Are we ‘Generation Bareback’?

It’s been 35 years since the New York Times reported on a ‘rare cancer seen in 41 homosexuals’ – an article from the summer of 1981 that’s considered the first major news story about HIV/AIDS. A generation of gay men have since grown up with condoms and safer sex campaigns a familiar part of everyday life.

Recent studies show an increase in unprotected sex amongst HIV-negative gay men. Why are some of us ditching condoms? And in a world of treatment, undetectability and PrEP, is this the start of generation bareback?

SINGLE GAYS

This summer,  surveyed over 1,500 gay and bisexual men about their general sexual health.

One question asked ‘How much sex in the past year was unprotected anal sex?’

•   14% said that they have not had any any anal sex in the last year.
•   22% said that they have not had any unprotected anal sex in the last year.
•   18% said that about one-quarter of the sex they are having is unprotected
•   7% said about half
•   4% said about three quarters
•   19% said nearly all of the sex they had was unprotected.
•   16% said they only have unprotected anal sex.

To round all the above off, about 36% of gay men did not have unprotected anal sex in the last year. About 25% said they only had unprotected anal sex some of the time. And 39% said that all or nearly all of it was unprotected. So who is not using condoms?

Gay men who are married/civil partnered or dating a regular partner can reach a stage in their relationship when they agree to condom-free sex with each other – indeed 51% of the men who responded to our survey say they’ve had sex with just one partner in the past year. 41% said they were in a monogamous relationship.

But gay men in long-term and monogamous relationships aren’t the only ones choosing not to use condoms. Almost a quarter (24%) those are single men. Being single gay men, they may be having bareback sex with any number of partners.  The survey asked these single men how many sexual partners they had unprotected anal sex with in the past year. Their answers are:

•   14%: 1 partner
•   26%: 2-4 partners
•   25%: 5-12 partners
•   15%: 13-29 partners
•   16%: 30-99 partners
•   4%: 100+ partners

Ian Howley told us his thoughts on these stats: “We know that the majority of gay and bisexual men use condoms some of the time. There is an idea out there that everyone doesn’t use condoms, and for a lot of people who responded to this survey this is the case. But many of these men are in long term relationships, or are married/civil partnered or said they were in a monogamous relationship. When you look at these stats, it’s only a small percentage of gay men, who are having lots of unprotected anal sex, who are at a high level of risk. So to say everyone barebacks all of the time is untrue”

The survey also asked everyone who took the survey about their HIV status. Of the single men who completed the survey:

•   38% are definitely HIV-negative
•   16% are probably HIV-negative
•   34% are definitely HIV-positive
•   2% are probably HIV-positive
•   10% don’t know

Altogether, 54% of single men who are having bareback sex describe themselves as HIV-negative. We decided to ask these men why they choose not to use condoms.

SINGLE, NEGATIVE AND BAREBACK

Sam is 35 from Brighton. He’s single. He doesn’t worry about picking up STIs or becoming HIV-positive, nor does he ask the status of his casual sex partners.

“I’m not concerned,” he says. “I know I should be, but I don’t use a condom. I presume most who have HIV are on treatment so are safe.”

Lorne is 24 from Cardiff. He’s single, only has bareback sex, and has had condomless anal sex with over 30 guys in the past year. He’s not worried about becoming HIV-positive either. “It’s far from a death sentence,” he says, “I’d prefer to have HIV than diabetes.” He’s also not concerned about having bareback sex with someone who is HIV-positive. “I endeavour not to decline someone based on their HIV status.”

Mike is 30 from Manchester. He’s single, and nearly all of the sex he’s had in the past year was bareback. He doesn’t worry about HIV or other STIs. “I know it can happen but I just don’t think about it. I get tested regularly.”

Joe is 25 from the Isle of Wight. He’s single, nearly all of the sex he has is unprotected, and he has been fucked bareback by over 30 guys in the last year. “As much as I have no desire to catch HIV, I’ve already adjusted to the fact that it may just happen,” he says. “The reality is, I’m in a high risk group, and even without having bareback sex, I could still be at risk. I don’t want it, but I realise that it could happen, safer or not.”

