a confration of risk and masculinity

8/17/2019 A Confration of Risk and Masculinity

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Dave Holmes, School of Nursing, Faculty of Health Sciences, University of Ottawa; Denise Gastaldo,Faculty of Nursing, University of Toronto; Patrick O’Byrne, School of Nursing, Faculty of Health Sciences,University of Ottawa; and Anthony Lombardo, Department of Public Health Sciences, Faculty of Medicine,University of Toronto.

The authors would like to thank the Canadian Institutes of Health Research—Institute of Gender &Health and Institute of Population Health—for funding this research.

Correspondence concerning this article should be address to Dave Holmes, School of Nursing, Faculty

of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario Canada, K1H 8M5. Electronicmail: [email protected]

International Journal of Men’s Health, Vol. 7, No. 2, Summer 2008, 171-191.© 2008 by the Men’s Studies Press, LLC. http://www.mensstudies.com. All rights reserved. jmh.0702.171/$12.00 DOI: 10.3149/jmh.0702.171

Bareback Sex:A Conflation of Risk and Masculinity

DAVE HOLMES DENISE GASTALDO

University of Ottawa, Canada University of Toronto, Canada

PATRICK O’BYRNE ANTHONY LOMBARDO

University of Ottawa, Canada University of Toronto, Canada

From a healthcare perspective, there is an underlying assumption that most gayand bisexual men do not intentionally seek to have unprotected anal sex. Thispaper presents the results of a qualitative investigation conducted in three Cana-dian gay bathhouses regarding unprotected anal sex among men. It is our con-

tention that much epidemiological research, though helpful, obfuscates essentialfactors in the practice of bareback sex. Consequently, the paper addresses twothemes: the identification from the participants’ perspective of the risk factors in-volved in the practice of bareback sex and the identification of specific risk-re-duction strategies used by barebackers. Our research results indicate that themajority of the participants were informed about health risks and took steps toavoid harmful practices even when engaging in high-risk sexual activities. Manyparticipants, regardless of their HIV status, used risk-reduction strategies becausethe majority wanted to protect both their partners and themselves.

Keywords: bareback sex, masculinity, public health, qualitative research, risk

For the past few years, Internet access has facilitated casual and anonymous sex-ual encounters by increasing initial contacts between potential partners through the useof chat rooms and virtual communities. In Canada, however, although the Internet isconsidered an easy way for locating sexual partners, bathhouses remain the most pop-ular and convenient way venues for men who have sex with men to meet (Ross, Tikkea-

nen, & Mansson, 2000; Somlai, Kalichman, & Bagnall, 2001). Bathhouses enhance


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desire and promote sexual diversity. Within their milieu, voluntary unprotected analintercourse, commonly referred to as “bareback sex” is one of the choices available. Theterm bareback sex derives from the expression bareback riding (that is, riding a horse

without a saddle). The usage acquired popularity about a decade ago (Scarce, 1999) andrefers to a sexual practice in which condom use is explicitly and consciously eschewedduring anal intercourse.

Although unsafe sex has been identified and reported since the beginning of theHIV epidemic, the general assumption is that most gay and bisexual men do not in-tentionally seek to have unprotected anal sex. We believe that this conclusion obfuscatesessential components powering the practice of bareback sex and that this understand-ing of unsafe sexual practices is superficial because it does not recognize several de-termining sociocultural and psychological factors (Holmes & Warner, 2005).

The goal of this paper is to present the results of a qualitative research project onbareback sex conducted in three Canadian gay bathhouses and to attempt to fill a gapin the current scientific literature by addressing the following issues: the participants’perception of the risk factors implicated in the practice of bareback sex and the risk-re-duction strategies (if any) used by the barebackers themselves. We contend that a bet-ter understanding of these issues is necessary in order to facilitate the implementationof healthcare interventions better adapted to the needs of this population.

Background

According to UNAIDS (2002), 75,000 people in high-income countries acquiredHIV in 2001. Unsafe sex, reflected in outbreaks of sexually transmitted infections, andwidespread intravenous drug use is propelling these epidemics. Despite preventioncampaigns, HIV remains a challenge in most Western countries. The majority of newHIV infections in both North America and Europe are sexually transmitted (HealthCanada, 2005). As a result, the relationship between HIV/AIDS and men having sexwith men has been studied extensively for more than two decades. At present, the risein the popularity of bareback sex has led to new research on this sexual practice (Halki-tis, Parsons, & Bimbi, 2001; Suarez & Miller, 2001). However, a change in infectiontrends is neither able to determine the link between a particular sexual practice andHIV increases, nor to provide insight into how to develop healthcare interventions(Halkitis, Wilton, & Drescher, 2005; Halkitis, Wilton, & Galatowitsch, 2005; Wolitski,2005). In the case of bareback sex, one reason that causation cannot be established maybe that it does not constitute a new phenomenon. Sex without condoms was the normbefore AIDS (Wolitski). A further confounding variable for determining the role of bareback sex in the recent surge in HIV infections is that while the public health liter-

ature claims that the number of men having sex with men who engage in bareback sexis a relatively small subset of the population, other sources indicate that bareback sexis practiced by individuals from every sociodemographic stratum and serostatus (Halki-tis, Wilton, & Drescher, 2005) and does not occur because of poor planning or sponta-neous decision-making (Dawson, Ross, Henry, & Freeman, 2005). In addition, there is

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no evidence regarding why some men engage in barebacking while others refrain orwhat differences exist in defining barebacking as a practice versus barebacking as anidentity (Halkitis, Wilton, & Drescher, 2005; Wolitski, 2005).

