"Barebacking" in a diverse sample of men who have sex with men

To assess the prevalence of and factors associated with "Barebacking" as a sociocultural phenomenon in a sample of HIV-positive and -negative men who have sex with men (MSM), and to assess the reasons for barebacking and venues for meeting partners.

A cross-sectional survey of MSM recruited in the San Francisco Bay Area from July 2000 to February 2001.

Barebacking, defined as "intentional anal sex without a condom with someone other than a primary partner", was assessed among men who had heard of the term. Participants were recruited outside multiple venues and interviewed later at community locations. Chi-square and multivariate logistic regression were used for analysis.

The sample (n = 554) of MSM were African-American (28%), Latino (27%), white (31%) and other race/ethnicity (14%); 35% reported being HIV-positive. Seventy per cent of the men had heard of barebacking. Among men aware of the term, 14% had barebacked in the past 2 years (22% of HIV-positive versus 10% of HIV-negative men, P < 0.001); 10% of the full sample did so. The prevalence of barebacking did not differ by race/ethnicity or sexual orientation identification. Men tended to report bareback partners who had the same HIV serostatus; however, a sizeable proportion of men had partners of different or unknown serostatus. Increased physical stimulation and emotional connectedness were the primary reasons for barebacking.

New approaches are needed to reduce bareback behavior and the risk of HIV transmission, including innovative health-promoting behavioral and biomedical interventions.