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I feel good about [that] shit. Yeah, I like the ass, I like to fuck, and I like to get fucked. You know, and I like to be explicit. Barebacker, huh? You know, that is that term. About one quarter of respondents rejected labelling themselves. At times, this wasrelated to the stigma associated with the behaviour, particularly for HIV-negative men. I guess just the stigma attached to it.

A few respondents said that the label applied to them only partially or sometimes.

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Some contradicted themselves in trying to explain why:. Sixty percent of the times, yes, I do, mm-hmm. Yes I do. Or I would just love to run up in them and — stuff like that.

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Our methodology for this part of our study relied exclusively on qualitative interviews so as to gain a deeper understanding of the phenomenon of barebacking without imposing preconceived notions. Since we specifically recruited men who identified as barebacker or someone who practises barebacking, and furthermore, someone who had had intentional, condomless, anal intercourse with a man or men met over the Internet, we expected some consensus in their accounts. Instead, the diversity of responses reported here suggests the distinct possibility that the same or even a wider range of views on barebacking pertain to gay men broadly.

This would seem to support investigators who reported that the colloquial term originally used mainly for HIV-infected individuals may have lost its early specificity Halkitis However, generalisation has not occurred; we found much variation among respondents in the interpretation of everything beyond this initial phrasing. Our findings reveal pitfalls in considering bareback as a simple reference to condomless sex. This leads us, and others, to question the validity of some research undertaken thus far. Berg in press states:. Moreover, the reification of barebacker from one who practises a behaviour to one who has a specific identity has exacerbated the confusion.

Our respondents eloquently argued for and against the barebacker label. For some, identifying as barebacker might be interpreted as defiance of mores that restrict sexual freedom, but it is doubtful that it functions as the organising principle for a sexual identity.

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For other respondents, the label was an uncomfortable one that they either rejected outwardly or accepted partially, with different rationalisations to explain their views. There was evidence that stigma associated with intentionally having unprotected anal sex affected HIV-negative men in different ways from HIV-positive men. Yet, it is more complex than that. In fact, there was no single definition embraced by all men; and assertions from researchers, or practitioners, that there is a prevailing community-held consensus on what bareback means are not supported by these men, the very ones practising bareback sex regularly enough to anticipate consensus.

Nor was there evidence of an overwhelming uptake or positioning of barebacker as a dominant or functional identity. These findings pose a challenge for research and HIV prevention. First, we focus on research implications. Researchers are not simply reflecting larger confusion existing among gay men or in gay community discourse; researchers have played a part in creating this confusion.

As Junge , p. Farmer has focused particularly on how publication of AIDS research in peer-reviewed scholarly journals provides a site of discursive production wherein choices in lexical representation may reinforce stigmatizing or essentializing conceptualizations of certain populations. As Tomso , p. Second, we must note the interaction between researchers and our findings, with those responsible for designing and delivering HIV prevention.

For researchers are not the only ones responsible; other social actors are involved too—activists, advocates, educators, commentators, the media and anyone else who proclaims on the issue. Within this interaction, the men who bareback lose their voice and the right to constitute bareback as it pertains to their lives. For, as Clatts and Mutchler , also cited by Junge , p. Supporting evidence-based prevention is a central purpose of this project—called Frontiers in Prevention. Given our results and literature review, we believe there is need to re-conceptualise the idea of bareback to focus public health discourse and inform its practice.

However, Huebner et al. Additionally, even studies that do define the expression might encounter problems among participants who understand barebacking differently and ignore researcher definitions when responding.

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Even if participants can be compelled to suspend their own understanding of the term and to report about barebacking as defined by researchers, the external validity of such research is questionable given that definitions are constructed in the study that might not exist in the real world. Yet, if no attempt is made to clarify this definition of barebacking, then confusion will continue, research incomparability will grow and evidence-based prevention will be even less possible. Therefore, as a first step, there is a need to separate from other sexual events a category of condomless acts between two or more men, whether unintentional or intentional that do not constitute a risk for a HIV infection, either because both individuals are seroconcordant both either positive or negative , and irrespective of whether the participants call their behaviour barebacking or call themselves barebackers.

We concur with Wolitski , p. We make this distinction for a number of reasons, not least being that each kind of condomless event in this first category requires a targeted HIV prevention strategy and, therefore, different health promotion approaches to assist the men involved to assess and reduce risk, e.

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We recognise concerns about super-infection and STI risk, but we argue these warrant prevention strategies that are not central to primary HIV prevention. Next, we need to clarify a second category: Here too, sexual positioning may render some behaviours riskier than others. This category does include those who may, in retrospect, label themselves barebackers after the event, even if this was not a label or shorthand term they applied to themselves beforehand.