Based on research, men who have sex with men have indicated that bareback sexproduces greater stimulation, heightens emotional closeness with a partner, and is ameans of rebelling against established norms (Wolitski, 2005; Dawson, Ross, Henry,& Freeman, 2005). At this time, twelve theoretical factors have been implicated in theattitudes of gay and bisexual men toward this practice: (1) an erroneous perception of risk, (2) self-destructive impulses, (3) other destructive impulses, (4) AIDS fatigue, (5)a need for intimacy, (6) rational risk-taking, (7) diminished self-control, (8) a sense of invulnerability, (9) assertiveness failure, (10) a sense of fatalism, (11) condom-relatederectile dysfunction, and (12) other condom-related attitudes (Shidlo, Yi, & Dalit,

2005). However, current public health strategies ignore the social context of sexualpractices (Parsons, 2005) and many current models assume that unsafe sexual prac-tices are the result of lack of knowledge and disregard the fact that individuals may in-tentionally engage in activities which put them at risk (Halkitis, Wilton, & Drescher,2005), thus making these models inadequate for addressing the issue. Unfortunately, be-cause of these limitations, interventions from outside the gay community may be per-ceived as thinly veiled attacks on an already marginalized lifestyle (Wolitski, 2005)especially since many reports identify bisexual men as vectors of HIV transmissioninto the heterosexual population (Bimbi & Parsons, 2005).

Theorizing Risk and Masculinity

A poststructuralist perspective supports the analysis of power relations at the in-dividual and the collective level. In this paper we will apply this perspective to exam-ine the conflation of risk and masculinity in the context of hegemonic male power usingthe lens of Foucault’s (1991) concept of governmentality to examine bareback sex.

Governmentality, a term coined by Foucault (1991), describes the general mech-anisms of society’s governance. It does not refer specifically to the term government,as it is commonly understood. As Gordon (1991) explained, “government as an activ-ity could concern the relation between self and self, private interpersonal relations in-volving some form of control or guidance, relations within social institutions andcommunities and finally, relations concerned with the exercise of political sovereignty”(pp. 2-3). According to McNay (1994), Foucault considered governmentality as a com-plex system of relations that binds government in a tripartite manner involving threeforms of power: sovereign, disciplinary, and pastoral. The idea of government impliesall of the tactics, strategies, techniques, programs, dreams and aspirations by which au-

thorities shape beliefs and the conduct of populations (Nettleton, 1991) and, in theseterms, is an activity that aims to shape, mould, or affect the conduct of an individual orgroup. Furthermore, the notions of governmentality and risk focus strongly on the sub- ject’s position within the discursive construction of risk, most specifically the mannerin which individuals should be personally responsible for their well-being (Castel,

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1991), and with this increased focus on individual responsibility, risk assessment hasbecome a major industry (Ewald, 1991). This suggests that individuals are held re-sponsible for avoiding risks based on established lists of perceived risky behaviours, lest

they be considered “foolhardy, careless, irresponsible, and even ‘deviant’” (Lupton &Tulloch, 2002, p. 114).

By accepting it as a socially constructed phenomenon, risk can be considered assomething to which we are all subjected in one way or another in our everyday lives.Lupton (1999) has suggested that these experiences are negotiated within and throughcontextual, dominant discourses, most notably those of medical science, industry andgovernment. Such a concept relies largely on Foucauldian ideas of governmentalityand the technologies of power that are seen to restrict or direct social agency. Individ-uals position themselves and self-identify through the dominant discursive construc-

tions that are, at any given time, multiple and sometimes conflicting.Sexual risk-taking may also have important legal implications (Holmes &

O’Byrne, 2006). Moreover, they may have an impact on health and may come to des-ignate an individual as deviant because of a proclivity for risky behaviors. For exam-ple, since the early 1980s, a vast number of academic and popular publicationsexploring HIV/AIDS have considered and defined risky behavior and at-risk popula-tions (Lupton & Tulloch, 2002) while emphasizing risk as something to be avoided, orat the very least controlled “as long as expert knowledge can be properly brought to bearupon it” (Lupton, 1999, p. 5).

The social construction of masculinity is intrinsic to understanding gendered ex-periences of risk (Frost, 2003, 2005), and can be related to the notion of risk and socialidentity. The social constructionist perspective argues that gender is not an essentialcharacter trait, but is rather a summation of behavioural and bodily practices that arelearned through interaction with others in various social realms. As such, masculinityand femininity are learned traits that have been assigned to individuals of a given bio-logical sex. Expected gender performances are established as binary opposites—maleor female, masculine or feminine (Butler, 1999).

