable now to ask [other men about tions have reported good levels of data quality Rather than outright lying and telling the sex their HIV serostatus]. If I ask [them whether or (e.g., reliability and validity) in their partner that one knows that one is HIV-nega- not they are HIV-positive], then I don’t get laid. research.11 This is particularly relevant for tive when, in fact, one is HIV-positive, this par- . . . I’m a world class athlete and a horny guy. I self-reported measures that involve relatively ticular practice involves a variety of ways of not like to have sex, and I want to have sex. If guys small occurrences (e.g., number of times hav- answering the HIV serostatus question. Some commercialwon’t have sex with me because I want to talk ing a particular kind of sex during the previous men change the subject in an inconspicuous about HIV with them, then I just won’t talk 30 days), which characterize the substantial way, so that the questioner thinks that he got about HIV with them. That way, I can still get majority of the data collected in this study.12 an answer (or due to the diverted discussion laid. Otherwise, I’d be 49 years old and frustrat- Other researchers have also commented favor- that takes place, subsequently forgets that he ed. . . . But I make it a point of taking advantage ably on the reliability and/or the validity of self- did not get an answer to his question)Non when, in of every opportunity I can afterward, after reported information in their studies regard- fact, he did not. Other men answer the HIV we’re done having sex, to talk with them about ing topics such as condom use and substance serostatus question with a non-response, such it [HIV]. use/abuse.13-16 as Do I look like I have HIV to you? or Why do Likewise, R949’s comments are illuminating Second, this paper was based on analysis of you even ask me a question like that? with the on this subject, as are the interviewer’s notes a relatively small sample size, particularly with hope that these responses will cause enough immediately following them: I use a ‘Don’t ask, regard to the behaviors pertaining to gift giv- discomfort in the questioner that he will drop don’t tell’ approach with men and sex. I assume ing. Moreover, some of the concepts intro- the subject and proceed with the sex. Speaking that if they want to know, they’ll ask. And then duced in this research (e.g., generationing and about answer dodging, R800 noted: I don’t tell I always tell them the truth. But if they don’t stealthing) are either new to the scientific lit- them anything. It’s just none of their business, ask, I assume that they don’t care or don’t want erature or among the first to be reported in the you know? I mean, if they ask me, it’s still none to know that I’m positive. [Interviewer notes: literature, leaving unknown the extent to of their business, and I don’t tell them nothin’. All of the sex that R949 reported having during which these behaviors occur. It would, of Me having HIV is my business, not theirs. the preceding 30 days was unprotected. It is course, have been preferable to have access to Convenient omission of information or worth noting that this man answered all but a more robust sample size, so that greater con- answer dodging may be considered to be a type one of the HIV knowledge questions correctly, fidence could be placed upon the findings. The of gift giving and a type of stealthing because too; so he is well aware of the risks that he is present study’s findings should, therefore, be the HIV-infected man knows that he has HIV, taking and posing to his partners.] In the most construed as preliminary until such time that yet actively takes steps to avoid disclosing his rigid definition of stealthing as a form of gift further research can be undertaken.