Mike is 32 from London. He’s single and has had unprotected anal sex with over 30 guys in the past year. He doesn’t worry about picking up STIs or becoming HIV-positive, nor does he ask the status of his casual sex partners. “I don’t ask as I don’t care,” he says. “I’m a bareback cumdump. I understand the risks.”

GAY SEX SURVEY STATS

This echoes a pattern identified in the most recent Gay Men’s Sex Survey.

“The data from the Gay Men’s Sex Survey 2014 indicates that condom use among HIV-positive men hasn’t changed much since 2010,” says Cary James of THT, “but it does appear that condom use amongst HIV-negative men has declined and so has the overall statistic for gay men.”

“In the 2010 survey, 35.9% said they had condomless anal sex with a non-steady partner in the last year,” elaborates Ford Hickson of Sigma, who carried out the research. “In the 2014 survey, 39.2% had.”

Breaking this down by HIV status, these figures were:

• 32.7% in 2010 and 36.6% in 2014 for men without diagnosed HIV (moderate increase).

• 64.3% in 2010 and 63.5% in 2014 for men with diagnosed HIV (no significant change).

TREATABLE, BUT STILL TRAUMATIC

“I don’t feel nostalgic for the days when there was no effective treatment for HIV. I lost far too many friends at a young age as a result of HIV, and the effective treatment we now have seems to me little short of miraculous,” says Matthew Hodson.

“But I don’t feel surprised that the motivation to protect yourself against HIV has become less pressing when we have seen a shift from it being a death sentence to a virus that is now very treatable.

“I do know some men who have been diagnosed with HIV and have largely shrugged and taken it in their stride,” Matthew adds. “Far more often I encounter men who have really struggled to come to terms with their diagnosis, at least in the short term. For most, hearing equivalent words to: ‘Your result has come back and you’ve tested positive for HIV’ is still a powerful and traumatic moment.”

WORRIES

Sam, Lorne, Mike, Joe and Mike aren’t unusual in not worrying about STIs including HIV.

Of the single HIV-negative men who mostly or only have bareback sex, 42% said in our survey they’re not worried about HIV, and 43% said they’re not worried about other STIs. However, 47% admit they do worry about becoming HIV-positive, and 48% worry about picking up an STI – but despite these worries, they continue having unprotected sex.

Some accept that becoming HIV-positive is an inevitable consequence of this choice. “I enjoy anonymous unprotected sex,” says David, 27 from Manchester. “It’s bound to happen.”

Others have concerns about the level of honesty and clarity around a HIV diagnosis. “I don’t sleep around and just sleep with guys I’m dating,” says Daniel, 35 from Essex. “The last guy was someone in an open relationship and he said he was negative and free from STIs, but there’s always a slight worry in the back of my mind that they may have something that wasn’t detected in a test, or they may have been dishonest. I prefer to sleep with someone unprotected who has been tested, but I get concerned not everyone is as honest as me.”

And others have deep concerns about the consequences of their preference for bareback. Carlos is 23 and lives in Ireland. He’s bisexual, single, mostly passive, and nearly all of the anal sex he’s had in the past year was unprotected. He worries about picking up STIs and becoming HIV-positive. “Due to my last few instances of engaging in high risk behaviour, against my better judgement,” he explains, “becoming positive is still very much a real danger and it’s a lifelong disease to be stuck with.”

Darius is 26 from Glasgow. He’s single, versatile, and all the anal sex he’s had in the last year has been bareback. He worries about picking up STIs and becoming HIV-positive. “I’m petrified,” he admits. “I think it is the fear of the unknown and fear of the stigma associated with it. I am currently waiting for the results of my latest tests. I’m scared in case I do pick something up – and it could have been easily prevented.”

REASONS TO WORRY

“HIV remains distinct from most other STIs because there is no cure. If left untreated it will kill you, and it is one of the most stigmatised of all medical conditions,” says Matthew Hodson.