Green (1997) noted that an empirical study of children found that the perceptionof risk in boys as young as seven was different from that of their female peers. Whenthe participants were asked to recount and react to accident narratives, the girls re-sponded in ways suggesting traditional feminine constructs (concern, responsibility,and nurturing), but the boys were much less concerned about others and could be seenas willing participants in risky behaviour. Numerous studies on the construction of mas-culinity in boys propose that many different social milieus work in concert to constructthis “appropriate” masculinity (Bramham, 2003).

Other studies suggest that males are active participants in risk-taking behaviours

and perceive risk differently than do females because of the expected performance of masculinity (Finucane, Slovic, Mertz, Flynn & Satterfield, 2000; Le Breton, 2004;Mitchell, Crawshaw, Bunton, & Green, 2001). Behaviour such as engaging in “un-safe” tasks, reckless driving or other breaches of legal or parental authority (Le Breton,2004), participation in extreme sports (Laurendeau, 2004; Le Breton, 2000; Lyng,

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2005), and even overtly aggressive play during sports and social games that bothfavours and puts male bodies at risk and has been created within hegemonic genderconstructs, (Young & White, 2000) work to gain young boys masculine capital, thereby

constructing social identity both personally and with peers.In contemporary Western society, behaviours to which boys are expected to sub-

scribe include assertiveness, competitiveness, independence, and dominance. Con-versely, behaviors such as expressiveness, sympathy, passiveness and understandingshould be avoided, lest one be thought feminine. Bodily practices include the devel-opment of hard, strong, muscled bodies that perform tasks that are acceptable withinthe range expected of masculine performance (Bramham, 2003).

There is an almost universal assumption of heterosexuality in this. When dealingwith homosexuality and ideas of masculinity, there is an ironic relationship between

sexuality and gender (Nardi, 2000; Pronger, 1990), even though masculine performanceand homosexual behaviour have been considered in literature addressing socially de-fined risky sexual practices, especially in the era of HIV/AIDS. The following sectionswill address a specific form of high risk sexual practice: bareback sex.

Method

Some authors attribute the recrudescence of sexually transmitted infections (STI)and HIV to bareback sex (Condon, 2000). However, because there is very little relevant

scientific literature, we chose an exploratory research design to help us better under-stand our topic. Bareback sex is commonly described as a gay sub-cultural trend thatis practiced in public spaces; therefore, ethnography following the principles proposedby Hammersley and Atkinson (2004) seemed to be the most appropriate methodolog-ical approach.

Contrary to the findings of many American authors, it was observed during a pilotstudy (Holmes & Warner, 2005) that men who have sex with men frequently meet eachother at bathhouses. Consequently, we decided to situate our research and recruitmentfor the qualitative portion of the study in this environment. Note, however, that the ob- jective of this paper is not to provide a thick ethnographic account of gay bathhouses(see Holmes, O’Byrne, & Gastaldo, 2007), but rather to explore risk as it is perceivedand enacted (or not enacted) by the participants in bareback sex in these milieus.

Data Collection

Following a comprehensive review of the literature relating to bareback sex, 28structured in-depth interviews with barebackers were carried out in three Canadian

cities. The participants were recruited while an ethnographic study in gay bathhouseswas being conducted by the researchers (Holmes, O’Byrne, & Gastaldo, 2007), as wellas through advertisements posted in gay bars in the cities of study. The resulting inter-views, which were conducted in university offices in the three target cities, were audio-taped and then transcribed. The transcriptions were double-checked by a second

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researcher. All of the participants were of the age of majority according to provincial jurisdictions, and defined themselves as heterosexual, homosexual, bisexual, gay, orqueer, and as regularly engaging in bareback sex with anonymous male partners. In-

terviewing continued until data saturation occurred.

Data Analysis

Content analysis was selected as the preferred means for exploring and analyzingthe data (Denzin, 1998). During this process, knowledge of risk, risk representation, riskrationalization and risk-reduction strategies emerged as significant themes. For the pur-pose of this paper, our analysis will focus specifically on these four themes. In analyz-ing the data, we drew on the insights risk offered by poststructuralist theorists.

Ethics

The Canadian Tri-Council Ethics Policy (2005) was fully acknowledged and re-spected. We were well aware of the intrusive nature of a qualitative study exploring thepersonal sexual practices of specific individuals. Consequently, the rights and wishesof the participants were scrupulously respected at all times regarding content disclosureand any wishes to prematurely end an interview. The 28 participants who agreed tosemi-directed in-depth interviews all signed consent forms.

Rigour

Applying the principles of credibility, transferability, reflexivity, and resistanceensured the rigour of this research project. The more traditional rigour criteria of de-pendability and confirmability were removed because they are incommensurate withthe research paradigm of inquiry (critical theory). Credibility served to evaluate inter-nal commensurability between the paradigmatic assumptions, theoretical framework,and findings. It is important to note that in this modified sense credibility does not referto confidence in the truth of the data.

