Barebacking: a review of the literature

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.