The discussion of barebacking, or unsafe anal sex between two gay men, is so taboo that you’ll find few people willing to talk about it openly. However, due to the increase in unsafe-sex practices within the GLBT community, this discussion is starting to gain a voice. On one side of the dialogue are the sexual revolutionaries that advocate reclaiming our gay sexuality. On the other side are the health educators and social organizations that warn of a new AIDS epidemic that could overshadow the first wave – and then there is everyone else in between.

Unprotected sex between two men has many titles – skin on skin, raw, natural – yet the most common is barebacking. However, the term “bareback” has different meanings to different people. To say that barebacking is “sex without a condom” is too broad a definition.

To accurately identify what barebacking is, the sexual activities between gay men need to be divided into several categories. First, there are the guys that use condoms every time they engage in sexual activity. The second are those that make a conscious and deliberate decision not to use a condom. Most people would agree this category of people would be called true “barebackers.”

“Barebacking is not just defined by not using a condom. I think of it as a trend of people who have information and knowledge and they are making a decision to have unprotected sex,” said Jim Zians, project manager for UCSD’s Edge Research Study. “I would like to think that most men [that do not use a condom] are not part of that group. They are struggling with condom use.”

The third category, those men struggling with condom use, is a little vague because it is the gray group in the middle of the first two. They use condoms most of the time, but not all of the time; or, depending on your perspective, they bareback most of the time, but not all of the time. Are they barebackers?

“Is barebacking a struggle around condom choices or is barebacking a decision not to use condoms?” Zians asked. “I think both things are going on.”

“Barebacking scares people because there’s a whole community of people that will do it and whole community that will not do it, and there’s a whole community in between,” said Michael Scarce, an HIV prevention activist, in the 2002 documentary Our Brothers, Our Sons.

Not knowing the size of each of these barebacking communities is what scares people the most. It’s difficult to track sexual practices, and the surveys that do ask questions about sexual safety differ in their results. Yet every indication shows an increase in barebacking activity.

“What we are seeing now is about 60 percent of the population is practicing safe sex most of the time, and about 40 percent of the population are barebacking or not practicing safe sex,” Zians said.

Those figures are down from the late ’90s when 80 percent practiced safe sex, and even down from 70 percent just a few years ago. These national numbers are staggering, but San Diego’s demographics may be even more drastic – one local survey shows that barebackers encompass up to half of the San Diego gay population.

Factors contributing to the condomless numbers include a larger number of young gay men not hearing or relating to the safe-sex message, a surprising older population of guys abandoning condom use due to safe-sex fatigue, and a new epidemic among IV drug users.

Up until the 1970s, barebacking wasn’t an issue and the terminology wasn’t a well-known phrase. Sex without a condom was the norm. Condoms were used within the heterosexual community as a contraceptive measure, but rarely discussed in gay culture.

All that changed in the 1980s with the devastation of the HIV/AIDS virus. By the end of the decade, more than 117,000 infected people had died, according to the U.S. Centers for Disease Control and Prevention (CDC). In San Diego alone the Health and Human Services Agency recorded 2,136 AIDS cases before 1990; of those diagnosed, 2,027 died, a fatality rate of 95 percent.

The mode of transmission was attributed to sexual activity, and the gay community quickly adopted a safe-sex mantra. Condom sales skyrocketed; the greatest increase – 120 percent – occurred in 1987.

“Safer sex was introduced to gay men. It was sold to gay men as a stop-gap measure,” said Scarce. “We were told just wear a condom in the meantime. We’re not quite sure what’s going on.”

Out of fear of death and paranoia of this unknown “gay cancer,” condom use became the accepted norm. Sex without a condom – still not clearly recognized as the term “barebacking” at that time – became taboo.

Yet even though HIV/AIDS cases continued to rise in the early 1990s, an underground movement of men practicing unsafe sex began.

“Barebacking as a phenomenon started to emerge somewhere around mid 1993. It was largely facilitated by the more popular use of the Internet, specifically America Online, where men who had these secret stigmatized fantasies about fucking or getting fucked without rubbers began to seek one another out,” Scarce said.

