Bareback Sex:

A Conflation of Risk and Masculinity

DAVE HOLMES
University of Ottawa, Canada

DENISE GASTALDO
University of Toronto, Canada

PATRICK OBYRNE
University of Ottawa, Canada

ANTHONY LOMBARDO
University of Toronto, Canada

From a healthcare perspective, there is an underlying assumption that most gay

and bisexual men do not intentionally seek to have unprotected anal sex. This
paper presents the results of a qualitative investigation conducted in three Canadian gay bathhouses regarding unprotected anal sex among men. It is our contention that much epidemiological research, though helpful, obfuscates essential
factors in the practice of bareback sex. Consequently, the paper addresses two
themes: the identification from the participants perspective of the risk factors involved in the practice of bareback sex and the identification of specific risk-reduction strategies used by barebackers. Our research results indicate that the
majority of the participants were informed about health risks and took steps to
avoid harmful practices even when engaging in high-risk sexual activities. Many
participants, regardless of their HIV status, used risk-reduction strategies because
the 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 sexual encounters by increasing initial contacts between potential partners through the use
of chat rooms and virtual communities. In Canada, however, although the Internet is
considered an easy way for locating sexual partners, bathhouses remain the most popular and convenient way venues for men who have sex with men to meet (Ross, Tikkeanen, & Mansson, 2000; Somlai, Kalichman, & Bagnall, 2001). Bathhouses enhance

Dave Holmes, School of Nursing, Faculty of Health Sciences, University of Ottawa; Denise Gastaldo,
Faculty of Nursing, University of Toronto; Patrick OByrne, 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 ResearchInstitute of Gender &
Health and Institute of Population Healthfor 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. Electronic
mail: dholmes@uottawa.ca
International Journal of Mens Health, Vol. 7, No. 2, Summer 2008, 171-191.
2008 by the Mens Studies Press, LLC. http://www.mensstudies.com. All rights reserved.
jmh.0702.171/$12.00
DOI: 10.3149/jmh.0702.171

