‘Social Work’ Study Examines Psychosocial Factors And Drug Use In Barebacking

December 4, 2006 – “Condomless sex: gay men, barebacking, and harm reduction,” by psychotherapist Michael Shernoff, MSW, was published in Social Work, April 1, 2006.

Shernoff’s report surveys the current research on barebacking, including discussions of crystal meth use and various psychosocial factors that contribute to individuals engaging in risk taking behaviors.

Shernoff also notes that gays who practice safer sex for years are experiencing safe sex fatigue or burnout as a reason to return to unsafe practices such as barebacking.

High-risk behaviors have been linked to the advent of HIV antiretroviral therapy and provide gays with a misplaced sense of complacency. “Many believe that contracting HIV is not a big deal anymore – certainly not a risk to life,” said Shernoff.

In addition, party drugs have spawned an increase in barebacking. These include esctasy, GHB, ketamine, and crystal meth. Research has shown that the use of crystal is clearly related to barebacking among gay and bisexual men in sexually charged venues such as circuit parties, which can last several days.

The Internet has also contributed to an increase in barebacking, according to Shernoff, as gay males can easily find others who are willing to bareback.

Barebacking can be used as a way of meeting interpersonal and interpsychic needs. According to Shernoff, “It is all too easy to adopt a reductionistic approach and pathologize sexual risk takers as self-destructive, suicidal, damaged individuals or to believe that ‘for some gay men danger is a permanent fetish,” (Savage, 1999, p. 62). … It is the task of clinical social workers to help an individual articulate the particular meanings of his high-risk behaviors.”

Shernoff urges counselors to deal with this issue in a non-judgmental manner and to urge harm reduction behaviors for those who continue to bareback. One harm reduction method is to sign a mutual “negotiated safety agreement” on what each man expects during barebacking.

Writing for the Gay Health web site, Shernoff describes some of the other harm reduction practices, which include “serosorting,” which means having unprotected anal intercourse with a men who have the same HIV status; “strategic positioning”: where the infected male adopts the receptive bottom role during unprotected sex; “assessing the viral load”: using information that they or a partner have undetectable viral loads to make decisions about whether or not to bareback; “substitution”: using oral sex as a substitute for anal sex