Bareback sex: Breaking the rules of sexual health and the assumption of risks

Introduction: Dialogical relationship between sexual health and bareback sex ¹

Recently, a substantial research effort has been devoted to understanding why gay and bisexual men engage in risky sexual behaviours (Brennan et al., 2010; Jacobs et al., 2010; Mirandola et al., 2009; Starks et al., 2013). This question is quite complex, since it comes with the risk of stigmatizing sexual practices between two (or more) consenting men. In addition, focusing on individual responsibilities may have the problem of blaming HIV-positive people. As Paul Flowers points out, ‘processes of risk construction are far from innocuous, [as] they provide a readily available framework of responsibility and blame which posits the burden of the epidemic increasingly upon the shoulders of the infected’ (Flowers, 2001: 68).

In an attempt to answer this question, almost every recent reference about HIV prevention for men who have sex with other men (MSM) ² has been devoted to understanding the personal and social underlying factors that cause members of this group to engage in sexual practices that are considered to be risky. Specifically, ‘bareback sex’ is one of the factors that has been studied in relation to this assumption of risk in sexual practices. Steven Gendin introduced for the first time the term ‘bareback’ in POZ magazine, talking about the benefits of having unprotected anal sex (between HIV-positive gay men). Being an HIV/AIDS activist he discusses the empowering possibilities of this practice (Gendin, 1997). Since this publication, many men started using the word to refer to a different kind of unprotected sex and use it to get to know other men with the same interests (Dean, 2008, 2009, 2011; Harvey, 2011), not only in Anglophone countries but also in other geographical sites like Spain. Therefore, scientific literature started paying attention to this so-called ‘phenomenon’ or ‘study problem’.

On the one hand, considerable attention has been given to the role of psychosocial factors in bareback sex. Some authors (e.g. Galatowitsch et al., 2005; Remien et al., 1995; Wolitski, 2005) have noticed external factors such as the advance of highly active therapies for HIV (HAART therapies) (Crepaz et al., 2004; Stephenson et al., 2003), the spread of new cyber-spaces to find partners who do not want to engage in safer sex practices (Blackwell, 2008; Halkitis and Parsons, 2003; Ross et al., 2005) and even the role of the use of recreational drugs to engage in unprotected anal intercourse (Greenwood et al., 2001; Wilton, 2011; Wilton et al., 2005). In the particular case of Spain, since data reports a huge increase in new HIV-infections between MSM (Centro Nacional de Epidemiología, 2012), ³ many studies have tried to determine individual and social reasons for engaging in unprotected sex but have talked obliquely about bareback sex practices (Centro Nacional de Epidemiología, 2012; Fernández-Dávila, 2007, 2009; Rojas, 2004, 2007).

On the other hand, studies from critical perspectives have multiplied greatly in recent years, producing some internal or community explanations. These contributions examine different reasons, such as the ignorance of the consequences of AIDS among young people or the weariness of warnings about AIDS experienced by those MSM who have been using safer sex practices for more than 30 years now (Crossley, 2002), individual need of transgression (Crossley, 2002; Odets, 1995), the spread of masculinity roles in gay spaces and pornography (Dowsett et al., 2008; Lee, 2014) or even the emergence of a bareback subculture (Dean, 2009; Mowlabocus et al., 2013). The effort of all these studies has been crucial to understand the importance of the intersection of the above factors as the causes of conscious enrolment in risky sexual practices by some gay and bisexual men. All the more since ‘research on barebacking is often said to produce “moral panic” because it can seem as though large numbers of gay men are aiming to become HIV positive or at least that gay men are careless about their sexual health’ (Clarke et al., 2010: 132).

Following this second critical approach, I (Ávila and Montenegro, 2011) started a study with the aim of understanding the different meanings of the term ‘bareback’ for those who practise it in Spain, linking their discourses with those of the principles that guide Spanish sexual health promotion addressed to gay and bisexual men. In a preliminary analysis, I suggested that the definitions of bareback sex were quite different between both points of view. In addition, some of the participants in our research levelled fierce criticism at the prevailing sexual health model, amongst other findings. That lead me to a new research question: what role is sexual health prevention playing in the construction of bareback sex and the bareback subject? In this paper I will, therefore, argue for the influence of HIV intervention policies on the creation of a social space in which bareback sex is both possible and desirable: ‘Much of the current literature on barebacking provides a good example of why it is important to examine how sexual health is measured, and the social contexts surrounding sexual health’ (Clarke et al., 2010: 131). Thus, the aim of this article is to generate and explore the dialogic relationship between bareback sex discourse and the discourse articulated by sexual health promotion policies addressed to gay men in Spain.

