It should be no surprise to any gay man that having anal sex without a condom is still considered taboo. To some, it should stay that way. The risk of contracting an STD is greater without using some sort of protection. But, this leads to questioning the true definition of “protection.” And, is there only one method that should be acceptable?
We believe that it is time for our community to start telling the truth about our sex lives to those who can help us most; the medical community. As gay males, we know very well that condomless sex is not only common but on the rise. We also understand that the prospect of demanding we use latex for every sexual encounter for the entirety of our lives was never going to be possible. From our perspective, the only way to address the secrecy and lies, and thus receiving inaccurate sexual healthcare information, is to break the stigma against condomless sex. We cannot address a problem if we refuse to acknowledge its existence.
Condomless sex, more commonly known as barebacking, has a high negativity level attached to it that goes back to the 1980s. Ian Howley, CEO of GMFA’s parent organization LGBT HERO, says the LGBTQ community needs to tackle the deep-rooted stigma that affects our sexual choices. “The way HIV and AIDS were talked about in the late 80s and 90s has scared our community, and it’s going to take generations to get over it,” he says. “You have a group of men who grew up in this era who were told that they can’t have sex without condoms, and if they do, they are ‘dirty’ or ‘bad gays.’ That shame has passed on to younger generations – not to the same extent, but it’s still there.”
Before we dive into this admittedly controversial topic, we would like to stress a few important points:
- Condomless sex, or as we prefer to call it, natural sex, is not bad, dirty, wrong, or evil. It is not against the law, and no one was born with a condom on his penis.
- The choice to use condoms or not is a personal one made between the parties involved. They, and only they, are responsible for this decision and any potential consequences.
- “Safe sex” does not mean you must wear a condom. Other ways to protect yourself and your partner(s), even without latex, exist.
- Males, gay and straight, do not like wearing condoms for many reasons, and research has proven this. But the stigma around condomless sex is disproportionally borne by our community.
- No government in the world has ever specifically approved or cleared a male condom for use during anal intercourse.
- FDA researchers pointed out in a still seminal 1997 study that we don’t exactly know how much more often condoms break or slip off in anal as opposed to vaginal sex and the increased risks that leads to.
- Stigma has never solved any problem, forced someone to change their behavior permanently, or been a healthy method of influencing the actions of others.
Our purpose in tackling this issue is to discuss how this stigma is doing more harm than good for our community, look at the reasons why condoms have been sold to us as the gold standard for safer sex, and how they have caused many guys to reject new and better methods of protection in favor of the myth behind the effectiveness of latex in preventing the spread of STDs.
What we are NOT doing is telling you to stop using condoms, that they are totally ineffective in preventing STD infection or that our, or anyone else’s, views or actions should supplement what you believe is best for your sexual health.
How did we get here?
“As far as anyone can tell, 1000 B.C.E. is roughly when the use of condoms was first recorded. Unlike today’s latex or polyurethane, the early condoms were made of oiled silk paper, linen sheaths, leather, or very thin hollow horn”. 1885 saw the introduction of rubber to the construction of condoms, and men were told they could wash, and reuse them, until “they crumbled”. 1912 was the start of latex condom sales and were part of the medical kits given to servicemen during World War II. The 1980s saw condoms promoted as the best way, outside of abstinence, to prevent HIV infection.
If we unpack the above information, we should learn that condoms were invented to prevent pregnancy between males and females. Their usage has mainly been designed for and concerning penile/vaginal sex. This included use in protection against syphilis in the 1500s but was still aimed at straights.
Before HIV/AIDS, only a tiny percentage of homosexual males used condoms. At this point, it was mainly for hygienic purposes, but some did so to prevent STD infections. Condom usage for our community only became recommended widely due to this new virus. Interestingly, condoms still are not promoted, sold, or even marketed to gay males for use during anal sex by any latex manufacturer. This is because, even after 40 years of HIV, only one condom has been designed and approved by the USA FAD specifically for male anal sex.
How effective are condoms against HIV?
If members of our community continue to shame others for not using condoms, they should at least know the facts about the product they are demanding others use. When asking how effective condoms prevent HIV, we must get specific and ask about homosexual male anal sex. This is because the research into condoms mainly involves straights, and not gay males. “Regulators and researchers have shockingly limited information on how condoms hold up in anal as opposed to vaginal sex, two entirely different physical contexts, involving discrete types of tissue, muscle force, and natural lubrication, or lack thereof.”