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HOLMES ET AL.
desire and promote sexual diversity. Within their milieu, voluntary unprotected anal
intercourse, commonly referred to as bareback sex is one of the choices available. The
term 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) and
refers to a sexual practice in which condom use is explicitly and consciously eschewed
during anal intercourse.
Although unsafe sex has been identified and reported since the beginning of the
HIV epidemic, the general assumption is that most gay and bisexual men do not intentionally seek to have unprotected anal sex. We believe that this conclusion obfuscates
essential components powering the practice of bareback sex and that this understanding of unsafe sexual practices is superficial because it does not recognize several determining sociocultural and psychological factors (Holmes & Warner, 2005).
The goal of this paper is to present the results of a qualitative research project on
bareback sex conducted in three Canadian gay bathhouses and to attempt to fill a gap
in 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-reduction strategies (if any) used by the barebackers themselves. We contend that a better understanding of these issues is necessary in order to facilitate the implementation
of healthcare interventions better adapted to the needs of this population.
Background
According to UNAIDS (2002), 75,000 people in high-income countries acquired
HIV in 2001. Unsafe sex, reflected in outbreaks of sexually transmitted infections, and
widespread intravenous drug use is propelling these epidemics. Despite prevention
campaigns, HIV remains a challenge in most Western countries. The majority of new
HIV infections in both North America and Europe are sexually transmitted (Health
Canada, 2005). As a result, the relationship between HIV/AIDS and men having sex
with men has been studied extensively for more than two decades. At present, the rise
in the popularity of bareback sex has led to new research on this sexual practice (Halkitis, Parsons, & Bimbi, 2001; Suarez & Miller, 2001). However, a change in infection
trends is neither able to determine the link between a particular sexual practice and
HIV 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 may
be that it does not constitute a new phenomenon. Sex without condoms was the norm
before 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 literature claims that the number of men having sex with men who engage in bareback sex
is a relatively small subset of the population, other sources indicate that bareback sex
is practiced by individuals from every sociodemographic stratum and serostatus (Halkitis, Wilton, & Drescher, 2005) and does not occur because of poor planning or spontaneous 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 or
what differences exist in defining barebacking as a practice versus barebacking as an
identity (Halkitis, Wilton, & Drescher, 2005; Wolitski, 2005).
Based on research, men who have sex with men have indicated that bareback sex
produces greater stimulation, heightens emotional closeness with a partner, and is a
means of rebelling against established norms (Wolitski, 2005; Dawson, Ross, Henry,
& Freeman, 2005). At this time, twelve theoretical factors have been implicated in the
attitudes 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-related
erectile dysfunction, and (12) other condom-related attitudes (Shidlo, Yi, & Dalit,
2005). However, current public health strategies ignore the social context of sexual
practices (Parsons, 2005) and many current models assume that unsafe sexual practices are the result of lack of knowledge and disregard the fact that individuals may intentionally engage in activities which put them at risk (Halkitis, Wilton, & Drescher,
2005), thus making these models inadequate for addressing the issue. Unfortunately, because of these limitations, interventions from outside the gay community may be perceived as thinly veiled attacks on an already marginalized lifestyle (Wolitski, 2005)
especially since many reports identify bisexual men as vectors of HIV transmission
into the heterosexual population (Bimbi & Parsons, 2005).
Theorizing Risk and Masculinity
A poststructuralist perspective supports the analysis of power relations at the individual and the collective level. In this paper we will apply this perspective to examine the conflation of risk and masculinity in the context of hegemonic male power using
the lens of Foucaults (1991) concept of governmentality to examine bareback sex.
Governmentality, a term coined by Foucault (1991), describes the general mechanisms of societys governance. It does not refer specifically to the term government,
as it is commonly understood. As Gordon (1991) explained, government as an activity could concern the relation between self and self, private interpersonal relations involving some form of control or guidance, relations within social institutions and
communities and finally, relations concerned with the exercise of political sovereignty
(pp. 2-3). According to McNay (1994), Foucault considered governmentality as a complex system of relations that binds government in a tripartite manner involving three
forms of power: sovereign, disciplinary, and pastoral. The idea of government implies
all of the tactics, strategies, techniques, programs, dreams and aspirations by which authorities shape beliefs and the conduct of populations (Nettleton, 1991) and, in these
terms, is an activity that aims to shape, mould, or affect the conduct of an individual or
group. Furthermore, the notions of governmentality and risk focus strongly on the subjects position within the discursive construction of risk, most specifically the manner
in which individuals should be personally responsible for their well-being (Castel,
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HOLMES ET AL.
1991), and with this increased focus on individual responsibility, risk assessment has