“I often hear people condemning others for their sexual choices. It’s easy to judge but it usually isn’t helpful. Somehow because it involves sex (and, what’s more, it involves gay sex) people feel free to get moralistic in a way that they wouldn’t about smoking or drinking alcohol to excess.

“I would want to say to anyone who believes that HIV is inevitable for them, that it’s not,” Matthew adds.

OPEN RELATIONSHIP AND BB

It’s not only single guys, or guys in monogamous relationships, who are having bareback sex. Some guys in open relationships told us they have bareback sex with casual partners outside their relationship

Kevin is 34 from Ireland. He’s versatile, in an open relationship, and much of the sex he’s had in the last year was unprotected. He asks casual partners their HIV status before having sex: “So I could make an informed decision on the risks.” Kevin worries about becoming HIV-positive. “I’d prefer not to have to take a pill for the rest of my life, but it happens sometimes.”

Bruce is 42 from Leeds. He’s in an open relationship, he’s passive, and nearly all of the sex he has is unprotected. He doesn’t ask partners their status. “Although I am HIV-negative I don’t serosort,” he says. “This is partly because I’m on PrEP, partly because most HIV-positive guys are likely to be undetectable (and negative guys who don’t get tested are probably higher risk), and partly because I think sorting guys by HIV status is kinda dehumanising. If a guy tells me he’s positive it doesn’t deter me from letting him fuck me bareback. Most positive guys are undetectable these days.”

Bruce adds that he doesn’t worry about becoming HIV-positive: “I’m on PrEP but also I have several HIV-positive friends who live full healthy lives. I don’t expect to get it, but if I do I don’t think I’ll be too worried about it.” He does however worry about some other STIs. “Many other STIs are treatable, but super gonorrhoea and hep C do worry me.”

PrEP TALK

If condom-free porn is becoming the standard industry practice, does the normality of bareback porn affect gay men’s attitudes towards sex?

“Is really a pragmatic response to my sexual habits as I bareback rather a lot,” Bruce explains. “I do frankly think it should be available on the NHS because the protection it provides should be accessible for all those in high risk groups. I am HIV-negative and on PrEP. I have met poz guys who don’t like barebacking with neg guys, but have changed their mind on hearing I’m on PrEP.”

“I am on PrEP daily,” says Tom, 37 from London. “I always make sure I have bareback sex with other PrEP users or undetectable positive people.”

Mike, 30 from Manchester, would use PrEP if it were available on the NHS. “Better safe than sorry,” he says, “especially when my dick takes over my brain and I do things I know are risky, but I’m too horny to think clearly.”

PrEP WORK

“If you have unprotected sex with lots of sexual partners, the chances are that you will pick up STIs – and unless you are taking PrEP, that includes HIV,” says Matthew Hodson.

“Some people go through periods of their lives when they feel that they are not able to stop having unprotected sex. For many this will just be a phase, for some it’s a long-term choice. For these people PrEP could make a real difference, and the cost of providing PrEP for a period is much cheaper than the cost of HIV treatment and care for life.”

PORN EXPECTATIONS

“Gay men who struggle with their use of chems for sex often say that it’s as a result of wanting to live up to the porn fantasy of sex,” Matthew adds.

“It’s a part of the struggle of modern life that our expectations are often raised far beyond what we are likely to achieve.”

Steven from Eurocreme disagrees, adding: “Gay porn, I believe, doesn’t set the standard for sex. It acts as an access point to find what you’re into. Some people may be disappointed in sex at times – even porn stars get that from time to time – but that’s life. Not every day will be a blast, so why should we expect the same to happen in sex?

“If you feel down in the dumps regularly in life, you should talk about it with someone and inevitably try changing your perception or find what’s bringing you down and change it. The same goes for sex.

“If you watch god-like hardcore action and find yourself unable to orgasm with your husband, boyfriend or latest hookup from Grindr, perhaps it’s not porn that’s the problem. Porn may act as a focus, but it shouldn’t be regarded as an all-out cause.”

