“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 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: 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 Black28 White31 Other/mixed14 Age (years) HIV status HIV+35 HIV-61 Unknown 4 Income (annual) <$10,00030 $10,000-29,99935 $30, Education HS degree or lower30 Some post-HS training34 BA or higher36 Sexual orientation identification Bisexual19 Gay79 Other

Table 2. Heard of barebacking, undefined (n=554). % Overall70 Race/ethnicity Latino 60 Black65 White83 * Age (years) HIV status HIV+72 HIV-70 Income (annual) <$10,00062 $10,000-29,99966 $30, * Education HS degree or less52 Some post-HS training74 * BA or higher82 * Sexual orientation identification Bisexual49 Gay76 * *p <.05

Table 3. Barebacked (defined) in past 2 years, among those who heard of it (n=390). %Med # (1 yr.) Overall14 3 Race/ethnicity Latino 13 5 Black14 2 White15 4 Age (years) HIV status HIV+22 * 3.5 HIV-10 3 Income (annual) <$10, $10,000-29, $30, Education HS degree or lower15 4 Some post-HS training13 3 BA or higher Sexual orientation identification Bisexual13 13 Gay *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+ partner5917 * HIV- partner1143 * HIV? partner3622 Unprotected Insertive Anal HIV+ partner4123 HIV- partner1432 HIV? partner2443 Drunk or high during sex *p <.05

Table 5. General risk for men who barebacked vs. men who did not. Barebacked (past 2 years) YesNo% STD (past year)21 8 * UA with partner of different or unknown HIV status (past 3 mo.)5317 * * p <.01

Table 6. Venues or approaches used to meet bareback partners (n=52). HIV+HIV- (n=29)(n=23) % Bars and dance clubs3152 Through friends and acquaintances1735 Internet and chat rooms2117 Bareback parties17 4 Commercial sex clubs14 9 Underground sex networks or clubs 1013 Ads (papers, magazines) 7 4 Telephone chat lines 7 0 Other

Table 7. Primary reasons for barebacking (3 maximum; n=52). HIV+HIV- (n=29)(n=23) % Greater physical stimulation8065 Emotional closeness/connectedness4039 Something taboo/racy1017 Take a major risk 722 Dislike condoms 722 Was high/dunk 717 Move on during long HIV epidemic 3 9 Other

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