Objectives: 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.
Design: A cross-sectional survey of MSM recruited in the San Francisco Bay Area from July 2000 to February 2001.
Methods: 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.
Results: 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.
Conclusion: New approaches are needed to reduce bareback behavior and the risk of HIV transmission, including innovative health-promoting behavioral and biomedical interventions.