Category Archives: STI

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.

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?

Hep C, syphilis, gonorrhea, oh my!

So it has been quite a while since my last post.  I must admit med school is kicking my ass, but I must find time to write since HIV prevention among MSM is my passion.

So in the HIV community we tend to solely focus only on HIV prevention and fail to realize that other nasty bugs are transmitted between MSM.  Many of these, co-occur in individuals with who already have HIV and may place further stress on an already damaged immune system.

As I live in a large urban city, I have come across several individuals that are infected with Hepatitis C and currently undergoing treatment.  While I have understood that Hep C is sexually transmitted, physicians and other individuals have engrained into my head that Hep C is mostly prevalent among drug users and transmitted by intravenous drug use, with occasional sexual transmission.    Perhaps individuals will mention that Hep C can be transmitted sexually, but then go on to quantify the statement saying it’s not likely.  A new study has found that in a cohort of HIV positive individuals followed, 75 percent of new Hep C infections occurred in individuals with no history of injection drug use.  Thus, the infections in this group must have been acquired sexually.  Hep C leads to liver damage, and potential liver disease, and if left untreated can be lethal.

Hep C is not the only thing that those who bareback (have sex without a condom) should be concerned about.  syphilis is on the upswing.  Over the past several years there has been a huge surge in syphilis cases among men who have sex with men in several urban centers. Primary stages of syphilis may cause painful sores and chancres, and such sores if left untreated can increase the probability of acquiring HIV.  MSM are also at increased risk for acquiring chlamydia and herpes.

But not all providers will test individuals for STIs aside from HIV, and will not test already positive HIV individuals for STDs.  I think many HIV testing centers due to resource constraint will not screen for STIs unless a specific request is made.  I came across a great article from the NY times (although it’s from 3 years ago).  Only about a third of gay men surveyed in urban cities reported being tested for syphilis and gonorrhea. Providers do not test these populations as frequently as they should, or follow national guidelines set out regarding testing for STI.

Bottom (no pun intended) line: Educate MSM to engage in safer sex.  Not only will this prevent HIV but it will help to decrease rates of Hep C, gonorrhea, syphilis and a range of other STIs.  HIV is not the only enemy.  But we can protect ourselves from other STIs in the same way that we do HIV.  HIV prevention programs should educate MSM about HIV in addition to other STIs and how to overall protect themselves and remain sexually healthy.