Before birth control pills became commercially available in the 1960s, people in the industrialized world who engaged in heterosexual intercourse and wanted to prevent pregnancies generally used condoms. Some did not, of course, such as devout Catholics, and some used condoms specifically to prevent sexually transmitted infections (STIs). Once birth control could be accomplished by the pill, people engaged in heterosexual relations had far less motivation than before to interrupt the spontaneity of their sex play in order to use such protection.
Among men who have sex with other men, however, whether they self-define as homosexual, bisexual, or heterosexual [note: This distinction is particularly significant among the many cultures and subcultures in which a man retains heterosexual status even though he is sexually active with other men as long as he is the top, or inserting, partner. In these cultures being gay is defined by being the receptive partner], condom use never had much currency. Pregnancy was not an issue, and until the advent of HIV, available medical treatments for gonorrhea, syphilis, and many other STIs made all such sex seem safe.
In the early 1980s,with the emergence of HIV in the gay communities of industrialized nations, sex – especially sex between men, and between women and men who had sex with other men – became much more dangerous. Policies advocating “safe,” “safer,” and “responsible” sex centered on prevention of disease transmission by promoting the use of condoms.
Over the years, most men came to terms with the need to protect themselves and their partners, and as the use of condoms increased, new HIV rates decreased. Yet there have always been men who declined to take this step. They have been conspicuous among men who patronize female prostitutes, sometimes offering to pay additional fees for sex without a condom, and they have been known as well in the gay and bisexual male cultures, where they are known as “barebackers.” Because new HIV rates are up lately, especially among men and women under 30, barebacking has become a significant health concern.
Strictly speaking, the term “barebacking” just refers to having sex without a condom; but usually it refers particularly to intentional unprotected anal intercourse between men. In general, anal intercourse is among the most direct routes for HIV infection, so barebacking is known to be dangerous. For individuals who are HIV-negative, the most obvious risk is initial infection, including infection with mutant strains of HIV that are resistant to all known medications. Those who are HIV-positive risk superinfection by augmenting one of the dozen strains of HIV with others. And everyone who barebacks, even without ejaculation, is at risk for contracting other STIs, some of which are incurable (herpes and genital/anal warts), and some of which are potentially fatal (hepatitis B and hepatitis C).
Still, despite the dangers, some people continue to bareback. The most obvious reasons appear to be the most common:
- barebacking is more spontaneous and convenient than protected sex;
- the sensation is greater in barebacking than it is during protected intercourse, and so is more pleasurable;
- barebacking is safe if neither partner is infected with HIV or any other STI;
- barebacking is less expensive than using condoms, which can matter to people on limited incomes;
- both the increased pleasure and even the risk entailed in barebacking can strengthen emotional ties between partners and lead to greater intimacy between them; therefore
- the ability to bareback safely gives monogamous couples an incentive to stay monogamous.
But there are other reasons as well, and it is important to appreciate their reality to understand why some men are willing to risk their lives for sex.
Some men no longer fear AIDS. Some think developments in treatment have made it a fully manageable disease, while others, who are already HIV-positive, are unaware of the health consequences of reinfection and think they no longer need to use condoms if they are only sexual with other positive men. Still others believe the myth that only the bottom can get infected during anal intercourse and bareback as long as they top, though in reality the top partner is at high risk, and the bottom partner is at higher risk. And some younger gay men, who have not experienced the loss and devastation caused by the AIDS-related deaths of their lovers and friends that older gay men endured in the 1980s and 1990s, don’t quite know what there is to be scared of, and take fewer precautions to protect themselves from infection.
People are more likely to bareback while under the influence of alcohol and other drugs, when inhibitions are released as the ability to think rationally diminishes. In a similar context, some men get caught up in passions of the moment and neglect to use condoms even though they ordinarily do. And then, some men simply hate using condoms: in addition to the common complaint that condoms reduce sensation, they find putting on condoms to be a hassle, they find condoms a barrier to intimacy, they think condoms interfere with sex play, or they find they lose their erections while using condoms.
While some men are in denial that they will ever get infected and don’t protect themselves, some fatalistic men assume HIV is inevitable so they don’t even try to avoid it; and some are desperate to belong: HIV-positive men (“poz”’s) often have their own groups of friends and social lives with other positive men. Since the unique status of being positive can provide a sense of belonging, some men allow themselves to get infected in order to gain admission to these circles. A small number of men known as “bug chasers” purposely get themselves infected with HIV.
Finally, some men are so sick of hearing about AIDS they just ignore the whole issue.
Barebacking is a controversial and complicated issue, since it deals with both health and human behavior. Most men of any orientation do not bareback, and many men, gay as well as straight, do use condoms every time they have sex with anyone. But other men find it very difficult to use a condom every time they have sex with every one of many partners over a period of time measured in years, decades, or even a lifetime. Most gay and bisexual men make conscious decisions about sex, and for a small but significant minority the intimacy, increased pleasure and other benefits of unprotected sex outweigh the risks. They choose to have anal intercourse without a condom.
If people are going to really understand barebacking – for good and ill, but without prejudice and with tolerance for the choices others make – then we all need information that will allow us to make informed decisions. To judge by what the growing incidence of barebacking, with a concommitant increase in new HIV and other STI cases among heterosexual, as well as gay and bisexual men and women, we need HIV prevention campaigns with messages that are meaningful to the relevant people. To be meaningful is to promote options that address their sex lives. Abstinence is a short-term intervention, not a policy. Genuine monogamy is an ideal praised by many but practiced by few. And “use a condom every time” is the sort of advice that fails to reach too many men who have sex with men; often it also doesn’t reach women at all, nor the men who have sex with them. Even men who prefer to use condoms sometimes don’t.