# Presentation: 305868

## “Barebacking” in a Diverse Sample of MSM_____________

- Gordon Mansergh, Gary Marks, Grant Colfax, Rob Guzman, Melissa Rader, Susan Buchbinder
- STD Prevention Conference
- March 2002

## MSM Prevention Messages Study Team________________

- San Francisco Dept. of Public Health, AIDS Office:
- 	    - Susan Buchbinder, PI
- 	    - Grant Colfax, co-PI
- 	    - Rob Guzman, Project Coordinator
- CDC, Division of HIV/AIDS Prevention, Epi. Branch:
- 	    - Gordon Mansergh, PO
- 	    - Gary Marks, co-PO
- 	    - Melissa Rader, Project Coordinator

## Background

- Attention to “barebacking” in gay communities:
- 	- Anecdotal information
- 	- Multiple definitions
- First quantitative study of barebacking:
- 	- Specific definition (sociocultural)
- 	- Diverse sample

## Bareback definition

- Intentionally set out to have unprotected anal sex
- Someone other than a primary partner (someone
- 	you lived with or saw a lot and to whom felt a special emotional commitment)

## Methods

- Convenience sample:
- 	- July 2000 to February 2001
- 	- 50+ venues (bars, clubs, community agencies)
- 	- 4 geographical areas in San Francisco Bay Area
- 	   (Mission, Tenderloin, Castro districts; Oakland)
- 	- Over-sampled Latino, Black and HIV+
- Eligibility:
- 	- 18+ years old
- 	- Resident of San Francisco Bay Area
- 	- Identify as gay/bisexual or sex with man in past year
- Survey:
- 	- 1 hour interviewer-administered
- 	- $25 stipend

## Table 1. Sample characteristics (n=554).

- 					%
- ------------------------------------------------------------
**Race/ethnicity**
- 	Latino 			27
- 	Black				28
- 	White				31
- 	Other/mixed			14
**Age (years)**
- 	18-29				32
- 	20-39				40
- 	40+				28
**HIV status**
- 	HIV+				35
- 	HIV-				61
- 	Unknown			  4
**Income (annual)**
- 	<$10,000			30
- 	$10,000-29,999			35
- 	$30,000+			35
**Education**
- 	HS degree or lower		30
- 	Some post-HS training		34
- 	BA or higher			36
**Sexual orientation identification**
- 	Bisexual			19
- 	Gay				79
- 	Other				  2
- ------------------------------------------------------------

## Table 2. Heard of barebacking, undefined (n=554).

- 					%
- ------------------------------------------------------------
**Overall****	****	****	****	****70**
**Race/ethnicity**
- 	Latino 			60
- 	Black				65
- 	White				**83 ***
**Age (years)**
- 	18-29				70
- 	20-39				74
- 	40+				66
**HIV status**
- 	HIV+				72
- 	HIV-				70
**Income (annual)**
- 	<$10,000			62
- 	$10,000-29,999			66
- 	$30,000+			**82 ***
**Education**
- 	HS degree or less			52
- 	Some post-HS training		**74 ***
- 	BA or higher			**82 ***
**Sexual orientation identification**
- 	Bisexual			49
- 	Gay				**76 ***
- ------------------------------------------------------------
- *p < .05

## Table 3. Barebacked (defined) in past 2 years, among those who heard of it (n=390).

- 				%	Med # _(1 yr.)_
- ----------------------------------------------------------------------
**Overall****	****	****	****14****	****     3**
**Race/ethnicity**
- 	Latino 		13	     5
- 	Black			14	     2
- 	White			15** ****	****     **4
**Age (years)**
- 	18-29			10	     1.5
- 	20-39			15	     4.5
- 	40+			17	     4
**HIV status**
- 	HIV+			**22 ***	     3.5
- 	HIV-			10	     3
**Income (annual)**
- 	<$10,000		13	     3
- 	$10,000-29,999		18	     4
- 	$30,000+		11**	****     3**
**Education**
- 	HS degree or lower	15	     4
- 	Some post-HS training	13**	****     **3
- 	BA or higher		14**	****     **3.5
**Sexual orientation identification**
- 	Bisexual		13	     13
- 	Gay			14 	**     **14
- ----------------------------------------------------------------------
- *p < .05

## Table 4. Behavior during last bareback encounter by HIV-status, among men who barebacked in past 2 years (n=52).

- 				**HIV+****	****HIV-**
- 				(n=29)	(n=23)
- 				-----------------------
- 				%	%
- -----------------------------------------------------------
- Unprotected Receptive Anal
- 	HIV+ partner		59	17  *
- 	HIV- partner		11	43  *
- 	HIV? partner		36	22
- Unprotected Insertive Anal
- 	HIV+ partner		41	23
- 	HIV- partner		14	32
- 	HIV? partner		24	43
- Drunk or high during sex	52	65
- -----------------------------------------------------------
- *p < .05

## Table 5. General risk for men who barebacked vs. men who did not. 

- 					  Barebacked
- 					 (past 2 years)
- 					-------------------
- 					**Yes****	****No**
- 					%	%
- ---------------------------------------------------------------
- STD (past year)			21	  8  *
- UA with partner of different or
- unknown HIV status (past 3 mo.)	53	17  *
- ---------------------------------------------------------------
- * p < .01

## Table 6. Venues or approaches used to meet bareback partners (n=52).

- 					**HIV+****	****HIV-**
- 					(n=29)	(n=23)
- 					-----------------------
- 					%	%
- -----------------------------------------------------------------------
- Bars and dance clubs		31	52
- Through friends and acquaintances	17	35
- Internet and chat rooms		21	17
- Bareback parties			17	  4
- Commercial sex clubs		14	  9
- Underground sex networks or clubs 	10	13
- Ads (papers, magazines)		  7	  4
- Telephone chat lines		  7	  0
- Other				45	48
- -----------------------------------------------------------------------

## Table 7. Primary reasons for barebacking (3 maximum; n=52).

- 					**HIV+****	****HIV-**
- 					(n=29)	(n=23)
- 					-----------------------
- 					%	%
- -----------------------------------------------------------------------
- Greater physical stimulation		80	65
- Emotional closeness/connectedness	40	39
- Something taboo/racy		10	17
- Take a major risk			  7	22
- Dislike condoms			  7	22
- Was high/dunk			  7	17
- Move on during long HIV epidemic	  3	  9
- Other				43	35
- -----------------------------------------------------------------------

## Summary

- Most MSM are aware of barebacking; a small but notable subgroup report barebacking (with multiple partners)
- Barebacking is more common among HIV+; men tend to bareback with partners of same HIV status, but sizeable group of men did not
- Most men bareback under the influence of alcohol/drugs
- Men who bareback are higher risk beyond barebacking, with further risk for HIV/STD transmission
- Partners are commonly met in bars and dance clubs, through friends and internet
- MSM bareback primarily for physical stimulation and emotional connection

## Limitations

- Convenience sample may not be representative of MSM in San Francisco Bay Area or other regions
- 14% rate of barebacking in past 2 years:
- 	-  Prevalence rate among MSM who had heard
- 	   of it in this sample, not all MSM
- 	- May be an underestimate due to controversial
- 	   nature of reporting the behavior
- Analyses of bareback behavior by respondent HIV status is based on small subgroups

## Implications

- More research is needed on larger samples to better understand bareback behavior
- New approaches to HIV/STD prevention are needed for MSM who bareback:
- 	- Holistic health approaches that consider multiple needs
- 	- Programs that target men by HIV-status
- 	- Prevention specialists and community members
- 	   should work together to develop effective programs
- MSM who bareback could benefit from microbicide development; others may not