Without Condoms Unprotected Sex Gay Men and Barebacking 1st Edition by Michael Shernoff 9781135416836 1135416834

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ISBN 10: 1135416834
ISBN 13: 9781135416836
Author: Michael Shernoff 

After years of activism, risk awareness, and AIDS prevention, increasing numbers of gay men are not using condoms, and new infections of HIV are on the rise. Using case studies and exhaustive survey research, this timely, groundbreaking book allows men who have unprotected sex, a practice now known as “barebacking,” to speak for themselves on their willingness to risk it all. Without Condoms takes a balanced look at the profound needs that are met by this seemingly reckless behavior, while at the same time exposing the role that both the Internet and club drugs like crystal methamphetamine play in facilitating high-risk sexual encounters. The result is a compassionate, sophisticated and nuanced insight into what for many people is one of the most perplexing aspects of today’s gay male culture and life style. Michael Shernoff digs deep and forces us to see that the AIDS epidemic is not over. We must now ask the hard questions and listen to the voices that answer. The stakes are too high to ignore.

Without Condoms Unprotected Sex Gay Men and Barebacking 1st Table of contents:

Part One: Gay men, sex, and condoms: an overview
Chapter One: Introduction and overview
Getting oriented
Early homosexual activism in the United States
The convergence of sexual liberation and gay liberation
Gay sexual health before AIDS
The impact of AIDS on gay men’s sexuality
The age of safer sex
Riding “bareback”: the history of the controversy
Defining the terms: what is barebacking?
Combination therapy and safer-sex fatigue
How many are barebacking?
“Barebacker” becomes a sexual identity
Peer pressure
Barebacking as deviance?

Chapter Two: Gay men’s sexuality and psychotherapy: from cure to affirmation
Robert, a relatively recent barebacker
Chapter overview
Sex, shame, and barebacking
The talking “cure”
Gay-affirmative psychotherapy
Gays counseling gays
Gay liberation as good mental health
Gay men’s sexual cultures
Psychotherapy in the time of AIDS
A brief history of AIDS prevention efforts
Psychological attacks on gay sexual culture
AIDS, sex, and mourning
Sexual shame, homophobia, and erotophobia
Mourning and melancholia
Mourning, grief, and psychiatric diagnoses
Eroticizing safer sex
Deconstructing shame
The limits of therapy
Barebacking: an ecological perspective

Chapter Three: Why do men bareback? No easy answers
Toby, a passive barebacker
Rationales for barebacking: chapter overview
Why men are taking sexual risks
Factors that lead to sexual risk-taking
Rational and irrational barebacking
Barebacking as an example of “sensation-seeking”
Serosorting
Barebacking to feel in control
Semen exchange and emotional connection
The psychology of peer pressure
Is barebacking symptomatic of mental illness?
To diagnose or not to diagnose?
Risks from barebacking
Love, desire, and risk
The various meanings of barebacking
Barebacking research from Great Britain
Barebacking, internalized homophobia, and transgression
Risk-taking and the unconscious
Barebacking and self-care
Postexposure prophylaxis
Conclusion

Chapter Four: Trips and slips
Phillip, an example of the sex and drugs connection
Creating change: chapter overview
Drugs and sex in gay culture
Barebacking and substance use
Club drugs and party drugs
Introducing “Tina” (crystal methamphetamine)
Crystal and sex
Psychological effects of crystal
Esteban and the crystal-sex equation
Circuit parties
Is there a link between crystal and UAI?
“Crystal dick” and Viagra
Treating drug abuse to reduce unprotected anal intercourse
Abstinence
Harm reduction
Stages of change model
Motivational interviewing
Precontemplation
Contemplation
Preparation/determination
Action
Maintenance
Harm reduction and crystal
Moderation management
Andrew, a rational barebacker
Difficulty for the therapist
Compulsivity and barebacking
Critique of the harm reduction model
Conclusion: internet outreach

Chapter Five: Cruising the internet highway
Mario, cyber cruising, and barebacking
Computers, sex, and HIV: chapter overview
Hooking up online
Widespread use of the internet to meet men
Barebackers on the internet
The barebacking label and cyber cruising
AIDS education on bareback websites
Barebacking profiles — how it works
Bug chasers and gift givers
Intentionally spreading HIV
Bug chasers
The gift
Bug chasing in the media
Sex parties for HIV-positive men
Bug chasing as taking control
Therapy with bug chasers

Part Two: Taking off the condoms: raw sex in relationships
Chapter Six: Love in the time of plague: male couples, sex, and HIV
A couple in conflict over condoms
All UAI is not barebacking: chapter overview
Research on couples and condomless sex
High-risk sex within relationships
Why couples take risks
Frank and Jesus: recognizing power issues
Factoring in love and lust
Love and self-sacrifice
Four agreements on condom use
Understanding gay nonmonogamy
Pathologizing gay men’s sexual cultures
Male couples’ sexual diversity
Nonmonogamy may not be infidelity
Negotiating open relationships
Stage of relationship and sexual risk-taking
Negotiated safety
How safe is a negotiated safety agreement?
Conclusion

Chapter Seven: Love, sex, and trust
Section I: Seroconcordant male couples
Jake and Mark: positive negotiations
Couples and condoms: chapter overview
Romantic rationality
Monogamy and male couples
“Is it safe if we’re both HIV-negative?”
The risks of reinfection
Condoms, intimacy, and trust
Section II: Partners of different HIV status
Research on discordant couples
Sexual risk-taking as a test of love
Love, trust, and disclosure
How safe is unprotected oral sex?
Combination antiviral therapies and infectivity
New love and risk-taking
Sexual satisfaction and risk-taking within relationships
Risk-taking as a turn-on
Sexual and emotional safety
Barebacking as a stress on a relationship
Conclusion

Part Three: The role of the professional and the community
Chapter Eight: Can barebacking be curbed? What (if anything) works?
Chapter overview — interventions with barebackers
Therapists’ limitations
The best clinical intervention for barebacking
The challenge of clinical neutrality
Met case example — engaging with a client’s ambivalence
Community-based harm reduction interventions
Harnessing the impulse for self-preservation
Barebacking on a sexual continuum
Innovative AIDS prevention programs — the use of humor
Assessing sexual hierarchies
A positive sexual health approach to prevention
Internet-based approaches to risk reduction
Conclusion

Chapter Nine: Conclusions: sexual freedom and sexual responsibility
The need for shared responsibility
Sexual freedom and personal responsibility
Approaching barebacking realistically
Viral status
Strategies for infected men
Drug use
Ethics and barebacking
Challenges for therapists
Clinical detachment
A feminist perspective
Ethics and HIV infection
Political contradictions
Moral contradictions

Appendix One: Negotiated safety agreement questionnaire
The agreement questionnaire: Part One
The agreement questionnaire: Part Two
The agreement questionnaire: Part Three
The agreement questionnaire: Part Four

Appendix Two: Safer barebacking procedures
Negative
Untested
Positive
Carry on screening
Come outside
Viral load range
To fuck or be fucked
Toys for boys
Wet and wild

Appendix Three: Squashing the “super-bug”: an open letter to gay and bisexual men

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