For many of these potential transmission scenarios, HIV science has long had inconsistent names, incommensurable theories, and incompatible data sets and findings, that to render these a single research object is nonsense. Furthermore, to call all these behaviours barebacking, either in research or for prevention purposes, confuses a complex set of sex events that do not have the same determinants or factors and cannot be addressed by singular prevention strategies.

The third category comprises condomless anal intercourse that is intentional and may result in primary transmission of HIV. The issue of awareness of appreciable risk is central to this category—the risk calculus is done and condomless sex proceeds anyway. It is important not to assume ignorance or lack of knowledge always plays a part here. Lastly, this includes condomless anal intercourse that is not called barebacking by some of those who practise it, that which is called barebacking, and that by those who also identify as barebackers.

The usefulness of this typology lies in its capacity to focus attention where the epidemiological importance lies. Behaviours in the first category carry significantly less epidemiological importance from the perspective of primary HIV transmission than behaviours from the second and third categories, since the first, by definition, will not result in new HIV cases. It is not the case that HIV prevention education is not needed for this first category—mistakes can be made, judgement can be poor—but it needs a different kind of education.

This includes strategies that stimulate correct and consistent condom use, as well as strategies for dispensing with condoms in certain situations and after clear precautions, e. The second category also includes a well-known cluster of prevention problems that HIV prevention researchers and educators have uncovered and grappled with as the epidemic progressed, and which have enhanced epidemiological importance.

Contextual factors pertain too, e. Adam , p. There is increased risk of primary infection here, but the risk arises from a very different set of circumstances from the other two categories, and warrant their own prevention agenda. Educating men to understand these and develop strategies to deal with potential infection, e.

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This leaves the third category as a clear, although not entirely new, target see Gold and Skinner , in which the condomless anal intercourse with appreciable risk that may result in new infection is intentional. This is the category we call bareback, and we believe the use of that term should be restricted to this category, first by researchers and, subsequently, by practitioners. Barker et al. After all, we have known that not all condomless sex is risky for a long time—this was first discussed in the literature 15 years ago Kippax et al.

We recognise these are clearly issues that merit further research and discussion. However, we argue that it behoves researchers not to muddy the waters for both research and for the development of targeted HIV prevention or related health promotion with imprecise or inapplicable usage of the term bareback for all sex acts in all three categories.

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Our typology acknowledges that some gay men regard all condomless anal intercourse as bareback, while other gay men say not all condomless intercourse is bareback, and there are those who use the term merely as shorthand. Nonetheless, our typology prevents the confounding of prevention education targeting in deploying any overarching notion of barebacking that cannot offer sufficient specificity. It recognises that while all who call themselves barebackers practise barebacking, not all who engage in barebacking call themselves barebackers.

After all, as Junge points out, a couple having condomless sex may include one partner who does it intentionally and another who is unaware of the situation or is responding to pressure. It is the sexual relations between people and how these influence behaviour—rather than the terms adopted or identity—which may, or may not, facilitate primary HIV infection. Such sexual events may be understood as belonging in different categories at the same time and so require different approaches to prevention.

There is heuristic value in focusing scientific inquiry on bareback Internet sites, on sex clubs that sponsor bareback events or offer bareback rooms, and on sero-sorting networks that facilitate condomless intercourse. However, in developing evidence-based prevention focused on the terms barebacking or barebackers, the target of these efforts would be less than specific and quite dispersed unless there is definitional rigour and the definition is restricted as our typology suggests. Moreover, if norms concerning condom use relax, e.

Until that happens, the focused usage we suggest may be the most helpful way out of the current confusion. Our study has some limitations. It focused on a moving target—the use of a vernacular term—but one that is also discursively constructed in research.

Of course, our conclusions are likely to be time-bound by where the debate is to date and should be considered with caution accordingly. The use of qualitative methods precludes generalisations to all gay men. Our findings may also be affected by sample specificity, and may not reflect what is currently happening outside the USA or amongst all men who engage in intentional condomless sex.

Nevertheless, our findings emphasise the importance for researchers, as a start, to define and operationalise the terms we use carefully to reduce confusion, and, in this case, to specify barebacking narrowly and assist thereby in producing better focused research.

This is important if the evidence offered by researchers is to be useful to prevention workers in developing well-targeted programmes where bareback sex may be implicated. The authors thank the respondents for their openness in discussing intimate and private behaviours with the interviewers. National Center for Biotechnology Information , U. Cult Health Sex.

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