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Another BB thread. Extract of an illogical conversation with a young man who made


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I know... this subject keeps coming back...

 

Another BB thread. Extract of an illogical l conversation with a young man who made a wrong choice.

 

A local escort copied a conversation he had on adam4adam with a potential hook up, he sounded smart, yet he made a mistake with someone who had a made a mistake and he's unapologetic about it. I asked his permission to post this online and I've made sure to have removed the screen names yinz used online.

 

Remember that a condom is less than a dollar and all of this could have been avoided with just condoms.

 

This local escort, always uses condoms, even the times he was offered more money to BB.

 

Local guy

 

Btw, I'm poz but undetectable, I'm on truvada and I can't transmit it.

 

Escort

 

(2 hrs ago) If it's so hard to get infected with HIV, how did you get infected?

 

Local guy

 

(2 hrs ago) I was visiting my ex, who I was still good friends with... He had unknowingly been infected by a mutual friend of ours about 4 weeks before. Since he was unaware, he hadn't started treatment yet, and was hugely infectious. And our friend that infected him... It was the same thing. He had unknowingly gotten it about 3 weeks before. I can send you to some legitimate sites that talk about what "undetectable" really means, and it's impact on transmission.

 

Pretty sure this thing won't let me put a web link in the message, but if u google search "the body pro partner study zero infections"... The first result should be the summary of the study I mentioned.

 

Local guy

 

(1 hr ago) Unread The whole idea, is once it's suppressed and no longer detectable in your blood. There's a study called "The partner study" (you can google it) that's currently 3 yrs into it's 5 year plan. It is tracking sero-discordant couples (one poz and one neg partner) in which the poz partner is on treatment & verified "undetectable" and all of the couples report that they don't use condoms with each other or with other men. Anyway after 3 years of following thousands of couples, so far, not a single case of transmission, period. In fact, across all areas of hiv research, they still have not been able to identify a single case of transmission from an undetectable partner. It's pretty incredible, but sadly, the gay community doesn't get the public health info they need to reduce their risk exposure, so most guys are totally uninformed. :-/

now that I'm on the pill I BB all the time knowing I'm doing the right thing and I can't transmit it, BB with me is safer than using a condom with a negative guy.

 

Escort

 

(1 hr ago) Sorry, I don't BB at all.

Liberal, born and raised in Maryland, proud member of pink pistols!

Ignore list: WilliamM

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......BB with me is safer than using a condom with a negative guy.

 

From what I understand about it, no one has ever contracted HIV from someone who is negative. (I know, like this guy who got it from a guy who thought he was negative, you can only assume your partner is negative.) So what the likelihood for contracting HIV with a truly negative person is 0%, then obviously there is no possibility that BB with Local guy is safer.

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I know...Another BB thread. Extract of an illogical l conversation with a young man who made a wrong choice...

 

I think classifying this as "another BB thread" does it a disservice. It is a great study in how people often misinterpret information. Without re-hashing the entire study, the HIV+ partner's viral load needs to be under 200 copies/ml to be considered "undetectable." Taking someone's word that they are undetectable is the same as taking their word that they are negative.

 

 

From what I understand about it, no one has ever contracted HIV from someone who is negative. (I know, like this guy who got it from a guy who thought he was negative, you can only assume your partner is negative.) So what the likelihood for contracting HIV with a truly negative person is 0%, then obviously there is no possibility that BB with Local guy is safer.

 

What Local Guy is trying to say, I think, is that unprotected sex with him is less risky than unprotected sex with a guy who says/thinks he is negative because Local Guy knows he is undetectable. At least as of his last blood test. Just like "Guy Who Says/Thinks He Is Negative"

 

PS: I am still not a fan of assuming everyone is positive. Don't assume anything. Just use a condom.

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I think classifying this as "another BB thread" does it a disservice. It is a great study in how people often misinterpret information. Without re-hashing the entire study, the HIV+ partner's viral load needs to be under 200 copies/ml to be considered "undetectable." Taking someone's word that they are undetectable is the same as taking their word that they are negative.

 

 

 

 

What Local Guy is trying to say, I think, is that unprotected sex with him is less risky than unprotected sex with a guy who says/thinks he is negative because Local Guy knows he is undetectable. At least as of his last blood test. Just like "Guy Who Says/Thinks He Is Negative"

 

PS: I am still not a fan of assuming everyone is positive. Don't assume anything. Just use a condom.

 

"Just use a condom" has been as effective as "just say no" and we all know how well that turned out. Totalitarian approaches rarely work folks

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Just assume you want to stay negative and use a fucking condom. What is the big fucking deal. Use a goddamn motherfucking condom and shut the fuck up.

If local guy had used a condom he wouldn't have to take medication for the rest of his fucking life.

If his ex had used a condom neither of them would be spending hundreds of thousands of dollars over his shortened lifetime on medical care and medication.

If their friend had used a condom, all three of them would be free of the threat of a slow lingering wasting death that may leave them as a shell of the person that fucked without a condom to start all of this.

Use a fucking condom.

Use a fucking condom.

Use a goddamn motherfucking condom and you wont have to wonder on your deathbed at 35: "Why the fuck didn't I use a condom."

 

Just reminder in case you are still unsure of my message: Use a condom.

I have never seen a purplekow :)

I hope I never see one ;)

But I can tell you this and how I would rather see than be one :D

 

Help there is a purplekow in my mirror :eek:

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"Just use a condom" has been as effective as "just say no" and we all know how well that turned out. Totalitarian approaches rarely work folks

 

How did not using a condom work out for the three guys here? Oh right, they are all infected. A fucking chronic disease is still a goddamn disease.

