POZlife

POZLife: Life from the Infected and Effected point of veiw.

Riding Bareback:Trends in unsafe-sex practices and its impact on the community

Posted by pozlife on September 2, 2006

by Jonathan Young

 

 

The discussion of barebacking, or unsafe anal sex between two gay men, is
so taboo that you’ll find few people willing to talk about it
openly. However, due to the increase in unsafe-sex practices within the
GLBT community, this discussion is starting to gain a voice. On one
side of the dialogue are the sexual revolutionaries that advocate
reclaiming our gay sexuality. On the other side are the health
educators and social organizations that warn of a new AIDS epidemic
that could overshadow the first wave – and then there is everyone
else in between.

 

Defining a taboo

 

Unprotected sex between two men has many titles
– skin on skin, raw, natural – yet the most common is
barebacking. However, the term “bareback” has different
meanings to different people. To say that barebacking is “sex
without a condom” is too broad a definition.

 

To accurately identify what barebacking is, the
sexual activities between gay men need to be divided into several
categories. First, there are the guys that use condoms every time they
engage in sexual activity. The second are those that make a conscious
and deliberate decision not to use a condom. Most people would agree
this category of people would be called true “barebackers.”

 

“Barebacking is not just defined by not
using a condom. I think of it as a trend of people who have information
and knowledge and they are making a decision to have unprotected
sex,” said Jim Zians, project manager for UCSD’s Edge
Research Study. “I would like to think that most men [that do not
use a condom] are not part of that group. They are struggling with
condom use.”

 

The third category, those men struggling with
condom use, is a little vague because it is the gray group in the
middle of the first two. They use condoms most of the time, but not all
of the time; or, depending on your perspective, they bareback most of
the time, but not all of the time. Are they barebackers?

 

“Is barebacking a struggle around condom
choices or is barebacking a decision not to use condoms?” Zians
asked. “I think both things are going on.”

 

“Barebacking scares people because
there’s a whole community of people that will do it and whole
community that will not do it, and there’s a whole community in
between,” said Michael Scarce, an HIV prevention activist, in the
2002 documentary Our Brothers, Our Sons.

 

Not knowing the size of each of these barebacking
communities is what scares people the most. It’s difficult to
track sexual practices, and the surveys that do ask questions about
sexual safety differ in their results. Yet every indication shows an
increase in barebacking activity.

 

“What we are seeing now is about 60 percent
of the population is practicing safe sex most of the time, and about 40
percent of the population are barebacking or not practicing safe
sex,” Zians said.

 

Those figures are down from the late ’90s
when 80 percent practiced safe sex, and even down from 70 percent just
a few years ago. These national numbers are staggering, but San
Diego’s demographics may be even more drastic – one local
survey shows that barebackers encompass up to half of the San Diego gay
population.

 

Factors contributing to the condomless numbers
include a larger number of young gay men not hearing or relating to the
safe-sex message, a surprising older population of guys abandoning
condom use due to safe-sex fatigue, and a new epidemic among IV drug
users.

 

Creating a new gay terminology

 

Up until the 1970s, barebacking wasn’t an
issue and the terminology wasn’t a well-known phrase. Sex without
a condom was the norm. Condoms were used within the heterosexual
community as a contraceptive measure, but rarely discussed in gay
culture.

 

All that changed in the 1980s with the
devastation of the HIV/AIDS virus. By the end of the decade, more than
117,000 infected people had died, according to the U.S. Centers for
Disease Control and Prevention (CDC). In San Diego alone the Health and
Human Services Agency recorded 2,136 AIDS cases before 1990; of those
diagnosed, 2,027 died, a fatality rate of 95 percent.

 

“Back
in the ’80s, the prevention specialists said, ‘Sex is just
as good with condoms.’ You can’t give messages that
aren’t true. You can learn to have satisfying sex using condoms.
People who have difficulty with a condom should use one all the time.
Over time, you will adjust to the condom and you will have more and
more satisfying sex. The benefits are enormous.” — Jim Zians, project manager for UCSD’s Edge Research Study

 

The mode of transmission was attributed to sexual
activity, and the gay community quickly adopted a safe-sex mantra.
Condom sales skyrocketed; the greatest increase – 120 percent
– occurred in 1987.

 

“Safer sex was introduced to gay men. It
was sold to gay men as a stop-gap measure,” said Scarce.
“We were told just wear a condom in the meantime. We’re not
quite sure what’s going on.”

