University of Central Florida STARS Faculty Bibliography 2000s Faculty Bibliography 1-1-2008 Men Who Have Sex With Men and Recruit Bareback Sex Partners on the Internet: Implications for STI and HIV Prevention and Client Education Christopher W. Blackwell University of Central Florida Find similar works at: https://stars.library.ucf.edu/facultybib2000 University of Central Florida Libraries http://library.ucf.edu This Article is brought to you for free and open access by the Faculty Bibliography at STARS. It has been accepted for inclusion in Faculty Bibliography 2000s by an authorized administrator of STARS. For more information, please contact [email protected]. Recommended Citation Blackwell, Christopher W., "Men Who Have Sex With Men and Recruit Bareback Sex Partners on the Internet: Implications for STI and HIV Prevention and Client Education" (2008). Faculty Bibliography 2000s. 133. https://stars.library.ucf.edu/facultybib2000/133 American Journal of Original Articles Men’s Health Volume 2 Number 4 December 2008 306-313 Men Who Have Sex With Men © 2008 Sage Publications 10.1177/1557988307306045 http://ajmh.sagepub.com and Recruit Bareback Sex Partners on hosted at the Internet: Implications for STI and http://online.sagepub.com HIV Prevention and Client Education Christopher W. Blackwell, PhD, ARNP-C Men who have sex with men (MSM) frequently use other high-risk activities such as drug use and communi- Internet-based Web sites to recruit sex partners. Although cation of other sexually transmitted infections. This arti- many MSM users of such sites advocate for safe sex prac- cle summarizes the literature assessing this phenomenon tices in their personal profiles, some users actively recruit on the Internet. Specific recommendations are provided sexual partners who wish to participate in anal sexual for clinicians, health educators, and researchers. intercourse without the use of condoms, also known as “bareback” sex. Participating in this sexual practice places Keywords: AIDS; anal sex; bareback sex; condoms; both sexual partners at higher risk of HIV transmission. In HIV prevention; Internet; men who have sex with men; addition, data indicate this behavior is associated with sexually transmitted infections Introduction The Emergence of Barebacking as a Cultural Phenomenon Unsafe sexual practices among men who have sex with men (MSM) are of great public health concern There has been a recent increase in social science in the United States. Clinicians and public health inquiries examining the emergence of condomless advocates strive to decrease behaviors that can pro- sex by MSM (Shernoff, 2006). The term “bareback” mote the transmission of HIV and other sexually carries different constructs in different samples of transmitted infections (STIs) among this population. MSM (Halkitis, 2007; Halkitis, Wilton, & Drescher, The Internet is an emerging tool being used among 2005). However, the general concept of condomless MSM to meet partners for unsafe anal intercourse. sex is of great public health concern as the majority This article summarizes the literature assessing this of new diagnoses of HIV infection are among MSM phenomenon on the Internet and provides specific (Centers for Disease Control and Prevention, 2005). recommendations for clinicians, health educators, In fact, studies comparing unsafe sexual intercourse and researchers. among homosexual versus heterosexual samples sug- gest gay men use the Internet to meet sexual partners at much higher rates. Bolding, Davis, Hart, Sherr, and Elford (2006) found that only 5% of heterosex- ual women and 10% of heterosexual men used the Internet to find sexual partners, whereas 43% of the From the College of Nursing, University of Central Florida, gay men in their sample had. Orlando. There are many hypothesized etiologies for the Address correspondence to: Christopher W. Blackwell, PhD, emergence of barebacking. Researchers have sug- ARNP-C, Assistant Professor, College of Nursing, University of Central Florida, PO Box 162210, Orlando, FL 32826-2210; gested some of this activity results from accident e-mail: [email protected]. or temporal relapse, whereas during other sexual 306 Recruiting Bareback Sex Partners on the Internet / Blackwell 307 encounters, MSM deliberately decide to participate incidence of unprotected anal intercourse (Dawson, in bareback sex (Carballo-Dieguez & Bauermeister, Ross, Henry, & Freeman, 2005). Carballo-Dieguez 2004). Wolitski (2005) proposed six etiologic forces (2001) asserted that recent reports in major cities increasing the incidence of bareback sex among across the United States of increased incidence of MSM, including improvements in HIV treatment, STIs (including increased diagnoses of HIV infec- more complex sexual decision