I have never seen a purplekow :)

I hope I never see one ;)

But I can tell you this and how I would rather see than be one :D

 

Help there is a purplekow in my mirror :eek:

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"Just use a condom" has been as effective as "just say no" and we all know how well that turned out...

 

Your statement is absolutely wrong. New cases of HIV drastically declined in the 1990's when men having sex with other men started using condoms in large part due to the massive education campaigns about condoms' role in preventing the transmission of HIV. Infection rates started to increase again in the 2000's when men stopped using them. At the same time, safer sex campaigns were waning and advertisements for HIV medications were promoting how easy they were to take and how manageable the disease would become once the drugs were used. While I believe the HIV meds have done a wonderful service by reducing the impact of the virus, soft-pedaling prevention because meds are available was not a way to do a wonderful service. My guess is your misunderstanding of the facts is borne out of ignorance. Based on the age you list in your ad, you were only 13 when safer sex campaigns started waning in 2000. By the time you reached adulthood, they had all but fizzled out.

 

Until the very recent advent of PrEP, there was one relatively certain way, one absolutely certain way, and one risky way of preventing transmission: condom use, abstinence, and so-called serosorting, respectively. The story above (any others like it) demonstrates that serosorting in conjunction with barebacking is not very effective in preventing the transmission of HIV. Abstinence, which "Just Say No" promoted as part of a dismal excuse for a drug prevention campaign, simply does not work. Condom usage does work. However, like PrEP, you have to use them in order for them to work.

 

Totalitarian approaches rarely work folks

 

Totalitarianism is not an approach. The definition of totalitarian is "of or relating to a system of government that is centralized and dictatorial and requires complete subservience to the state." There is nothing dictatorial or requiring subservience in the statement "I am still not a fan of assuming everyone is positive. Don't assume anything. Just use a condom." Being dictatorial would indicate forcing people to, in this case, use a condom, as would forcing people to have bareback sex or using Truvada. Nothing in that statement forced or implied forcing anyone to do anything.

 

One final note: You either did not understand what I meant, chose not to understand it, or understood what I meant and chose to take part of the statement and equate it to the Reagan administration's lame excuse for drug education. Totalitarian regime propaganda had a habit of taking partial quotes and misrepresenting their meaning in oder to advance the regime's viewpoint. While I hope that your intent was not to misrepresent what I said, the way in which you selectively used the quote certainly seemed like it was.

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Just assume you want to stay negative and use a fucking condom. What is the big fucking deal. Use a goddamn motherfucking condom and shut the fuck up.

If local guy had used a condom he wouldn't have to take medication for the rest of his fucking life.

If his ex had used a condom neither of them would be spending hundreds of thousands of dollars over his shortened lifetime on medical care and medication.

If their friend had used a condom, all three of them would be free of the threat of a slow lingering wasting death that may leave them as a shell of the person that fucked without a condom to start all of this.

Use a fucking condom.

Use a fucking condom.

Use a goddamn motherfucking condom and you wont have to wonder on your deathbed at 35: "Why the fuck didn't I use a condom."

 

Just reminder in case you are still unsure of my message: Use a condom.

 

This would make a great PSA. In fact, wasn't it a PSA back in the 1990's? You know, back when new HIV infection rates were declining.

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I think classifying this as "another BB thread" does it a disservice. It is a great study in how people often misinterpret information. Without re-hashing the entire study, the HIV+ partner's viral load needs to be under 200 copies/ml to be considered "undetectable." Taking someone's word that they are undetectable is the same as taking their word that they are negative.

 

You're right! It's an important issue, I was concerned about been called redundant.

 

PS: I am still not a fan of assuming everyone is positive. Don't assume anything. Just use a condom.

 

I disagree with you on that last part, I assume everybody is poz. Condoms are a must in your life and mine too!

 

Thanks for taking time to make all this comments about this subject.

Liberal, born and raised in Maryland, proud member of pink pistols!

Ignore list: WilliamM

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YESS!

 

It is great to see sane and self-preserving thoughts here.

 

Many thanks to the OP for this and all the posts on meth abuse. I'm not personally into sex with kids 1/3 my age ... but it terrifies me that so many of them are exposing themselves to all sorts of REALLY, demonstrably dangerous problems while looking for sex which, it seems to me, should be pleasurable in and of itself, without needed either the "thrill" of BB or the "buzz" of meth ...especially considering the consequences.

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I remember after a session a client thanked me for keeping it safe, implying that in the heat of the moment some people "forget" about safe sex measures.

 

It's a good idea to discuss safe sex practices ahead of time and make sure that condoms will be used.

 

http://www.adrespect.org/photos/adlibrary2/picresized_1246514594_sauna.jpg

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I remember after a session a client thanked me for keeping it safe, implying that in the heat of the moment some people "forget" about safe sex measures.

 

It's a good idea to discuss safe sex practices ahead of time and make sure that condoms will be used.[/color]

 

http://www.adrespect.org/photos/adlibrary2/picresized_1246514594_sauna.jpg

 

 

Precisely! Your previous post and this one and Purplekow's sum up this thread in a salient, responsible, intelligent, concerned manner!

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People SHOULD do a lot of things that are healthy for them but they don't condoms being one of them. I know its nice to all pat yourselves on the back because your all responsible gay men but the issue of barebacking is not black or white, there is a huge grey area that requires empathy and lack of judgement. I have yet to see one post that discusses barebacking on this forum that doesn't devolve into shaming people. There are a myriad of sociological and psychological issues at play here (the grey area). This was a great op ed, please take a read and if you still have time or interest watch this clip of ted talks that tackles shame.