 

Out of fear of death and paranoia of this unknown
“gay cancer,” condom use became the accepted norm. Sex
without a condom – still not clearly recognized as the term
“barebacking” at that time – became taboo.

 

Yet even though HIV/AIDS cases continued to rise in the early 1990s, an underground movement of men practicing unsafe sex began.

 

“Barebacking as a phenomenon started to
emerge somewhere around mid 1993. It was largely facilitated by the
more popular use of the Internet, specifically America Online, where
men who had these secret stigmatized fantasies about fucking or getting
fucked without rubbers began to seek one another out,” Scarce
said.

 

Porn star Scott O’Hara is credited as the first to publicly advocate barebacking. In a 1995 edition of Steam,
his self-published journal devoted to sex in public places, he wrote,
“I’m tired of using condoms, and I won’t … and
I don’t feel the need to encourage negatives to stay
negative.”

 

A few years later the terminology became more
recognizable in both the gay and mainstream communities with a series
of events. In September 1997 the term barebacking hit the mainstream
news when Newsweek published the feature story “A Deadly
Dance.” Former Miss America Kate Shindle authored a commentary
entitled “Barebacking? Brainless!” in the February 1998
issue of The Advocate. Vice President Al Gore used the term
barebacking with the AIDS Advisory Council. Barebacking was even the
focus of one of the storylines in a 1998 television episode of
“ER.”

 

As the awareness of barebacking increased, the
death and infection rate of HIV/AIDS decreased. The CDC reports the
annual rate of death due to AIDS peaked in 1994-95, decreased rapidly
through 1997 and nearly leveled off after 1998. But by 1998, as the
HIV/AIDS epidemic was becoming less of a threat, a genuine barebacking
subculture had established itself.

 

The risqué movement gained additional
momentum in August 1998 at the National Lesbian and Gay Health
Conference. Barebacking became a hot topic when Scarce and Tony
Valenzuela presented a workshop entitled “Reducing the Risk of
Doing It Raw: Strategies for Barebacking Harm Education.” The
conversation focused on how health providers and activists could assist
barebackers in reducing their risk of acquiring HIV.

 

“AIDS prevention efforts have written off
barebackers, demonizing them as the poster boys of unsafe sex. We need
a concrete and specific harm reduction approach that might not always
include condom use,” Scarce said at the conference, as reported
by the Web site Gay Today.

 

“We wanted to move past moral judgments of
bareback sex,” Valenzuela added, “and provide supportive
and useful information to meet these gay men who bareback where they
are at.”

 

Scarce and Valenzuela continued to make headlines a few months later when POZ published
its “Boys Who Bareback” issue in February 1999. Not only
did Valenzuela appear naked on the cover riding a horse bareback, but
the controversial issue also featured Scarce’s groundbreaking
“A Ride on the Wild Side,” where the author went
“through the latex looking glass to discover who’s doing it
raw and why.” In the issue, both negative and positive gay men
expressed their condom fatigue, their intense need to connect and share
cum, their HIV-meds complacency and the so-called bug-chasers (men
seeking out HIV-positive partners in order to purposefully become
infected).

 

Barebacking emerged in the mainstream news again in the February 2003 edition of Rolling Stone magazine.
In a feature called “In Search of Death,” the magazine
asserted that 25 percent of all new HIV infections in gay men were from
barebacking bug chasers. Critics have called the Rolling Stone article
“grossly sensationalistic reporting,” and health officials
said the information “is spurious, is unfounded and is
untrue.” Despite its alleged inaccuracies, the article did
initiate a positive debate: Who are the barebackers?

 

Bareback demographics

 

As the barebacking numbers increase, safe-sex
educators are attempting to identify the demographics of their
community. The more they know about barebackers’ ages,
ethnicities and locations, for example, the better they can tailor a
safe-sex message. Again, gathering this information is speculative and
somewhat limiting, because few surveys have been conducted that ask
about sexual practices.

 

 

Ethnicity: The figures from the County
Department of Health show the Caucasian population as the highest
number of new HIV/AIDS cases in San Diego (62 percent), followed by
Hispanic (22 percent) and African-American (13 percent).

 

“You have to look at the fact that the
epidemic is different in different parts of the country,” said
Terry Cunningham, chief of the Health and Human Services Agency, HIV,
STD and Hepatitis Branch (formerly the Office of AIDS Coordination). He
explains that population demographics are not always a clear indication
of HIV/AIDS cases. “We’ve got a significantly different
epidemic here in San Diego. African-American is overly represented. Yet
it’s definitely more in the Caucasian population.”