Porn star Scott O’Hara is credited as the first to publicly advocate barebacking. In a 1995 edition of Steam, his self-published journal devoted to sex in public places, he wrote, “I’m tired of using condoms, and I won’t … and I don’t feel the need to encourage negatives to stay negative.”

A few years later the terminology became more recognizable in both the gay and mainstream communities with a series of events. In September 1997 the term barebacking hit the mainstream news when Newsweek published the feature story “A Deadly Dance.” Former Miss America Kate Shindle authored a commentary entitled “Barebacking? Brainless!” in the February 1998 issue of The Advocate. Vice President Al Gore used the term barebacking with the AIDS Advisory Council. Barebacking was even the focus of one of the storylines in a 1998 television episode of “ER.”

As the awareness of barebacking increased, the death and infection rate of HIV/AIDS decreased. The CDC reports the annual rate of death due to AIDS peaked in 1994-95, decreased rapidly through 1997 and nearly leveled off after 1998. But by 1998, as the HIV/AIDS epidemic was becoming less of a threat, a genuine barebacking subculture had established itself.

The risqué movement gained additional momentum in August 1998 at the National Lesbian and Gay Health Conference. Barebacking became a hot topic when Scarce and Tony Valenzuela presented a workshop entitled “Reducing the Risk of Doing It Raw: Strategies for Barebacking Harm Education.” The conversation focused on how health providers and activists could assist barebackers in reducing their risk of acquiring HIV.

“AIDS prevention efforts have written off barebackers, demonizing them as the poster boys of unsafe sex. We need a concrete and specific harm reduction approach that might not always include condom use,” Scarce said at the conference, as reported by the Web site Gay Today.

“We wanted to move past moral judgments of bareback sex,” Valenzuela added, “and provide supportive and useful information to meet these gay men who bareback where they are at.”

Scarce and Valenzuela continued to make headlines a few months later when POZ published its “Boys Who Bareback” issue in February 1999. Not only did Valenzuela appear naked on the cover riding a horse bareback, but the controversial issue also featured Scarce’s groundbreaking “A Ride on the Wild Side,” where the author went “through the latex looking glass to discover who’s doing it raw and why.” In the issue, both negative and positive gay men expressed their condom fatigue, their intense need to connect and share cum, their HIV-meds complacency and the so-called bug-chasers (men seeking out HIV-positive partners in order to purposefully become infected).

Barebacking emerged in the mainstream news again in the February 2003 edition of Rolling Stone magazine. In a feature called “In Search of Death,” the magazine asserted that 25 percent of all new HIV infections in gay men were from barebacking bug chasers. Critics have called the Rolling Stone article “grossly sensationalistic reporting,” and health officials said the information “is spurious, is unfounded and is untrue.” Despite its alleged inaccuracies, the article did initiate a positive debate: Who are the barebackers?

As the barebacking numbers increase, safe-sex educators are attempting to identify the demographics of their community. The more they know about barebackers’ ages, ethnicities and locations, for example, the better they can tailor a safe-sex message. Again, gathering this information is speculative and somewhat limiting, because few surveys have been conducted that ask about sexual practices.

Ethnicity: The figures from the County Department of Health show the Caucasian population as the highest number of new HIV/AIDS cases in San Diego (62 percent), followed by Hispanic (22 percent) and African-American (13 percent).

“You have to look at the fact that the epidemic is different in different parts of the country,” said Terry Cunningham, chief of the Health and Human Services Agency, HIV, STD and Hepatitis Branch (formerly the Office of AIDS Coordination). He explains that population demographics are not always a clear indication of HIV/AIDS cases. “We’ve got a significantly different epidemic here in San Diego. African-American is overly represented. Yet it’s definitely more in the Caucasian population.”

