Bareback sex and gay men: an HIV prevention failure

Bareback sex, or actively seeking unprotected anal intercourse is occurring in the gay male community. This represents a new phenomenon, different from previously identified "relapse" unsafe sexual behavior and poses an important HIV prevention problem. This article reviews the extant literature regarding bareback sex. The lay press and scientific literature are reviewed. Although discussion of issues surrounding bareback sex is abundant in the gay press, scientific literature regarding this phenomenon is nonexistent. The evidence-based literature addresses relapse to unsafe sexual behavior. Although this literature provides further understanding of safer sexual behaviors in gay men, barebacking is a unique issue that requires additional exploration. In this article, factors underlying bareback sexual behavior are explored, including previous HIV prevention efforts and their relationship to this phenomenon. Finally, bareback sex in the gay male community and its implications for nursing practice, research, and education are explored. The harm reduction model is offered as a useful guide for nursing assessment and intervention.