City Research Online City, University of London Institutional Repository Citation: Grundy-Bowers, M.C.S. (2014). Barebacking and sexual position: An analysis of the personal accounts of HIV-negative and unknown status gay men who have condomless anal sex. (Unpublished Doctoral thesis, City University London) This is the accepted version of the paper. This version of the publication may differ from the final published version. Permanent repository link: https://openaccess.city.ac.uk/id/eprint/11872/ Link to published version: Copyright: City Research Online aims to make research outputs of City, University of London available to a wider audience. Copyright and Moral Rights remain with the author(s) and/or copyright holders. URLs from City Research Online may be freely distributed and linked to. Reuse: Copies of full items can be used for personal research or study, educational, or not-for-profit purposes without prior permission or charge. 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City Research Online: http://openaccess.city.ac.uk/ [email protected] CITY UNIVERSITY LONDON Barebacking and sexual position: An analysis of the personal accounts of HIV-negative and unknown status gay men who have condomless anal sex Matthew Christopher Stuart Grundy-Bowers A thesis submitted to City University London in accordance with the requirements for the degree of Doctor of Philosophy in Public Health School of Health Sciences April 2014 CONTENTS Tables and illustrations ............................................................................................................... vii Figures .................................................................................................................................... vii Tables ...................................................................................................................................... vii Dedication .................................................................................................................................. viii Acknowledgements ...................................................................................................................... ix Declaration .................................................................................................................................... x Abstract ........................................................................................................................................ xi Abbreviations and key terms ...................................................................................................... xii AbbreviationS ......................................................................................................................... xii Key terms............................................................................................................................... xiii Introduction .................................................................................................................................. 1 1.1 INTRODUCTION ............................................................................................................. 1 1.2 SECTION one: background to the study .............................................................................. 3 1.2.1 THE origins of the research .............................................................................................. 3 1.2.2 BAREBACKING: a contested concept ............................................................................... 6 1.2.3 The origins of barebacking ............................................................................................... 7 1.2.4 Barebacking: evolving use of the term ............................................................................ 7 1.2.5 Professional conceptualisations of barebacking .............................................................. 8 1.2.6 The prevalence of barebacking ........................................................................................ 9 1.2.6.1 Population and geographical considerations ..................................................... 11 1.2.7 Professional perceptions of those who have bareback sex ........................................... 12 1.2.8 HIV: an overview ............................................................................................................ 14 1.2.8.1 Transmission ........................................................................................................... 15 1.2.9 The prevalence of HIV and other sti’s among MSM ...................................................... 17 1.2.9.1 The prevalence of HIV among MSM ....................................................................... 18 1.2.9.2 The prevalence of sexually transmitted infections among MSM ........................... 19 1.2.10 HIV: a public health priority ......................................................................................... 21 1.3 Section two: A review of The literature ................................................................................ 22 1.3.1 The search strategy ........................................................................................................ 22 1.3.2 A description of the studies ........................................................................................... 27 1.3.3 A discussion of the findings of these studies ................................................................. 27 1.3.3.1 Theme 1: the management of risk .......................................................................... 27 i 1.3.3.2 Theme 2: The meanings men ascribe to bareback sex ........................................... 30 1.3.3.3 Theme 3: Barebacking in romantic relationships ................................................... 33 1.3.3.4 Theme 4: The negotiation of bareback sex ............................................................. 35 1.3.3.5 tHEME 5: Substance use and bareback sex............................................................. 36 1.3.3.6 Theme 6: Affective states and bareback sex ........................................................... 37 1.3.3.7 Theme 7: The spaces where individuals connect with partners ............................. 38 1.3.3.8 Theme 8: Partner attributes and bareback sex ....................................................... 40 1.4 The location of this study within the existing literature ....................................................... 40 1.4.1 The thorny issue of HIV .................................................................................................. 41 1.4.2 the top and bottom of sexual position .......................................................................... 42 1.4.3 The interconnectedness of factors associated with bareback sex ................................ 44 1.5 Aims and objectives .............................................................................................................. 46 1.5.1 Aims ................................................................................................................................ 46 1.5.2 Objectives ....................................................................................................................... 46 1.6 Conclusion ............................................................................................................................. 47 Method and methodology ......................................................................................................... 48 2.1 Introduction .......................................................................................................................... 48 2.2 Methodological considerations .................................................................................... 49 2.2.1 Epistemological position ................................................................................................ 50 2.2.2 Phenomenology ......................................................................................................... 50 2.2.3 Hermeneutics ................................................................................................................. 53 2.2.4 Ideography ..................................................................................................................... 54 2.2.5 guidelines for conducting the research ......................................................................... 54 2.2.6 Sampling ......................................................................................................................... 55 2.2.7 The Collection of data .................................................................................................... 55 2.2.8 The Analysis .................................................................................................................... 56 2.2.9 The presentation of self in everyday life ........................................................................ 58 2.2.10 Sexual Script Theory ..................................................................................................... 59 2.2.10.1 Intrapsychic scripts (experience) .......................................................................... 60 2.2.10.2 Interpersonal scripts (relationships) ..................................................................... 60 2.2.10.3 Intersubjective cultural surround ........................................................................