When studying a resistance practice – such as intentional unsafe sex – it is essential to pay attention to the context of power in which it takes place (Foucault, 1989, 1991). The effects of sexual health discourse on people’s behaviours, which have been argued in other areas (e.g. Leonard, 2012), are crucial to understand a practice such as bareback, constructed as a reaction to hegemonic sexual health discourses. Following similar research (Dean, 2009, 2011), this paper seeks to fill a small but significant gap in the extensive literature devoted to this issue. As I will argue later, it is not by chance that intentional unprotected sex has emerged as a new social category among MSM, whereas it is just another practice for other groups that have not been historically related to AIDS. However, bareback sex will not be seen as a distinct subculture with its language, rituals, etiquette, institutions and iconography, as Tim Dean’s novel analysis does (2009). Although I share the same respectful and caring spirit in approaching bareback sex, the present paper defines this phenomenon as a sexual practice with multiple dimensions that call into question contemporary sexual health promotion. Therefore, I seek to highlight an overlooked aspect of bareback sex: the role of Spanish HIV prevention discourses addressed to MSM in the constitution of barebacking.

In this article I will follow a Foucauldian critical approach to the understanding of governmentality practices in the sexual health arena and, more specifically, I will discuss how the safer sex moral value is connected with the assumption of risk for gay and bisexual men. Understanding that ‘power is not an institution, and not a structure; neither is it a certain strength we are endowed with; it is the name that one attributes to a complex strategical situation in a particular society’ (Foucault, 1976: 93), governmentality will be understood hereafter as the different practices where power is not a hierarchical structure but different conventions of social control carried out by several institutions, self-regulating manners and the contemporary way of knowledge production. A theoretical discussion of governmentality in sexual health promotion in Spain will be developed below, paying special attention to the concepts of risk factor construction in public health discourse and the process of interpellation in the construction of a bareback subject. Therefore, I will study governmentality practices in both institutional public discourse and the technologies of the self in the construction of a bareback subject.

After this introduction, which defines the problem under consideration and presents a brief review of barebacking research approaches, the complete investigation is then described as well as the different types of evidence that have been taken into account. In the third and fourth sections, the findings of the investigation are presented, followed by, in the final section, the conclusion of the paper where I set out the limits of this article and recommend areas for future research and intervention goals.

Methodology: Construction of narrative productions, HIV prevention campaigns analysis and other evidence

In order to contribute to the development of the feminist discussion about ‘what we might mean by the curious and inescapable term “objectivity”’, Donna Haraway lays the foundation for what will be her understanding in what is well-known today as ‘situated knowledge’ (Haraway, 1988: 575). According to Haraway (1997), a researcher participates in the performance of an investigation with different and yet linked social partners. The researcher does not start from a naïve point of view, but establishes relations with some specific actors (and not others) depending on her/his own interests and background. This epistemological position has immediate implications for methodological design. First, the researcher must define her/his own located position in order to ensure research objectivity. Second, as a consequence, the author must specify the social actors to whom the topic of study is connected.

Regarding my position, while working (as a health promoter and as a volunteer) for an NGO aimed at LGBTI sexual health promotion and non-stigmatization of HIV-positive people, I noticed that many people who considered themselves as barebackers were concerned about safer sex and, more specifically, how to reduce the possibility of infection when not using a condom. At the same time, I noticed that there were few programmes or specific information available about these matters. The silence of health promotion for bareback sex in Spain or the moral fear of talking about the conscious assumption of the risk that some MSM were engaging in was the starting point of this investigation.