 

Sexual Orientation: On a national level,
AIDS affects more than just the gay community. About 65 percent of all
current AIDS cases are in the heterosexual community, with homosexuals
being the minority. Here in San Diego, however, the statistics are
drastically askew. The Health and Human Services Agency reports 78-91
percent of all new HIV/AIDS cases are from the gay community. The
majority of those transmissions are credited to barebacking, with a
smaller percentage attributed to drug use.

 

“It’s disturbing because that was the
population we’ve targeted most in prevention, because it was the
largest population showing statistics,” Cunningham said.

 

Age: There is a clear generational gap
within the gay community when it comes to barebackers, creating three
distinct age categories: There is the older generation of 45 years and
older, the Baby Boomers that survived the HIV/AIDS epidemic; a
middle-age generation between 30 and 45 years old, a generation that
matured during the height of the HIV/AIDS crisis; and the younger
generation of men younger than 30, the Generation X population that did
not grow up with the fear of AIDS. (These age ranges differ among
various studies.)

 

The younger generation is taking a lot of the
blame for the increase in barebacking. The increased barebacking trends
in men younger than 30 can be attributed to a lack of awareness and
education, and not perceiving HIV/AIDS as a life-threatening disease.
Their friends are not dying at an alarming rate, and they see many
positive men living long, healthy lives.

 

The trend of targeting the younger generation
began in the late 1990s when CDC statistics indicated a barebacking
rise among men in their 20s. Valenzuela and Scarce’s presentation
at the 1998 National Lesbian and Gay Health Conference and subsequent
story in 1999’s POZ magazine also brought attention to the younger population.

 

“It was my generation who was being scapegoated for barebacking,” Valenzuela said in the Our Brothers, Our Sons
documentary. “A lot of what came down soon after was this
scapegoating of not just me but who I represented – which was my
generation of gay men who didn’t care about AIDS and didn’t
care about gay politics and didn’t care about the things my older
brothers built for our community. What it brought to light was there
was this enormous generation gap.”

 

“Seeing the rise in young gay males
terrifies me. I’ve lived through this catastrophe one time. I
can’t do it again. I can’t see what we saw in the early
’90s again,” Cunningham said.

 

Some young gay men – the ones that identify
themselves as true barebackers – have been informed about the
health issues and have heard the safe-sex message.

 

The trend to target and blame young America might
have been justified using the data at the time. That information,
however, is outdated. Current stats show the largest age demographic
that is barebacking is the 30 to 45-year-old community. Men 30-40 years
old comprise 45 percent of the new HIV/AIDS cases – the highest
number.

 

“What we’re seeing – and this
is all speculation – is barebacking is going on more in the men
who have sex with men in the 35-45 range, rather than the 25-35
range,” Cunningham said. “When I talk to colleagues in
other parts of California, that’s what I am hearing from other
parts of California.”

 

The speculation is that the older men who have sex with men are just tired of three decades of AIDS and safe sex.

 

“There are some [barebacking] trends among
the men who are getting older. They are finding they have worn condoms
for a while and now they are not wearing them,” Zians added.

 

Barebacking is also on the rise in the older
population, the retiring Baby Boomers. According to the CDC, 30 percent
of new HIV/AIDS cases nationally were in people older than 45. In San
Diego that number is around 38 percent for men older than 40.

 

“That’s
fine. Be sexual. But be sexual responsibly. If anybody is preaching
anything other than that, they are asking people to put their lives at
risk. I don’t think any orgasm is worth your life.— Terry Cunningham, chief of the Health and Human Services Agency, HIV, STD and Hepatitis Branch

 

“One of the challenges in people 45 and
older is the mistaken belief that they’re not at risk,”
said Dr. Robert S. Jannsen, director of CDC’s division of
HIV/AIDS prevention. Jannsen warned that older patients, raised before
the AIDS epidemic of the 1980s, are less likely to see the importance
of using condoms. Stereotypes and lack of awareness about the older
generations’ sexual activity is another challenge.

 

While it is difficult or almost impossible to
estimate which group has a higher percentage of barebackers, all
experts can testify that barebacking is on the rise among all age
groups.

 

POZatives and negatives

 

There are many explanations that support
barebacking trends and rationalize, if not support, sex without a
condom. There are an equal amount of arguments against it, advocating a
safer approach to sex. True barebackers use these points to justify
their actions, while safe-sex educators counter with health-related
facts and figures.