 

http://www.advocate.com/commentary/2014/09/08/op-ed-slut-shaming-cause-hiv

 

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People SHOULD do a lot of things that are healthy for them but they don't condoms being one of them. I know its nice to all pat yourselves on the back because your all responsible gay men but the issue of barebacking is not black or white, there is a huge grey area that requires empathy and lack of judgement. I have yet to see one post that discusses barebacking on this forum that doesn't devolve into shaming people. There are a myriad of sociological and psychological issues at play here (the grey area). This was a great op ed, please take a read and if you still have time or interest watch this clip of ted talks that tackles shame.

 

http://www.advocate.com/commentary/2014/09/08/op-ed-slut-shaming-cause-hiv

 

 

in the late 80's and 90's everybody was using condoms... if we had kept behaving like this the disease will be found mostly in laboratories, unfortunately some people still don't get it.

 

Just assume you want to stay negative and use a fucking condom. What is the big fucking deal. Use a goddamn motherfucking condom and shut the fuck up.

If local guy had used a condom he wouldn't have to take medication for the rest of his fucking life.

If his ex had used a condom neither of them would be spending hundreds of thousands of dollars over his shortened lifetime on medical care and medication.

If their friend had used a condom, all three of them would be free of the threat of a slow lingering wasting death that may leave them as a shell of the person that fucked without a condom to start all of this.

Use a fucking condom.

Use a fucking condom.

Use a goddamn motherfucking condom and you wont have to wonder on your deathbed at 35: "Why the fuck didn't I use a condom."

 

Just reminder in case you are still unsure of my message: Use a condom.

 

+1

 

I always test the escorts I want to hire, I email them asking for safe sex, and from a different account I email them asking for BB, unfortunately 80% of them agree to BB because I say I'm negative and they say they're negative, we're both negative, right? Nobody lies to get laid...

 

There was a huge HIV conference here in DC a couple of years ago, the same local escort who passed me this conversation on an email, told me that all of the sudden the phone started ringing about guys who wanted to BB, emails too, he didn't know why... it was because of the conference delegates here asking for money wanted to have fun, the same kind of fun that got hem infected.

 

People!

Liberal, born and raised in Maryland, proud member of pink pistols!

Ignore list: WilliamM

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If people don't agree with you, it doesn't mean they "shame" you.

 

 

Assessing motivations to engage in intentional condomless anal intercourse in HIV-risk contexts (“bareback sex”) among men who have sex with men

 

José A. Bauermeister, MPH, PhD, Alex Carballo-Diéguez, PhD, Ana Ventuneac, PhD, and Curtis Dolezal, PhD

 

The publisher's final edited version of this article is available at AIDS Educ Prev

 

 

While condom use is an effective barrier against HIV transmission, some men who have sex with men (MSM) engage in bareback sex (unprotected anal sex in risky contexts) and increase their risk for HIV (re)infection. Understanding MSM's decision to bareback (vis-à-vis condom use) is essential to develop effective HIV/AIDS prevention programs for this population.

 

Method

 

An ethnically diverse sample of men who bareback (n=120) was recruited exclusively on the Internet and stratified to include two-thirds who reported both URAI and being HIV-uninfected. We use exploratory factor analysis to explore the domains within the DBB scale, and test the association between DBB and risky sexual behaviors.

 

Results

 

HIV-positive MSM (n=31) reported higher costs/losses associated with condom use than HIV-negative men (n=89). We found two underlying factors in the DBB scale: a Coping with Social Vulnerabilities subscale (8 items; α = .89) and a Pleasure & Emotional Connection subscale (5 items; α = .92). We found a positive association between DBB (i.e. greater gains associated with bareback sex) and URAI occasions, number of partners, and having one or more serodiscordant partners in the past 3 months.

 

Conclusions

 

MSM may avoid using condoms in order to cope with psychosocial vulnerabilities and create intimacy with other MSM. This population could benefit from alternatives to condoms such as pre/post exposure prophylaxis and rectal microbicides.

 

 

Introduction

Intentional condomless anal intercourse in HIV-risk contexts (popularly referred to as “bareback sex”) has received much attention in the popular and scientific literature (Berg, 2008; Carballo-Diéguez, Dowsett, Ventuneac, Remien, Balán, Dolezal et al., 2006; Huebner, Proescholdbell & Nemeroff, 2006; Parsons & Bimbi, 2007). Specifically, this literature has looked into the underlying factors that may motivate behavior, as they aid to create individual-level behavior change programs. Pinkerton and Abramson (1992), for instance, argued that unprotected anal intercourse may result from rational decision-making process in which benefits (e.g., pleasure, intimacy) outweigh risks (e.g., risk of infection or disease severity). In a qualitative study of men who have sex with men (MSM) who actively sought out partners online to engage in intentional condomless sex (N = 62), Carballo-Diéguez & Bauermeister (2004) found that some MSM reported that bareback sex was more enjoyable and a personal choice, while others appeared to be more influenced by contextual factors that mitigated HIV-prevention concerns, such social isolation and perceiving that HIV-infection is inevitable.

