"I don't always use condoms when I have sex with a guy. I know I shouldn’t bareback but I'm prepared to take the risk. It's like smoking. I know it can give me cancer, but I still do it."
To some, 26-year-old Joburger Kenny's statement may be shocking, but many guys will also relate to his views when it comes to barebacking; the practice of having anal sex without using condoms.
In fact, recent research suggests that barebacking is not just a fringe phenomenon among a small minority, but that many gay men and other men who have sex with men may do it regularly.
A survey of men from around the world on hook-up services such as Grindr and Manhunt found that almost half are having unprotected sex.
According to researchers from New York’s non-profit Community Healthcare Network, Dr Freddy Molano and Renato Barucco, almost 47 percent of respondents said that they bareback “always, often or sometimes,” while almost 54 percent say they never have unprotected anal intercourse.
“We have spent a lot of money and time on condom initiatives, and I’m pretty sure that many people are using condoms, but the reality is other people have decided that they would rather have sex without condoms,” Molano told Canadian gay newspaper Xtra.
The survey found that most of these men have unprotected sex because they say that condoms don't feel good (85 percent), they do so when acting impulsively (74 percent) or when under the influence of drugs or alcohol.
Dawie Nel, Director of OUT, the Pretoria-based LGBT health NGO, agrees that, in his experience, some men may bareback by deliberate choice while others might do so because of circumstances.
"For some men, it's a decision that they make. They don't like using condoms and that's that. For others, it may depend on the context. Perhaps they're in a monogamous relationship, or they may sometimes use condoms but at other times forget, or they don’t have any handy, or are too drunk or high to care," he suggests.
Nel, like Molano, acknowledges that while it may not be politically correct to say it, we may have to accept that some men will continue to have unsafe sex, no matter what they may know or what messaging and information they are exposed to.
"For the many men who are open to it, we must continue to inform and remind them that using condoms and water-based lube remains the least risky way of having sex," he says, "but we also need to offer guidance and support for those men who bareback."
Nel's comments are echoed by the results of the survey, which found that most of the men who bareback understand the possible consequences of their actions, with 81 percent knowing that HIV is transmitted through unprotected anal sex and possibly through oral sex.
Nel also points out that even guys who normally would never have unprotected sex may find themselves in a situation in which they may bareback.
"We're all human. It could happen to almost anyone and we can't be judgemental towards guys who bareback," he says. "We must offer them the best advice and support to keep them as healthy as possible."
If you choose to bareback make sure you understand the risks of unprotected sex and how best to limit the danger. OUT's resident nurse, Gérard Damstra, offers a number of suggestions to consider if you are barebacking or have barebacked.
- If you barebacked because you "slipped up" and are concerned that you might be infected, go on a course of PEP (Post Exposure Prophylaxis) medication within 72 hours of having had the risky sex. This will dramatically reduce your chances of becoming infected.
- Remember to use lots of lubrication if barebacking. This reduces friction and helps prevent small anal capillaries from bursting, limiting blood transmission.
- Pull out before ejaculating – this may help reduce the risk of infecting the bottom partner.
- HIV infection is not the only risk of barebacking. Look out for signs of other sexually transmitted infections (STIs) such as yellowish discharge coming from the tip of your penis, painful and burning urination or genital or anal warts.
- Stay faithful to one partner; the fewer your partners, the lower your risk.
- Discuss your sexual histories with your sex partners before having unprotected sex.
- Abstain from sex with high risk sex partners such as sex workers and intravenous drug users.
- Avoid using drugs and alcohol before having sex. You’re more likely to make more level-headed decisions if you’re sober.
- If you are in a relationship with an HIV positive partner or engage in very high risk sexual activities, speak to a specialist or your doctor about the appropriateness of using medication to reduce your risk of HIV infection, known as PREP (Pre Exposure Prophylaxis).
For advice and information on getting PEP and other health services for men who have sex with men, contact OUT in Pretoria on 012 430 3272.