become a major industry (Ewald, 1991). This suggests that individuals are held responsible 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 as
something 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 through
contextual, dominant discourses, most notably those of medical science, industry and
government. Such a concept relies largely on Foucauldian ideas of governmentality
and the technologies of power that are seen to restrict or direct social agency. Individuals position themselves and self-identify through the dominant discursive constructions that are, at any given time, multiple and sometimes conflicting.
Sexual risk-taking may also have important legal implications (Holmes &
OByrne, 2006). Moreover, they may have an impact on health and may come to designate an individual as deviant because of a proclivity for risky behaviors. For example, since the early 1980s, a vast number of academic and popular publications
exploring HIV/AIDS have considered and defined risky behavior and at-risk populations (Lupton & Tulloch, 2002) while emphasizing risk as something to be avoided, or
at the very least controlled as long as expert knowledge can be properly brought to bear
upon it (Lupton, 1999, p. 5).
The social construction of masculinity is intrinsic to understanding gendered experiences of risk (Frost, 2003, 2005), and can be related to the notion of risk and social
identity. The social constructionist perspective argues that gender is not an essential
character trait, but is rather a summation of behavioural and bodily practices that are
learned through interaction with others in various social realms. As such, masculinity
and femininity are learned traits that have been assigned to individuals of a given biological sex. Expected gender performances are established as binary oppositesmale
or female, masculine or feminine (Butler, 1999).
Green (1997) noted that an empirical study of children found that the perception
of risk in boys as young as seven was different from that of their female peers. When
the participants were asked to recount and react to accident narratives, the girls responded in ways suggesting traditional feminine constructs (concern, responsibility,
and nurturing), but the boys were much less concerned about others and could be seen
as willing participants in risky behaviour. Numerous studies on the construction of masculinity in boys propose that many different social milieus work in concert to construct
this 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 unsafe 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 both
favours and puts male bodies at risk and has been created within hegemonic gender
constructs, (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 subscribe include assertiveness, competitiveness, independence, and dominance. Conversely, behaviors such as expressiveness, sympathy, passiveness and understanding
should be avoided, lest one be thought feminine. Bodily practices include the development of hard, strong, muscled bodies that perform tasks that are acceptable within
the range expected of masculine performance (Bramham, 2003).
There is an almost universal assumption of heterosexuality in this. When dealing
with homosexuality and ideas of masculinity, there is an ironic relationship between
sexuality and gender (Nardi, 2000; Pronger, 1990), even though masculine performance
and homosexual behaviour have been considered in literature addressing socially defined risky sexual practices, especially in the era of HIV/AIDS. The following sections
will 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 understand our topic. Bareback sex is commonly described as a gay sub-cultural trend that
is practiced in public spaces; therefore, ethnography following the principles proposed
by Hammersley and Atkinson (2004) seemed to be the most appropriate methodological approach.
Contrary to the findings of many American authors, it was observed during a pilot
study (Holmes & Warner, 2005) that men who have sex with men frequently meet each
other at bathhouses. Consequently, we decided to situate our research and recruitment
for the qualitative portion of the study in this environment. Note, however, that the objective of this paper is not to provide a thick ethnographic account of gay bathhouses
(see Holmes, OByrne, & Gastaldo, 2007), but rather to explore risk as it is perceived
and 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, 28
structured in-depth interviews with barebackers were carried out in three Canadian
cities. The participants were recruited while an ethnographic study in gay bathhouses
was being conducted by the researchers (Holmes, OByrne, & Gastaldo, 2007), as well
as through advertisements posted in gay bars in the cities of study. The resulting interviews, which were conducted in university offices in the three target cities, were audiotaped 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, or
queer, and as regularly engaging in bareback sex with anonymous male partners. Interviewing continued until data saturation occurred.
Data Analysis
Content analysis was selected as the preferred means for exploring and analyzing
the data (Denzin, 1998). During this process, knowledge of risk, risk representation, risk
rationalization and risk-reduction strategies emerged as significant themes. For the purpose of this paper, our analysis will focus specifically on these four themes. In analyzing the data, we drew on the insights risk offered by poststructuralist theorists.
Ethics
The Canadian Tri-Council Ethics Policy (2005) was fully acknowledged and respected. We were well aware of the intrusive nature of a qualitative study exploring the
personal sexual practices of specific individuals. Consequently, the rights and wishes
of the participants were scrupulously respected at all times regarding content disclosure
and any wishes to prematurely end an interview. The 28 participants who agreed to
semi-directed in-depth interviews all signed consent forms.