 

While it is important to understand the psychosocial factors that influence MSM's decision to bareback (vis-à-vis to use condoms) in order to promote safer sex behaviors, the scientific inquiry in this area has been limited by a lack of consensus regarding the meaning of “bareback sex” among researchers (for a discussion of the conceptual differences between ‘unprotected male-to-male anal sex’ and ‘bareback sex’, see Carballo-Diéguez, Ventuneac, Bauermeister, Dowsett, Dolezal, Remien, et al., in press); the inconsistent attention to the role that intentionality and risky contexts play in differentiating this behavior from male-to-male condomless anal sex; and by the scarcity of construct-related measures with sound psychometric properties. Berg (2008), for example, found that Zagumny and Brady's (1998) AIDS Health Belief Scale, a measure assessing the main four predictors (i.e., perceived severity, perceived susceptibility, perceived benefits, and perceived barriers) of the Health Belief Model (Janz, Champion & Strecher, 2002), had poor reliability when administered to a geographically-diverse sample of barebacking MSM recruited online. Recently, Parsons and Bimbi (2007) underscored the importance of increasing theory-based approaches to the study of barebacking behavior. While several scales with good psychometric properties have been developed to assess attitudes towards unprotected anal intercourse (Shidlo, Yi & Dalit, 2005) and the benefits to bareback sex (Halkitis, Parsons & Wilton, 2003), these scales have not explored men's motivation to engage in risky sexual behavior vis-à-vis their motivation to use condoms. We present here an innovative and complementary approach to these subscales by creating a decisional balance scale to bareback (i.e., the net motivation to bareback even after accounting for MSM's motivation to use condoms). Originally proposed by Janis and Mann (1977), decisional balance to carry out a behavior is conceptualized as a schema that helps individuals make a decision. As its underlying assumptions, Janis & Mann (1977) argue that

 

“it is not the absolute amount of gain and loss he expects to encounter that determines the value a person will place on a given choice, but the amount relative to a comparison level, based on the amount of reward or punishment the person has obtained in the past or has seen other people obtaining. The more the anticipated outcome exceeds the comparison level, the more satisfying it is; the farther it is below the comparison level, the more unsatisfying.” (p.136).

 

Furthermore, the outcome of weighing different gains and losses of a behavior will be influenced by the utilitarian gains and losses for the individual and his significant others.

 

As a construct, decisional balance takes into consideration the reality of negotiating sexual encounters; that is, while men may know that condoms protect against HIV, they may have other non-HIV prevention motivations to bareback (Halkitis et al., 2003). From a research standpoint, the creation of a decisional balance scale may help us understand how MSM weigh the pros and cons of barebacking over using condoms across different situations. Additionally, it may inform HIV/STI prevention programs for MSM who engage in intentional unprotected anal intercourse in risky contexts (Prochaska, Redding & Evers, 2002). Consequently, we explore and test the psychometric properties of a decisional balance scale that considers the gains and losses of bareback sex (vis-à-vis condom use) at multiple levels: the individual-level (e.g., pleasure versus discomfort), the interpersonal-level (e.g., intimate connection to partner versus awkward condom negotiation), and societal-level (e.g., social acceptance versus sexual prejudice).

 

This study had four aims. First, we explored the psychometric properties of a scale to measure MSM's decisional balance to engage in bareback sex vis-à-vis condom use (DBB). Second, we compared MSM's decisional balance score by HIV status given that HIV-positive and HIV-negative men may have different motivations to engage in bareback sex (Carballo-Diéguez & Bauermeister, 2004). We then explored the association between the decisional balance to bareback and several sex risk behaviors (i.e., number of partners, number of unprotected receptive anal intercourse occasions, and having one or more serodiscordant partners). Finally, we tested whether the magnitude of the correlations between DBB and risky sex behaviors is different for HIV-positive and HIV-negative MSM as their HIV status may lead men to have different decisional balance weights to the gains (i.e., more pleasurable) and losses (i.e., reducing risk of infection or transmission) associated with bareback sex.

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Method

Sample and Recruitment

 

This report is based on data collected in a four-year, NIMH-funded study that focused on MSM who meet sexual partners through the Internet to intentionally engage in condomless anal intercourse in situations in which there is risk of HIV transmission (the “Frontiers in Prevention” study). By study design, the men had to be recruited exclusively through the Internet and agree to a face-to-face interview in our research offices. Between April 2005 and March 2006, we recruited men who fulfilled the following eligibility criteria: 1) be at least 18 years old; 2) live in New York City or within commuting distance; 3) report using the Internet to meet men at least twice per month; 4) self-identify as a barebacker or as someone who practices barebacking (“Are you into bareback or do you consider yourself a barebacker?” however the respondent understood these terms); 5) have had intentional, condomless anal intercourse with a man met over the Internet (this was posed as a separate, unrelated question); and 6) use at least one of the six most popular Internet sites identified in the first phase of the study. We recruited approximately equal numbers of European Americans, African Americans, Latinos, and Asian Pacific Islanders. We also stratified the sample to include about two thirds who reported both being HIV-negative and having had unprotected receptive anal intercourse (URAI) in the previous year. Individuals who qualified were scheduled for a face-to-face interview as close as possible to the date of the initial screening. Of the 188 men who qualified, 64% completed a face-to-face interview.

 

Procedure

 

After giving consent to participate in this study, each respondent underwent an in-depth, face-to-face interview conducted by one of three clinical psychologists on our staff. During this interview, we explored, among other topics, how participants defined “bareback sex” (see Carballo-Diéguez et al., in press). This was followed by a structured questionnaire that was completed through a Computer Assisted Self-Interview (CASI; Couper & Rowe, 1996). This report is based on the quantitative data. The interviews lasted about two hours in total, at the end of which respondents were compensated with $50 for their time. This study had been reviewed and approved by the Institutional Review Board at the New York State Psychiatric Institute.

 

Measures

 

Demographic characteristics

Respondents were asked to report their age, highest year of school completed, current occupational status (including whether participants where on disability), annual income (including money earned off the books), and ethnic and racial group membership. For ethnicity, respondents were asked to report if they considered themselves Latino or Hispanic. Those who did not identify as Hispanic or Latino were asked to report their race from the following categories: African American or Black, Asian or Pacific Islander, White or European American, Native American, and Other.