As for the social actors relevant to the topic of this study, in the present paper I try to set up a dialogue between public sexual health promotion discourses and those who engage in bareback sex as is outlined above. In order to do so, I considered two different sources: Spanish Ministry HIV prevention campaigns specifically addressed to MSM, and written texts produced – for the purpose of this investigation – by men that considered themselves as barebackers in Spain. While the first texts are publicly distributed, my work intended to elaborate written discourse, which includes, on equal footing, the political point of view and theoretical reflection of barebackers. In doing so, participants are not objects of this research, but active agents in the production of knowledge. Given that I wanted to access bareback discourse and their tensions with public sexual health promotion discourse, no interviews with health promoters were conducted at this stage of the investigation. ⁴

Using a qualitative methodology for the construction of political discourses (Balasch and Montenegro, 2003), I carried out several interviews and produced a final text validated by all of the interviewees – which will be referred to as ‘narrative production’. Since some studies show that the Internet is the most common place to manage bareback sex (Dowsett et al., 2008; Fernández-Dávila and Zaragoza Lorca, 2011), all participants were connected by a well-known online chat space designed for meeting people and arranging sex encounters in Spain. ⁵ I contacted eight men whose nicknames included terms such as ‘bareback sex’, ‘raw sex’, ‘cum in my mouth’ and so on. Once the study was presented and they agreed to participate, I carried out simultaneous online interviews (O’Connor et al., 2008) with them – three per participant. The intention was to create a similar atmosphere as in a face-to-face interview but without them having to reveal their identities, since most of the participants were unwilling to do so.

For the first session a script had been prepared in order to conduct a semi-structured online interview. This script included the most relevant topics on the barebacking academic literature, for example, the sexual practices participants associated with barebacking, their definition of risky sex and their own point of view in relation to sexual health discourses. After this first interview, I produced a text per interviewee that turned the chat into expository prose (from a full log of the interview). This text was returned to participants, arranging a second session where the text was reviewed. In addition, in this session I gave the participants a second text ⁶ signed by a sexual health promoter, which contained an explicit criticism of bareback sex and barebackers. The goal of introducing this second text was to establish a dialogical tension between the discourse of interviewees and the one carried out on this text. After introducing the modifications and additions to the text provided by the participant, a final version of the document was sent to participants arranging a third interview. In the last interview, participants could change whatever they wanted and give final approval to the text. This last version will be referred to as ‘narrative production’ (Balasch and Montenegro, 2003).

Only six participants completed the process and, therefore, six final narratives were produced. Each narrative production will be referred to with the nickname chosen by each participant: ⁷ Young Barebacker (2,275 words), Apostate (2,414 words), Conscious Barebacker (2,659 words), Pure Sex (1,513 words), No Consequences (1,708 words) and Fucking Raw (1,779 words). These six texts summarize the interviewees’ points of view while theorizing about bareback sex and arguing about sexual health promotion. Each text develops different topics selected and approved by the participants. ⁸ In such a way, participants are not treated as subjects for the investigation purposes but as actors implicated in bareback sex whose discourse should be equally taken into account. Power participates in the creation of possibilities for some discourses to be considered as dominant and others as marginal (Tamboukou, 2008: 104) and using this methodology may help me establish new and elaborated connections with barebackers.

Finally, following Fraser’s (2004) proposal, I considered the different topics that emerged from all the narrative productions and tried to reveal tensions and similar positions between them. Particularly, I examine the narrative productions ‘for commonalities and differences that exist among and between participants’ (Fraser, 2004: 194). This was done contrasting general topics through the produced material of the six participants and highlighting both similarities and differences – topics related to governmentality practices will be presented below. Moreover, in this research ethical issues have been taken into account at different stages: (i) the selection of participants, (ii) in obtaining consent, (iii) the sessions themselves, (iv) analysis of data, (v) and in the drafting of the final report, following William Smythe and Maureen Murray’s (2000: 329–333) recommendations.

Regarding participant selection, I chose barebackers because I believe their discourse has generally been analysed from the outside. Furthermore, I tried to be very clear about the objective of the research from the beginning and not to force participation. Once participants agreed to get involved, clear consent was requested, and I explained that their texts could be used for writing various research reports. However, I informed them that the process of producing a text was different from analysing plain interviews, that is to say, participants could elaborate their discourse and reflect on deciding the way they wanted to present their point of view. I got involved in the sessions, following guidance given by Balasch and Montenegro (2003), so when participants asked me about my point of view I answered from the same position as them. This explicit positioning during narrative production may have changed the final product of this research and yet has helped me produce narrative texts from partial connections between researcher and participant (Haraway, 1991, 1992), as already mentioned above. Finally, one participant collaborated in the analysis of data and a final report with the examination of commonalities and differences was sent to all of them.