Rigour
Applying the principles of credibility, transferability, reflexivity, and resistance
ensured the rigour of this research project. The more traditional rigour criteria of dependability and confirmability were removed because they are incommensurate with
the research paradigm of inquiry (critical theory). Credibility served to evaluate internal commensurability between the paradigmatic assumptions, theoretical framework,
and findings. It is important to note that in this modified sense credibility does not refer
to confidence in the truth of the data.
The principle of transferability ensured that a thick description of the sample was
obtained and displayed to allow findings to be applied to similar groups. Reflexivity
forced the researchers to view the process as subjective and to acknowledge the effect
of our personal, paradigmatic, theoretical and methodological biases regarding the research process. Thus, reflexivity promoted scrutinizing and evaluating our own behaviours, 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. Research should be evaluated in terms of its ability to act as a resource for understanding
and for producing resistances to local structures of domination (such as certain ramifications of the public health dispositif).

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Results
Although barebacking is a highly personal and intense activity, the research teams
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 appraisal
of the data collected. For example, we were always aware of our epistemological stand
and, as a consequence, we acknowledge that, although we followed a rigorous data
analysis scheme, this section is firmly rooted in the paradigm of critical theory (Guba
& Lincoln, 2002). We also acknowledge that our personal experiences in the public
health domain had an impact on the analysis process. This having been said, our research shows that risk is an important concept for the barebackers we interviewed. Almost 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 those
used by HIV- individuals; however, the serological status of participants will be made
explicit when necessary to highlight differences between these two groups of barebackers. At this point, we will turn our attention to the results obtained from the interviews.
Table 1 gives an overview of the demographics of the research participants. All individuals who engaged in the interview process (n=28) were asked to complete a brief
survey describing their sexual orientation, age, socio-demographic status, average number of partners, and HIV testing history and results. One interviewee declined to complete the survey and two others were not practicing bareback sex; therefore, the results
presented 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 (3/25) defined themselves as bisexual, 52
percent (13/25) as homosexual, 24 percent (6/25) as gay, 4 percent (1/25) as queer and,
finally, 8 percent (2/25) as other. No additional information, however, was provided in
this category. For education, 32 percent (8/25) of respondents indicated high school as
their highest level completed, 24 percent (6/25) indicated a college diploma, 28 percent
(7/25) indicated a bachelors degree, and 16 percent (4/25) indicated that they had attained a masters degree or higher. Respondents were also asked to check the income
bracket that corresponded with their gross annual income. 24 percent (6/25) earned less
than $15,000 per year, 32 percent (8/25) earned between $15,000 and $29,999 per year,
8 percent (2/25) earned between $30,000 and $44,999, 20 percent (5/25) earned between $45,000 and $59,999, 8 percent (2/25) earned between $60,000 and $74,999,
and 8 percent (2/25) earned more than $75,000 per year. In the space listing the number of partners in the previous six months, 4 percent (1/25) of respondents indicated
none, 36 percent (9/25) indicated between 1 and 10, 28 percent (7/25) indicated 11 to
30 partners, 12 percent (3/25) indicated 30 to 50 partners, and 20 percent (5/25) indicated more than 50 partners. Of this group, 92 percent (23/25) had previously been
tested for HIV and the remaining 8 percent (2/25) had not. Under the heading of last
HIV test result, 8 percent (2/25) answered not applicable (no prior testing), 8 percent
(2/25) did not answer the question, 44 percent (11/25) answered HIV negative, and 48
percent (12/25) had been previously diagnosed as HIV positive.
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Table 1
Description of Sample
Age (M SD)

Sexual orientation
(Self-defined)

Education
(Highest diploma)

37.6 9.5

(range: 22-54 years)

Bisexual
Homosexual
Gay
Queer
Other

3
13
6
1
2

12
52
24
4
8

High school
College diploma
Bachelor diploma
Masters degree

8
6
7
4

32
24
28
16

<15,000
15,000-29,999
30,000-44,999
45,000-59,999
60,000-74,999
>75,000

6
8
2
5
2
2

24
32
8
20
8
8

None
1-10
11-30
31-50
>51

1
9
7
3
5

4
36
28
12
20

No
Yes

2
23

8
92

No Answer
Negative
Positive

2
11
12

8
44
48

Income ($)

Number of partners
(Last 6 months)

Previous HIV test

Result of last HIV test

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

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Before we present our qualitative data, we would like to refute an assumption often
held by professionals working in the field of public health. Some authors state that
barebacking is more likely to occur in certain specific settings, gay bathhouses being
targeted most often. Our previous research in three Canadian gay bathhouses leads us
to conclude that, on the contrary, bareback sex can happen in any environment where
men meet for sex (Holmes, OByrne, & Gastaldo, 2007). Our participants supported
this assertion, as the following quote makes very clear: Barebacking happens pretty
much everywhere. It happens in the porn theatres, it happens in the bathhouses, it happens in the washrooms; it happens in the cars, it happens in the parks, beaches . . . just
everywhere (PA 22, p. 19).
While bathhouses are often under attack by public health figures for their involvement in the transmission of HIV and STIs, it is important to note that barebackers 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, & Rebchook, 2000; Holmes & Warner, 2005). We agree with these researchers and gay activists that it is not where you have sex or the number of partners you have that is
important, but rather what you do. In light of this, we will now explore the four categories that emerged during data analysis.
C-1 Knowledge of Risk
In contrast to public health claims that bareback sex usually occurs because of ignorance or due to the influence of drugs, it is essential to emphasize that the participants
in this research project were well aware of the associated risks. We believe that the
misguided public health assumption is highly problematic because it incorrectly frames
several educational and prevention campaigns. For example, an HIV-negative participant who practices bareback sex as well as oral sex without condom states:
For me, its the state of my oral hygiene, Did I brush my teeth before I
went out? Yes . . . then no oral sex is going to happen . . .. Thats in
case someone has a lot of pre-cum, because pre-cum can be very heavy
with HIV. I was just talking to a friend of mine whos very into the HIV
policy thing at Health Canada, he came across a new term hes never
seen before, a super seminal shedder. Someone who secretes a lot HIV
in the semen, the pre-cum, and its particularly prevalent in older men.
(PA 18, p. 8).