 

Sexual Behavior

Respondents were asked to report their sexual behavior with men and women during the previous two months using the Sexual Practices Assessment Schedule (SPAS; Carballo-Diéguez, Remien, Dolezal, & Wagner, 1999). Questions were posed both in formal language and vernacular (in italics) to increase comprehension. Of relevance for the present report are three questions on sexual behavior with men in the past two months: a) “How many times did a male partner put his penis in your rectum? (How many times did you get fucked in the ass?)”, b) “How many times did a male partner put his penis in your rectum without a condom? (How many times did you get fucked in the ass without a condom?)”, and c) “How many men put their penises in your rectum without a condom? (How many men fucked you in the ass without a condom?)”.

 

HIV Status

Participants were asked whether they had been tested for HIV, if they had received their test result, and whether they were HIV infected (no actual HIV test was performed). Participants who reported having received a positive test result were coded as 1, and those who had not taken an HIV test or who reported being HIV negative were scored as zero.

 

Partner Serodiscordance

Participants who reported having URAI with one or more partners were asked, “Of those men, how many had actually told you they were HIV-negative and you had no reasons to doubt it?” and “Of those men, how many do you know to be HIV-positive?” The difference in the wording between the two questions was based on our interest to know if the participant had actually been expressly told by the partner he was HIV-negative (as opposed of assuming seronegativity given that the partner “looked healthy”), and our acknowledgement that someone may find out a partner's HIV-positive status without actually discussing it (e.g., finding HIV prescription drugs in his medicine cabinet). Those partners who were neither included in the HIV-negative nor HIV-positive counts were considered of unknown status. We created a dummy variable to measure the risk of having one or more potentially serodiscordant partners during URAI in the previous two months (0 = seroconcordant, 1=one or more serodiscordant partners). Among HIV-negative participants, having a serodiscordant partner was operationalized as having one or more partners who were HIV-positive or of unknown status. Among HIV-positive participants, a serodiscordant partner was operationalized as having one or more partners who were HIV-negative or of unknown status.

 

Decisional Balance to Bareback (DBB)

Based on our research team's review of the literature on barebacking, we developed a 30-item scale in which respondents were presented 15 statements twice. Each statement referred first to bareback sex being immediately followed by an identical statement asking about sex with condoms. Participants rated each statement using a 10-point scale ranging from 1 (Completely untrue for me) to 10 (Completely true for me). Respondents' score was computed by summing the net difference between bareback and condom use scores across the statements. Greater positive scores reflect greater benefits/gains associated with bareback sex. Negative scores reflect greater benefits/gains associated with condom use. Scores hovering close to zero indicate neutrality in the costs and gains associated with safer and unprotected anal sex. We include the items' content in Table 1.

 

Table 1: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699594/table/T1/

 

 

Data Analytic Strategy

 

Prior to conducting any analyses, we tested the normality of study measures. After comparing different transformations based on how well they reduced the magnitude of the skewness statistic, we selected a log-10 transformation to adjust for skewness in the count of URAI occasions and number of partners in the past two months, respectively.

 

We conducted exploratory principal axis factor analysis with varimax rotation to obtain orthogonal (“independent”) factors from the DBB items. Items with factor loadings greater than .50 were included within a factor (Kim & Mueller, 1978). This analytic approach was consistent with our intent to break down the underlying domains captured across the 15 statements. We then tested for differences across study measures by HIV status; and decided to stratify our analyses by HIV-status given the number of differences found. Finally, we tested the bivariate association between sex risk behaviors and the DBB factor scores. Using Fisher's r-to-Z conversion, we tested whether the magnitude of the observed correlations were statistically significant by HIV status. We used a Z critical value of 1.96 (two-tailed test; p < .05) to test whether the observed correlations between sex behaviors and the condom use decisional balance scores were different for HIV-positive and HIV-negative participants (i.e., Ho: r(HIV) − r(HIV+) = 0). We performed a post-hoc correction to decrease the Type-I error using the Bonferroni correction in order to reduce spurious findings due to the multiple comparisons carried out.

 

 

Results

 

Sample Description

 

Participants (N = 120) reported a mean age of 34 years (SD = 9.63 years), having some college education, and an average income of $27,950 (SD = 23,890). Close to two-thirds of the sample (63%) reported having a part-time or full-time job. Thirty-one men (26%) reported being HIV-positive (see Table 2). Compared to HIV-negative men, HIV-positive men were older by an average of six years and earned less income. HIV-positive participants were more likely to be underemployed or work fewer hours than HIV-negative participants (χ2(2) = 20.84; p < .01). In addition, 11 of the 13 men that reported being on disability were HIV-positive (χ2(1) = 25.98; p < .01). We found no differences in education or race/ethnicity by HIV status.

 

Table 2: Descriptive Statistics for Study Variables by HIV-Status

 

 

Sexual risk behaviors and HIV status

 

We compared the sexual risk behavior reported by participants in the two months prior to the interview by HIV status (see Table 2). Approximately half of the sample reported having had one or more potentially serodiscordant partners in that period. Overall, participants reported having had receptive anal intercourse on multiple occasions (M = 6.93, SD = 14.21). HIV-negative men reported fewer partners in receptive anal intercourse (M = 8.03, SD = 10.59) than HIV-positive men (M = 14.32, SD = 29.94). HIV-positive men reported having greater number of URAI occasions, having more partners with whom they had URAI, and having a greater likelihood of having had URAI with a potentially serodiscordant partner.

 

Table 3: Factor Loadings for the Decisional Balance to Bareback Scale

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Overall, participants reported having multiple partners (M = 5.89, SD = 13.14). HIV-negative men reported fewer partners with whom they had URAI (M = 4.71, SD = 5.97) than HIV-positive men (M = 5.97, SD = 25.30); p < .05. We found no statistical difference in the total number of unprotected insertive anal intercourse occasions between HIV-negative (M = 5.29, SD = 9.70) and HIV-positive (M = 5.13, SD = 7.87) participants.