 

“We have a fairly significant population
out there, whether you want to call them barebackers or not, who have
made informed decisions not to use condoms as part of their regular sex
practice. At the same time, we’ve got community organizations and
government health agencies who continue to come to us with this
singular message of, ‘Use a condom every time,’”
Scarce said. “Inevitably, there’s this ‘good gay, bad
gay’ routine that gets played out in public. I think it’s
going to get ugly.”

 

The Family Health Centers of San Diego conducted
a survey as part of its HIV Behavior Change Campaign in November 2004.
The survey is considered the most up to date and complete information
for the sexual practices of gay men in San Diego. Of note, one of the
questions asked men for the “reasons for not using a condom when
having anal sex.” These were the top answers:

 

Being in a committed relationship: Most men used this reason as their answer, 68 percent.

 

“There’s a whole idea of when people
are in a relationship – or what’s called ‘negotiated
safety,’ where you are negotiating with a regular partner –
that you will not use condoms with each other, but you will [with]
everyone else,” explained Zians. “Health experts have
difficulty with that because there are still health risks involved.
Because you get people who are switching back and forth from using a
condom to not using a condom, they struggle with condom use.”

 

I am a top: The number-two answer for barebacking was “I’m a top,” or guys that fuck.

 

According to the Gay Men’s Health Crisis
Web site: “For the guy who is penetrating [the top], it’s
more difficult to get HIV because of two factors. One, the top would
have to have contact with blood from the bottom’s anus, which may
or may not happen. The second factor is that the urethra is a small
opening, so it’s harder to get your partner’s blood into
your bloodstream through the hole. For these reasons, it’s more
difficult for the top to get HIV than for the bottom, but it does
happen.”

 

Already HIV positive: The HIV-positive
group stated that many men who are HIV positive only have sex with
other men who are HIV positive, and, therefore, are less concerned
about using condoms, according to the survey.

 

“Barebacking between two people who are
positive is still a high-risk activity, because of … different
strains of HIV,” Cunningham said. “Not only HIV, but other
sexually transmitted diseases.”

 

Cunningham continued, “Anyone who is HIV
infected and engages in unprotected anal intercourse is opening
themselves up to the potential of contracting a whole array of diseases
because their immune system is less functional than someone who does
not have HIV.”

 

It’s important to point out that not all
positive men bareback. “The studies are showing that the HIV
positives and HIV negatives don’t look that different
[demographically],” Zians said. “Some negative men are
practicing unsafe sex, many of them are practicing safe sex; as with
the HIV positive, some of them are and some of them are not.”

 

Condoms reduce sensation: Participants said that condoms reduce the intimacy of skin-to-skin contact.

 

 

“Back in the ’80s, the prevention
specialists said, ‘Sex is just as good with condoms.’ You
can’t give messages that aren’t true,” Zians said.
“You can learn to have satisfying sex using condoms. People who
have difficulty with a condom should use one all the time. Over time,
you will adjust to the condom and you will have more and more
satisfying sex. The benefits are enormous.”

 

Drug use: A story about barebacking would
not be complete without discussing crystal meth, said one source.
Although drug use in the gay community is a story itself (see Gay & Lesbian Times
issue 907, May 12), there are direct connections to the barebacking
phenomenon. “Alcohol and other drug use is often a factor in
unsafe sexual behavior,” the Family Health Centers survey cited.
The “other drug use” is crystal methamphetamine.

 

“Link Between Methamphetamine Use and
Sexual Risk Behavior,” a study released by the CDC in January
2005, concludes that meth use is consistently associated with
unprotected anal sex among gay men. More than 80 percent of meth users
are barebacking, according to the CDC study.

 

“We know that if you use methamphetamines,
you have twice the rate of HIV sero-conversion than non-methamphetamine
users among men who have sex with men,” Zians said. “There
is the theory that the drugs impair your judgment, and therefore it is
because of the drugs that people aren’t using condoms.”

 

Reclaiming sexual identity: Although not
on the Family Health Centers’ survey, there is a recurring theme
among the true barebackers that sex without a condom is a reclaiming of
their sexual identity. Scott O’Hara was one of these first
outspoken advocates of taking back what HIV/AIDS had taken away.

 

“I know there are books that have been
written about how gay men have to reclaim their sexuality because
that’s a defining marker of who they are,” Cunningham
explained. “That’s fine. Be sexual. But be sexual
responsibly. If anybody is preaching anything other than that, they are
asking people to put their lives at risk. I don’t think any
orgasm is worth your life.”

