It’s not that thecondom slipped or was forgotten. Results of a safer-sex survey of gay men in Toronto last year suggests that as many as half of those who had unsafe sex did it consciously and with intent.
“The fairly high proportions of men who do identify with the bareback label make up about half of the unsafe sex that’s happening in Toronto,” says lead researcher Barry Adam, who is a University Of Windsor professor.
Researchers surveyed almost 1,000 men during Pride Toronto events last year. The number of men who said they purposely bareback was higher than Adam expected, which raises important questions about how AIDS organizations should be promoting safe sex.
“How to engage them in a dialogue that they’ll be interested in and care about and is respectful and is not just some kind of attempt to blow them out of the water?” says Adam.
Adam is very careful about using the word “bareback” — he says the word is charged with different meanings and judgments. But he says a high percentage of those who admitted to risky behaviour self-identified as being part of the bareback scene.
Among the men who have completely abandoned safer sex, Adam has found that a large number of them have done so consciously, and have worked out a philosophy.
“They think, ‘Everybody knows the score these days and if I’m interacting with another guy and he’s adult and he’s been around the block then it’s okay if both of us don’t use a condom,'” says Adam. Many of the men who subscribe to this attitude are HIV-positive.
This becomes a deeper problem because of another pattern found by the research team: several different currents or sub-cultures among gay men in Toronto who are having casual sex. Each of these currents is working under a different set of assumptions leading to some high-risk sex between the groups.
For example, some of the guys who might have unsafe sex are depressed, are not looking after their own well-being or feel less attractive with a hotter guy, sometimes because of issues of race or age. These low-esteem guys will follow the cues of the first group, not necessarily because they share the philosophy but because the first group sets the rules.
Now Adam is trying to assess if there is a socializing process — in particular via bars or bathhouses or some other method — where gay men move away from a safe-sex practices to become barebackers.
“There is a social niche where guys are interacting with each other, nodding in each other’s direction, ‘Ya, this is the way the world works.'”
The challenge is reaching these men and preventing that socialization process, something that doesn’t seem to be achieved by advertising campaigns that tell gay men that condoms prevent infections.
“We’ve got to get at the reasoning processes that are out there,” Adam says. “It’s not just going to be a question of wagging a finger at people’s faces or getting to the facts again, because they know the facts. There has got to be some innovative thinking that takes account of these rationales.”
These results are one element of a three-part project, funded with $200,000 from the Ontario HIV Treatment Network, which also funded the “How do you know what you know?” Assumptions campaign.
The survey had about 950 respondents (about 20 of them were discarded — they were from men who hadn’t had sex with men). About 60 percent of those surveyed had a casual partner in the previous six months, 8.8 percent of whom had unprotected anal sex. If you include men who had sex with a regular partner, that number goes up 25.3 percent.
For Adam, there is a fine line between using this information to change attitudes and blaming a certain gay subcultures for HIV- infection rates. Stigmatizing any group of gay men such as barebackers or positive guys, pointing a finger at them and declaring that they’re the problem will not do much good.
“Because they might be part of the problem, but they are just one piece of the story.”
Adam says he would also like to see a follow-up on is what a prevention campaign would look like for guys who are already positive.
“I would only do that by working with PWA [people living with HIV/AIDS] groups, because I think it’s fundamental that this be an idea generated from positive guys and not some lecture developed at them,” he says.