The Bay Area Reporter - April 3, 1998
Don Howard, ACT UP/Golden Gate Writers Pool

The statistics

During March, ACT UP/Golden Gate performed an anonymous survey of 105 men who have sex with men (39 percent HIV-positive, 54 percent HIV-negative, 7 percent unsure). The survey was conducted on the street in the Castro and in two popular sex clubs (Eros and Blow Buddies) in an effort to learn more about gay men's sex habits and attitudes about changes in the HIV epidemic. Some of the results:

* More than one in three men surveyed (37 percent) has been a top or a bottom in anal sex without a condom (barebacked) in the last six months (41 percent among those surveyed in sex clubs, 33 percent among those surveyed on the street).

* Almost half of the those who bareback are HIV-negative or did not know their HIV status (46 percent).

* More than a quarter (28 percent) of those who bareback have sex to ejaculation (nearly equal rate among both negative and positive people who bareback).

* Half of the HIV-positive men in the overall survey are not worried about reinfection with HIV.

* Of those who bareback, 30 percent report that they are having riskier sex now than a year ago (vs. 18 percent of those who do not bareback).

Other studies, similar results

Our survey results are not surprising to Dan Wohlfeiler, education director for the STOP AIDS Project, one of San Francisco's leading HIV prevention groups serving gay men. "Your numbers aren't that different from ours," says Wohlfeiler. "Ours is just a bigger sample, based on almost 22,000 surveys. Our analysis - which we did with the Department of Public Health - is literally just out of the computer and I'm glad to make it public.

"Back in 1994, 24 percent of the men our outreach volunteers spoke with reported having unprotected anal sex with two or more partners. That has steadily increased, to the point where now 33 percent report the same behavior. More worrisome: 32 percent of the guys who reported having unprotected anal sex with two or more partners did not know their partners' HIV status. So while certainly some of the unprotected sex is attributable to negotiated safety - people choosing to have sex with men of their own HIV status - these numbers show that some men are not going that route, and are having unprotected anal sex with multiple partners without finding out their partners' status."

Mitch Katz, Director of Public Health, agrees ACT UP/Golden Gate's "results are quite consistent with other studies, including the recent young men's study, that over 30 percent of men who have sex with men have had unprotected anal intercourse in the prior six months."

Is it the drugs?

Some speculate that there is more barebacking because gay men think that HIV is not as risky as it was before the introduction of protease inhibitors and other new treatment advances. Our survey data indicate that men who bareback seem to have somewhat more faith in the new treatments than those who do not bareback - 69 percent of the barebackers agreed (or somewhat agreed) that "HIV was no longer the death sentence it used to be" vs. 61 percent of the non-barebackers.

Others have argued that the availability of Post Exposure Prophylaxis (using anti-HIV drugs in the hours after being exposed to stay negative) is causing gay men to abandon safer sex practices. Our survey showed a slightly higher opinion or awareness of Post Exposure Prophylaxis (PEP) among those who bareback - 24 percent of those who bareback agreed (or somewhat agreed) with the statement "there is a morning-after pill I can take for HIV" vs. 13 percent of those who do not bareback.

Have condom-centered prevention programs failed barebackers?

In our ACT UP survey, twice as many of the HIV-negative men who bareback agreed (or somewhat agreed) that they are tired of using condoms (40 percent vs. 20 percent of the HIV-negative men who did not bareback). Our survey suggests that current prevention strategies, centered around the condom code, are not relevant to the growing number of gay men who bareback: twice as many men who bareback said that current HIV prevention programs are not relevant and do not help them stay safe (37 percent for those who bareback vs. 18 percent for those who did not).

Race Bannon, a local sex activist who has worked on sex panic issues, says "I believe that the increase in barebacking is a phenomenon that is likely to continue its rise within our community and that prevention efforts must address this reality directly. While I do not personally endorse barebacking, it would be foolish to ignore its ramifications. Our community must be careful not to scapegoat in order to come up with a reason for barebacking's popularity. As with so many sexuality issues, the reasons for barebacking are complex and no one fully understands them. The convenient, but misguided, explanation would be that 'sex is the enemy' - and such a viewpoint would spawn a whole new round of sex-negative prevention campaigns that would ultimately fail."

Tom Coates, Director of UCSF's AIDS Research Institute, agrees that prevention agencies need to address barebacking within the community. Coates says, "the agencies should be holding conversations with the community to understand better who is barebacking and why. I think that there is probably a variety of motivations behind barebacking and we don't fully understand all of them.

"It is also the case that the message is out there, and that people think it is dangerous - and that's probably why they do it. It's both dangerous and defiant, and the gay community has always enjoyed being dangerous and defiant. That's how we got to where we are now. We need to continue to be dangerous and defiant - it pushed us ahead in the battle against AIDS - but we also need to be around so that we survive and that's why barebacking concerns me. Danger and defiance are interesting, but HIV is lethal."

The SF Department of Public Health is in the planning phases of a study, directed by Dr. Susan Buchbinder and Dr. Grant Colfax, to determine how prevention messages need to change to reflect changes in treatment of HIV disease. In the meantime, other communities, notably Boston, have begun poster campaigns discussing misconceptions that the epidemic may be over. Clearly, the rise in bareback sex is one more indication that more needs to be done in our community to address the changes issues negative and positive men confront in keeping themselves healthy in the new era of HIV treatment.
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