 

Decisional Balance to Bareback

 

Using the principal axis factor analysis with varimax rotation, we extracted two factors explaining 58.29% of the total variance (see Table 1). We removed two scenarios (“[bareback/Sex with condoms] relieves my stress” and “[bareback sex/Sex with condoms] is my own personal decision”) from subsequent analyses because their factor loadings had similar weights across both factors.

 

The first factor, Coping with Vulnerabilities, had 8 items referring to a decisional balance between condom use and bareback sex as a way of coping with psychosocial vulnerabilities such as anxiety, loneliness, depression, homophobia, and racism. This factor explained 49.70% of the total variance and had strong reliability (adjusted Cronbach's α = .89).

 

The second factor, Pleasure and Emotional Connection, had 5 items referring to a decisional balance between condom use and bareback sex as a way of seeking pleasure and emotional connection with other men. This factor explained an additional 8.59% of the total variance and had strong reliability (adjusted Cronbach's α = .92).

 

As expected, given the sample selection criteria, when a differential score was computed by subtracting participants' ratings to bareback items from their sex with condoms items across the 13 scenarios, we found MSM were more likely to favor bareback sex. A positive DBB score (M = 3.42, SD = 5.48) reflected more benefits/gains associated with barebacking. Overall, participants' score on the Coping with Vulnerabilities subscale (M = −0.07, SD = 2.25) indicated an equilibrium between the weight assigned to condom use and bareback sex. In contrast, respondents' score on the Pleasure and Emotional Connection subscale (M = 3.51; SD = 3.82) indicated a decisional balance in favor of bareback sex. This finding, however, was less evident when we computed the mean difference for each subscale (see Table 3).

 

Does DBB vary by HIV status?

 

We found differences in respondents' overall mean DBB scores by HIV status: HIV-positive men were significantly more likely to assign benefits/gains to bareback sex than HIV-negative men (see Table 1). When we looked at the subscales, HIV-positive men were significantly more likely to assign benefits/gains to bareback sex as a way of coping with vulnerabilities than HIV- positive men. We found no difference by HIV-status on the Pleasure and Emotional Connection subscale.

 

Is there an association between DBB and sex risk behaviors?

 

Number of Insertive Partners for Unprotected Sex. We found moderate associations between respondents' DBB and number of partners (see Table 4). Among HIV-negative participants, number of partners was positively associated with greater benefits/gains to bareback sex in the overall score (r = .32; p < .01), the Coping with Vulnerabilities subscale (r = .35; p < .01), and the Pleasure and Emotional Connection subscale (r = .25; p < .05). Among HIV-positive participants, number of partners was also positively associated with greater benefits/gains to bareback sex in the overall score (r = .36; p < .05) and marginally significant in the pleasure and emotional connection subscale (r = .33; p < .10). We found no correlation between number of partners and the coping with vulnerabilities subscale among HIV-positive participants.

 

Table 4: Correlation Matrix of Sex Behaviors and DBB by HIV-Status

 

Frequency of URAI. We also found moderate positive associations between respondents' number of URAI occasions and the benefits/gains of bareback sex (see Table 4). Among HIV-negative participants, number of URAI occasions was associated with greater benefits/gains of bareback sex in the composite score (r = .33; p < .01), the coping with vulnerabilities subscale (r = .33; p < .01), and the pleasure and emotional connection subscale (r = .28; p < .01). Among HIV-positive participants, we found a positive association between the number of URAI occasions and greater benefits/gains to bareback sex in the overall score (r = .38; p < .05). We also found a marginally significant trend in the association between the number of URAI occasions and the pleasure and emotional connection subscale (r = .33; p < .10) and the coping with vulnerability subscale (r = .34; p < .10).

 

After transforming the HIV-status specific correlations into Z-scores, we tested whether the magnitude of the correlations presented in Table 4 differed by HIV-status. We found the association between number of partners and URAI occasions was significantly stronger (Z = 2.85; p < .05) for HIV-positive men (r = .97; p < .001) than for HIV-negative men (r = .90; p < .01). The magnitude of the association between the Coping with Vulnerabilities subscale and the benefits/gains of bareback sex was statistically smaller (Z = 1.97; p < .05) for HIV-positive (r = .68; p < .01) than for HIV-negative (r = .85; p < .01) participants. We found no other differences in the correlational magnitude between HIV positive and HIV negative participants.

 

 

Discussion

 

Prevalence estimates of bareback sex among MSM have ranged from 10% to 84% across study samples, making an accurate estimation of barebacking behavior difficult (Berg, 2008). One potential explanation for this variation is that the construct has been poorly defined or understood by participants in very different ways (Carballo-Diéguez et al., in press). As Berg (2008) argued, the limited research in this area has been associated with the absence of theoretically-derived psychometric scales to understand bareback sex. In this study, we developed and tested the psychometric properties of a decisional balance scale in a sample of MSM who engage in bareback sex. Decisional balance to bareback (vis-à-vis sex with condoms), as measured here, seems to be motivated by two factors: sex as a way of coping with social vulnerabilities and stressors, and sex as a way to connect and to experience pleasure with other men. When divided into subscales, we found the two subscales were orthogonally constructed, had strong internal consistency, and shared a moderate correlation between them. These findings are consistent with Díaz and Ayala's (2001) argument that sexual intimacy and pleasure among MSM is strongly linked to their desire to cope with social stressors such as racism, loneliness, and homophobia.

