04/08/2002 "HIV prevention messages failing to convince gays - Christopher Heredia, Chronicle Staff Writer"

HIV prevention messages failing to convince gays - Christopher Heredia, Chronicle Staff Writer
A small but worrisome proportion of gay men in the Bay Area are engaging in unprotected anal intercourse, knowingly putting themselves at risk for AIDS, a groundbreaking health study shows.

A small but worrisome proportion of gay men in the Bay Area are engaging in unprotected anal intercourse, knowingly putting themselves at risk for AIDS, a groundbreaking health study shows.

The study demonstrates that despite years of programs promoting the use of condoms as a means of HIV prevention, some gay men are nonetheless actively seeking out partners who will have unprotected sex with them, elevating concerns about rising HIV infection rates.

Authors of the study said it underscored the need for a new approach to prevention.

"What it says is that, in this group, other needs supersede prevention of HIV transmission," said Gordon Mansergh, lead author of the study and a behavioral scientist with the Centers for Disease Control
and Prevention in Atlanta.

"Our conclusion was that we need to develop new prevention interventions differently. People are decidedly not using a condom. The old way is not working."

The study by researchers at the CDC and San Francisco's Department of Public Health is the first serious analysis of the practice of "barebacking," in which gay or bisexual men intentionally engage in
sex without a condom with someone other than their primary partner.

Seventy percent of the 554 gay men contacted for the survey said they were familiar with barebacking, and of those, 14 percent said they had engaged in the practice within the past two years. Twenty-two percent of HIV-positive men had done so, compared with 10 percent of HIV-
negative men.

The primary reasons the men cited for engaging in barebacking was greater physical stimulation and "emotional connection."

Participants in the survey were recruited at bars, dance clubs and community organizations in San Francisco and Oakland, and the study was conducted between July 2000 and February 2001.

The practice of barebacking has grown at the same time that rates of HIV infection have begun to rebound in San Francisco. City health experts estimate that there will be 700 to 800 new HIV infections in San Francisco this year, numbers rivaling the early years of the AIDS epidemic.

Some community activists have been calling for expanded public health outreach efforts to look at the totality of gay men's health, from fitness and cancer to mental health and substance abuse.

Eric Rofes, professor of education at Humboldt State University, said the study's conclusion recommends just that.
The study authors "seem to be understanding we need to work with gay men on broader health and wellness issues, instead of focusing solely on HIV," Rofes said. "In doing that, it will help us reduce the number of HIV infections."

The barebacking phenomenon is occurring with increasing frequency through connections made on gay Web sites and chat rooms, gym steam rooms, commercial sex clubs and bars, said Keith Folger, who heads the Prevention for Positives program at the Stop AIDS Project.

Half of the men in the study who said they engaged in barebacking did so while they were on drugs or alcohol. Men also cited improved treatments for HIV disease as reasons for having more unprotected sex.

"(Barebacking) comes up at every event we have," Folger said. "In addition to figuring out how men should disclose their (HIV-positive) status, they want to know how they can go home and have sex without a condom."

Folgr has talked to other HIV-positive men who have abandoned condoms to avoid the hassles and negative guys who go latex-free just for the feel.

"We've failed in prevention by not asking the 25-year-old gay or bisexual men, 'What is it about HIV that you're not afraid of?'" Folger said. "There's a psychosocial illness in San Francisco. Despite how
hard we've been hit by AIDS in this city, there's a silence around HIV. It's no longer in people's faces, yet people are still dying."

Study co-author Grant Colfax, director of HIV prevention studies at the Department of Public Health, said the study highlighted "shifting social norms" in the gay community.

"This is the hard-core group, but they're having an influence on those who might not identify as being part of the barebacking phenomenon," Colfax said.

"We need to begin talking about negotiated safety, not using drugs while engaging in unprotected sex, appeal to HIV-positive men's altruism to not spread the disease and drive home the message that AIDS isn't cured.

You can still get HIV."