HIV prevention: New research findings

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Professor Gary Dowsett, deputy director of the Australian Research Centre in Sex, Health and Society (ARCSHS) at La Trobe University and collaborators from Columbia University in the United States concluded in the study, Sexual Pleasure and Intimacy Among Men Who engage in "Bareback Sex", that, in some cases, the HIV-seropositive men saw condom use as a barrier to expressing and experiencing intimacy and passion.

'From a personal safety perspective, although infected individuals were aware of the possibility of contracting other sexually transmitted infections (STIs) or becoming infected with a different strain of HIV ("superinfection"), these were not sufficient deterrents to having condomless sex. Actual discussions about serostatus before having sex were not the norm,' says Professor Dowsett and his colleagues.

An ethnically diverse sample of 120 mostly gay-identified men who engaged in "bareback" intercourse was recruited through the internet in New York City. Thirty-one of the participants were HIV-seropositive and engaged in condomless, receptive, anal-intercourse in situations of appreciable risk of HIV transmission, as "bareback" sex is defined by the authors.

Thoughts and feelings explored

The study's participants underwent an in-depth face-to-face interview that investigated psychological factors that may be involved in barebacking among HIV-seronegative and seropositive gay identified men. The team of researchers - comprising of psychologists and sociologists - used a developmental approach to explore how barebacking was understood by the men and what might support or encourage its continuation.

Professor Dowsett says the authors explored the thoughts and feelings associated with first and subsequent experiences of bareback sex. 'In general, no single reason or set of circumstances led to the first barebacking experience, but rather a combination of factors including curiosity, heat of the moment, engaging in foreplay that culminated in unprotected intercourse, not having condoms available, and feeling that AIDS was no longer a death sentence,' the authors conclude.

The first experience was often a turning point that led to more frequent engagement in the behaviour and progressive desensitisation to the risks involved. Some participants alternated between abstinence and avoidance of condomless intercourse and bouts or "binges" of barebacking, the research team found.

Thrilled and fulfilled

An underlying theme present in the explanation for reasons leading to the first barebacking experience was the issue of pleasure. 'Participants frequently expressed their enjoyment of the accompanying sensations as well as how they felt excited, sexually satisfied, thrilled, fulfilled and intimate with the partner,' the authors report.

Among the participants in the study were HIV counsellors. In the interviews with counsellors, the researchers found a strong motivational force based on pleasure that overwhelmed their knowledge about HIV prevention and their behavioural skills to enact condom use.

'Prevention approaches that seek alternatives to condoms may acknowledge the power of the libido while seeking to promote safer ways of attaining sexual and erotic satisfaction. The impression derived from the analysis of the narratives of the participants in our study is that for an HIV-prevention intervention to be successful in this population, it should impinge as little as possible on sexual pleasure and sexual satisfaction,' Professor Dowsett and his colleagues conclude.

Source: La Trobe University, Melbourne