I reminded them that pieces of their narrative productions could be used in further papers and they all agreed to such use. I made it clear that their identities at all times would be protected and they would remain anonymous throughout the process and in any texts emanating from the work.

After a first phase of research with barebackers, I noticed that an accurate analysis of HIV prevention campaigns addressed to MSM in Spain was necessary to define the biopolitics of safer sex as presented in institutional health discourse (Ávila and Gras, 2014). Therefore, I decided to include in my analysis all campaigns produced by the Spanish National AIDS Plan addressed specifically to MSM, which would give a sense of the discourse gay men receive from public institutions. The corpus contains a total amount of six campaigns from 2006 to 2011. ⁹ For each campaign there was a single sided poster, a complete brochure with further information ¹⁰ and several postcards with similar design and information as in the poster. Following a critical discourse analysis (Fairclough et al., 2011), I analysed how the HIV campaigns’ discourse selects their targets – and, therefore, excludes other possible addressees – and defines socially desirable behaviour, regarding male-to-male sexual practices. In particular, this paper (Ávila and Gras, 2014) examines (i) the discursive construction of the target of these specific campaigns, (ii) the description of the roles of HIV positive/negative MSM in the processes of prevention and infection of HIV and (iii) the type of arguments offered to justify the need for safer sex practices. I will exemplify some of the findings by the analysis of an HIV campaign.

In addition to narrative productions and HIV campaigns analysis, the paper includes other evidence such as field diary annotations, observations about sexual meeting places, and pieces of conversations with colleagues. These examples will be used to discuss the ‘theory’ led by the investigation in order to contemplate the possibilities of the disruption of barebackers’ discourse in questioning some of the taken for granted assumptions of sexual health promotion. The aim here is not to demonstrate how things are, but to discuss how the hegemonic public health discourse and its governmental practices may be activating some reactions. Following Haraway (1991): I will be using these experiences from my everyday life –as a health promoter and as a man who has sex with other men– as points of diffraction ¹¹ for thinking about and theorizing how bareback sex discourse offers a chance to rethink sexual health promotion today.

‘Taking the risk’: Governmentality in HIV prevention addressed to MSM

The issue of risk and its implications in sexual health featured prominently in the barebackers’ narrative productions. Thorough analysis of the narrative shows that risk was a social construction used by all participants. All narratives discussed what is considered as risky or safe – whether participants had a good understanding of the topic or not – and risk reduction in relation to unprotected sex. Furthermore, participants referred to the sexual arousal of risky sex, as addressed below:

Anyway, risk is horny. We like danger, what’s forbidden. Generally, since having sex without protection is something wrong – prohibited – I think this is what makes it hotter ¹² (Young Barebacker, narrative production, April 2009; emphasis added)

More than 30 years ago, the first deaths caused by AIDS had no repercussions for governments all over the developed world since this syndrome was considered a disease that was only affecting gay men (Butler, 1996; Watney, 1987). Particularly, in 1981 the first identified man who died of AIDS in Spain was a young gay man (López, 2001; Sida Studi, 2011). Yet, Spanish governments in the 1980s were more concerned about denying the existence of homosexuality and, therefore, little attention was paid to gay men living with AIDS (Carrascosa and Vila Núñez, 2005; Llamas, 1995). As Judith Butler (1996) points out, political decisions about technological, social or medical foundations are circumscribed within the exercise of modern power. The author states that those who do not deserve to live may suffer the silenced withdrawal of required resources that prevent death. The fact that almost all governments did not act quickly enough after the first cases of AIDS (non-investing in HAART therapies, sexual health promotion, or non-stigmatization of HIV-positive people) resulted in the delimitation of an abject individual whose life was not worthy of receiving public investment. Furthermore, establishing homosexual men as those who were responsible for new HIV infections easily constructed the gay community and its practices –especially the sexual ones– as the virus carrier (Bersani, 1987; Butler, 1996).