Despite the fact that this participant practices barebakcing, he seems more concerned about the risk associated with oral sex if the mucosa is not intact. It is interesting to note that this participants knowledge of the term super seminal shedder is in
fact superior to the knowledge of many HIV clinicians and researchers who are un179

HOLMES ET AL.
aware of the concept. The same interviewee was explicit in his description of the potential risk of HIV transmission via oral sexual contact:
Sucking is as safe as the cock youre sucking and the state of your mouth
. . . people just doesnt [sic] understand the dangerous place for a potentially HIV-infected cum is actually your mouth. I mean, the obvious
thing 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 its spitting it out, then spit it out, but get it out. Thats where the important potential risk of infection is, its actually in your oral cavity. (PA
18, 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 an
understanding of the location of possible infection (the oral cavity) and is aware that
the likelihood of infection increases as the length of time of exposure increases. Another
participant showed his knowledge and acceptance of risk relating to his practices. He
did not act in a state of ignorance:
And probably theres always the risk they say of cross infection or maybe
another strain of the virus and whatnot and I think that maybe the risk is
a little bit less when they dont cum inside you. The risk is still there but
in my own mind the risk of cross, whatever you call it, contamination or
receiving another virus is probably less if you dont have the person ejaculate inside you. (PA 19 p. 17).

Many participants were also well aware of the risks associated with drug use. One
interviewee was able to clearly identify the licit source of the drugs he was using, the
potential benefits of the drug, and the possible side effects of an overdose:
Ketamine its an anesthetic thats used in veterinary. And it produces
a sense of euphoria. I dont like it, and thats why I dont do it, but people do it on bumps. So theyll be on ecstasy and they want to, get higher,
theyll do a bump on the dance floor, it can, if you do too much of it can
lead to a dissociative state and thats what I dont like. (PA 2 p. 12)

In contrast to the assumption that drug use occurs strictly for the accompanying
sensations, this participant provided a description of the source of the drug, the sensations produced, and a formula to ensure that an appropriate high is attained while the
negatively reported dissociative state is avoided. In addition, most of the individuals
we interviewed engaged in bareback sex despite knowing the risks. An HIV+ participant stated:

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Im fully aware of cross-contamination, cross-infection, re-infecting
yourself, you know. Radical viruses, things like that. I take the risk. (PA
20, p. 7)

Another HIV+ interviewee added:

I dont have to worry about catching HIV; the only thing I have to worry
about is the different strains of the virus and the other STDs. Ive had
many a discussion with my doctor about this, and the one doctor finally
said, you know the risk, so thats 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 knowledge came from several sources including the Internet.
Actually I have a friend, who has a number of listservs she organizes, and
one of them is a daily popular press email on HIV-related issues, and so
she sends me that. Im always reading and put the little the pieces together. (PA 6, p. 12)

This participant illustrates that bareback sex in this case is not the result of ignorance.

C-2 Representation of Risk amongst Barebackers

The next category that emerged from our data was the representation of risk. Although it could be interpreted as barebackers exhibiting ignorance about sexual practices, in our view, this category represents a personal integration of knowledge of risk
from a variety of sources. At a time when even organizations such as the CDC and
Health Canada are unable to provide coherent and matching definitions of risk and
transmission, it is an internalization of a variety of sources on the topic of HIV transmission rather than a recitation of all possible risk sources. In this context of anonymous
bareback sex at bathhouses, the negotiation of sexual practices (including condom use)
takes place within this personal representation of risk and because these encounters are
often enveloped in an aura of silence, non-verbal communication is the norm (Holmes,
OByrne, & Gastaldo, 2007). The following excerpt of conversation between the interviewer and a participant illustrates this vividly:
Researcher: When youre having sex, how do you decide whether to use
a condom or not?
Participant: Its I leave that up to the discretion of the bottom.
Researcher: Ok. So if he doesnt say anything

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Participant: If I am the top and they dont say anything, I proceed. If Im
the bottom, Im always very cautious and I am clear about the rules of
engagement. Its like certain things are going to happen and one of them
is youre going to put a condom on. But those are my decisions. If the
other person doesnt want to or has made those decisions not to wear a
condom, then thats their decision. (PA 18, p. 5)