NEG OR POZ?

Some men will only have bareback sex with negative guys, while others feel it’s better to bareback with men who are positive, on treatment, and with an undetectable viral load.

Darius explains that he wouldn’t have unprotected sex with someone who told him they were HIV-positive. “I would be too scared to put myself at risk,” he says, “and I understand this is silly as it is safer to have unprotected sex with someone who knows they have HIV and is receiving treatment, rather than someone who doesn’t know their status.”

Max is 41 from London. He’s top only, and nearly all of the sex he’s had in the past year was bareback. He’s not worried about picking up STIs including HIV. “I don’t shag anonymous randoms,” he says. He would consider having sex with someone who is HIV-positive. “Possibly, I suppose. It would depend on their health, viral load, medication, and whether they were undetectable – but I think the sensible option would be to use a condom.”

POSITIVELY BB

And what of HIV-positive single guys who only or mostly have bareback sex?

“I am HIV-positive and undetectable,” says Harrie, 50 from London. “I only play bareback, and usually with other positive guys, or negative on PrEP.”

“I’m HIV-positive and only have sex with other positive guys,” agrees Chris, 36 from Manchester.

“I never do ask,” admits Ben, 31 from Middlesbrough, “and very rarely get asked myself either.”

HEAT OF THE MOMENT

“Asking why someone has unprotected sex is like asking why someone drinks too much,” says Matthew Hodson.

“There are going to be a vast array of reasons why someone might do that. It might be that they’re unaware of the health consequences, that they believe they can personally avoid any harms, that they don’t care or that they know and care but find themselves unable to take control – or a combination of these.”

“Any decrease in condom use is something which we take very seriously,” says Cary from THT, “but it’s important to remember that gay men use condoms more than any other highly affected group, so although gay men’s condom use is not perfect, that fact should be recognised and supported.

“That said, most gay men at some point in their lives have chosen not to use a condom. The moment that we decide to use a condom or not is a very intimate, often emotional, and irrational moment. In the heat of the moment, rationality and logic are often not the first things in our minds. It’s important that HIV prevention recognises that reality. For some men, knowing the facts about HIV prevention will be enough to motivate them to use a condom. But for others a different approach might be needed. It’s important that we work to drive behaviour change on rational, social and emotional levels. In this way we will have the best chance of reaching those who may not have responded to messages in past.”

“We are complex beings and our needs, desires and concerns are complex too,” adds Matthew. “Easy answers tend not to work and what works for some people will not work for others. Which is why HIV prevention and sexual health will be most effective when it can address a variety of needs, relating to an individual’s knowledge, will and power to take control of their health, recognising that there will still be some who will choose not to do so.”

INFORMED CHOICE

“Condom use among gay men went from virtually zero in the early 80s, pre-AIDS, to very high numbers in the late 80s and early 90s’’, says Matthew.

‘‘Condom use has slipped back a little since then, partly because HIV is no longer a death sentence, and partly because we’re not seeing the same investment in sexual health that we saw a decade ago. With resources deployed to promote condoms and sexual health, encourage testing, challenge stigma, ensure that all gay men are well educated about HIV prevention and PrEP provided, we could end HIV within a generation.”

“The field of HIV prevention has changed enormously in recent years,” agrees Cary from THT. “The recent results of the PARTNERS study have shown that HIV-positive people with undetectable viral load can’t pass on the virus. And PrEP has given us another powerful tool in stopping more men from becoming infected. All of these things will change the way people view HIV. That is not something to be feared but an opportunity for us to evolve towards our goal of eliminating HIV.”

“GMFA wants all gay men to have a choice,” Matthew adds. “We want the choices that men make to be informed ones, so that they know how to avoid HIV and other STIs, and they know the consequences of having HIV. And we want men to have the will and the power to make choices for themselves.”

What will the next generation be? Will more of us choose generation bareback? And if we do, does that risk derailing the possibility of ending HIV?