Category Archives: anal sex

Bareback.com?

So perhaps these websites for men interested in bareback sex have been around for a while, but I have been unaware of them.  Recently, a friend informed me of one such site, barebackrt.com, however several more exist.   At first I wasn’t quite sure what to think.   Upon digesting this concept some more, I came to an initial conclusion that perhaps these sites could serve as an online forum for serosorting i.e. a place where HIV+ men could find other HIV+ to have bareback sex with, and where HIV- men could presumably find other HIV- men for bareback anal sex.

Indeed, this is what bareback.com, the “original bareback only site” envisions:

“Now at BareBack.com you know that we are not AIDS Nazis, condom wrappers or fearful fools! What we are is a community of gay men who like the feel of raw nasty sex and want the whole world to be able to spray our holes!

That’s why we embrace a policy of containment. What does that mean – It’s simple. If poz boys stick to poz boys and neg boys stick to neg boys AIDS will be over. It’s just that simple.”

Or is it?  So although the same site site intro states that “The only drugs you should use should come from your doctor! Nothing makes you more likely to fuck up, get sick or be an asshole than poppers, meth or other party drugs.” So, I can say that I have heard negative men, who know they are negative, fucked up by drugs, tell me that they have used this site to search for men, and HIV status was irrelevant – the bottom line was the negative men just wanted bareback sex and such sites were the easiest place to find it.   Then of course there are the men who don’t really know if they are negative since they haven’t been tested (the site encourages people to know their status), but just like to assume that they are negative even though they have had unprotected sex with everyone under the sun, because it is easier for them to personally accept.  Such “negative” men will go onto to have sex with men who truly are negative who utilize the site.  Also, positive men may not always sero sort, and may have sex with negative men who agree to take the risk of having bareback sex with a positive man, simply because they like bareback sex.

While I am not judging anyone’s sexual preferences (I can not with a clear conscience say that plastic up one’s ass is sensual or comfortable), I guess the thing that irks me about such sites as a physician and public health practitioner, is that there are no sites (at least that I know of) promoting dirty needle use  for IV drugs or unsafe blood transfusions.  While I acknowledge men who want to have bareback sex will, and will find any avenue to do so, why must we create an avenue to directly promote this behavior? Why can we not have a “safe only” site? Upon googling I have found nothing.  While mainstream sites such as Grindr and Manhunt allow users to state their safe/bareback preference, are there sites dedicated exclusively to safe sex?

As bareback.com notes, users need to be made aware that not only can HIV be contracted by bareback sex, but other STDs such as gonorrhea and herpes can also be shared between bareback partners.   I just still can’t see the value of such sites from a HIV eradication/prevention standpoint.  Perhaps someone can comment to offer me some insight?  I know the mainstream porn movement has sought to not glamorize bareback pornography, and this is a battle that is still being fought as one can find bareback porn as easily as they can a hookup on Grindr.  In my ideal corner of the earth, I would hope that everyone using such sites was already aware of their HIV status, understood the risks that bareback sex poses, and made an educated choice which would put both them and their partner at the least risk possible.

Has anal sex gone out of vogue? What does this mean for HIV prevention?

Note: Since posting this article I was able to look at the full text of the study, which does ask participants questions about condom use at last encounter.  Roughly about 33% of respondents state that they used a condom at some point during their last sexual encounter, with almost half of those that have had intercourse stating a condom was used.  However, the article does not go onto the provide more specific analysis on condom use, since it is difficult to extrapolate generalities regarding condom use, based on information about singular encounters

So the Advocate recently reported the findings of a large-scale survey on sexual behaviors.  Apparently, only 37.2% of over 24,000 gay and bisexually identified men indicated that their last sexual encounter consisted of anal sex.   The most practiced activities were kissing (almost 75%) and mutual masturbation (73%).

The survey, entitled  ‘The Gay and Bisexual Men’s National Sex Survey’ was sponsored by Manhunt,  its sexual health affiliate Manhunt Cares (see my past post here about them) and  its research partners,  present the findings in a cutesy interactive graphical form which can be accessed from clicking on the picture on the left (i.e. I found out that 80.8 % of surveyed men have eaten cum at some point in their lives!) The abstract of the study, which appears in the Journal of Sexual Medicine can be found here.

Now before we give up our lube and condoms and other devices we find makes our anal sex experience more comfortable, there a few things to keep in mind.  For some reason, the majority of respondents in this latest conducted by researchers from Indiana University and George Mason University were Caucasian males.  Perhaps results would be changed if there was some diversity in the subject pool.  Also, one should note that the respondents were “self identified” gay or bisexual.  Perhaps if behaviors of non-identified men who have sex with men, (i.e. heterosexual identifying men) were recorded the results would also show a higher indication of anal sex.  However, I like the point that one of the commentators made:   Anal sex does require a lot of effort (much like vaginal penile sex as well) and perhaps people don’t want to go through such effort simply to get off.