Few studies have examined condom effectiveness for HIV prevention among MSM. Researchers estimated condom effectiveness per partner in four cohorts of MSM during 1993–2003 (JumpStart, Vaccine Preparedness Study, VAX004, and Project Explore). Although HIV transmission risks have been reported, quantitative condom effectiveness studies have recently been conducted for MSM. Early studies defined condom failure in terms of reported slippage and breakage without regard to whether infection occurred.
When discussing research into condom usage and HIV infection, it is essential to know that this data is based on self-reporting from the males in the study. Due to the stigma around condomless sex, the reliability of their statements is considered a limitation to the outcome.
So, let’s get into some numbers!
In 2015, Dawn Smith, MD, MS, MPH, and colleagues at the Centers for Disease Control published an article in JAIDS analyzing condom effectiveness data for men who have sex with men. Their sample included data from two extensive studies: VAX 004 (4,492 men) and EXPLORE (3,233 men). These studies were conducted in the late 90s/early 2000s (i.e., before PrEP). Both of these studies included HIV-negative men who reported having sex with an HIV-positive partner.
Males who say they ALWAYS use condoms: Among the thousands of men in the two studies, only 16.4% reported “always” using condoms with all sexual partners over the year or more the study lasted. The estimated effectiveness of condom use for these gay men with known HIV-positive partners is 70%.
Males who say they SOMETIMES use condoms: In this study, inconsistent (“sometimes”) condom use with known HIV-positive partners offered “minimal or no protection” from HIV. People in the study having receptive and insertive anal sex who reported “sometimes” using condoms had an estimated condom effectiveness rate of 8%.
Condom effectiveness, even in those who claim to use them with every sexual encounter, may vary depending on the males involved. User error is the most common reason for failure. But The FDA acknowledges that condoms may break more often during anal since rectums don’t self-lubricate like vaginas and so can create serious friction without the copious use of the appropriate lube type. Matt Mandell, the owner of prophylactic superstore Condomania, has observed that the rectum seems to absorb water-based lubes, making them rapidly ineffective at reducing friction. Charlie Glickman, a sex educator and author of The Ultimate Guide to Prostate Pleasure, adds that water-based lubes seem to irritate the lining of the rectum, raising risks of micro-abrasions or tears in sex, and as such the risk of transmitting an infection if a condom does break or slip.
“But it does seem that condoms might be more likely to slip off during anal intercourse. If you insert so far that the base of the condom goes inside the anus, the rectum’s ring will tend to pull back on the base of the condom more than the vagina does.” This seems to be in accord with what the FDA says and others’ observations that condoms may slip more often in anal than vaginal sex.
But wait, there is more information to confuse the issue
In 2018, a new estimate by the US Centers for Disease Control and Prevention (CDC) found that condoms, used 100% of the time, stop more than nine out of ten HIV infections (~90%). Two previous analyses, one published back in 1989 (Detels) and the other in 2015 (Smith), found that they only stopped seven out of ten infections (~70%).
Why is this new estimate of efficacy (91.6%, in the case where the HIV-negative partner is the receptive one) so much higher than previous ones (72.3% for the same risk in the 2015 analysis)? As reported by AIDSMAP.org
There are several possible reasons, the CDC researchers think. One is that the new analysis examines condom efficacy in four different studies, whereas the previous ones only looked at a single study (Detels) or two (Smith).
However, they think the crucial difference is that they look at condom efficacy per number of partners instead of per sex act.
Counting the number of partners may be a more reliable guide to risk than counting sex acts. This is because in cases where there are multiple sex acts between one couple, the risk tends to go down with time: at least one early study showed an extremely high risk (about a 25% chance of infection) during the first year of exposure but then a considerable falling-off of risk; transmissions became infrequent after a few years. This may be due to variation in viral load: partners with high viral loads transmit in the first year, while those with low ones may never do.
Because there is less risk of infection as time goes on, the risk of not using condoms also diminishes over time – and so, therefore, does their apparent efficacy.
Suppose on the other hand, someone continues having sex with multiple partners. In that case, their infection risk does not diminish over time because their chances of encountering someone with a high viral load stays constant – and therefore so does the efficacy of condoms.