For a few, place is an important element in the risk appraisal equation, whether this
be physical location or receptive versus penetrative status in the sexual encounter. For
example, one participant clearly states that, for him, gay bathhouses are places where
the risk of exposure to HIV and STIs is higher. While he admits to practicing bareback
sex with anonymous partners of unknown serological status in various milieus, he believes that meeting another barebacker outside the bathhouse setting is safer: if you
dont 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 category signified that some barebackers rationalize the risk of the activities in which they
engage. An HIV- barebacker states that:
As a top, barebacking is to me not a particularly risky activity, thats my
own personal line that Ive drawn. As a bottom, its a very risky activity. The rationalization that Ive come to in that decision is, Ill let someone suck me without a condom and it doesnt matter I dont ask
whether theyre HIV positive or not, to me thats an acceptable risk in my
world. Ive talked to a lot of people, and eventually came to the conclusion for myself that to be a top, all things being equal, the state of my
penis is healthy, then to me its as risky as oral sex. Its the same level
of risk, and if Ive made that rationalization for oral sex, then whats the
difference for anal sex? (PA 18, p. 2)

While this statement could be seen as ignorance of HIV risk, the participant states
that his beliefs were developed through discussion.
Another participant adds:
I bareback because we all die from the time we pop out. And I feel like
Im a little more spiritually evolved, than I was before. I believe that
death 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 acquisition of HIV is not an interruption of the natural lifecycle, but one of its many
facets.
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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; for
example: (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) decreased number of partners.
1- Sero-selection
Some barebackers reduce the risk of their sexual practices by sero-sorting. Depending on whether the sexual partner is sero-concordant or sero-discordant, the likelihood as well as the type of sexual activity varies. Selection of partners according to
HIV status is explained by an HIV+ participant:
Well, I am HIV+, and if Im going to be a top, then I wont bareback, Ill
use a condom, because I dont want anyone else to contract HIV, and if
Im going to be a bottom, its usually with people who are HIV+, so no
condom, its consensual. (PA 10, p. 1)

The intentional selection of similar HIV sero-status partners is a strategy of personal 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 physical appearance. Barebackers are cognizant of the physical changes caused by both
HIV and HAART (Highly Active Anti-Retroviral Treatment). For example, changes
such as lipodystrophy were discussed. Some of the participants would avoid individuals who have a typical HIV+ appearance:
If I see someone who looks sick, etc. You must stay away from him. But
if another guy looks healthy; I am ready for barebacking (PA 23, p. 36)

Therefore, according to some participants, assessing the physical attributes of a

potential 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 used
by several of the men. However, some individuals practice this method because they
want to see the semen, rather than as a risk reduction strategy. An HIV- participant
says:
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HOLMES ET AL.
I dont mostly cum inside. Because I like the feeling of seeing cum. I
Like cumming on someones chest. Mostly people like to see cum. Thats
what 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 ejaculate that is used to reduce the quantity of bodily fluids that are deposited within a sexual partner.
A participant who is HIV+ states:
When I am being fucked bare, I ask them not to cum inside me. There is
always the risk of cross infection or maybe another strain of the virus and
whatnot and I think that maybe the risk is a little bit less when they dont
cum 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 you
dont have the person ejaculate inside you. (PA 3, p. 8)

Obviously, coitus interruptus serves as a means by which barebackers reduce their

risk 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 the
anus for sexual activity, thus reducing the risk of damage to anal tissue such as abrasions and open lesions. For some participants, extended foreplay constitutes part this
preparation and, as such, involves oral-anal stimulation, digital dilation of the sphincter, and the use of a substantial amount of lubricant. The following quotes illustrate
some 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 that
theyre ready to have sex. Its pretty bad to slam your cock into someones ass, thats just not the way it goes. Its like having sex with a
woman, you cant just shove it in. I use water-based lubes. I find a little
bit 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 just
loosening it up a bit with the fingers while youre having fun and doing
certain things... and then having anal sex afterwards. (PA 8, p. 15)