The principle of transferability ensured that a thick description of the sample wasobtained and displayed to allow findings to be applied to similar groups. Reflexivityforced the researchers to view the process as subjective and to acknowledge the effectof our personal, paradigmatic, theoretical and methodological biases regarding the re-search process. Thus, reflexivity promoted scrutinizing and evaluating our own be-haviours, beliefs, and reactions in the same manner as we did the research data. The last

rigour criterion was resistance, which views research as a means, rather than an end. Re-search should be evaluated in terms of its ability to act as a resource for understandingand for producing resistances to local structures of domination (such as certain ramifi-cations of the public health dispositif ).

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Results

Although barebacking is a highly personal and intense activity, the research team’s

professional experience in sexual health clinics combined with in-depth knowledge of up-to-date research and theoretical sensitivity allowed for a sound and critical appraisalof the data collected. For example, we were always aware of our epistemological standand, as a consequence, we acknowledge that, although we followed a rigorous dataanalysis scheme, this section is firmly rooted in the paradigm of critical theory (Guba& Lincoln, 2002). We also acknowledge that our personal experiences in the publichealth domain had an impact on the analysis process. This having been said, our re-search shows that risk is an important concept for the barebackers we interviewed. Al-most all of them discussed the issue. At this point, however, we cannot assert that HIV+

individuals use pre-determined risk reduction strategies that are different from thoseused by HIV- individuals; however, the serological status of participants will be madeexplicit when necessary to highlight differences between these two groups of bare-backers. At this point, we will turn our attention to the results obtained from the inter-views.

Table 1 gives an overview of the demographics of the research participants. All in-dividuals who engaged in the interview process (n=28) were asked to complete a brief survey describing their sexual orientation, age, socio-demographic status, average num-ber of partners, and HIV testing history and results. One interviewee declined to com-

plete the survey and two others were not practicing bareback sex; therefore, the resultspresented 1 are all calculated using n=25.

The ages of the interviewees ranged between 22 and 54 years, with an average of 37.5. Under sexual orientation, 12 percent had been previously diagnosed as HIV positive.

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Table 1 Description of Sample

Age ( M ± SD) 37.6 ± 9.5 (range: 22-54 years)n %

Sexual orientation(Self-defined) Bisexual 3 12

Homosexual 13 52Gay 6 24Queer 1 4Other 2 8

Education(Highest diploma) High school 8 32

College diploma 6 24Bachelor diploma 7 28Master’s degree 4 16

Income ($)75,000 2 8

Number of partners(Last 6 months) None 1 4

1-10 9 3611-30 7 2831-50 3 12>51 5 20

Previous HIV testNo 2 8Yes 23 92

Result of last HIV testNo Answer 2 8Negative 11 44Positive 12 48

N = 25 Note: Twenty-eight men agreed to be interviewed; one declined the socio-demographic ques-tionnaire; two were not considered barebackers as they always engaged in protected anal inter-course.


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Before we present our qualitative data, we would like to refute an assumption oftenheld by professionals working in the field of public health. Some authors state thatbarebacking is more likely to occur in certain specific settings, gay bathhouses being

targeted most often. Our previous research in three Canadian gay bathhouses leads usto conclude that, on the contrary, bareback sex can happen in any environment wheremen meet for sex (Holmes, O’Byrne, & Gastaldo, 2007). Our participants supportedthis assertion, as the following quote makes very clear: “Barebacking happens prettymuch everywhere. It happens in the porn theatres, it happens in the bathhouses, it hap-pens in the washrooms; it happens in the cars, it happens in the parks, beaches . . . justeverywhere” (PA 22, p. 19).

While bathhouses are often under attack by public health figures for their in-volvement in the transmission of HIV and STIs, it is important to note that bareback-

ers themselves report that bathhouses are just one location where this practice occurs.Furthermore, several studies have indicated that although a considerable proportion of men who engage in high-risk activities frequent gay bathhouses, only a minority of them report having had unsafe sex while there (Woods, Binson, Mayne, Gore, & Reb-chook, 2000; Holmes & Warner, 2005). We agree with these researchers and gay ac-tivists that it is not where you have sex or the number of partners you have that isimportant, but rather what you do. In light of this, we will now explore the four cate-gories that emerged during data analysis.

C-1 Knowledge of Risk

In contrast to public health claims that bareback sex usually occurs because of ig-norance or due to the influence of drugs, it is essential to emphasize that the participantsin this research project were well aware of the associated risks. We believe that themisguided public health assumption is highly problematic because it incorrectly framesseveral educational and prevention campaigns. For example, an HIV-negative partici-pant who practices bareback sex as well as oral sex without condom states:

For me, it’s the state of my oral hygiene, “Did I brush my teeth before Iwent out?” Yes . . . then no oral sex is going to happen . . .. That’s incase someone has a lot of pre-cum, because pre-cum can be very heavywith HIV. I was just talking to a friend of mine who’s very into the HIVpolicy thing at Health Canada, he came across a new term he’s neverseen before, a “super seminal shedder”. Someone who secretes a lot HIVin the semen, the pre-cum, and it’s particularly prevalent in older men.(PA 18, p. 8).