Finally, the last data in this analysis was collected 15 years ago. Much has changed since then – regarding gay men’s condom use, their perception of risk, the likely infectiousness of partners with HIV, and whether they are likely to be using other prevention methods such as pre-exposure prophylaxis (PrEP). For these reasons, recent studies might come to different conclusions in estimating both the absolute efficacy of condoms – and their effectiveness in contributing to the prevention of HIV within the gay population. But, these researchers openly acknowledge the limits of their methods.
- No matter which study or studies you wish to follow, the main issue is if you use condoms 100% of the time, each and every time you have sex, regardless of your relationship with your partner.
- Having sex with ONE partner reduces the risk of HIV infection and increases the efficacy of condoms.
- Multiple partners may increase the risk of HIV infection and thus reduce the efficacy of condoms.
- Condoms are not and have never been 99.99% effective in preventing HIV infection.
- If you do not use condoms 100% of the time, you still fall into the category of someone who has condomless sex.
- These are “estimates” of risk and condom efficacy based on self-reporting. Your outcomes may drastically differ from these results.
- Using a condom is much better than using nothing, but it is not the only or best method of safer sex.
Stampede of the Barebackers!
There is a reason we call condomless sex “natural sex“; because it is. What is unnatural is putting a piece of latex on your member. This is not to say that there are not perfectly good and practical reasons for wearing a condom, and that treating guys who don’t use them like they are doing something foreign and unrelatable is wrong. This is not the way to encourage safer sex practices.
We are also confused by the large number of media outlets, government agencies, HIV/AIDS orgs, and even average everyday gay males that are under the belief that guys practicing condomless sex is new. IT IS NOT. Even during the very early days of the AIDS epidemic, there were lots of guys who refused to use condoms. Getting an entire generation of gay males to unlearn natural sex practices was an issue. One that, unfortunately, cost far too many their lives.
BBing is everywhere
If you stick to the strict definition of a barebacker being someone who does not use a condom during anal sex, yes, they are everywhere. And always have been. But there are other ways to look at the term.
The term ‘bareback’ appeared in the gay press in the mid-1990s. It initially referred to intentional condomless anal intercourse, mainly among HIV-infected gay men (Gendin 1997). However, by the time Silverstein and Picano published a new edition of the iconic The Joy of Gay Sex in 2003, bareback was defined simply as condomless gay sex.
Barebacking may also be viewed as a reinforcement of sexual identity, resistance to imposed behavioral norms, creating a new sexual and political identity, or a continuation of practices unaffected by organized messages to stop such practices. Thus providing a social identity for men who prefer unprotected sex, creating role models that celebrate the benefits of unprotected sex, changing social norms about protected and unprotected sexual practices, and establishing social and sexual networks of men who prefer unprotected sex.
As a social identity, a barebacker is someone who practices intentional UAI [unprotected anal intercourse] and experiences it as ego-syntonic, or consistent with his sense of self: “I have bareback sex because this is who I am”‘.
Those who first purposefully took on the name associated with condomless sex as an identity were mostly gay males living with HIV. This was considered a defiant act against a society that told them their worth as a person was gone and that sexual activity for them was not only immoral and wrong but also criminal. Barebacking was viewed as a way to take back control of their sexual lives. This also included a significant reliance on “serosorting” for other guys living with HIV. This group also fought against the unproven prediction of an HIV superbug that would be transmitted between those living with the virus.
Of course, this movement, if we can call it that, would not stay within these confines. Some even argue that as the number of guys choosing not to wear condoms rises, it pressures others to follow along. This is usually viewed through the lens of males aged 18-24 with the highest rate of condomless sex.
If you believe in peer pressure or not, there is no denying that the usage of condoms among gay males is dropping across every demographic. A 2016 Australian study of gay and bisexual men in 2011 and 2012 of 15,615 guys found:
Overall, 38% had no casual partners (and are not included in this analysis, even if they did not use condoms with their partner), 28% always used condoms with casual partners, and 13% had no anal sex. That leaves 21% who reported anal sex without a condom with at least one casual partner in the previous year – this group was the focus of the study.
