arebacking, bug chasers and gift givers are some of the expressions of a subculture that claims that "safer sex is not real sex, it’s pretend sex," a recent trend of unknown origin and yet-to-be-determined impact on the spread of the HIV epidemic.

Barebacking  or intentional anal sex without a condom with someone other than a primary partner  is a sexual behavior that has become more prevalent in the last two years. In 2000, a review by Goodroad et al. [PubMed] described it as "a new phenomenon different from previously identified 'relapse' unsafe sexual behavior." Nowadays, the behavior is disseminated by web sites such as Barebackcity.com and Xtremesex.com, that market videos showing unprotected sex to the homosexual community, and have the potential to compromise AIDS prevention efforts worldwide.

Earlier, in an article entitled "Protease dis-inhibitors? The gay bareback phenomenon" Nicolas Sheon and Aaron Plant, associate editors of HIV InSite, say that new treatments based on protease inhibitors and other antiretroviral drugs have changed the perception of risk of contracting HIV for many gay men who now believe that the benefit of unsafe sex outweighs the risks. "The new treatments have led some men to conclude that the consequences of HIV infection for themselves or their negative partners have been minimized," they say. The latest available annual report produced by the San Francisco Department of Public Health (2001 San Francisco HIV/AIDS Epidemiology Annual Report) has some alarming data on sexual risk behavior among men who have sex with men (MSM). The department surveyed MSM reporting unprotected anal intercourse in the previous six months for the years 1998 to 2001 (see graph), and MSM reporting unprotected anal intercourse with multiple partners in the previous six months for the same years (see graph). While both measures of unsafe sex have increased in the last years, the proportion of MSM practicing unprotected anal intercourse with multiple partners is alarming.

Others believe that the phenomenon is a reaction to years of failing efforts to adequately address the complexity of sexual behavior and related issues among gay men. Additionally, too much attention has been focused on anal sex as a risky activity, giving a symbolic meaning to a practice that many now see as an act of deep intimacy and true love, where the virus itself achieves a level of fetishism, eroticism and glamour.

A recent study by Mansergh et al. [PubMed] showed that "increased physical stimulation and emotional connectedness were the primary reasons for barebacking." The sample analyzed included 554 MSM from different ethical backgrounds and nationalities. In this sample, approximately 10% of the individuals practiced barebacking. A different view of the phenomenon was recently suggested in an article published in AIDS Alert. The article [PubMed] suggests that the epidemic of methamphetamine use in gay nightclub and party circuit settings is closely related to the phenomenon of barebacking, because under the effects of the drug men are led to engage in barebacking and other risky sexual behaviors.

Barebacking is not the only phenomenon in the AIDS epidemic attracting media attention or gaining notoriety among the public health workforce. Bug chasers comprise another alarming new trend. Bug chasers have been defined as HIV negative individuals who want to become HIV positive through an anticipated and desired conversion carried out by a ‘gift giver,' an HIV positive individual purportedly willing to infect other individuals.

Based on the belief that HIV/AIDS has become a chronic manageable disease, bug chasers and gift givers are creating a type of brotherhood in which the HIV virus represents life rather than death and unprotected sex is the expression of true love. With the AIDS epidemic spreading into many countries worldwide the need for an HIV vaccine has never been higher. It is yet to be known whether phenomena like barebacking and bug chasing will acquire more significant proportions, compromising future vaccination efforts in some countries. It has already been predicted that an HIV vaccine will likely provide only partial efficacy, which could leave many vaccinated individuals with a false sense of protection. This will undoubtedly increase the risk of HIV transmission.

Behaviors such as barebacking and bug chasing indicate how some people react under the erroneous assumption that AIDS is a disease under control. But that's not all. This kind of behavior also brings just another wrinkle to the developing debate on the risks, consequences and value of an only partially effective HIV vaccine.

See also "Prevention efforts ignore late-night crowd, study finds," from the CDC HIV/STD/TB Prevention News Update, February 19, 2003.

*Associate Editor, AIDScience