HIV risk concerns and risk reduction practices of HIV negative MSM who bareback

Background: Intentional unprotected anal intercourse in situations with risk of HIV transmission, commonly referred to as “barebacking,” among MSM has raised concerns about another wave of HIV infections among this population. Barebacking has been attributed to condom fatigue, decreased concerns about HIV infection, and even a desire to be infected with HIV (“bug-chasing”). This paper explores HIV risk concerns expressed by HIV-negative men who bareback and their approaches to reducing risk of HIV infection. We also identify areas where interventions could be aimed so that MSM who bareback can reduce the risk of infection.

Methods: Eighty-nine HIV-negative MSM of diverse ethnicities, who live in the New York Metropolitan area and engage in barebacking were recruited online. They underwent an in-depth qualitative interview and a brief quantitative assessment.

Results: While very few participants appeared motivated to stop barebacking, most reported conducting some type of HIV risk assessment prior to sex and subsequently deciding whether or not to use condoms with a particular partner. Other risk reduction strategies included limiting the number of barebacking partners and the settings where barebacking occurs (e.g. no groups or bathhouses), and barebacking only with men they presumed to be HIV-negative. The men often obtained serostatus information from online profiles or through online chats, which, for many men, was easier than asking for this information in person.

Conclusions: The participants' risk reduction efforts reveal their interest in avoiding HIV infection and they appear amenable to HIV risk reduction interventions that are not solely based on condom use.