Middle-age gay men who were sexually active before the onset of the AIDS crisis, are foregoing the use of condoms (Bonnell, Weatherburn, & Hickson, 2000). Men of all ages are engaging in barebacking. Many gay men of color cite social inequities that result in lower education, lack of access to health care, substance use, and poor mental health as contributing to apathy regarding sexual risk taking (CDC, 2002a Gomez, Mason, & Alvarado, 2005). Internalized homophobia can contribute to barebacking by creating an unconscious sense that a gay man is unimportant and undervalued, thus increasing his sense that he is expendable, and so too are the men with whom he has sex and from whom he seeks love and validation. Environmental stressors such as racism, homophobia, and economic disadvantage may play a role in the rise of barebacking. Loneliness, HIV status, unmet intimacy needs, alienation from the gay community, and love might well warrant consideration as well. These include attitudes toward condom use (Van de Ven, Prestage, French, Knox, & Kippax, 1998) the relevance of risk in committed versus noncommitted couples (Elford, Bodling, & Sherr, 2002) identification with the gay community (Seal et al., 2000) the combined effects of internalized homophobia and racism on young gay men of color (Seal et al.) internalized homophobia (Meyer & Dean, 1998) a sense of fatalism (Kalichman, Kelly, Morgan, & Rompa, 1997) and the effects of substance use (Halkitis & Parsons, 2002), depression, antigay violence, and childhood sexual abuse or substance abuse (Stall et al., 2003). Research has explored a wide variety of reasons gay men engage in bareback sex. The rates increased most among white men, followed by black and Hispanic men. At the 2003 National HIV Prevention Conference, the CDC reported the number of gay and bisexual men diagnosed with HIV during 1999-2002 increased 17 percent (CDC, 2003).
Sexual behavior that poses a risk of transmitting HIV is on the rise among all men who have sex with men (MSM) (CDC, 2002b), but this article is limited to men who identify as gay or bisexual. Also known as "barebacking," the practice is occurring among most sectors of gay-identified men, and it has been studied specifically among white, black, and Latino men in New York City (Halkitis, Parsons, & Wilton, 2003) San Francisco and New York City (Parsons, Halkitis, Wolitsky, Gomez, & Seropositive Urban Men's Study Team, 2003) Detroit and Milwaukee (Seal et al., 2000) and Baltimore, Dallas, Los Angeles, Miami, and Seattle (Centers for Disease Control and Prevention, 2002a). But many are returning to the ways of sex before the onset of AIDS-having unprotected anal intercourse (UAI).
During the first wave of the AIDS epidemic, sexually active gay men began using condoms during anal intercourse (Martin, 1987).