Barebacking: A Review of the Literature

Abstract

This article synthesizes the peer-reviewed literature about barebacking, an HIV risk behavior that is generally understood as intentional unprotected anal intercourse between men where HIV transmission is a possibility. Of the 42 academic reports identified in the Anglophone literature, the greatest attention is given to U.S. publications and empirical projects. The variable nomenclature about barebacking is recognized and it is concluded that although epidemiological data suggest prevalence of barebacking varies across regions, time, and serostatus, the majority of men who have sex with men (MSM) do not intentionally seek out condomless anal sex. Findings show that macro-, meso-, interpersonal-, and intrapersonal level factors, such as homonegativity, community norms, partner intimacy, and drug use, converge to influence the likelihood that an individual will bareback. A conceptual framework to examine the reciprocal and dynamic relationships sustaining barebacking is proposed. In examining the theoretical and methodological limitations of the research about barebacking, the atheoretical nature of the studies, failure to report analyses conducted, and suboptimal measures are included among the study constraints. Furthermore, in research to date, the majority of participants have been white, urban, and gay-identified; thus, more research is needed to capture the viewpoints of diverse MSM communities. There has also been an overly individualistic focus on barebacking which needs to be tempered by greater consideration of the impact of macro- and meso-level factors upon MSM's behavior. With respect to programmatic responses, more culturally bound strategies are called for.

The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development

“…These relate to issues such as conflicting and limited evidence: 43 on the one hand, the heterogeneity of populations included in studies and, on the other hand, where population criteria is more tightly specified, the small number of studies available for review. 48,62 Many of the studies available suffer from high or unclear risk of bias. 62 Primary studies often suffer from high attrition, 48,53 a lack of statistical power, 48 limited follow-up periods, 48 heterogeneity of intervention content, 54 heterogeneity of cultural context regarding implementation, 49 differential attrition between intervention and control, a lack of information regarding cost-effectiveness, 34 a lack of focus relating to theories of behaviour change, 34 a lack of focus regarding the complexity and changing nature of HIV risk-related behaviours, 34,55 a lack of inclusion of qualitative and mixed-methods studies, 55 and the heterogeneity of outcome measures.…”

“…58 However, overall, these evidence syntheses do suggest cautious support for the efficacy of behavioural interventions among MSM. 34,43,49,55,56,58,59,62 Moreover, they suggest that evidence-based interventions have larger effects than non-evidence-based interventions. …”

Endemic disease, awareness, and local behavioural response

“…Although we do not expect this to be a common scenario, and it is beyond the scope of this paper, it is more than a theoretical possibility and could be encountered, for instance, in risk-seeking behaviour, such as deliberate contacts between infected with uninfected individuals in communities where HIV is highly prevalent [3], or in the increased movement of livestock in anticipation of a ban on movement, in the presence of a zoonosis.…”

“…subject to the equilibrium value of I − which can be determined only from the full system of ODEs (3). If the second summand under the square root of Eq.…”

Assessing attitudinal and related concepts to Bareback in men who have sex with men in Mexico City.

“…El término bareback también es conocido como "sexo a pelo" o "sexo al natural" y puede ser diferenciado de otras prácticas sexuales de riesgo por: 1) la intencionalidad y premeditación de llevar a cabo el acto sexual sin utilizar un método de barrera como es el condón en sus múltiples presentaciones; 2) enfocarse a prácticas de sexo anal entre hombres; 3) tener un referente temporal y cultural que se da después de la aparición y propagación del VIH/SIDA. Berg (2009) diferencia al bareback de otros fenómenos como son el bugchasing definido como el acto de llevar a cabo sexo bareback cuando uno de los participantes presenta estatus serológico positivo y el otro no; en este acto sexual el participante con estatus serológico negativo -denominado como bugchaser -busca de modo premeditado ser infectado por su compañero sexual -designado como giftgiver -. De acuerdo con el autor citado, el bugchasing es un caso marginal de la práctica bareback con características radicalmente distintas a éste.…”