First, usually the receptive bottom has to be sure that they have maintained proper ass hygiene – for some folks this means just a thorough cleaning in the shower, however for others this means anal douching (see my past insightful entry on this issue).  Then, both inserter and receptive partner both need to be properly lubricated.  Any condom needs to be applied, towels need to be made readily available to absorb the lube and any other pre and post-fucking products,  and finally one may fuck.  For some individuals this ceremonial ritual just may not be worth it.  I am not one of these people, but I can see the non appeal.  Additionally this survey stated that 40% of men surveyed said that their sexual encounter was with someone who they were in some way committed to.  For many couples anal sex is a special sex act, that does not have to be performed during every sexual encounter.  In my opinion, I seem to see anal sex as the final act in the play of random hooking up (especially bar sex) but I personally tend to think couples in a relationship have generally been with each other so long they have other ways of turning each other on and understand that anal sex is not a necessity.

I don’t think this study can necessarily tell us too much about HIV prevention strategies, or where they should be aimed.  As some may know, receptive anal intercourse without a condom is the most risky sexual activity one can perform in terms of HIV acquisition.  And although we know that only 40% of these Caucasian gay identified men admit to having anal sex, we don’t know anything about condom use (I couldn’t find anything about condom use at last anal sex in any of these graphics).  So, it can be assumed that a portion of those having anal sex (or oral sex) are having unprotected sex.  Additionally, we can assume that many of these surveyed men did either not know their own or their partners HIV status (which is likely given that 60% of the sex acts were recorded to be with people whom the respondent was not intimately partnered with.) So this our crusade most likely should continue.  Even if anal sex is supposedly  not the most common sex act, it is the most risky, and deserved to still receive, in my opinion, the bulk of prevention attention directed toward MSM.  However, additionally since oral sex almost seems to be universally practiced, individuals should also understand the risks of such behavior, especially with an individual one does not know, including herpes and other sexually transmitted infections.

So in my opinion, while interesting, and while it sheds light on the sexually behavior of a self selected group of gay and bisexual individuals, this survey does little to give us insight into HIV prevention. But I guess that was not its intention.  However, I would expect that a survey carried out by Manhunt and partners would include information on condom use. (see note above: it does).

Salaam to HIV – MSM HIV Epidemic in the Middle East

Salaam alakoom friends (hello in Arabic).   In the first study of its kind, researchers from Cornell University in Qatar have concluded that concentrated epidemics (infection rates above 5 percent in a certain group) among men who have sec with men exist in Egypt, Sudan, Pakistan and Tunisia.  There is little data on this region where homosexuality is considered taboo.  According to one researcher quoted in the article, the region is like a “black hole” in the global HIV data since such little data is available.  The research has found “considerable and increasing epidemiological evidence on HIV and risk behavior among men who have sex with men” in the region.

The findings are not surprising  – in  2008 researchers found that  HIV transmission via anal sex among men was responsible for more than a quarter of notified cases of HIV in several countries in the region.  This is not surprising given the fact that sex, let alone homosexuality is rarely if ever discussed in the region.  Men who have sex with men have no resources to turn to for sexual health services, and like in many societies must have underground sex.  In such scenarios without education and intervention and acknowledgement from NGOs and the government HIV spreads outside of the MSM population to the general public – although the article states that in Lebanon and Pakistan NGOs have emerged to deliver services to this highly hidden population.  Education, education, education – remove the stigma of homosexuality and the barriers to service that prevail.  It won’t happen overnight – but neither did the spread of HIV. Oh yeah – I forgot its also illegal for men to have sex with men in 18 out of 21 countries in this region.

HIV is hottest at the start

In browsing the web, I cam across a new provocative and racy HIV testing campaign aimed toward MSM in Vancouver, British Columbia, Canada.  The campaign, called “HIV: It’s Hottest at the start”  compares acute early HIV infection to hot early relationship (or hookup?) sex.  Much like sex with a new partner has an element of thrill and spontaneity, the campaign goes on to state that HIV is extremely infectious in the early phases infection, and if one doesn’t know their status in the early phase and has unprotected sex, they can very easily pass the virus to others.  The ads encourage individuals to take a new HIV test (which I must admit I didn’t know existed) designed to detect HIV infection within the last 10 days.  The new test detects the HIV virus, as opposed to the traditional tests which detect antibodies, which may take up to three months after infection to appear.  The ads inform individuals that if they are fucking without condoms during this early “hot” phase of HIV infection it is easy to spread the disease.

The campaign is designed and carried out by HIM, Health Initiative for Men, a community health organization strengthening the health of gay men in Vancouver.