 

AIDS is livable: Another reason cited
among those that bareback is that HIV/AIDS is a livable disease. Before
1990, men who tested positive for AIDS had a 95 percent fatality rate.
In San Diego, there were at least two deaths per day even up through
the early 1990s. This year, however, there have only been four deaths
in the past six months, and the fatality rate is down to 3 percent.

 

By the numbers, HIV/AIDS is not as frightening as
it used to be. “On the surface, no it’s not scary,”
Cunningham said. “If you scratch that surface, you see a
different picture. I think if you ask anybody with AIDS, they will give
a whole different perception than that.

 

“We don’t have the markers we used to
have,” Cunningham continued. “You don’t walk through
Hillcrest any more and see the walking dead, the people where you
didn’t know if their next step was going to be their last one.
You don’t see the posting of the memorial services that we saw
when we had hundreds of people dying a year.”

 

Barebackers also cite the number of community
organizations and government agencies that offer support – from
medication funding, housing assistance and job placements to free
services like haircuts, massages and laundry. As new cases have leveled
since the late 1990s, there is an unspoken, politically correct
movement to present HIV/AIDS as a mainstream disease. Since it is no
longer the epidemic it was a decade ago, politicians are less likely to
fund government support agencies.

 

“Who knows when that free ride is going to
stop? We’ve lost a million dollars for the Ryan White funding in
the last two years,” Cunningham said in reference to government
funding that is available to HIV/AIDS patients only as a last resort.
Even with MediCal, Medicare, Social Security Insurance (SSI) and Ryan
White funds, Cunningham said the average monthly income of consumers is
only $780.

 

In addition, backlash against the bareback
movement is giving community organizations – individuals, at
least – a chance to question their support of a disease that is
preventable. That sentiment was first heard when Scarce and Valenzuela
conducted their barebacking workshop in 1998.

 

“There was a woman who stood up in the
audience and she was livid,” Hoffman recalled. “She
screamed at him and she said, ‘How dare you? We fought for
funding for you, we marched in AIDS Walks for you, we demonstrated with
you and we held your hands in hospitals … we did all of these
things. Now you know better as a young gay man, and still you do this.
If you are going to do that, then we’re going to stop supporting
you.”

 

Continuing the safe-sex message

 

The support does continue. Those communicating
the safe-sex message have a challenging job. They have to counter the
bareback advocates, teach a new generation about the risks involved in
unsafe sex while holding onto the current generation’s attention,
and constantly evolve their message to avoid falling victim to safe-sex
message fatigue.

 

“Anyone
who is HIV infected and engages in unprotected anal intercourse is
opening themselves up to the potential of contracting a whole array of
diseases, because their immune system is less functional than someone
who does not have HIV.” — Terry Cunningham, chief of the Health and Human Services Agency, HIV, STD and Hepatitis Branch

 

The biggest challenge, however, is the budget.
Not only did the Health and Human Services Agency lose money for the
Ryan White CARE Act, they also lost $1.3 million in funding for
preventative campaigns, down from $3 million.

 

“Try to do any kind of behavioral change
education with $1.7 million when you got 3 million people out there
that need to hear a message,” Cunningham said. “We should
be putting $10 million into prevention, but we’ve only got $1.7
[million].”

 

Cunningham warned that new money is not going to be coming any time soon, either.

 

“How do I justify [to the politicians]
putting money into a behavioral change campaign to a population that is
a subpopulation that is a subpopulation engaging in a high-risk
activity that is preventable?” Cunningham asked. “At some
point in time, the party is going to end, and it’s not going to
be pretty.”

 

“It’s very difficult to educate
people and get them to use condoms. The education involves being ready,
willing and able; feel like you are at risk, and you are ready to do
this,” Zians said.

 

Still organizations like Cunningham’s and
Zians’, plus the Family Health Centers of San Diego, the CDC and
an array of other associations throughout San Diego, will continue to
communicate their message.

 

“If we change one person’s behavior
so they don’t get infected, so they don’t have to go
through the psychological, emotional, physical and societal
ramifications of having this disease, then we’ve saved a
life,” Cunningham said. “I think we save a lot of lives all
the time. I think we save a lot of lives by telling people to get
tested so they know they are positive or they are negative. We save
lives by educating people who are negative how to stay negative. We
save lives by telling people who are positive that life is worth living
and here is how [to have] a good quality of life and be respectful of
your partner. I see people who are not listening. It’s difficult
to see, but sometimes that message gets through. I think that makes it
worth it.”

 

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