Fridae

"No limits. No barriers. No condoms." That's the tagline promoting a new porn video featuring barebacking among men who have sex with men (MSM). The first study gauging the incidence of barebacking among MSM proves it is in no way a mere fantasy, rather a kind of sex that is putting MSM at high risk for HIV and other sexually transmitted diseases (STDs).

A total of 14 percent of almost 400 MSM surveyed reported barebacking -- which was defined in the study as intentional unprotected sex with a non-primary partner -- in the past two years. The findings were released last week at the National STD Conference in San Diego.

The study, conducted in San Francisco from July 2000 to February 2001 by Gordon Mansergh, Ph. D., a behavioral scientist from the Centers for Disease Control and Prevention (CDC), focused exclusively on the rates and reasoning behind barebacking.

"Fourteen percent strikes me as considerably lower than reality," gay activist and author Eric Rofes told the Southern Voice. "This is a highly charged issue and expecting people to self-report automatically raises questions about the research."

However, Dr. Mansergh offered a different perspective. "This is a very specific behavior we are talking about, we are not just talking about unprotected anal sex," Dr. Mansergh told GayHealth.com. "We're talking about intentional unprotected sex with someone who is not a primary partner."

In the study barebacking did not include spontaneously or unplanned unprotected anal sex. "If we look at those rates over all in the same sample, they're much higher. It's roughly 30 percent or so within just the previous three months," Dr. Mansergh said. "The 14 percent in two years shows how much of a subgroup barebacking is."

Along with his colleagues Dr. Mansergh surveyed 554 MSM; 390 of the men understood the term barebacking, and 53 of those MSM reported barebacking in the past two years.

MSM with HIV were more likely to bareback than those without HIV; of the 28 HIV-infected men who had barebacked, 38 percent reported insertive intercourse with a partner of different or unknown HIV serostatus. Of the 23 HIV-negative men who had barebacked, 39 percent reported receptive intercourse with a partner of different or unknown HIV serostatus.

Are MSM not afraid of getting HIV anymore? The most common reason given for barebacking was greater physical stimulation and more emotional intimacy with a partner.

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"A condom is a physical barrier and it represents for some people an emotional barrier as well," said Dr. Mansergh. But why do these reasons outweigh the need for MSM to protect themselves from disease?

The availability of better treatments was given as a reason for barebacking with 19 percent of men who had barebacked saying that improved treatments caused them to have more unprotected sex. Some men may falsely believe having unprotected sex with an HIV positive man is safe because medications prevent HIV transmission.

"There is no doubt that a lower viral load corresponds to less risk. But we also know that viral loads often "blip" up -- even in people who are faithfully taking their medication and have steadily undetectable readings," said Susan C. Ball, M.D., M.P.H., assistant director of the Birnbaum Unit HIV Care Center at New York Presbyterian Hospital.

A total of 58 percent of the MSM reported being drunk or high -- another contributing factor that may increase the likelihood of risky behavior -- during their last barebacking encounter.

Dr. Mansergh says there is a need for new prevention strategies that specifically target MSM who bareback. For example, he said there needs to be more research on microbicides -- substances that help reduce the risk of HIV transmission, usually in the form of gels or lubes -- as an alternative for condoms.

"Most people either haven't heard of them or see them as a "pie in the sky" luxury we might have someday. But someday could be as little as five years away. If the gay community is interested enough to demand them," Anna Forbes, MMS, wrote in a recent GayHealth.com feature article.

"Our data suggest that most men who bareback are likely to use a future rectal microbicide, even if such a product were protective only 50 percent of the time that it was used. An effective microbicidal product could provide protection without compromising physical stimulation and emotional connectedness," according to the study authors.

Researchers warn, however, that microbicides would only reduce HIV risk for those MSM not using condoms. There is concern about whether microbicides may in fact increase the risks for MSM who may stop using condoms. "More collaboration is needed in laboratory research, clinical trials and behavioral studies to identify safe, effective and acceptable rectal microbicides."