 

We found HIV-positive men were more likely to associate gains with bareback sex as a way of coping with social vulnerabilities than HIV-negative men. The extraction of a Coping with Social Vulnerabilities subscale highlights the need to account for social-level gains and losses when exploring the gains and benefits of engaging in bareback sex. Similarly, the extraction of a Pleasure and Emotional Connection subscale also acknowledges the importance of measuring individual and interpersonal-level gains and losses associated with bareback sex. HIV-positive and HIV-negative MSM reported similar gains associated with bareback sex in the Pleasure & Emotional Connection subscale. This work is consistent with Halkitis and colleagues' (2003) and Carballo-Diéguez & Bauermeister's (2004) arguments that bareback sex is an intentional act providing sexual and emotional rewards that may not be present when MSM use condoms for anal sex. Taken together, these findings suggest that MSM's decision to forego condoms is linked to the presence of social vulnerabilities and to the role of sexual intercourse as a mechanism to achieve emotional and sexual connections.

 

Even when men were asked to rate barebacking vis-à-vis condom use across multiple statements, we found the benefits/gains associated with bareback sex were positively associated with number of URAI occasions, number of partners, and risk of having one or more sexual intercourse occasions with a serodiscordant partner, regardless of HIV status. Taken together, these findings imply that MSM may benefit from a greater variety of HIV prevention technologies, particularly among men who assign larger costs/losses to condoms as the only effective HIV prevention method. It is vital to provide alternative harm reduction approaches to condom use, including access to pre/post exposure prophylaxis (Nodín, Carballo-Diéguez, Ventuneac, Balán, & Remien, 2008) and microbicidal agents (Carballo-Diéguez et al., 2007; Carballo-Diéguez, Dolezal, Bauermeister, O'Brien, Ventuneac & Mayer, in press), as they may minimize the risk of HIV (re)infection. If found to be successful for HIV prevention, pre/post exposure prophylaxis and rectal microbicides may offer opportunities to decrease HIV infection further, particularly in spur-of-the moment situations where MSM have unprotected anal intercourse with partners of unknown serostatus (Nodín et al., 2008). Furthermore, exploring whether a person's DBB score is associated with intentionality to use these promising approaches may be useful. It is possible, for example, that MSM assigning greater costs/losses to condom use may consider using other prevention strategies as more viable. Additional support for ongoing research that explores the acceptability and effectiveness of pre/post exposure prophylaxis and rectal microbicides as a prevention mechanism that does not mitigate the gains associated with bareback sex is necessary.

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This study has several limitations deserving mention. First, our results may not be generalizable to all MSM. By sample design, we recruited participants who reported identifying or engaging in bareback sex, and having sought out a partner over the Internet for bareback sex in the past two months. Future studies should replicate our study findings through a confirmatory factor analysis with other MSM samples. Furthermore, we do not know whether the DBB scale is associated with a person's willingness to change their condom use behavior. Given that our cross-sectional design limits our ability to test a causal hypothesis adequately, prospective studies exploring the temporal relationship across DBB scores and behavior change are required as they will help inform HIV prevention strategies. These limitations not withstanding, our study is the first in developing a theoretically-derived scale that quantifies MSM's decisional balance to engage in bareback (vis-à-vis condom use) and test its psychometric properties in an ethnically diverse sample of MSM who self-report engaging in bareback sex.

 

source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699594/

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If people don't agree with you, it doesn't mean they "shame" you.[/color]

 

 

Assessing motivations to engage in intentional condomless anal intercourse in HIV-risk contexts (“bareback sex”) among men who have sex with men

 

José A. Bauermeister, MPH, PhD, Alex Carballo-Diéguez, PhD, Ana Ventuneac, PhD, and Curtis Dolezal, PhD

 

The publisher's final edited version of this article is available at AIDS Educ Prev

 

 

While condom use is an effective barrier against HIV transmission, some men who have sex with men (MSM) engage in bareback sex (unprotected anal sex in risky contexts) and increase their risk for HIV (re)infection. Understanding MSM's decision to bareback (vis-à-vis condom use) is essential to develop effective HIV/AIDS prevention programs for this population.

 

Method

 

An ethnically diverse sample of men who bareback (n=120) was recruited exclusively on the Internet and stratified to include two-thirds who reported both URAI and being HIV-uninfected. We use exploratory factor analysis to explore the domains within the DBB scale, and test the association between DBB and risky sexual behaviors.

 

Results

 

HIV-positive MSM (n=31) reported higher costs/losses associated with condom use than HIV-negative men (n=89). We found two underlying factors in the DBB scale: a Coping with Social Vulnerabilities subscale (8 items; α = .89) and a Pleasure & Emotional Connection subscale (5 items; α = .92). We found a positive association between DBB (i.e. greater gains associated with bareback sex) and URAI occasions, number of partners, and having one or more serodiscordant partners in the past 3 months.

 

Conclusions

 

MSM may avoid using condoms in order to cope with psychosocial vulnerabilities and create intimacy with other MSM. This population could benefit from alternatives to condoms such as pre/post exposure prophylaxis and rectal microbicides.

 

 

Introduction

Intentional condomless anal intercourse in HIV-risk contexts (popularly referred to as “bareback sex”) has received much attention in the popular and scientific literature (Berg, 2008; Carballo-Diéguez, Dowsett, Ventuneac, Remien, Balán, Dolezal et al., 2006; Huebner, Proescholdbell & Nemeroff, 2006; Parsons & Bimbi, 2007). Specifically, this literature has looked into the underlying factors that may motivate behavior, as they aid to create individual-level behavior change programs. Pinkerton and Abramson (1992), for instance, argued that unprotected anal intercourse may result from rational decision-making process in which benefits (e.g., pleasure, intimacy) outweigh risks (e.g., risk of infection or disease severity). In a qualitative study of men who have sex with men (MSM) who actively sought out partners online to engage in intentional condomless sex (N = 62), Carballo-Diéguez & Bauermeister (2004) found that some MSM reported that bareback sex was more enjoyable and a personal choice, while others appeared to be more influenced by contextual factors that mitigated HIV-prevention concerns, such social isolation and perceiving that HIV-infection is inevitable.