Sexual Orientation: On a national level, AIDS affects more than just the gay community. About 65 percent of all current AIDS cases are in the heterosexual community, with homosexuals being the minority. Here in San Diego, however, the statistics are drastically askew. The Health and Human Services Agency reports 78-91 percent of all new HIV/AIDS cases are from the gay community. The majority of those transmissions are credited to barebacking, with a smaller percentage attributed to drug use.

“It’s disturbing because that was the population we’ve targeted most in prevention, because it was the largest population showing statistics,” Cunningham said.

Age: There is a clear generational gap within the gay community when it comes to barebackers, creating three distinct age categories: There is the older generation of 45 years and older, the Baby Boomers that survived the HIV/AIDS epidemic; a middle-age generation between 30 and 45 years old, a generation that matured during the height of the HIV/AIDS crisis; and the younger generation of men younger than 30, the Generation X population that did not grow up with the fear of AIDS. (These age ranges differ among various studies.)

The younger generation is taking a lot of the blame for the increase in barebacking. The increased barebacking trends in men younger than 30 can be attributed to a lack of awareness and education, and not perceiving HIV/AIDS as a life-threatening disease. Their friends are not dying at an alarming rate, and they see many positive men living long, healthy lives.

The trend of targeting the younger generation began in the late 1990s when CDC statistics indicated a barebacking rise among men in their 20s. Valenzuela and Scarce’s presentation at the 1998 National Lesbian and Gay Health Conference and subsequent story in 1999’s POZ magazine also brought attention to the younger population.

“It was my generation who was being scapegoated for barebacking,” Valenzuela said in the Our Brothers, Our Sons documentary. “A lot of what came down soon after was this scapegoating of not just me but who I represented – which was my generation of gay men who didn’t care about AIDS and didn’t care about gay politics and didn’t care about the things my older brothers built for our community. What it brought to light was there was this enormous generation gap.”

“Seeing the rise in young gay males terrifies me. I’ve lived through this catastrophe one time. I can’t do it again. I can’t see what we saw in the early ’90s again,” Cunningham said.

Some young gay men – the ones that identify themselves as true barebackers – have been informed about the health issues and have heard the safe-sex message.

The trend to target and blame young America might have been justified using the data at the time. That information, however, is outdated. Current stats show the largest age demographic that is barebacking is the 30 to 45-year-old community. Men 30-40 years old comprise 45 percent of the new HIV/AIDS cases – the highest number.

“What we’re seeing – and this is all speculation – is barebacking is going on more in the men who have sex with men in the 35-45 range, rather than the 25-35 range,” Cunningham said. “When I talk to colleagues in other parts of California, that’s what I am hearing from other parts of California.”

The speculation is that the older men who have sex with men are just tired of three decades of AIDS and safe sex.

“There are some [barebacking] trends among the men who are getting older. They are finding they have worn condoms for a while and now they are not wearing them,” Zians added.

Barebacking is also on the rise in the older population, the retiring Baby Boomers. According to the CDC, 30 percent of new HIV/AIDS cases nationally were in people older than 45. In San Diego that number is around 38 percent for men older than 40.

“One of the challenges in people 45 and older is the mistaken belief that they’re not at risk,” said Dr. Robert S. Jannsen, director of CDC’s division of HIV/AIDS prevention. Jannsen warned that older patients, raised before the AIDS epidemic of the 1980s, are less likely to see the importance of using condoms. Stereotypes and lack of awareness about the older generations’ sexual activity is another challenge.

While it is difficult or almost impossible to estimate which group has a higher percentage of barebackers, all experts can testify that barebacking is on the rise among all age groups.

There are many explanations that support barebacking trends and rationalize, if not support, sex without a condom. There are an equal amount of arguments against it, advocating a safer approach to sex. True barebackers use these points to justify their actions, while safe-sex educators counter with health-related facts and figures.

“We have a fairly significant population out there, whether you want to call them barebackers or not, who have made informed decisions not to use condoms as part of their regular sex practice. At the same time, we’ve got community organizations and government health agencies who continue to come to us with this singular message of, ‘Use a condom every time,’” Scarce said. “Inevitably, there’s this ‘good gay, bad gay’ routine that gets played out in public. I think it’s going to get ugly.”

