Why unprotected sex is just too risky

BAREBACKING, or unprotected sexual intercourse between men (MSM), is prevalent and risky.

Men who use location mobile apps to find male sexual partners were the subject of the Zero Feet Away survey recently conducted by New York’s Community Health Network.

46% of respondents said they “always, often or sometimes” engaged in barebacking. The extent of the activity becomes more apparent when you consider more than 4m men in 192 countries use Grindr, just one of the dating apps included in the survey.

In February this year, Facebook removed a community page dedicated to barebacking, though it had more than 20,000 ‘likes’. The page was further confirmation that as perilous and irresponsible as barebacking might be, there’s an appetite for it.

As for the reasons why so many people engage in the practice, Dublin GP and sexual health expert, Dr Shay Keating, says, “Barebacking is widely promoted on the internet, on mobile phone dating apps and on dating sites. It is widely practised across all age groups in Ireland.”

Jimmy Goulding, spokesperson for lobby group, Positive Now, says people engage in unprotected sex for diverse reasons. “For some, it’s a search for deeper emotional connection. For others, it’s the thrill of having bareback sex with HIV positive men.”

Assumptions play a role in the reasons why people intentionally have unprotected sex, says Susan Donlon, prevention education and training co-ordinator at Dublin AIDS Alliance.

“There’s an assumption that those who bareback are HIV negative and that those who haven’t tested for HIV are not infected.

“There’s also an assumption that those who don’t say they’re HIV positive are HIV negative.

“The reality is that 30% of those who are HIV positive in Ireland do not know they are, so we encourage everyone engaging in risky sexual behaviour to get tested regularly.”

For respondents to the Zero Steps Away poll, the reasons for engaging in unprotected sexual intercourse were carnal and emotional — 62% agreed barebacking was ‘hotter’ than safe sex, 45% agreed it was ‘sexier,’ and 42% said they did it because it increased intimacy.

While ‘hotter’ and ‘sexier’ are subjective terms, many people decide against using condoms because they prefer having sex without them. The manufacture of more aesthetically pleasing varieties, which would substantially enhance rather than diminish sexual sensation, might encourage more people to use them more often.

Origami Condom, a small US company, is working towards that goal. In 2005, they patented silicone condoms designed to enhance sensation from the inside rather than from the outside, as some latex varieties do.

Other Origami innovations include a male condom that slides rather than rolls on, and an anal condom designed to be inserted into the receptive partner.

The latter will launch in 2015, if FDA, and other necessary approvals, are obtained.

As for the popular belief that barebacking increases intimacy between men, Ann Matthews, a psychosexual therapist at Mind and Body Works, is not convinced.

“Unprotected sexual intercourse is not a short-cut to intimacy. Risky behaviour is not conducive to trust and respect, both of which are central factors in the creation of emotionally close bonds,” she says.

For one young Irish man, who lives in London and prefers to remain anonymous, the reasons for engaging in unprotected sexual intercourse with men are straightforward. “For me, it’s a show of trust, a search for closeness with the man I want. It’s about giving that man what he wants. If he wants bareback, I give him that,” he says.

“Nobody in my set uses condoms. We have no fear of HIV. If we get it, we’ll take pills and life will go on.”

He says that while he has been treated for STIs on “a couple of occasions,” this wasn’t something that bothered him.

As for using condoms to protect others, if not himself, he says. “Barebacking is a personal choice, with every man taking responsibility for himself.”

Commenting on this young man’s take on barebacking, Matthews says: “He’s engaging in group think. That’s an easy route to take, as it means he doesn’t have to think for himself.

“Barebacking reflects a lack of self-value,” she says.

“It can be driven by low self-esteem and by a feeling that you don’t deserve, and can’t ask for, what’s best for you. It can reflect an unconscious desire to self-sabotage.”

Twenty years have passed since homosexuality was decriminalised in Ireland. Attitudes have changed. In movie terms, the Irish perception of MSM relationships is now more Brokeback Mountain (romantic) than Philadelphia (doomed).

One of the factors that brought about that shift is that a HIV diagnosis is no longer a death sentence. This was confirmed in a recent study, which found that those who are on anti-retroviral therapy (ART) have no higher risk of dying than those who do not have the illness.

While advances in medical science have removed the fear of AIDS as a death sentence, that fear seems to have been replaced by a worrying complacency towards HIV. Because Irish heterosexuals receive little encouragement to test for HIV, the number of diagnoses remains low and the true prevalence of the condition, in that population group, remains unknown.

“We target the MSM and migrant populations to test for HIV, because there’s an increase in positive diagnoses in those groups,” says Susan Donlon, prevention education and training co-ordinator at Dublin AIDS Alliance.

“Last year, we recorded 341 new HIV diagnoses in Ireland. That represents a 7% increase on the previous year — 49% of the new diagnoses were among MSM. Sex between men is the predominant mode of HIV transmission in Ireland and MSM is the population group most affected by the virus.

Other groups are also at risk. “These include heterosexual teens who have anal sex in an effort to lower the chances of pregnancy resulting from unprotected intercourse,” says Donlon. “It’s not because a man has sex with another man that increases his chance of testing positive for HIV. It’s the type of sex he has which increases that risk.”

Dr Shay Keating agrees. “While we associate the transmission of HIV with the MSM community, any person who has sex can become infected orally, vaginally or anally,” he says.

One who works hard to spread the message about the life-long damage HIV can cause is Goulding, who was diagnosed with the disease in 1990. “There’s a belief that because it can be treated, HIV is easy to live with, but this is not the case. The treatment is life-altering and there are massive side-effects.

“It can cause bouts of constant diarrhea and fatigue, and there’s an increased risk of heart-attack, and of getting old people’s diseases before your time,” Goulding says.

“HIV is a chronic illness,” says Dr Keating. “We can’t cure it, but we can treat it. This involves taking potentially dangerous meds for life.

“While these medications appear to be safe, there’s a possibility that they could damage the stomach, liver or kidney, or cause bone disease, in the longterm. ”

“For too many, the message isn’t getting through,” says Goulding. “One in four gay men in Ireland is HIV positive and doesn’t know it. Too many wait until they get STIs before testing. This is not a good idea. It’s important to test regularly, especially if you’re having bareback sex.”

Goulding says that those who are not testing for HIV, and who use dating sites to have unprotected sex, play a role in spreading the virus.

“The fact that HIV positive people are often disinclined to assert their status on dating sites makes it more difficult for potential partners to correctly identify risk,” Goulding says.

Treatment is most effective in the early stages of infection. “The saddest part of the HIV story is the number of people who are positive and don’t know it,” says Dr Keating.

“This largely comes down to a reluctance to test. Between 30 and 40% of Irish gay men have never tested for HIV.”

For who those who have recently had unprotected sex and are fearful for their health, Dr Keating recommends post-exposure prophylaxis (PEP).

“This is an emergency medical treatment, which is available to those who have taken a significant sexual risk within the past 72 hours. It substantially reduces the likelihood of infection and it’s available free at most STI clinics and A&E departments,” Dr Keating says.



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