making, the Internet, tions) such as chlamydia, syphilis, gonorrhea, and substance use, safer sex fatigue, and changes in HIV hepatitis support an increased incidence of unpro- prevention programs. The influence of advances in tected anal intercourse. HIV diagnoses are increasing HIV treatment in the increase of bareback sex was among MSM for the first time in nearly two decades proposed by Carballo-Dieguez and Bauermeister (Wolitski, 2005). Analysis of 2006-2007 STD infec- (2004). This rationalization concerns false perceptions tion rates among MSM in San Francisco indicated among MSM that HIV is no longer a terminal illness increases in the number of clients diagnosed with HIV, and is instead chronically manageable with pharma- syphilis, and male rectal chlamydia (San Francisco ceutical intervention. As HIV treatment methods Department of Public Health, 2007). All of these data dramatically improved over time, preventive strate- provide compelling evidence that increasing numbers gies remained stagnant and may, in fact, have actually of MSM are not consistently maintaining safer sex declined as MSM began the return to condomless sex practices (Wolitski, 2005). (Carballo-Dieguez & Bauermeister, 2004; Halkitis The emergence of increasing bareback sex among et al., 2005). MSM could indicate a cultural shift among this com- Drug use, particularly the increased use of crystal munity’s overall attitudes and thought regarding the methamphetamine by MSM, has been linked to a rise risk of becoming infected or communicating HIV to in the practice of bareback sex (Halkitis et al., 2005; others as well as the physical, mental, and social con- Shernoff, 2006). Environmental stressors such as sequences of being HIV positive (Wolitski, 2005). racism, homophobia, and socioeconomic disadvantage Wolitski (2005) hypothesized the increase in this may contribute to this risky sexual behavior (Shernoff, behavior may be a symptom of new powerful anti- 2006). A 2001 report authored by the World Health retroviral drug cocktail therapies and changes in Organization (WHO) suggested socioeconomic disad- prevention programs and changes within the gay vantage might increase unsafe sex practices by pro- community itself. Finally, the labeling of an individual moting compensated sexual interactions between as a “barebacker” may actually perpetuate the prac- partners; this same report also critically examined the tice of bareback sex through the creation of role correlation between racism and HIV rates and trans- models and identities that celebrate the benefits of mission. Specific racial correlates listed included unprotected anal sex while altering societal norms disparities in prevention, screening, and treatment about protected and unprotected sexual practices and modalities between dominant and nondominant establishing social and sexual networks of MSM who ethnic groups; marginalization of higher risk ethnic prefer bareback anal sex (Wolitski, 2005). Emerging groups; and increased stigmatization of HIV-infected data indicate the Internet is introducing a multitude individuals by certain ethnic groups (WHO, 2001). of interacting variables that are also playing a signif- HIV-positive (HIV+) serostatus might also be a icant role (Davis, Hart, Bolding, Sherr, & Elford, predictor for bareback sex. Halkitis (2007) reported 2006; Engler, Frigault, Leobon, & Levy, 2005; that a large number (41.2%) of self-identified bare- Halkitis et al., 2005; Liau, Millett, & Marks, 2006; backers in his sample were HIV positive. Another Shernoff, 2006; Wolitski, 2005). proposed risk factor for bareback sex among MSM is internalized homophobia. Shernoff (2006) asserted Risks of Using the Internet to Recruit internalized homophobia contributes to barebacking Bareback Sexual Partners by “creating an unconscious sense that a gay man is unimportant and undervalued, thus increasing his Actual sexual risk behaviors related to transmission sense that he is expendable, and so too are the men of HIV or STIs do not physically occur online. Chat with whom he has sex and from whom he seeks love rooms, sex sites, and other virtual environments fre- and validation” (p. 106). quently serve as points of entry to actual locations Although comprehensive data to assess the precise where sexual activities can occur (Carballo-Dieguez number of MSM who practice bareback sex are diffi- et al., 2006). An increasing number of MSM are find- cult to obtain, data do exist that indicate an increased ing sexual partners through the Internet (Davis et al., 308 American Journal of Men’s Health / Vol. 2, No. 4, December 2008 2006; Halkitis, 2001; Liau et al., 2006). Current esti- sexual partners have found compatibility based on mates indicate that MSM are 7 times more likely to each man’s