Since there was no guaranteed support for the first people affected by this disease, several and varied social organizations were created in Spain to assist them, from neighbourhood to LGBTI or drug users associations (Larrazabal, 2011). The Spanish LGBTI movement was quite weak in those years and associations were mainly concerned with the social link between male homosexuality and AIDS that was being spread by media (Carrascosa and Vila Núñez, 2005). In 1986 Gais per la Salut (Gay people for health) was founded in Barcelona to help decrease new infections and take care of people living with AIDS. Their first actions consisted of condom distribution and campaigns to promote safer sex. ¹³

Some other associations, which had emerged to promote LGBTI rights, were engaged by the HIV/AIDS activism. In the early 1990s radical activist groups such as LSD and La Radikal Gay turned their efforts to fight against political structures that stigmatized, criminalized and made invisible the first cases of AIDS amongst the gay community (Carrascosa and Vila Núñez, 2005; Mira, 2004). They followed the main strands of actions initiated by other renowned worldwide groups like ACT UP (Larrazabal, 2011). The work of many of these activists was not only important, but was essential in launching initiatives to look after members of their own communities. As shown by many studies (Llamas, 1995; Mira, 1993), Spanish media blocked homosexual images even when talking about AIDS suggesting that although homosexuality existed, it was undesirable and, therefore, AIDS information in the media was not taking into account homosexual people (Carrascosa and Vila Núñez, 2005; Mira, 2004). This means that all the initial campaigns to reduce new infections among MSM were conceived by LGBTI associations themselves, that is to say, La Radikal Gay and Gais per la Salut. Thanks to community work the importance of prevention for gay and bisexual men and the experience of living with AIDS was emphasized (Carrascosa and Vila Núñez, 2005).

But after some years of fighting against AIDS and once Spanish governments of the middle and late 1990s started to pay attention to specific needs of the community, LGBTI associations were aware of the consequences of the social link between HIV infection and male homosexuality and they started discussing the side effects of the so-called risk groups. Efforts were made to change the attention from the subject (homosexual or bisexual men) to the practices involving a high level of risk for HIV infection or, once someone was infected, to the development of the acquired immune deficiency syndrome (UNAIDS, 2000). On the one hand, this switch was made not only as a result of the stigma of this connection but also because of the increased number of new infections among many men who had sex with other men but did not consider themselves as gay or bisexual. On the other hand, this change was necessary to focus on prevention programmes with other vulnerable individuals (such as women or heterosexual men). This development, studied through other health arenas (Castel, 1991), still impacts the subject today.

Unprotected anal intercourse among MSM is considered the most risky sexual behaviour for HIV epidemiology since MSM is the group with the highest level of HIV prevalence in North America and Western and Central Europe today (UNAIDS, 2010). In fact, 56% of new HIV diagnoses reported in Spain occurred through men who had sex with other men (Centro Nacional de Epidemiología, 2012), as has been the case in other European countries (Lattimore et al., 2008). Likewise, a Catalan study shows that 32% of MSM reported recently they had had unprotected anal sex with a casual partner (Folch et al., 2009). Despite the effort made not to stigmatize the homosexual subject, there is still some sort of surveillance of sexual practices of men who have sex with other men. Many of the participants in my study agreed:

When you are a homosexual and you get involved in a ‘gay way of life’ you have lots of information that reminds you of your lack of freedom. Or what is worse, that allows you to be free by accepting to live a monogamous life … I’m sick of seeing a [sexual health] campaign poster even when I am in a café. (No Consequences, narrative production, May 2009)

Alan Petersen (2002) rethinks certain general prevention campaigns and the role of different health promoters in this same sense: ‘Health promoters are helping to forge a new conception of the political and see themselves as closely allied with the new social movements in their concern to “empower” citizens’ (Petersen, 2002: 196). As has been said before, the embodied fight carried out by marginal bodies has somehow influenced the way gay community members understand sexual health. By way of an example, David Harvey presents an in-depth review of how different AIDS activists have been considered as transgressors of gay social mores when they admitted to loving anal sex without condoms (Harvey, 2011: 168). The presence of HIV is evident in different areas of a gay man’s life. Similarly, a study carried out in Madrid showed that for most Spanish gay men being a ‘good homosexual’ involves maintaining safer sex practices (Villaamil and Jociles, 2008).