Despite the fact that this participant practices barebakcing, he seems more con-cerned about the risk associated with oral sex if the mucosa is not intact. It is interest-ing to note that this participant’s knowledge of the term “super seminal shedder” is infact superior to the knowledge of many HIV clinicians and researchers who are un-

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aware of the concept. The same interviewee was explicit in his description of the po-tential risk of HIV transmission via oral sexual contact:

Sucking is as safe as the cock you’re sucking and the state of your mouth. . . people just doesn’t [sic] understand the dangerous place for a po-tentially HIV-infected cum is actually your mouth. I mean, the obviousthing is to not let someone come in your mouth but if it does happen . .. well, get it out of your mouth, so if that swallowing it, then swallow it,if it’s spitting it out, then spit it out, but get it out. That’s where the im-portant potential risk of infection is, it’s actually in your oral cavity. (PA18, p. 21)

While the language used by this participant is not euphemized with medical jargon,an in-depth knowledge of risk is definitely present. In fact, this quotation illustrates anunderstanding of the location of possible infection (the oral cavity) and is aware thatthe likelihood of infection increases as the length of time of exposure increases. Anotherparticipant showed his knowledge and acceptance of risk relating to his practices. Hedid not act in a state of ignorance:

And probably there’s always the risk they say of cross infection or maybeanother strain of the virus and whatnot and I think that maybe the risk is

a little bit less when they don’t cum inside you. The risk is still there butin my own mind the risk of cross, whatever you call it, contamination orreceiving another virus is probably less if you don’t have the person ejac-ulate inside you. (PA 19 p. 17).

Many participants were also well aware of the risks associated with drug use. Oneinterviewee was able to clearly identify the licit source of the drugs he was using, thepotential benefits of the drug, and the possible side effects of an overdose:

Ketamine – it’s an anesthetic that’s used in veterinary. And it producesa sense of euphoria. I don’t like it, and that’s why I don’t do it, but peo-ple do it on bumps. So they’ll be on ecstasy and they want to, get higher,they’ll do a bump on the dance floor, it can, if you do too much of it canlead to a ‘dissociative’ state and that’s what I don’t like. (PA 2 p. 12)

In contrast to the assumption that drug use occurs strictly for the accompanyingsensations, this participant provided a description of the source of the drug, the sensa-

tions produced, and a formula to ensure that an appropriate high is attained while thenegatively reported “dissociative state” is avoided. In addition, most of the individualswe interviewed engaged in bareback sex despite knowing the risks. An HIV+ partici-pant stated:

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I’m fully aware of cross-contamination, cross-infection, re-infectingyourself, you know. Radical viruses, things like that. I take the risk. (PA20, p. 7)

Another HIV+ interviewee added:

I don’t have to worry about catching HIV; the only thing I have to worryabout is the different strains of the virus and the other STDs. I’ve hadmany a discussion with my doctor about this, and the one doctor finallysaid, you know the risk, so that’s it. (PA 22, p. 5-6)

In fact, not only were the barebackers in our study not ignorant of risks, they were

also highly involved in becoming more informed about HIV and STI risks. This knowl-edge came from several sources including the Internet.

Actually I have a friend, who has a number of listservs she organizes, andone of them is a daily popular press email on HIV-related issues, and soshe sends me that. I’m always reading and put the little the pieces to-gether. (PA 6, p. 12)

This participant illustrates that bareback sex in this case is not the result of igno-

rance.

C-2 Representation of Risk amongst Barebackers

The next category that emerged from our data was the representation of risk. Al-though it could be interpreted as barebackers exhibiting ignorance about sexual prac-tices, in our view, this category represents a personal integration of knowledge of riskfrom a variety of sources. At a time when even organizations such as the CDC andHealth Canada are unable to provide coherent and matching definitions of risk andtransmission, it is an internalization of a variety of sources on the topic of HIV trans-mission rather than a recitation of all possible risk sources. In this context of anonymousbareback sex at bathhouses, the negotiation of sexual practices (including condom use)takes place within this personal representation of risk and because these encounters areoften enveloped in an aura of silence, non-verbal communication is the norm (Holmes,O’Byrne, & Gastaldo, 2007). The following excerpt of conversation between the in-terviewer and a participant illustrates this vividly:

Researcher: When you’re having sex, how do you decide whether to usea condom or not?Participant: It’s… I leave that up to the discretion of the bottom.Researcher: Ok. So if he doesn’t say anything…

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Participant: If I am the top and they don’t say anything, I proceed. If I’mthe bottom, I’m always very cautious and I am clear about the rules of engagement. It’s like certain things are going to happen and one of them

is you’re going to put a condom on. But those are my decisions. If theother person doesn’t want to or has made those decisions not to wear acondom, then that’s their decision. (PA 18, p. 5)

For a few, place is an important element in the risk appraisal equation, whether thisbe physical location or receptive versus penetrative status in the sexual encounter. Forexample, one participant clearly states that, for him, gay bathhouses are places wherethe risk of exposure to HIV and STIs is higher. While he admits to practicing barebacksex with anonymous partners of unknown serological status in various milieus, he be-

lieves that meeting another barebacker outside the bathhouse setting is safer: “if youdon’t go to bathhouses, then you are again going to cut the risk” (PA 11, p. 20).