 

While it is important to understand the psychosocial factors that influence MSM's decision to bareback (vis-à-vis to use condoms) in order to promote safer sex behaviors, the scientific inquiry in this area has been limited by a lack of consensus regarding the meaning of “bareback sex” among researchers (for a discussion of the conceptual differences between ‘unprotected male-to-male anal sex’ and ‘bareback sex’, see Carballo-Diéguez, Ventuneac, Bauermeister, Dowsett, Dolezal, Remien, et al., in press); the inconsistent attention to the role that intentionality and risky contexts play in differentiating this behavior from male-to-male condomless anal sex; and by the scarcity of construct-related measures with sound psychometric properties. Berg (2008), for example, found that Zagumny and Brady's (1998) AIDS Health Belief Scale, a measure assessing the main four predictors (i.e., perceived severity, perceived susceptibility, perceived benefits, and perceived barriers) of the Health Belief Model (Janz, Champion & Strecher, 2002), had poor reliability when administered to a geographically-diverse sample of barebacking MSM recruited online. Recently, Parsons and Bimbi (2007) underscored the importance of increasing theory-based approaches to the study of barebacking behavior. While several scales with good psychometric properties have been developed to assess attitudes towards unprotected anal intercourse (Shidlo, Yi & Dalit, 2005) and the benefits to bareback sex (Halkitis, Parsons & Wilton, 2003), these scales have not explored men's motivation to engage in risky sexual behavior vis-à-vis their motivation to use condoms. We present here an innovative and complementary approach to these subscales by creating a decisional balance scale to bareback (i.e., the net motivation to bareback even after accounting for MSM's motivation to use condoms). Originally proposed by Janis and Mann (1977), decisional balance to carry out a behavior is conceptualized as a schema that helps individuals make a decision. As its underlying assumptions, Janis & Mann (1977) argue that

 

“it is not the absolute amount of gain and loss he expects to encounter that determines the value a person will place on a given choice, but the amount relative to a comparison level, based on the amount of reward or punishment the person has obtained in the past or has seen other people obtaining. The more the anticipated outcome exceeds the comparison level, the more satisfying it is; the farther it is below the comparison level, the more unsatisfying.” (p.136).

 

Furthermore, the outcome of weighing different gains and losses of a behavior will be influenced by the utilitarian gains and losses for the individual and his significant others.

 

As a construct, decisional balance takes into consideration the reality of negotiating sexual encounters; that is, while men may know that condoms protect against HIV, they may have other non-HIV prevention motivations to bareback (Halkitis et al., 2003). From a research standpoint, the creation of a decisional balance scale may help us understand how MSM weigh the pros and cons of barebacking over using condoms across different situations. Additionally, it may inform HIV/STI prevention programs for MSM who engage in intentional unprotected anal intercourse in risky contexts (Prochaska, Redding & Evers, 2002). Consequently, we explore and test the psychometric properties of a decisional balance scale that considers the gains and losses of bareback sex (vis-à-vis condom use) at multiple levels: the individual-level (e.g., pleasure versus discomfort), the interpersonal-level (e.g., intimate connection to partner versus awkward condom negotiation), and societal-level (e.g., social acceptance versus sexual prejudice).

 

This study had four aims. First, we explored the psychometric properties of a scale to measure MSM's decisional balance to engage in bareback sex vis-à-vis condom use (DBB). Second, we compared MSM's decisional balance score by HIV status given that HIV-positive and HIV-negative men may have different motivations to engage in bareback sex (Carballo-Diéguez & Bauermeister, 2004). We then explored the association between the decisional balance to bareback and several sex risk behaviors (i.e., number of partners, number of unprotected receptive anal intercourse occasions, and having one or more serodiscordant partners). Finally, we tested whether the magnitude of the correlations between DBB and risky sex behaviors is different for HIV-positive and HIV-negative MSM as their HIV status may lead men to have different decisional balance weights to the gains (i.e., more pleasurable) and losses (i.e., reducing risk of infection or transmission) associated with bareback sex.

 

If you don't see even a morsel of shame in this discussion you might need to get your eyes checked.

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If you don't see even a morsel of shame in this discussion you might need to get your eyes checked.

 

Shame comes from within. No one but you can make you feel or express feelings of shame. I see shame and defensiveness in every post you have made in this thread, including the one where you co-opted Brene Brown's work to somehow equate shame with disagreeing with you. The statement quoted above seems like an attempt to make the reader feel ashamed of himself by suggesting he has a physical defect (impaired vision) if he disagrees with you. I, for one, do not feel ashamed of myself for disagreeing with the statements and the methods you have used while making them. I do, however, feel frustrated because you just don't seem to listen. To paraphrase the wise Dr. Angelou, I had to check your posts to remember exactly what you wrote, but I had no problem remembering the frustration I felt when I read them.

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Killian James does a great job explaining why he doesn't bareback on camera or off (and yes that includes his randy blue live shows, its all talk) and doesn't feel the need to take truvada. I think he hits the nail right on the head why the younger generations are so lax on the subject, and why no one claiming to be on prep is a safe bet. You can find it here http://queermenow.net/blog/killian-james-anti-bareback/#more-147059

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