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BAREBACK SEX
Usually theres always, um, rimming involved prior so that provides
some lubrication and theres all part of the foreplay before the fucking.
(PA1 9, p. 9)
The top introduces his finger to apply a bit of lubeDirect skin-to-skin
sex, is supposed to hurt good, not hurt bad. And not using lube, I mean,
one could run the risk of getting torn, damaged, and its not very pleasurable. And you cant endure, or continue for a long time. (PA 20, p. 19)

In the last quotation, the participant describes a formulaic approach to bareback

sex. 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 infection. For some participants, the requirement and the type of foreplay depend on the
location where bareback sex occurs. The following quote from a participant who often
meets partners at the bathhouse, constitutes a good example:
If its a bathhouse I wont rim him. Usually you just start by fingering
him, and usually you just use actions to describe what you want to do
next (no verbal communication) so you finger them right, and if they
let you, and you keep going, and they dont move your hand and everything, then you can slowly move their body towards you. So, it just generates, it just starts the anal sex. (PA 9, p. 19)

The preparation for anal sex is not undertaken using words. Body language, movement, and gestures set the stage. Another prevention ritual involved the state of the participants nails: Nails have to be trimmed (PA 25, p. 14); and
My nails are... usually cut short anyway. Because you never know with
me, I may walk to the store and end up meeting somebody and going
somewhere. I have been meeting people; I have been meeting guys off
the street, and gone back to their place. A few hours later, Im heading
back home or into where I had to go. (PA 22, p. 23)

These quotes clearly demonstrate that barebackers do not engage in sexual practices that put them at risk for acquiring HIV out of ignorance. Most of the men we interviewed employed an array of harm reduction strategies.
5- Self-Awareness
Some participants use discretionary abstinence as a method for reducing risk. They
stated that they are aware of the risks associated with barebacking and that self-awareness of the physical condition of their skin is the most important aspect of harm prevention for them.

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I wont give a guy a blowjob if I had a meal within the last couple of
hours. Im a lot more in tune I pay a lot more attention to my own
body and where its at. And if I have any doubt that the skin on my penis
has been compromised, thats it, its over. (PA 18, p. 5)

Another added:
Lets say Ive been at a bathhouse for a while, and Ive had a lot sexual
encounters, and there was a particularly rough blowjob or handjob, then
I just wont take the chance that theres been any abrasions. (PA 20, p.
6)

These participants describe a reliance on their own physical sensations as a guide

for transmission. In situations where the integrity of the protective skin layer has been
compromised, cessation of sexual contact may ensue.
6- Decreased Numbers of Partners
Limiting the number of partners is another strategy employed by barebackers, even
HIV+ individuals who are concerned about the risk of super-infection with a different
strain 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 were HIV, sometimes a guy could have a different strain of the virus, that
could also be passed on to me or I can pass something to him. But now, I have three
guys that I see that I socialize with. I go to their house and visit down, or spend a weekend, whatever. I bareback with these men onlywe are all positive (PA 24, p. 8-9)

Discussion
The interrelationships of men who have sex with men, risk taking, and masculinity are complex and paradoxical. It has been suggested, for example, that to a great extent, Western gay masculinity has evolved in response to traditional gender
constructions that consider gay men as deviant or feminine (Pronger, 1990). Beginning
in the 1950s, and evolving in the 1970s as a response to the drag queen image typically
associated with gay culture, gay masculinity has now developed even further into its
current form. Halkitis (2001) has labelled this current performance of dominant gay
masculinity 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 image
of disease and frailty onto the gay community. Another aspect of the buff agenda is
the gay poster re-used by a group of barebackers depicting the Marlborough man to
promote the idea that real men like to ride bareback with its underlying message that
real men are not afraid to take risks.
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BAREBACK SEX
Ridge (2004) suggests that there are multiple and complex meanings underlying
participation in bareback sex, some of which are contradictory. However, one theme
that emerged fairly consistently was that of masculinity, although even this notion was
constructed in various ways. Primarily, participants considered masculinity as an embodied experience (Halkitis, 2001; Halkitis & Parsons, 2003). There were, however,
contradictory considerations of this when discussing the active (penetrative) and passive (receptive) roles in anal sex:
The narratives suggest that sex, including anal penetration, does not have
fixed meanings based on dichotomies such as active/passive. On the contrary, accounts of informants have confirmed that sex is a repository for
a range of meanings (Ridge, 2004, p. 274).

