Objectives: The objectives of this study were to examine the extent to which HIV-positive gay men in London intentionally seek unprotected anal intercourse (“barebacking”) and the contribution this makes to total sexual risk.
Study Design: In 2002 to 2003, HIV-positive gay men surveyed in an HIV outpatient clinic or on the Internet were asked whether they had intentionally looked for anal sex without a condom in the previous 12 months.
Results: Of 481 men in the clinic, 59 (12.3%) said they had intentionally looked for anal sex without a condom, 34 (7.1%) only with another HIV-positive man and 25 (5.2%) with a man of unknown or discordant HIV status. Overall, 85 men reported unprotected anal intercourse (UAI) with a casual partner of unknown or discordant HIV status; 20 (23.5%) had intentionally looked for UAI with such a partner, whereas the remaining 65 (76.5%) had not. Of 66 men surveyed on the Internet, 32 (48.5%) said they had intentionally looked for anal sex without a condom.
Conclusion: Although barebackers made a disproportionate contribution to sexual risk, three-fourths of high-risk sex reported by HIV-positive gay men in London was not intentional. The Internet sample overestimated the prevalence of barebacking among HIV-positive gay men because of sampling bias.
Although gay men who intentionally looked for unprotected anal sex made a disproportionate contribution to sexual risk taking, most high-risk sex reported by HIV-positive gay men in London was not intentional.
From *City University, London, U.K.; †Royal Free and University College Medical School, London, U.K.; and the ‡MRC Social and Public Health Sciences Unit, Glasgow, U.K.
The authors thank www.gaydar.com, http://uk.gay.com, Royal Free Hampstead NHS Trust Hospital, all the men who completed a questionnaire, all those who distributed and collected questionnaires, and Theresa Allen for statistical advice.
This research was funded by the UK Medical Research Council (grant no. GO 100159).
Correspondence: Professor Jonathan Elford, City University, Institute of Health Sciences, St. Bartholomew School of Nursing and Midwifery, 24 Chiswell Street, London EC1Y 4TY, U.K. E-mail: firstname.lastname@example.org
Received for publication November 7, 2005, and accepted April 10, 2006.