Fucking without condoms is reproved, even for gay people. I’ve just talked about it with men with whom I’ve had unprotected sex. Safe sex is a dogma of faith. Decreasing HIV prevalence among gay men is seen as a triumph of civilization. (Fucking Raw, narrative production, June 2009)

Likewise, the fact that the desirable behaviour is having healthy sex turns unprotected sex into an undesirable practice and HIV-positive individuals into those who have failed in their prevention and self-care strategies. Since ‘the terms “healthy” and “unhealthy” have become signifiers of normal and abnormal identity; of one’s moral worth’ (Petersen, 1992: 198), individuals whose conduct is risky are likely to be seen as irresponsible citizens who lack self-control. These implications in the boundaries of selfhood are even more obvious when talking about AIDS: people living with the HIV infection have been historically outcast and are commonly treated as responsible for the infection: ‘It’s not the disease that hurts you. It’s society. People glare at you when they know you are HIV-positive … your friends, your family … you can’t talk to them about it, you feel alone, you feel guilty’ (Conscious Barebacker, narrative production, May 2009; emphasis added). Furthermore, there has been a significant debate about the responsibility of seropositive people in new HIV infections. Health promoters can be sympathetic to why uninfected people fail in their prevention measures, but condemn risky sex activities of those who are infected ¹⁴ (Marks et al., 2006). When talking about barebackers infected with HIV having sex with HIV-negative barebackers it can even turn into legal problems in some countries (Global Network of People Living with HIV/AIDS Europe and Terrence Higgins Trust, 2005). ¹⁵

As many authors have noted for general health issues (e.g. Petersen, 1992; Scott and Williams, 1992), there has been an intervention shift away from the notion that the state should protect the sexual health of individuals to the idea that individuals should take responsibility to protect themselves – and others – from HIV and the risk from other sexually transmitted infections (STIs). Moreover, specific oversight of MSM might lead to the understanding that engaging in man-to-man sex practices involves a higher risk of HIV infection regardless of preventions taken: ‘Somehow, some public health approaches seem to assume that when one is gay one will end up being HIV-positive, no matter what’ (Young Barebacker, narrative production, April 2009). Since all participants supported similar affirmations, I carried out a critical analysis of the dominant discourse in Spanish HIV prevention campaigns addressed to MSM. Though its results will be published soon, I will discuss the preliminary analysis of one of the preventive programmes for illustrative purposes: ‘Get a medal’ ¹⁶ (Plan Nacional Sobre el SIDA, 2010).

The purpose of this campaign was to give information about HIV infections in MSM. To be specific, ‘the aim of this campaign is to draw your attention to the alarming rise in new HIV infections among men who have sex with men’ (Plan Nacional Sobre el Sida, 2010). Messages like ‘get a medal: protect yourself’ and signs such as a rainbow coloured medal and a pink condom define the following target of the campaign: an HIV-negative homosexual man whose challenge is to protect himself from the infection. The analysis of the image also shows a healthy good-looking young man. This is supported by other messages where sex practices under surveillance are not practices at all but identities. For instance, the footnote to the figure of new HIV infections distinguishes homosexual infections from heterosexual or drug infections instead of talking about unprotected anal intercourse between men. Even though the intention of the selection of these terms may have been their simplification, it can easily lead to the understanding that gay men are more likely to be infected. In fact, the use of the LGBTI symbols and other messages like ‘in studies carried out in Spain ONE IN TEN MEN who have sex with men are infected’ intensifies this idea. This last quotation as well as others – for instance, ‘when the proportion of infected men is higher, as now, lowering your guard poses a greater risk of infection’ – constructs HIV-positive individuals as those who have failed in prevention, on the one hand, and as the responsible subjects of infection, on the other.

Furthermore, this programme had a website where detailed information about risky sex practices was given. This website included a quiz for the evaluation of levels of personal awareness in respect to HIV prevention information with several multiple-choice questions such as: ‘Select the correct option: when the proportion of HIV-infected men is higher, as now: (a) drop your guard poses a greater risk of infection; (b) the risk of infection is the same; (c) the risk of infection is independent of the proportion of HIV-infected men’. The right option was (a).