[Health Psychology Research 2014; 2:1582] [page 57] Article

es might be an effective way of teaching HIV- gers inherent in stealthing lies in enhancing Conclusions negative, unprotected-sex-seeking MSM spe- partner communication and HIV serostatus cific strategies they can use to broach the sub- discussion/disclosure skills, especially among Despite these limitations, a number of ject of HIV serostatus, so that they can feel HIV-negative men. Another possible way to interesting and important findings come from more comfortable discussing this with poten- combat the practice of stealthing – one that is this study. First, as other researchers have doc- tial sex partners. likely to be effective with only a portion of the umented with regard to bug chasing – which is Another contribution that the present study men who engage in the practice – would be to the true counterpart to the gift giving phenom- makes to the scientific literature is its intro- alert these men to the legal ramifications of enon that is the focus of the present study – duction of the concept of generationing as a their actions. Many states now treat the inten- gift giving appears to be an infrequent practice type of gift giving behavior. In preparing this tional transmission of HIV as a crime, invoking among MSM who use the Internet. In the pres- article, the present author was unable to locate existing laws governing assault as the basis ent study of men using the Internet specifically any information in the scientific literature for such criminality;20 and some men who to find other men with whom they could about this practice. Consequently, much knowingly infect HIV-negative men with HIV engage in unprotected sex, approximately 1 remains to be learned and documented regard- may be unaware of the legal statutes where HIV-positive, unprotected-sex-seeking man in ing the behavior. Future studies, especially they live. Making them aware of the illegality 22 was an active/committed gift giver – that is, those undertaken with a qualitative methodol- of their actions may lead some of them to someone who intentionally was trying to infect ogy (or a mixed-methods approach), are need- reconsider their involvement in stealthing. To other men with HIV. This figure is comparable ed. In all likelihood, generationing is a low- the extent that these men find stealthing to be to the estimates provided by other prevalence practice, even among barebacking a highly erotic sexual practice, though, height- researchers,2-4 which is noteworthy in light of MSM; but among persons engaging in this ening awareness of potential legal conse- the different manner in which the present behavior, it is one that carries with it an quences probably will not be sufficient to erad- study’s prevalence estimate was derived when extremely high risk of transmitting HIV. For icate the behavior. compared to those provided by these other that reason alone, researchers and HIV preven- Gift giving, in whatever form it happens to researchers. When a more-relaxed definition tion/intervention practitioners must be made take in a particular situation, is an HIV trans- of gift giving is employed, such that men who aware of generationing. Bareback sex parties, mission practice that is not well-understood at are indifferent to the transmission of HIV to which are popular among many Internet-using this time.only Much more research is needed on their sex partners are included in the defini- barebacking MSM,19 may be especially popular this subject, particularly in light of recent evi- tion of gift givers (what might be termed pas- among men wishing to engage in genera- dence suggesting that the practice may be sive or opportunistic gift givers), the preva- tioning, because these parties make it possible increasing in prevalence.3,4 Reliable data are lence of this phenomenon rises greatly, to for several men to come together to haveuse sex needed to pinpoint more accurately the preva- more than 40% of the population of HIV-posi- with multiple persons in one session. Those lence of the behavior because currently we tive, unprotected-sex-seeking men. who are interested in participating in genera- simply do not know how (un)common gift giv- Regardless of which definition of gift giving tioning may find bareback sex parties to be a ing is among HIV-positive MSM. Additionally, one uses, the prevalence figures are sufficient- particularly convenient way to bring their gen- studies are needed to identify what character- ly high as to raise concerns about the trans- erations together in a setting in which current- istics differentiate active or committed gift mission of HIV to currently-uninfected MSM. ly-uninfected but willing sex partners may be givers from those who might be described as One of the main implications of this finding is found and infected successfully. Again, future passive or opportunistic gift givers, as well as that interventionists need to work with HIV- studies need to learn much more about gener- what characteristics differentiate gift givers positive men to bolster their rates of HIV ationing: How prevalent is this behavior? What from their barebacking HIV-positive MSM serostatus disclosure, particularly to new sex factors are associated with involvement in this counterparts who do not wish to transmit HIV partners who are unaware that they are about practice? How do men who are interested in to their sex partners. Identifying such charac- to have sex with someone who is HIV-positive. engagingcommercial in generationing find one another? teristics can help future intervention programs Published studies have shown that greater How often do men participating in one per- to offer targeted efforts to prevent the spread partner communication regarding HIV serosta- son’s generationing chain become sufficiently of HIV among MSM. Also needed are studies tus is associated with reduced involvement in enthralled with the practice that they decide to that can illuminate the reasons why men risky sexual practices.17,18 Role playing exer- initiate a generationing chain of their own? At engage in gift giving behaviors. Understan - cises, in which HIV-positive men can rehearseNonpresent, the answers to these fundamental ding why these persons want and try to infect specific strategies for informing potential sex questions are unknown. their sex partners with HIV may help interven- partners about their HIV serostatus and simul- Another contribution made by the present tionists and HIV prevention workers to develop taneously receive feedback and constructive study is its findings regarding yet another type strategies to counteract these persons’ suggestions about better ways to discuss this of gift giving, namely stealthing. Once again, actions. Finally, additional research is needed topic with potential sex partners, might prove very little is known about this practice, partic- to learn more about the gift giving-related phe- to be a helpful way of accomplishing this. ularly in terms of how prevalent it is, who nomena of generationing and stealthing as Another implication of the present study’s engages in it (demographically speaking), well as any other currently-unknown ways in prevalence-related findings for gift giving is what factors are associated with involvement which gift givers endeavor to infect their sex that interventionists need to work with HIV- in the practice, the circumstances that lead partners with HIV. negative men to improve their partner commu- some men to engage in stealthing, or the spe- nication skills as well. These men need to take cific motivations for wanting to infect an personal responsibility for maintaining their unaware partner with HIV. Although it is prob- sexual safety, and they must do this on a con- able that, like generationing, stealthing is a References sistent basis. Many HIV-negative MSM do not low-prevalence activity among barebacking engage in this practice at all, or do so inconsis- MSM, it is a practice that has major implica- 1. Moskowitz DA, Roloff ME. The existence of tently, leaving themselves vulnerable to con- tions for men’s health whenever it is undertak- a bug chasing subculture. Cult Health Sex tracting HIV. Once again, role playing exercis- en. Once again, the key to combating the dan- 2007;9:347-57.

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