Facilitators of barebacking among emergent adult gay and bisexual men: implications for HIV prevention.

We undertook a qualitative study to develop a greater understanding of "intentional" unprotected anal intercourse among drug-using gay and bisexual men, also known colloquially as barebacking. In our analysis, we investigated this behavior in a subset of 12 HIV-negative men in the early adulthood stage of life to disentangle factors that functioned as facilitators of barebacking, a behavior that may place these men at risk for HIV infection. Based on thematic analysis of life-history interviews, we delineated 4 main themes associated with barebacking: drug use, the role of responsibility for safer sex, misunderstandings about HIV transmission, and underlying mental health issues. The data suggest that lack of knowledge about HIV transmission is insufficient in explaining risk-taking. Rather, rationalization processes may be a factor in the sexual risk-taking behaviors of young HIV-negative men, and moreover, deep intrapsychic processes (often heightened by concurrent substance use), and the desire to please sexual partners may drive the decision-making of these men. Future intervention strategies must motivate and empower young men to seek support for the states that drive sexual risk-taking.