In 2018, a new study was published in the Lancet HIV journal. 17,000 gay and bisexual men were recruited from the Victoria and New South Wales regions. In these areas, there is a high rate of uptake of PrEP usage. Over the period between 2013 and 2017, the number of HIV-negative people who took PrEP for HIV prevention rose from a mere 2 percent to 24 percent. Over this time, the researchers note, men having unprotected sex with other men rose from 1 percent to 16 percent.
Condom use declined from 46 percent to 31 percent during this time. Men who were not on PrEP also had unprotected anal sex, which rose from 30 percent to 39 percent.
This trend is not specific to Australia, as every other nation worldwide is beginning to report similar findings. Some have a knee-jerk reaction to the introduction of PrEP but these figures were growing before this medication was even on the market. In some countries, like the United States, PrEP usage is abysmally low in our community. Specifically communities of color.
“Scholars have posited several explanations for this decline in condom use. Some have suggested that three decades of condom-based prevention messaging and interventions have caused safer sex fatigue or burnout, leading to inconsistent condom use. New interventions that focus solely on condoms may be viewed as ineffective or unrealistic, and may therefore be rejected, particularly among older gay men who are tired of prevention messaging focused primarily or exclusively on condoms.”
“Emotional and erotic factors may also influence condom use practices. Condoms are frequently perceived as a barrier to sexual pleasure and arousal, whereas CAI (condomless anal intercourse) is viewed as facilitating sensation, physical pleasure, and deeper levels of eroticism and lust. A desire for trust, intimacy, commitment, and love may provide further motivation, wherein CAI manifests these emotions and represents the depth of a given partnership; condoms by contrast are seen as a barrier to intimacy.”
“Existing literature also highlights the impact of substance use on consistent condom use. Excessive consumption of alcohol and crystal methamphetamine use, in particular, have been shown to increase incidences of CAI, with binge drinking and club drug use potentially leading to high-risk encounters with casual, HIV-serodiscordant partners.”
“The final and perhaps most significant factor influencing condom use is the emergence of highly active antiretroviral therapy (HAART) – based biomedical interventions: Treatment as Prevention (TasP) – using HAART to treat HIV positive individuals and lower individual and population-level viral loads; Pre-Exposure Prophylaxis (PrEP) – consistent use of HAART by HIV negative individuals to prevent seroconversion in case of exposure; and Post-Exposure Prophylaxis (PEP) – a 28-day course of HAART taken by HIV negative individuals immediately following potential exposure to prevent seroconversion.”
It’s not your imagination
When you look online and see a growing number of guys stating that they “only bareback,” it is not your imagination playing tricks on you. The numbers are growing, and hook-up sites are a significant meeting place. From Barebackrealtime to Grindr, Scruff, and even Facebook and Twitter, the search for like-minded sexual partners has become commonplace.
Major cities worldwide are seeing a growth of condomless sex-specific parties, POZ parties, and a mixture of the two where guys can meet others who share their practices.
Not to mention the movies and images from mainstream and homemade porn producers. “Raw is Law” has become a growing slogan amongst this group. But this does not mean that they are not practicing safer sex. Condoms are not the only way to keep yourself and your partners from contracting HIV, and studies have shown various methods in use.
- Serosorting (having a partner perceived to have the same HIV status) when having anal sex without condoms.
- Strategic positioning when having anal sex without condoms – in other words, the HIV-positive partner is taking the receptive position (bottom).
- Withdrawal before ejaculation during anal sex without condoms.
- Using PrEP
- Knowing the facts about UequalsU
HIV-positive men who didn’t consistently use condoms with casual partners reported serosorting (60%), strategic positioning (17%), and withdrawal (15%).
HIV-negative men were more likely to report using condoms most of the time, but serosorting was still the most widely reported tactic (44%), strategic positioning (24%), and withdrawal (22%).
Despite a rise in condom-less sex, there is an overall decline in HIV because those diagnosed are rapidly put on anti-HIV pills that prevent them from spreading the infection, believe researchers. This is the reason why there is a decline in the number of HIV-positive individuals despite lower condom use. Unfortunately, this fact does not carry over to every racial/ethnic demographic in countries like the United States, Canada, and The United Kingdom, where race is a significant hurdle to proper medical care, treatment, and access to HIV prevention and treatment medications and information.