If the answer was correct the user not only had his consequent positive feedback but could also give a virtual medal to someone on Facebook. That was a way to involve community work into HIV prevention. In this same sense, some cards with the above mentioned messages also had the following text: ‘Do not keep this card! Pass it on to a friend or a sexual partner. This way, you help to stop the spread of HIV’. In short, such programmes show some governmentality strategies: constructing the positive image of a desirable subject of intervention who is responsible for his own practices and, in opposition, constructing the image of those who have not succeeded in taking care of themselves and therefore are beyond the reach of sexual health campaigns. Moreover, there is a sense of community responsibility that urges individuals to help other people by spreading information or raising public awareness.

But, obviously, consuming poppers or having raw sex is not the right thing to do for a gay man. It’s criminalized. Then, we all do it, because I’m pretty sure that almost everyone has had sex without using a condom with a stranger … But it’s not the right thing. It’s punished, damned, reproved. Even gay men think it’s wrong. (Conscious Barebacker, narrative production, May 2009)

‘Do you play it safe?’: The act of interpellation on a safer sex context

If one wants to analyze the genealogy of the subject … he has to take into account not only techniques of domination but also techniques of the self … he has to take into account the points where the technologies of domination of individuals over one another have recourse to processes by which the individual acts upon himself. And conversely, he has to take into account the points where the techniques of the self are integrated into structures of coercion and domination. (Foucault, 1993: 203)

Beyond the limits of this discursive theory, it might be helpful to understand the turning around act in the sexual health arena. One of the questions this research started with was: why is the designation of bareback sex only related to MSM sexual practices as a social category well known by most of the members of this group? ¹⁸ Even though engaging in risky sex practices (oral sex with ejaculation or unprotected anal or vaginal sex) is something everybody does, the emergence of the word ‘bareback’ only took place in the group most historically associated with HIV: homosexual (and bisexual) men. An HIV-positive gay activist blog was one of the first places where the term ‘bareback’ appeared. The intention of the author was talking about the sense of ‘liberation’ of practising sex without protection with another HIV-positive man (Gendin, 1997). Since then, the word has achieved many other meanings but it may still have the sense of the liberation connotation of its first uses (Ávila and Montenegro, 2011; Berg, 2009). So, what is it in the gay context associated with HIV prevention that is perceived as coercive and how is this context coming into play in the self-technologies strategies of subjection?

As I have been arguing, gay and bisexual men have been called to answer whether their sexual practices are healthy or risky. Considering gay and bisexual men as a group with a special vulnerability for HIV infection sets MSM as a target of sexual health promotion policies. Besides, the overlap of sexual health and gay identity, as has been shown before, implies the need for definition towards health prescriptions. This context facilitates an inquiry: ‘do you play it safe or do you play it raw?’ Yet, the subject turns around to answer the question. It is in this movement where the construction of the healthy/unhealthy subject takes place – where subjectivity germinates. To take this argument further, I will take into account some of the turning around scenes that I think are crucial to understanding the forming of a bareback subject. By way of illustration, I will explain one of the questions one may answer when registering a profile in a gay and bisexual male Internet platform for dating, cruising or even making friends. This kind of platform, popular among MSM, has different and varied fields to be filled in when signing up: age, weight and height, sexual orientation, interests, activity, sexual practices you like, and so on. One of the fields commonly used in these websites is ‘safer sex’, which often presents different choices as ‘always’, ‘needs discussion’, ‘never’ or even ‘yes except with my boyfriend’. ¹⁹ The importance of this example is not the fact that there is a field in a registration form, it also shows what frequently arises when establishing a sexual contact or even when thinking about one’s identity. In line with this argument, Crossley (2002, 2004) has reported how sexual health has become a key concept for gay and bisexual men when being in a sex situation with other men.

This is why I feel restrained about explaining my sexual practices. I feel self-conscious about talking of sex with multiple partners as well as showing attraction towards bareback sex. (Apostate, narrative production, June 2009)

For many years the strategy of working with the position of the subject towards safer sex and its moral value – even its social community implications – could be useful. Nevertheless, the actual context of HIV prevention is quite different. Naming just some of the differences, there has been a lot of progress on the side effects of HAART therapies and the intention of many public policies is promoting HIV tests to detect new cases as soon as possible and thus decrease the homosexual community viral load to reduce new HIV infections among MSM. From a non-biomedical point of view, the fear of dying is not as strong as it was in the first years of AIDS. ²¹ And yet there is still a huge pornography industry and other widely available images that help to establish risky practices as erotic (Mowlabocus et al., 2013).

