Purpose. Men who have sex with other men (MSM) account for more than one-half of all new HIV infections in the USA. This study reports on the prevalence of a variety of HIV risk behaviors in one specific subpopulation of risk-seeking MSM. Methods. The study was based on a national sample of 332 MSM who use the Internet to find partners for unprotected sex. Data collection was conducted via telephone interviews between January 2008 and May 2009. Results. Unprotected oral and anal sex was commonplace among study participants. Men engaged in a large number of other risky behaviors as well, including having had multiple recent sex partners (mean number = 11), simultaneous double-penile penetration of the anus (16%), eating semen out of another man’s anus (17%), engaging in multiple-partner sexual encounters (47%), engaging in anonymous sex (51%), and having sex while “under the influence” (52%). Conclusions. HIV intervention and prevention programs need to address numerous behaviors that place MSM at risk for contracting/transmitting HIV. Merely focusing on unprotected anal sex does a disservice to members of this community, who typically engage in many types of behavioral risks, each of which requires addressing if HIV transmission rates are to be reduced. 1. Introduction In recent years, evidence has been mounting to suggest that men who have sex with other men (MSM) increasingly are turning to the Internet to meet partners for sex. For example, in a sample of gay men who were recruited into a health promotion study via gay-oriented Internet websites, Bolding and colleagues’ [1] multivariate analysis revealed that the amount of risky sex in which men engaged was a significant predictor of their use of Internet websites to locate sex partners. Bolding et al. also reported that 47% of the men in their sample said that, when they wanted to identify potential sex partners, they preferred using websites to frequenting bars or other “offline” venues. In another study [2], among men actively using the Internet as a means of locating potential sex partners, 97% reported actually having met someone online for sex, and 86% said that they used Internet MSM sex sites at least once a week to identify possible partners. Ogilvie and colleagues [3] found that MSM who used the Internet to initiate sexual relationships reported having had more sex partners during the previous year than their counterparts who did not use the Internet for this purpose. Berg [4] noted that, compared with men who did not engage in bareback sex, barebacking men said that they met their sex
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Due to differences from website to website in terms of the information made available to users about whether or not their emails were received and read, or whether they were removed by the web host’s system prior to being read by the intended recipient, it is impossible to compute an accurate participation rate for The Bareback Project. Based on websites where enough information was available to users to allow for the participation rate to be calculated, the response rate was slightly greater than 10%. This could raise concern of selection bias and, therefore, the representativeness of the sample. Although it is difficult to be certain that the men who participated represent the men who did not, there is compelling evidence to suggest that differences between the two groups are minimal. Before The Bareback Project was started, the principal investigator conducted a large-scale content analysis with a random national sample of one of the main websites used by men to meet other men seeking unprotected sex partners (for additional information, see [19, 38, 72, 73]). The demographic composition of that sample and the one obtained in The Bareback Project closely match one another in terms of age representation, racial group composition, sexual orientation, and rural/suburban/urban location of residence. The two samples also resemble one another closely in terms of the types of sexual practices that men sought. The similarity of the two samples suggests that men who chose to participate in the present study represent those who did not, in terms of identifiable characteristics that are likely to be the best indicators of selection bias. Also, the demographic composition of men in The Bareback Project and the demographic composition of the male adult population-at-large are a fair approximation of one another in terms of their age breakdown [74] and rural/suburban/urban location of residence [75]. The present sample is better educated than men in the general population [74]
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