Why shaming barebackers hurts more than helps
No matter what anyone says or does, there will always be a significant number of guys who do not wear condoms for sex. This includes those who use them sometimes, often, and/or rarely. Attaching shame and stigma to the sexual lives of gay males under the guise of saving lives has not worked in the past 40 years and will not work in any coming years. We are sexual creatures but also homosexuals who have seen not only our sex lives condemned but also our very existence by many nations and religions. Natural sex will be seen by some as an act of defiance against these institutions, and stigma will only increase their efforts.
The most damaging outcome is that shaming and stigma creates a cone of silence around those most in need of accurate sexual health information and intervention. If guys are not allowed to truthfully express their sexual practices with their healthcare providers and even researchers, not only do they miss out, but our community does because we have members lacking knowledge and providers without accurate information on our lives.
Asking you not to attach stigma to condomless sex is not the same as asking you to participate or even expecting you to stop using condoms yourself. But it does require you and everyone in our community to understand that what we see is not always the whole truth.
For example. Porn companies regularly test their actors for HIV and other STDs, ensuring there is no risk. Some guys who post homemade videos and photos online are also sure of their and their partner’s HIV status and are not “taking chances with their lives.”
The number of guys using PrEp, either daily, on-demand, or soon with a three-month injection, will continue to grow. Seeing them have sex without a condom will become even more commonplace. But it does not mean that they are not practicing safer sex.
Finally, and maybe most importantly, HIV treatment medications have come a long way since the bad ole days of AIDS. Now, a once-daily single pill regimen is the standard, and many users quickly establish an undetectable viral load and are UNABLE to transmit HIV sexually.
Stigma keeps guys from learning these facts, especially as they hear inaccurate statements about the effectiveness of condoms. They are NOT 99.99% effective in stopping HIV, but PrEP is! Those on proper HIV treatment and possessing an undetectable viral load ARE EFFECTIVELY 100% unable to infect others.
Far too many of our brothers died so we can have the medications to prevent and treat HIV infection. It dishonors their memory to shame gay males who take advantage of these treatments because others are still more comfortable using condoms alone. We must begin sharing facts about condomless sex instead of stigma, shame, and fearmongering.
Barebacking stigma is a PROVEN barrier to PrEP usage
Two 2018 qualitative studies from Toronto shed light on how stigma affects the uptake of pre-exposure prophylaxis (PrEP) and the experience of taking it. In the first, young gay men acknowledged that they did not always use condoms but did not see themselves as the kind of ‘barebacker’ for whom they thought PrEP was intended.
“PrEP embodies the notion of bareback sex, which traditionally has been associated with negative elements, and it is quite clear that the young gay men in this research do not want to be associated as a barebacking subject,” writes Julien Brisson in Anthropology & Medicine. “This is one reason why they did not want to use PrEP.”
In the second study, early adopters described concealing their PrEP use because of what it might suggest to others about their sexual behavior. Nonetheless, most had an overwhelmingly positive experience of taking PrEP.
“Paradoxically, some men said that PrEP use both led them to experience stigmatizing reactions within their social and sexual networks, while also helping to remove stigma, shame, and fear related to HIV, sexuality, and sex with gay men living with HIV,” comments Daniel Grace in AIDS Patient Care and STDs.
“Successfully advocating for broader PrEP access requires that societal and structural stigma surrounding gay sexuality be addressed head-on.”
But what about other STDs?
Let’s have some real talk for a moment. Very few guys care about other STDs beyond HIV. When the masses complain about the lack of condom usage, it almost always pertains to the big bad HIV. If those promoting the usage of condoms and, to some extent, the practice of shaming and stigmatizing those gay males who practice natural sex, it would have begun BEFORE the discovery of HIV. They would also focus on STDs that do not have cures, such as herpes and HEP C.
Yes, once again, STD rates are rising, not just for gay males but for everyone. And many of them are transmitted in ways that condoms cannot prevent.
Before you go…
No matter where you stand on the issue of condomless sex, hopefully, we can agree that stigma and shaming are not healthy ways to address HIV prevention. Also, as a community, our sexual lives have been demonized, weaponized, and criminalized enough by straights. We do not need any of these actions to come from other gay males.
Instead of promoting stigma, we should encourage regular HIV/STD testing, the facts around Uequalsu, access to PrEP, and fight for a medical system that ensures all of our brothers can get HIV treatment medications AS SOON as they test positive.