What I am highlighting here is that the effort of making risky sex an unacceptable practice and helping individuals choose preventive methods as a moral value might not be useful today. In fact, a deeper analysis of concrete situations suggests that the call to safer sex may not only produce subjects willing to protect themselves from HIV infection but also subjects that assume they like risky practices –because of the risk or because of the eroticism of the practice.

My experience has been weird. I started thinking about fucking raw when some guy asked me if I did bareback … I’d never thought about it before. Actually, I’d always fucked without condoms, because I had sex with people I had confidence in … And now I’ve made some little changes. I’d say the most evident is changing my nickname … for one that says I’m a barebacker (Fucking Raw, narrative production, June 2009)

Conclusions: Moving forward on HIV prevention

The present study has examined the effect of governmentality practices on the construction of so-called bareback sex. The paper has highlighted contemporary safer sex programmes addressed to MSM are implicated in the construction of a social context where accepted individuals are those who protect themselves from HIV infection. Thus, the moral value set in this framework punishes risky sex practices and individuals who have failed in the adoption of preventive measures. At the same time, it has been shown that the actual surveillance of MSM practices is somehow a sociological and medical stakeout of homosexual and bisexual men since these practices are only possible within this group. Not least in this picture is the importance of subject construction processes. Establishing a model where individuals must answer to the call of safer sex not only produces subjects that will perceive themselves as people adopting safer sex practices but also at the same time subjects that will perceive themselves as people who engage in risky sex practices. A bareback subject is even more likely to be constructed in a Western social context where unprotected sex is shown as exciting and pleasant (not only for sexual activities between two or more men) and the effects of being HIV-positive are not as severe as they were 30 years ago. In addition, stereotyped prevention messages like ‘use a condom’ or ‘get tested for HIV’ have helped to create a moral value of safer sex.

These critical reflections on current sexual health promotion addressed to MSM do not answer a significant question: What can be done? Exploration of specific alternatives is crucial in this matter. Other authors (Crossley, 2002; Dean, 2009, 2011) clearly point towards a new line of interventions and reflections in the creation of opportunities for discussion within gay communities. This article should help in this same direction. Safer sex promotion will not be effective in practice unless its programmes take account of this context. Based on this research and similar investigations, some discussions could be launched in different health promotion spaces. That is to say, safer sex policies are trying to reinforce protected sex between gay and bisexual men in order to reduce new cases of infection and the way health promotion is being carried out delimitates a space where bareback sex is possible and desirable. Considering the effects of power and mandatory statements in the construction of subjects (both normal and abject) is crucial to redirect intervention policies.

If government and activists are worried about reported deliberate unprotected sex, they should stop pointing fingers or studying bareback subjects and start recognizing their own mistakes. ²² For instance, I recently participated in a discussion with an NGO about how to deal with the situation of bareback sex. This debate not only included the questioning of individual factors for the assumption of risky practices (drug use, risk seeking, masculinity and so on), but also the responsibility or implication of preventive discourses on the emergence of a need for liberation in sex practices among MSM. Opportunities to challenge actual campaigns and rethink health promotion discourses are a step forward in the rights of individuals to decide their sexual practices. Thus, this will help in the reconstruction of a social context where health promotion is not a binomial decision between safe sex and risky sex. It is important to consider that not using a condom is not a failure of prevention, but an understandable behaviour. Thus, engaging or getting interested in unprotected sex is not the exclusive preserve of barebackers.

New research initiatives are required to make an in-depth analysis to evaluate specific HIV prevention programmes. These initiatives should not only be intended to reduce unprotected sex but to understand the management of risk and understand how failures are being perceived. Furthermore, there is a huge lack of information about how gay and bisexual men perceive HIV infection (both HIV positives and HIV negatives) and how governmental policies are delimitating this infection and, therefore, infected subjectivities. However the aim of this article is not to condemn health promotion but to offer evidence that shows some failures in contemporary HIV prevention in Spain addressed to MSM. Likewise, this paper has the intention of providing some new discussion threads that could guide future research and intervention strategies.