SEXUAL SATISFACTION, IDENTITY AND SERO-ADAPTATION: AN INVESTIGATION INTO PERSONALITY AND BEHAVIOURAL CORRELATES OF BAREBACK IDENTITY AND BEHAVIOUR IN MEN WHO HAVE SEX WITH MEN by Natania Leah Marcus A thesis submitted in conformity with the requirements for the degree of Master of Arts in Clinical and Counselling Psychology Applied Psychology and Human Development Ontario Institute for Studies in Education University of Toronto © Copyright by Natania Leah Marcus (2016) SEXUAL SATISFACTION, IDENTITY AND SERO-ADAPTATION: AN INVESTIGATION INTO PERSONALITY AND BEHAVIOURAL CORRELATES OF BAREBACKING IDENTITY AND BEHAVIOUR IN MEN WHO HAVE SEX WITH MEN Master of Arts Clinical and Counselling Psychology 2016 Natania Leah Marcus Department of Applied Psychology and Human Development University of Toronto Abstract Barebacking, or condomless anal intercourse in the presence of risk of contracting HIV, has emerged as a common phenomenon between men who have sex with men (MSM). The present cross-sectional study investigated psychological correlates of barebacking behaviour and identity, as well as how MSM increase their sexual satisfaction while reducing risk of HIV transmission. Two hundred and fifty-six MSM across Canada and the US were recruited for an online survey. Men who engaged in barebacking were significantly more likely to be HIV-positive, be higher in sexual sensation-seeking, meet sexual partners online, and use substances before and during sex. Self-identified barebackers were also more sexually satisfied than non- barebackers. Further, MSM who engaged in barebacking were found to use more sero-adaptive strategies, which are harm-reduction techniques to reduce risk of HIV transmission such as strategic positioning and taking PrEP. Barebacking should be framed within the context of recent advancements in biomedical HIV- treatment and prevention. Keywords: HIV, Sexuality, Gay, bisexual and other men who have sex with men, Barebacking ii Acknowledgements Thank you to Prof. J. Roy Gillis for your support and input throughout this process. I have been an aspiring sexuality researcher since age seventeen, and I am very grateful to have actualized this goal under the supervision of someone who shares this stimulating and exciting research interest. Your insight into various theories, approaches and challenges of researching queer sexuality has been invaluable. Thank you as well to Dr. Daniel P. Schluter for your insight and input into this project. Finally, I’d like to thank my loving partner, Tamara Augsten for your continued support and dedication throughout my Master’s degree. iii Table of Contents ABSTRACT .................................................................................................................................................................................. II ACKNOWLEDGEMENTS ......................................................................................................................................................... III INTRODUCTION ......................................................................................................................................................................... 1 REVIEW OF THE LITERATURE .............................................................................................................................................. 3 BAREBACKING: DEFINITIONAL DEBATES ..................................................................................................................................................... 3 BAREBACKER VS. BAREBACKING: IDENTITY VS. BEHAVIOUR ................................................................................................................... 4 INDIVIDUAL DIFFERENCES: SEXUAL SENSATION SEEKING, SUBSTANCE USE AND ONLINE SEX-SEEKING ...................................... 5 BAREBACKING AS RESISTANCE ...................................................................................................................................................................... 8 BAREBACKING: PRIORITIZING PLEASURE, EROTICIZING RISK ............................................................................................................... 10 SEXUAL PLEASURE AND SATISFACTION IN MSM ..................................................................................................................................... 11 SERO-ADAPTIVE PRACTICES AND BAREBACKING ..................................................................................................................................... 12 IMPLICATIONS FOR HEALTH PROMOTION FOR MSM .............................................................................................................................. 17 THE PRESENT STUDY ............................................................................................................................................................ 18 HYPOTHESES .................................................................................................................................................................................................... 18 METHODS .................................................................................................................................................................................. 20 VARIABLES AND MEASURES ......................................................................................................................................................................... 20 PROCEDURE ..................................................................................................................................................................................................... 24 PARTICIPANTS ................................................................................................................................................................................................. 26 RESULTS .................................................................................................................................................................................... 27 GAY IDENTITY .................................................................................................................................................................................................. 28 BENEFITS OF BAREBACKING AND BAREBACKING IDENTITY .................................................................................................................. 29 SEXUAL SENSATION SEEKING ....................................................................................................................................................................... 30 ONLINE SEX SEEKING ..................................................................................................................................................................................... 30 SUBSTANCE USE BEFORE/ DURING SEX .................................................................................................................................................... 32 HIV STATUS ..................................................................................................................................................................................................... 34 STIS ................................................................................................................................................................................................................... 34 RISK BEHAVIOUR, BAREBACK IDENTITY AND HIV STATUS ................................................................................................................... 35 PLEASURE DISCREPANCY WITH CONDOMS ............................................................................................................................................... 36 SEXUAL SATISFACTION AND SEXUAL PROBLEMS ...................................................................................................................................... 37 SERO-ADAPTIVE STRATEGIES BY HIV STATUS AND BAREBACKER STATUS ........................................................................................ 38 HIV TREATMENT AND PREVENTION OPTIMISM AND PREVENTION MESSAGE RESISTANCE ........................................................... 39 PREVENTION STRATEGY USE AND SEXUAL ENJOYMENT ......................................................................................................................... 40 SEXUAL COMMUNICATION ............................................................................................................................................................................ 41 PREDICTORS OF BAREBACKING BEHAVIOUR ............................................................................................................................................. 41 DISCUSSION .............................................................................................................................................................................. 42 PSYCHOLOGICAL AND BEHAVIOURAL CORRELATES OF BAREBACKING ................................................................................................ 42 HIV SEROSTATUS AND OTHER STIS ........................................................................................................................................................... 44 SEROADAPTATION AND RISK REDUCTION ................................................................................................................................................. 46 TREATMENT