C-3 Rationalization of Risk among Barebackers

The rationalization of risk was another factor involved in barebacking. This cate-gory signified that some barebackers rationalize the risk of the activities in which theyengage. An HIV- barebacker states that:

As a top, barebacking is to me not a particularly risky activity, that’s myown personal line that I’ve drawn. As a bottom, it’s a very risky activ-ity. The rationalization that I’ve come to in that decision is, I’ll let some-one suck me without a condom and it doesn’t matter… I don’t askwhether they’re HIV positive or not, to me that’s an acceptable risk in myworld. I’ve talked to a lot of people, and eventually came to the conclu-sion for myself that to be a top, all things being equal, the state of mypenis is healthy, then to me it’s as risky as oral sex. It’s the same levelof risk, and if I’ve made that rationalization for oral sex, then what’s the

difference for anal sex? (PA 18, p. 2)

While this statement could be seen as ignorance of HIV risk, the participant statesthat his beliefs were developed through discussion.

Another participant adds:

I bareback because we all die from the time we pop out. And I feel likeI’m a little more spiritually evolved, than I was before. I believe thatdeath is just an extension or a continuation of life. (PA 20, p. 22)

For this participant, death is seen as a component of the life process, and the ac-quisition of HIV is not an interruption of the natural lifecycle, but one of its manyfacets.

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C-4 Risk Reduction Strategies Used amongst Barebackers

All the barebackers we interviewed knew the risks associated with unsafe anal sex

and the majority of them were practicing bareback sex with a harm reduction mindset.M were able to outline risk reduction strategies that they used with their partners; forexample: (1) sero-selection of partners, (2) physical appearance of partners, (3) use of coitus interruptus, (4) pre-anal intercourse preparation, (5) self-awareness, and (6) de-creased number of partners.

1- Sero-selection

Some barebackers reduce the risk of their sexual practices by sero-sorting. De-

pending on whether the sexual partner is sero-concordant or sero-discordant, the like-lihood as well as the type of sexual activity varies. Selection of partners according toHIV status is explained by an HIV+ participant:

Well, I am HIV+, and if I’m going to be a top, then I won’t bareback, I’lluse a condom, because I don’t want anyone else to contract HIV, and if I’m going to be a bottom, it’s usually with people who are HIV+, so nocondom, it’s consensual. (PA 10, p. 1)

The intentional selection of similar HIV sero-status partners is a strategy of per-sonal and public health risk reduction that is employed by many barebackers.

2- Physical Appearance

Another strategy employed in the selection of partners relies solely on their phys-ical appearance. Barebackers are cognizant of the physical changes caused by bothHIV and HAART (Highly Active Anti-Retroviral Treatment). For example, changessuch as lipodystrophy were discussed. Some of the participants would avoid individu-

als who have a typical HIV+ appearance:

If I see someone who looks sick, etc. You must stay away from him. Butif another guy looks healthy; I am ready for barebacking (PA 23, p. 36)

Therefore, according to some participants, assessing the physical attributes of apotential partner is another means by which risk is reduced.

3- Coitus Interruptus

Withdrawal of the penis from the anus prior to ejaculation is another strategy usedby several of the men. However, some individuals practice this method because theywant to see the semen, rather than as a risk reduction strategy. An HIV- participantsays:

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I don’t mostly cum inside. Because I like the feeling of seeing cum. ILike cumming on someone’s chest. Mostly people like to see cum. That’swhat sex is about. Sex is about the cum. People are always curious…

they just want to see it. (PA 23, p. 28-29)

As a harm-reduction strategy, this participant describes an eroticization of ejacu-late that is used to reduce the quantity of bodily fluids that are deposited within a sex-ual partner.

A participant who is HIV+ states:

When I am being fucked bare, I ask them not to cum inside me. There isalways the risk of cross infection or maybe another strain of the virus andwhatnot and I think that maybe the risk is a little bit less when they don’tcum inside you. The risk is still there but in my own mind the risk of cross… contamination or receiving another virus is probably less if youdon’t have the person ejaculate inside you. (PA 3, p. 8)

Obviously, coitus interruptus serves as a means by which barebackers reduce theirrisk of HIV transmission regardless of the motivation.

4- Pre-Anal Intercourse Preparation: Foreplay

Our results show that some barebackers insist on a preparation ritual to prepare theanus for sexual activity, thus reducing the risk of damage to anal tissue such as abra-sions and open lesions. For some participants, extended foreplay constitutes part thispreparation and, as such, involves oral-anal stimulation, digital dilation of the sphinc-ter, and the use of a substantial amount of lubricant. The following quotes illustratesome of the various means of preparation used to decrease the risk associated with

barebacking:

Lots of lube, lots of… sort of assplay, just sort of making sure thatthey’re ready to have sex. It’s pretty bad to slam your cock into some-one’s ass, that’s just not the way it goes. It’s like having sex with awoman, you can’t just shove it in. I use water-based lubes. I find a littlebit of lube and saliva is the perfect mixture… keeping things lubricated.(PA 18, p. 7)

Well, usually just, you know, like some Vaseline, usually and then justloosening it up a bit with the fingers while you’re having fun and doingcertain things... and then having anal sex afterwards. (PA 8, p. 15)