The Family Health Centers of San Diego conducted a survey as part of its HIV Behavior Change Campaign in November 2004. The survey is considered the most up to date and complete information for the sexual practices of gay men in San Diego. Of note, one of the questions asked men for the “reasons for not using a condom when having anal sex.” These were the top answers:

Being in a committed relationship: Most men used this reason as their answer, 68 percent.

“There’s a whole idea of when people are in a relationship – or what’s called ‘negotiated safety,’ where you are negotiating with a regular partner – that you will not use condoms with each other, but you will [with] everyone else,” explained Zians. “Health experts have difficulty with that because there are still health risks involved. Because you get people who are switching back and forth from using a condom to not using a condom, they struggle with condom use.”

I am a top: The number-two answer for barebacking was “I’m a top,” or guys that fuck.

According to the Gay Men’s Health Crisis Web site: “For the guy who is penetrating [the top], it’s more difficult to get HIV because of two factors. One, the top would have to have contact with blood from the bottom’s anus, which may or may not happen. The second factor is that the urethra is a small opening, so it’s harder to get your partner’s blood into your bloodstream through the hole. For these reasons, it’s more difficult for the top to get HIV than for the bottom, but it does happen.”

Already HIV positive: The HIV-positive group stated that many men who are HIV positive only have sex with other men who are HIV positive, and, therefore, are less concerned about using condoms, according to the survey.

“Barebacking between two people who are positive is still a high-risk activity, because of … different strains of HIV,” Cunningham said. “Not only HIV, but other sexually transmitted diseases.”

Cunningham continued, “Anyone who is HIV infected and engages in unprotected anal intercourse is opening themselves up to the potential of contracting a whole array of diseases because their immune system is less functional than someone who does not have HIV.”

It’s important to point out that not all positive men bareback. “The studies are showing that the HIV positives and HIV negatives don’t look that different [demographically],” Zians said. “Some negative men are practicing unsafe sex, many of them are practicing safe sex; as with the HIV positive, some of them are and some of them are not.”

Condoms reduce sensation: Participants said that condoms reduce the intimacy of skin-to-skin contact.

“Back in the ’80s, the prevention specialists said, ‘Sex is just as good with condoms.’ You can’t give messages that aren’t true,” Zians said. “You can learn to have satisfying sex using condoms. People who have difficulty with a condom should use one all the time. Over time, you will adjust to the condom and you will have more and more satisfying sex. The benefits are enormous.”

Drug use: A story about barebacking would not be complete without discussing crystal meth, said one source. Although drug use in the gay community is a story itself (see Gay & Lesbian Times issue 907, May 12), there are direct connections to the barebacking phenomenon. “Alcohol and other drug use is often a factor in unsafe sexual behavior,” the Family Health Centers survey cited. The “other drug use” is crystal methamphetamine.

“Link Between Methamphetamine Use and Sexual Risk Behavior,” a study released by the CDC in January 2005, concludes that meth use is consistently associated with unprotected anal sex among gay men. More than 80 percent of meth users are barebacking, according to the CDC study.

“We know that if you use methamphetamines, you have twice the rate of HIV sero-conversion than non-methamphetamine users among men who have sex with men,” Zians said. “There is the theory that the drugs impair your judgment, and therefore it is because of the drugs that people aren’t using condoms.”

Reclaiming sexual identity: Although not on the Family Health Centers’ survey, there is a recurring theme among the true barebackers that sex without a condom is a reclaiming of their sexual identity. Scott O’Hara was one of these first outspoken advocates of taking back what HIV/AIDS had taken away.

“I know there are books that have been written about how gay men have to reclaim their sexuality because that’s a defining marker of who they are,” Cunningham explained. “That’s fine. Be sexual. But be sexual responsibly. If anybody is preaching anything other than that, they are asking people to put their lives at risk. I don’t think any orgasm is worth your life.”

