Barebacking Troubles HIV Prevention Programs
Appeared in The San Francisco Examiner
For Ron Davis, a 33-year-old San Francisco gay man, sex is a thrilling game of Russian Roulette. Davis plays this game of life and death every time he has sex, skipping the condom, and not because he's in the heat of the moment.
That scares officials at the Centers for Disease Control and Prevention in Atlanta who studied the phenomenon, but reaction in San Francisco remains conspicuously silent - not just with gays, but with prevention authorities as well. For a city that prides itself on its commitment to HIV prevention, strikingly little has been done to keep barebacking in check.
According to a CDC study released in April, 14 percent of San Francisco gay men 'bareback' or intentionally practice unsafe anal sex with someone other than a primary partner. It's the intentional practicing of barebacking that scares the CDC the most. Gays are hungering for something racy or taboo and have found an outlet with dire consequences.
Experts say barebackers may have self-esteem issues that draw them towards unsafe sex practices. Doing something unconventional or recalcitrant seems to empower barebackers. For Davis, it's a way to feel better about himself and gain emotional connections that he feels is lacking. But how barebacking fills the void still puzzles researchers.
At 33, Davis is a generation behind the devastation and public awareness campaigns of the late 80's and early 90's when San Francisco was marred by a real fear of HIV infection. Which leads some activist to wonder if today's generation is filled with apathy, ignorance or denial when no longer confronted with frequent funerals.
Meanwhile, most prevention programs continue to emphasize the merits of using a condom - a message that has lost much of its effectiveness. With improved HIV treatments and a sense that the worst is behind them, more and more gays are turning a blind eye towards the mainstream prevention message.
But San Francisco's multitude of HIV prevention authorities and nonprofits has been reluctant to address the growing rate of barebacking. To be fair, experts say the phenomenon is new and some prevention programs are in the works. But still, the trend has the CDC rousing local communities to target individuals like Davis with a broader prevention message.
According to experts, prevention programs for barebackers require a more holistic approach to prevention -- incorporating emotional wellness and spirituality as well as the health aspects. And the most powerful weapon claim experts is to help barebackers build and foster intimate relations outside of sex.
Barebackers not only risk HIV, but many other STDs. Studies show syphilis and gonorrhea on the rise. This dangerous trend caused the CDC to go one step further in May: urging doctors to push gay men to test for STDs every six months.
San Francisco's STOP AIDS Project acknowledges that prevention groups are concerned by the increase in unsafe sex, but aren't yet armed with tools to counter barebacking. "It's happening everywhere and it's very concerning. The first step is getting people to talk about it and then to understand that preventing AIDS is a lifelong commitment," says a STOP AIDS spokeswoman.
In the meantime barebacking promises to undermine the drop off in HIV transmission if the phenomenon isn't dealt with quickly. It's an issue that will require the support of government, non-profits and individuals. The CDC took the first step in describing barebackers, but its now up to San Francisco to emerge again as the leading city in HIV prevention.
