Why Are More Gay Men Going Bareback?

In 1983, Michael Callen's and Richard Berkowitz's book "How to Have Sex in an Epidemic: One Approach" marked the first time the public was advised that using a condom would prevent HIV infection. In 2013, people are scratching their heads and wondering why, 30 years later, people still aren't listening.

Although, as the Centers for Disease Control reports, the rate of new infections has remained stable, that still means 50,000 people are contracting HIV each year in the United States. Men who are having sex with men are responsible for over three-quarters of new infections among men -- even though only 4 percent of men sleep with men -- and two-thirds of infections, if you include women.

"Within the overall estimates," the CDC added, "some groups are affected more than others. MSM [men who have sex with men] continue to bear the greatest burden of HIV infection, and among races/ethnicities, African Americans continue to be disproportionately affected."

Young black MSM represent the highest number of new HIV infections, even though blacks make up only 12 percent of the population (I'm assuming the gay male population is proportional to the population of the United States). One in 16 black men will be HV positive, if long-running trends continue.

Latinos also represent an outsized group of the infected. If 16 percent of the population accounting for 21 percent of infections doesn't sound dramatic, that's only because you just read about black men. Consider this: Hispanic men are infected 2.9 times more often than white males.

By far the most dramatic difference between 1983 and 2013 is the relatively low infection rate among heterosexuals. In 1983, news reports and magazines were full of dire predictions that AIDS was about to enter the mainstream. Popular entertainment reflected the panic. Brian De Palma called the 1987 film "Fatal Attraction," about a married man whose one-night stand goes very, very wrong, a "post-feminist AIDS thriller."

For a variety of reasons, HIV did not become nearly as widespread among heterosexuals as it did in Africa. Even so, women now represent one-quarter of all new infections, mostly from intravenous drug use or contact with a drug user; the percentage who got it from closeted MSM is considered much smaller.

Hearing, But Not Heeding, Prevention Messages

What may be most distressing, however, is a CDC survey released in November that confirmed what any gay man who's been in bars, on hook-up sites, in sex clubs or just catting around already knew: The percent of men having sex with men bareback keeps growing.

So what's to be done? Many agree with ACT UP. In August, the group held its first large demonstration in several years in New York City to protest, among other things, the city allegedly not running enough HIV awareness campaigns. Veteran activists like Peter Staley have been using every available platform to advocate for increased prevention education.

But at this point in time, it may be reasonable to ask whether some people can be reached, no matter how frequently they're bombarded with the safe sex mantra. By the time they reach adulthood, American gay men have been exposed to a barrage of safe sex messages.

If banks and supermarkets no longer display bowls of free condoms the way they did in the late '80s, safe sex is openly discussed in the media, popular entertainment and public service ads. From Circuit parties to gay-friendly churches, sex clubs to gay adult sports leagues, it's near impossible never to have gotten the word.

Everyone is searching for answers, but so far, no one really has any.

The CDC's chief, Dr. Thomas Frieden, was speculating after the November report came out that serosorting -- pozzers selecting only other pozzers for sex -- accounted for much of that increase.

"The problem with serosorting is that it's really easy to get it wrong," Frieden said. "When one-third of men aren't even tested in the last year, and a tenth of those who thought they were negative were actually positive, you don't want to risk your life on a guess."

Columbia University's Alex Carballo-Di�guez believes that younger gay men came into sexual awareness as HIV had ceased to be a death sentence and was becoming a "manageable" condition.

Another long-time researcher into gay men and HIV, New York University's Perry Halkitis, cited a recent study that people on the antiretroviral "cocktail" of drugs did not transmit HIV 94 percent of the time. That study, however, only showed the effect on heterosexual sex; and 4 percent transmission is still playing a numbers game with partners.

Halkitis also believe that the recession has played a part. "We see a higher risk behavior when people have more risk in their lives," Halkitis said.

Halkitis' theory about the effect of the economy seemed to be confirmed the same day the CDC report came out by a World Health Organization Study. No one had noticed a brief passage when the report came out earlier that said people in Greece were trying to get HIV so they could become eligible for government programs. The WHO quickly covered its tracks and said the statement was an error.

Maybe not in Greece, but an article in Out magazine about a young black man in Harlem made the point that some people in the U.S. are, if not intentionally trying to get infected with HIV, are at least not only without fear of its consequences, but also looking forward to gaining access to housing, medical care and other necessities denied to the uninfected.

Significantly, the man in the Out article said he had known about condom use but ignored it, and added that his life was indeed better since contracting HIV. Several people working in the field have privately expressed to me their frustration that at least a few gay men are more casual about HIV because they have seen friends receive subsidized housing, free medical care and other government programs not available to HIV-negative gay men.

Exchanging Fluids for Intimacy

Tim Dean believes that, as he wrote in a New York Times article, "Room for Debate", about the quandary of HIV prevention, "some gay men are using HIV to create relationships. They think about actively sharing the virus as a way to forge connection."

In his book "Unlimited Intimacy: Reflections on the Subculture of Barebacking," Dean, an English professor at the State University of New York at Buffalo, delved into what he calls the "subculture" of barebacking among gay men. He takes his theory that passing fluids is a symbol for intimacy a step further when he claims that, for some men, the very toxicity of semen has made it more exciting.

He's also revived a controversy that flared up briefly in the early part of this century, that of "gift givers," HIV-positive men who willingly inseminate other men with HIV. Although he doesn't use the term, the implication is that some HIV-negative men are "bug chasers." Perhaps tacitly, or even unconsciously, they are seeking HIV as a way to connect.

In the early 2000s, some experts believed that this was all more erotic fantasy than any kind of real phenomenon. But how many gay men have had a partner who wanted him to "breed me"? I know a man, now 28, who said those words. One night two years ago, an anonymous Internet hook-up did exactly that, and he seroconverted.

In an interview with Positivelight, a Canadian online HIV magazine, Dean maintained that barebacking porn companies, notably Treasure Island Media, purposely presents real guys as opposed to the muscle gods of most condom gay porn. These guys are older, overweight, hairy, and imperfect who can, Dean said, "still be a porn star, still be the object of sexual pleasure."

Dean dismisses the fantasy aspect of bareback porn thusly: "It's been proven again and again that watching pornography, of whatever kind, will not simply translate into imitating those behaviors."

In my own experience, I have found that the preference for bareback porn to a man has little or nothing to do with the "real guy" stuff and everything to do with the fantasy that's being presented. For some of them, such as a semi-retired queer studies professor and his partner, who works in healthcare (they met at an AIDS conference), it allows them to indulge in behavior they would never allow with a stranger.

People, I believe, do think about porn when they're in the bedroom. It might be a chicken-and-egg question, but are men looking at bareback porn because they are already having bareback sex, being turned off by mainstream, condomed porn? Or are some men so turned on by the fetishizing of barebacking that they want to live the fantasy?

Everyone, it seems, has a theory of why so many gay man are backsliding. But no one has figured out what to do about it. Until that happens, it looks as though we'll be living with HIV for another 30 years at least.

Steve Weinstein has been a regular correspondent for the International Herald Tribune, the Advocate, the Village Voice and Out. He has been covering the AIDS crisis since the early '80s, when he began his career. He is the author of "The Q Guide to Fire Island" (Alyson, 2007).

This story is part of our special report: "What's Happening Now". Want to read more? Here's the full list.