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Usually there’s always, um, rimming involved prior so that providessome lubrication and there’s all part of the foreplay before the fucking.(PA1 9, p. 9)

The top introduces his finger to apply a bit of lube…Direct skin-to-skinsex, is supposed to hurt good, not hurt bad. And… not using lube, I mean,one could run the risk of getting torn, damaged, and it’s not very pleas-urable. And you can’t endure, or continue for a long time. (PA 20, p. 19)

In the last quotation, the participant describes a formulaic approach to barebacksex. In a fashion that resembles pre-operation preparation for cleanliness and sterility,appropriate foreplay is required by this participant to reduce the risk of transmitted in-

fection. For some participants, the requirement and the type of foreplay depend on thelocation where bareback sex occurs. The following quote from a participant who oftenmeets partners at the bathhouse, constitutes a good example:

If it’s a bathhouse I won’t rim him. Usually you just start by fingeringhim, and usually you just use actions to describe what you want to donext (no verbal communication)… so you finger them right, and if theylet you, and you keep going, and they don’t move your hand and every-thing, then you can slowly move their body towards you. So, it just gen-

erates, it just starts the anal sex. (PA 9, p. 19)

The preparation for anal sex is not undertaken using words. Body language, move-ment, and gestures set the stage. Another prevention ritual involved the state of the par-ticipant’s nails: “Nails have to be trimmed” (PA 25, p. 14); and

My nails are... usually cut short anyway. Because you never know withme, I may walk to the store and end up meeting somebody and goingsomewhere. I have been meeting people; I have been meeting guys off

the street, and gone back to their place. A few hours later, I’m headingback home or into where I had to go. (PA 22, p. 23)

These quotes clearly demonstrate that barebackers do not engage in sexual prac-tices that put them at risk for acquiring HIV out of ignorance. Most of the men we in-terviewed employed an array of harm reduction strategies.

5- Self-Awareness

Some participants use discretionary abstinence as a method for reducing risk. Theystated that they are aware of the risks associated with barebacking and that self-aware-ness of the physical condition of their skin is the most important aspect of harm pre-vention for them.

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I won’t give a guy a blowjob if I had a meal within the last couple of hours. I’m a lot more in tune… I pay a lot more attention to my ownbody and where it’s at. And if I have any doubt that the skin on my penis

has been compromised, that’s it, it’s over. (PA 18, p. 5)

Another added:

Let’s say I’ve been at a bathhouse for a while, and I’ve had a lot sexualencounters, and there was a particularly rough blowjob or handjob, thenI just won’t take the chance that there’s been any abrasions. (PA 20, p.6)

These participants describe a reliance on their own physical sensations as a guidefor transmission. In situations where the integrity of the protective skin layer has beencompromised, cessation of sexual contact may ensue.

6- Decreased Numbers of Partners

Limiting the number of partners is another strategy employed by barebackers, evenHIV+ individuals who are concerned about the risk of super-infection with a differentstrain of HIV. In a state of self-awareness, some interviewees reported refraining from

sexual activity with certain partners at particular times as a way of reducing their risk:

Even if we’re HIV, sometimes a guy could have a different strain of the virus, thatcould also be passed on to me or I can pass something to him. But now, I have threeguys that I see that I socialize with. I go to their house and visit down, or spend a week-end, whatever. I bareback with these men only…we are all positive (PA 24, p. 8-9)

Discussion

The interrelationships of men who have sex with men, risk taking, and masculin-ity are complex and paradoxical. It has been suggested, for example, that to a great ex-tent, Western gay masculinity has evolved in response to traditional genderconstructions that consider gay men as deviant or feminine (Pronger, 1990). Beginningin the 1950s, and evolving in the 1970s as a response to the drag queen image typicallyassociated with gay culture, gay masculinity has now developed even further into itscurrent form. Halkitis (2001) has labelled this current performance of dominant gaymasculinity “the buff agenda” and argues that it is an embodied performance primarily

in response to the HIV/AIDS epidemic of the 1980s, which worked to project an imageof disease and frailty onto the gay community. Another aspect of the “buff agenda” isthe gay poster re-used by a group of barebackers depicting the “Marlborough man” topromote the idea that real men like to ride bareback with its underlying message thatreal men are not afraid to take risks.

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Ridge (2004) suggests that there are multiple and complex meanings underlyingparticipation in bareback sex, some of which are contradictory. However, one themethat emerged fairly consistently was that of masculinity, although even this notion was

constructed in various ways. Primarily, participants considered masculinity as an em-bodied experience (Halkitis, 2001; Halkitis & Parsons, 2003). There were, however,contradictory considerations of this when discussing the active (penetrative) and pas-sive (receptive) roles in anal sex:

The narratives suggest that sex, including anal penetration, does not havefixed meanings based on dichotomies such as active/passive. On the con-trary, accounts of informants have confirmed that sex is a repository fora range of meanings (Ridge, 2004, p. 274).