AIDS is livable: Another reason cited among those that bareback is that HIV/AIDS is a livable disease. Before 1990, men who tested positive for AIDS had a 95 percent fatality rate. In San Diego, there were at least two deaths per day even up through the early 1990s. This year, however, there have only been four deaths in the past six months, and the fatality rate is down to 3 percent.

By the numbers, HIV/AIDS is not as frightening as it used to be. “On the surface, no it’s not scary,” Cunningham said. “If you scratch that surface, you see a different picture. I think if you ask anybody with AIDS, they will give a whole different perception than that.

“We don’t have the markers we used to have,” Cunningham continued. “You don’t walk through Hillcrest any more and see the walking dead, the people where you didn’t know if their next step was going to be their last one. You don’t see the posting of the memorial services that we saw when we had hundreds of people dying a year.”

Barebackers also cite the number of community organizations and government agencies that offer support – from medication funding, housing assistance and job placements to free services like haircuts, massages and laundry. As new cases have leveled since the late 1990s, there is an unspoken, politically correct movement to present HIV/AIDS as a mainstream disease. Since it is no longer the epidemic it was a decade ago, politicians are less likely to fund government support agencies.

“Who knows when that free ride is going to stop? We’ve lost a million dollars for the Ryan White funding in the last two years,” Cunningham said in reference to government funding that is available to HIV/AIDS patients only as a last resort. Even with MediCal, Medicare, Social Security Insurance (SSI) and Ryan White funds, Cunningham said the average monthly income of consumers is only $780.

In addition, backlash against the bareback movement is giving community organizations – individuals, at least – a chance to question their support of a disease that is preventable. That sentiment was first heard when Scarce and Valenzuela conducted their barebacking workshop in 1998.

“There was a woman who stood up in the audience and she was livid,” Hoffman recalled. “She screamed at him and she said, ‘How dare you? We fought for funding for you, we marched in AIDS Walks for you, we demonstrated with you and we held your hands in hospitals … we did all of these things. Now you know better as a young gay man, and still you do this. If you are going to do that, then we’re going to stop supporting you.”

The support does continue. Those communicating the safe-sex message have a challenging job. They have to counter the bareback advocates, teach a new generation about the risks involved in unsafe sex while holding onto the current generation’s attention, and constantly evolve their message to avoid falling victim to safe-sex message fatigue.

The biggest challenge, however, is the budget. Not only did the Health and Human Services Agency lose money for the Ryan White CARE Act, they also lost $1.3 million in funding for preventative campaigns, down from $3 million.

“Try to do any kind of behavioral change education with $1.7 million when you got 3 million people out there that need to hear a message,” Cunningham said. “We should be putting $10 million into prevention, but we’ve only got $1.7 [million].”

Cunningham warned that new money is not going to be coming any time soon, either.

“How do I justify [to the politicians] putting money into a behavioral change campaign to a population that is a subpopulation that is a subpopulation engaging in a high-risk activity that is preventable?” Cunningham asked. “At some point in time, the party is going to end, and it’s not going to be pretty.”

“It’s very difficult to educate people and get them to use condoms. The education involves being ready, willing and able; feel like you are at risk, and you are ready to do this,” Zians said.

Still organizations like Cunningham’s and Zians’, plus the Family Health Centers of San Diego, the CDC and an array of other associations throughout San Diego, will continue to communicate their message.

“If we change one person’s behavior so they don’t get infected, so they don’t have to go through the psychological, emotional, physical and societal ramifications of having this disease, then we’ve saved a life,” Cunningham said. “I think we save a lot of lives all the time. I think we save a lot of lives by telling people to get tested so they know they are positive or they are negative. We save lives by educating people who are negative how to stay negative. We save lives by telling people who are positive that life is worth living and here is how [to have] a good quality of life and be respectful of your partner. I see people who are not listening. It’s difficult to see, but sometimes that message gets through. I think that makes it worth it.”