Ridges work is an important contribution to the understanding of gay masculinity and its social construction in response to HIV/AIDS; however, what has emerged
in more recent studies is not only the relationship between gender and sexuality, but also
the role of masculinity in high-risk sexual practices. According to the Centre for Disease Control, the number of gay men who reported not using condoms with multiple
anonymous partners increased from 24 to 45 percent between 1994 and 1999, and the
statistics for other Western countries reveal that this phenomenon is not limited to North
America. In a survey of more than 14,000 gay males conducted in the UK (Sigma Research, 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 reported increases in barebacking (Shernoff, 2006).
An increase in the efficacy of anti-retroviral drug treatments has been suggested
as 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 barebacking. The relevance to men who have sex with men of public health discourses regarding HIV/AIDS awareness was also questioned, suggesting a rift between the
dominant discourse and personal narratives (Ridge). When personal motivations for
practicing bareback sex were explored (Holmes & Warner, 2005), reasons such as connectedness through skin to skin sex contact, the spontaneity and naturalness of barebacking, and a sense of completion (including semen exchange) were offered.
Research conducted by Crossley (2002) clearly demonstrates states that expressing freedom, rebellion, or empowerment may also contribute significantly to a predisposition toward barebacking. Feelings of rebellion were also reported in earlier research
conducted by Holmes and Warner (2005). These authors applied interporeted bareback
sex as an act of resistance.
However, despite clear evidence of patterns of resistance on the part of barebackers, we found that most of them employed a vast array of harm- reduction techniques
to reduce the chance of infecting themselves or others with HIV and STIs. For example, health status was discussed by some of our participants who appraise or guess
the HIV status of an anonymous bareback partner as a risk-reduction strategy. Other re187

HOLMES ET AL.
search findings have reinforced the observation that individuals often participate in potentially high-risk sexual practices after a certain level of trust has been established
based on physical appearance. Consequently, some current American and Canadian
prevention programs are now addressing this assumption of security and trust based on
uncorroborated 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 challenge unexamined assumptions based on visible physical characteristics and targets
men who have sex with men of either serostatus who are engaging in barebacking with
anonymous partners.
Voluntary risk-taking can be connected to personal determination of ones self and
suggests that participation in activities such as barebacking can be seen as identity
forming because successful completion of an activity defined as risky within ones social 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 discursive constructions of risk, and while studies have suggested that subjectivities of
race or ethnicity, class and ability undoubtedly influence experiences of risk, we also
recognize the multiplicity of individual subjectivities that work to create an individuals
sense of self. Our data and other studies (Holmes & Warner, 2005; Holmes, OByrne,
& 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 accepted scientific evidence about risks and took steps to avoid harm, even when engaging in high-risk sexual practices. In fact, risk-reduction strategies were implemented by
many barebackers regardless of their HIV serostatus. Consequently, although we acknowledge that this might not be true in every barebakers case, we believe that our research results call for a rethinking of current public health campaigns that target sexual
health.
Conclusion
The research results presented in this article are important because they constitute
a necessary step in closing a current gap in gender studies and public health literature
by proposing a better understanding of risk representation and by identifying ways in
which barebackers reduce the risks associated with STI and HIV transmission. As such,
these results, by promoting a clearer understanding of the individuals who engage in
risky sexual practices may help healthcare providers to develop new intervention tools
in clinical settings. The current belief in the public health domain that individuals engage in unsafe sex because they are not aware of the associated risks, is questionable,
misguided and therefore ineffective. Barebackers know the risks associated with their
practice and engage in it nonetheless. Consequently, we strongly believe that HIV prevention campaigns must experience a paradigm shift if they are to reach this rapidly expanding population.
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By taking various complex concepts of risk as a starting point and by considering
different theoretical points of view and existing empirical research, we can see that risk
exists in multiple forms and is socially constructed through contextual, dominant discourses. Rather than being a global experience as suggested by the paradigm of the
risk society, risk and risk-taking (both voluntary and in terms of risk-management) are
negotiated through the localized experiences of individuals and need not always be
seen as something dangerous or negative. In fact, it has been suggested that voluntary
risk-taking can be seen to have positive effects in terms of personal agency and the development of social identity.
However, even voluntary risk-taking is still very much governed by discursive
constructions of risk, which are then experienced by different subjectivities including
gender, 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 constructions and performances of masculinity, and to representations of risk.

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