Ridge’s work is an important contribution to the understanding of gay masculin-ity and its social construction in response to HIV/AIDS; however, what has emergedin more recent studies is not only the relationship between gender and sexuality, but alsothe role of masculinity in high-risk sexual practices. According to the Centre for Dis-ease Control, the number of gay men who reported not using condoms with multipleanonymous partners increased from 24 to 45 percent between 1994 and 1999, and thestatistics for other Western countries reveal that this phenomenon is not limited to NorthAmerica. In a survey of more than 14,000 gay males conducted in the UK (Sigma Re-

search, 2003), up to 60 percent of respondents reported having practiced bareback sex.Studies in Russia and in the cities of Budapest, Melbourne and Sydney have all re-ported increases in barebacking (Shernoff, 2006).

An increase in the efficacy of anti-retroviral drug treatments has been suggestedas a factor in this resurgence in high-risk behaviour (Halkitis & Parsons, 2003; Ridge,2004); however, none of our participants offered this as a reason for engaging in bare-backing. The relevance to men who have sex with men of public health discourses re-garding HIV/AIDS awareness was also questioned, suggesting a rift between thedominant discourse and personal narratives (Ridge). When personal motivations forpracticing bareback sex were explored (Holmes & Warner, 2005), reasons such as con-nectedness through skin to skin sex contact, the spontaneity and naturalness of bare-backing, and a sense of completion (including semen exchange) were offered.

Research conducted by Crossley (2002) clearly demonstrates states that express-ing freedom, rebellion, or empowerment may also contribute significantly to a predis-position toward barebacking. Feelings of rebellion were also reported in earlier researchconducted by Holmes and Warner (2005). These authors applied interporeted barebacksex as an act of resistance.

However, despite clear evidence of patterns of resistance on the part of bareback-ers, we found that most of them employed a vast array of harm- reduction techniquesto reduce the chance of infecting themselves or others with HIV and STIs. For exam-ple, “health status” was discussed by some of our participants who appraise or guessthe HIV status of an anonymous bareback partner as a risk-reduction strategy. Other re-

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search findings have reinforced the observation that individuals often participate in po-tentially high-risk sexual practices after a certain level of trust has been establishedbased on physical appearance. Consequently, some current American and Canadian

prevention programs are now addressing this assumption of security and trust based onuncorroborated visual assessments. The San Francisco prevention campaign entitled“How do you know what you know?”’ is a good example of this. It is designed to chal-lenge unexamined assumptions based on visible physical characteristics and targetsmen who have sex with men of either serostatus who are engaging in barebacking withanonymous partners.

Voluntary risk-taking can be connected to personal determination of one’s self andsuggests that participation in activities such as barebacking can be seen as identityforming because successful completion of an activity defined as risky within one’s so-

cial milieu has an impact on social identity (Lupton & Tulloch, 2002, 2003; Lyng,2005).

While gendered subjectivities are key factors in both risk-taking activities and dis-cursive constructions of risk, and while studies have suggested that subjectivities of race or ethnicity, class and ability undoubtedly influence experiences of risk, we alsorecognize the multiplicity of individual subjectivities that work to create an individual’ssense of “self.” Our data and other studies (Holmes & Warner, 2005; Holmes, O’Byrne,& Gastaldo, 2007) suggest that the construction of risk is highly personal, hence subjective, and influenced by socio-cultural factors and knowledge gained regarding HIV

and STI. The majority of our participants were informed mainly on the basis of ac-cepted scientific evidence about risks and took steps to avoid harm, even when engag-ing in high-risk sexual practices. In fact, risk-reduction strategies were implemented bymany barebackers regardless of their HIV serostatus. Consequently, although we ac-knowledge that this might not be true in every barebaker’s case, we believe that our re-search results call for a rethinking of current public health campaigns that target sexualhealth.

Conclusion

The research results presented in this article are important because they constitutea necessary step in closing a current gap in gender studies and public health literatureby proposing a better understanding of risk representation and by identifying ways inwhich barebackers reduce the risks associated with STI and HIV transmission. As such,these results, by promoting a clearer understanding of the individuals who engage inrisky sexual practices may help healthcare providers to develop new intervention toolsin clinical settings. The current belief in the public health domain that individuals en-

gage in unsafe sex because they are not aware of the associated risks, is questionable,misguided and therefore ineffective. Barebackers know the risks associated with theirpractice and engage in it nonetheless. Consequently, we strongly believe that HIV pre-vention campaigns must experience a paradigm shift if they are to reach this rapidly ex-panding population.

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By taking various complex concepts of risk as a starting point and by consideringdifferent theoretical points of view and existing empirical research, we can see that riskexists in multiple forms and is socially constructed through contextual, dominant dis-

courses. Rather than being a global experience as suggested by the paradigm of therisk society, risk and risk-taking (both voluntary and in terms of risk-management) arenegotiated through the localized experiences of individuals and need not always beseen as something dangerous or negative. In fact, it has been suggested that voluntaryrisk-taking can be seen to have positive effects in terms of personal agency and the de-velopment of social identity.

However, even voluntary risk-taking is still very much governed by discursiveconstructions of risk, which are then experienced by different subjectivities includinggender, sexuality, ethnicity and race, class, and ability. In consequence, we conclude that

according to the relevant literature, barebacking is gender-specific, and is tied to con-structions and performances of masculinity, and to representations of risk.

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