I am not sure how I feel about these ads.   It appears that they are targeted at men who bareback as the ad states ” If you fuck without condoms and aren’t completely sure of your partner’s HIV status, get tested.”   Somewhere deep inside of me (no pun intended) I feel like anyone fucking someone with or without condoms who doesn’t know the other individuals status should get tested.  However, I suppose in order to maximize resources, HIM has chosen to focus on the more risky population: those who bareback in sero-unknown partnerships.  And, the ad does encourage condom use as a means of prevention if you go on to read. I guess part of the idea was to eroticize HIV associating it with carnal sex, rather than stigmatizing it.  “Hey if I have hot wild sex unprotected sex with the man I just met in the elevator or bath house then maybe I should get tested since I (or he) can have HIV and not know it and spread it to others easily in its early phases.  Why not? I’ll know within 10 days of my risky exposure and then can continue the hot affair.”   HIM seems to say that they are promoting sex-affirmative and sex-positive messaging, and that such explicit campaigns have higher message recall.

I’m not against the sexual messages – hell I love hot men engaging in sex acts.  However, I just can’t quite tell what their message is.  Any thoughts?

Can lube actually increase risk of HIV transmission?

So, as my post on anal douching was one of the highest read, I have decided to try to make the blog a little more ‘titillating’ so to speak.  Something of interest to all of us men who have sex with men (and basically all individuals who have sex) is lubricant, more affectionately referred to as ‘lube’.    So many different kinds that when you go to your nearest sex shop you may feel like a lost kid in a candy store.

Last year, an article in POZ magazine discussed the results of a very small trial which showed that individuals who used lubricant  were more likely to acquire rectal STIs and HIV.  This flies in direct contrast of everything I think I was ever taught about harm reduction, mainly that water or silicone based lubricants may help to decrease the risk of acquiring HIV transmission due to the lubrication.  Additionally, the study investigated the safety of several popular lubes, and found that some even wipe out colonies of good bacteria or epithelial cells in the rectum, which would explain some of the reason why such lubricants would increase the risk for HIV transmission.

While I don’t have enough evidence to state whether lube or not is best for bareback anal sex (I can sure as hell say lube makes it more comfortable) the one thing I can say with certainty is that condom sex is best.  And don’t forget to only use water or silicone based lubricants with condoms.  So what’s your favorite lube?

To douche or not to douche?

So I’m sure that anal douching is not a topic that we frequently discuss over dinner or coffee.  However, as some MSM know, anal douching is a part of some MSM’s sexual rituals.  For those that don’t know, anal douching involves cleansing the bowels usually with a stream of water introduced through a hose of some nature or a pump type device put up the anus as pictured to the left.  Many receptive partners douche in an attempt to become clean for their partner, however some also douche simply in order to cleanse their bowels.

So how does this relate to HIV?  There is currently no robust body of quantitative body of  research focused on HIV and anal douching.   Some have said that frequent repeated douching is a “risky behavior” and  may increase anal tears among MSM, thus contributing to increase spread of HIV (However, whether douche or no douche, of course, I would recommend to use condoms, which minimize this risk from douching).   A new qualitative study (the full text is not available without a fee)  shows that attitudes toward anal douching differ among HIV positive and negative individuals,  but does not discuss anal douching’s potential role in HIV transmission.  It does state that HIV positive men report douching more frequently than those who are HIV negative: In the sample 91% (10/12) of the HIV positive men douched and 50% (6/12) HIV- men douched. Obviously this sample is too small to draw any conclusions from.

For a humorous take on anal douching watch Hedda Lettuce’s Clip below.  Although there is no reference to HIV transmission and prevention it is funny nonetheless (or perhaps slightly offensive but I think funny).

Taking the “fe” out of the female condom for HIV protection

So recently I was reading my city’s gay newspaper, Metro Weekly, and the last page of the paper had a feature about the Washington, DC female condom campaign, and how the female condom can be used by MSM for anal sex (see article to the left). The condom, made of a synthetic rubber nitrile, contains two flexible rings, and can be inserted into the anus of a receptive partner prior to intercourse.

While initially I was confused why MSM would want to use the female condom when the male condom exists, I have come to understand that it provides another choice of prevention method.  And, the more choices that one has, the better.  Basically, there are times when an insertive “top” will not want to use a condom.  In these instances, the receptive partner can insert the female condom to protect himself and his partner.  Additionally, there are times when unfortunately it is next to impossible to negotiate condom use.   In the MSM community in North America, drugs like ecstasy and crystal meth increase sexual appetite, and decrease inhibitions, and thus condom use, fueling the HIV epidemic.    A receptive “bottom” can insert the female condom before going out to the club, drinking or partying, and stand a much better chance of protecting himself from HIV and other infections.

In case you wanted to see how to use the female condom is used I discovered this great video.  I’m not sure who produced it, or where it is from but I think it’s great. Unfortunately it says embedding has been disabled, but if you click on the “Watch on You Tube” link you should be brought the video!