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Try out PMC Labs and tell us what you think. Learn More. In an exploratory study of men who used Internet sites to meet partners and who reported recent episodes of barebacking, respondents outlined numerous strategies they deployed to avoid HIV infection instead of universal condom use. However, in interviews many participants acknowledged uneasiness with the flaws in their chosen strategies and the contradiction between their urgent desire to remain HIV-free and their sexual practices.

For some, the dissonance between the conflicting cognitions could be resolved through self-justification, mental compartmentalization, or invincibility beliefs so that barebacking can continue. For this sub-population continued reiteration of cognitive-based prevention messages have the potential to reinforce rather than undermine their attachment to inadequate strategies for disease avoidance.

The adoption of the term barebacking and its incorporation into Web sites and dating profiles suggested a paradigm shift in sexual risk-taking Berg, ; Van de Ven et al.

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The barebacking coining and controversy occurred as unprotected anal intercourse UAI was increasing among HIV-negative gay and bisexual male populations in North America and Europe Crepaz et al. In the first years of the HIV outbreak, many men feared that the new disease might lead to a reaction more deeply stigmatizing homosexual practices and were thus favorably disposed to accept and adopt the guidance emerging from the new AIDS information and advocacy groups as trustworthy, gay-friendly advice Junge, ; Shilts, Nevertheless, as HIV became a permanent feature of the sexual environment, more explicit challenges to the pd desirability or feasibility of universal condom use inevitably occurred, sometimes described as a backlash against relentless condom promotion Wolitski, Like their heterosexual peers, many gay and other men who have sex with men MSM gauged how much risk was in fact really risky, and some continued to engage in UAI with male partners despite the knowledge that condoms provide an effective barrier against HIV infection Dukers et al.

Unfortunately, the new prevention techniques did not keep incidence rates down Katz et al. Given the continuing high prevalence of HIV infection among urban gay populations Centers for Disease Control and Prevention, and the risk involved in barebacking, the practice has generated a of attempts at explanation. Similarly, the availability of successful clinical treatments that check viral replication and reduce morbidity could affect concern about HIV infection Adam et al. On the individual level, researchers have found correlations between barebacking and HIV-positive status Mansergh et al.

However, amid the data on motivations, influences, strategies, and beliefs about barebacking among those who practice it, little attention has been paid to how men understand the tension between their expressed desire to avoid HIV infection and engaging in a behavior that could cause it. We addressed this issue in the present study and sought insights into the explanations proffered by men who bareback for the inner contradictions that they sometimes manifested and even acknowledged. Festinger posited that conflicting cognitions about beliefs and behaviors e.

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Festinger categorized the mechanisms used to bring about this resolution as denial, distortion, and self-justification. When individuals want to continue the behaviors or find them difficult to change, they are stimulated to modify their beliefs or to incorporate new beliefs to reduce the dissonance and restore consistency. Both these contributions support our finding that when questioned about barebacking in the research interview, many men who practice it offered a perception of their own risk that fit the behavior engaged in. That is, the barebacking behavior of men in our sample appears to influence their construction of risk-avoidance postures that are consistent with continuing the practice.

This is quite different from the assumptions of behavior change models that address perceptions of risk as a precursor to risk modification. The interventions often involve techniques that compel participants to advocate behaviors to third parties that the participants themselves do not practice, thereby leading them to reexamine the behavior and their beliefs about it. Because nearly all of the barebacking men in our study described strategies to lessen their risk of HIV infection, we explored the possibility that contradictions between their stated desires and their actions were being resolved through the cognitive mechanisms described by Festinger.

Although the elaboration could have occurred during the research interview itself, some participants described their precautions as inadequate. How then did they explain their attachment to these strategies? How consistent were they in carrying them out, and how did they explain their failures to do so? All men approached on the sites were informed of the research immediately upon initial contact.

Additional contact depended upon participants agreeing to learn more about the study. Screen names were logged to prevent more than two contact attempts. By study de we sought to oversample HIV-negative men who reported having had unprotected receptive anal intercourse because this practice carries the highest degree of risk for HIV infection. Two active recruiting strategies were utilized: researchers sent instant messages to men on the sites to engage them in live chats about the study and invite them to participate.

In addition, we sent s to men who had posted profiles on the sites used for sexual contacts and allowed users to initiate contact with us via a Web. Among the questions asked during the interviews were: What are your concerns related to sexually transmitted infections and HIV? What are your feelings regarding what is right or wrong around HIV risk?

When do you discuss HIV status with new sex partners? What are your expectations regarding disclosure of HIV status between sexual partners? The interviews were audiotaped, transcribed, and verified for accuracy. A six-person team of researchers involved in the de and implementation of the study developed a preliminary codebook based on the interview guide. Each transcript was coded using NVivo qualitative analysis software QSR International,by at least two coders who then resolved discrepancies through consultation.

Although some men described pre-set risk calculations and their adherence to them, others offered explanations for their behaviors that were internally inconsistent and sometimes explicitly recognized as such by them. Four researchers independently coded these texts to verify concurrence. We then identified the most common as well as the full range of responses and selected extracts from the interviews to illustrate both the main themes and the variety of comments obtained.

Some respondents described their adherence to established disease avoidance strategies and stated that they accepted the risks involved as the cost of sexual fulfillment. For example, participants might have relied on HIV-specific knowledge such as the relatively lower risks of insertive versus receptive anal intercourse or the reduced infectiousness of individuals on successful antiretroviral treatments.

As one participant stated. I think, for me personally, I understand the risk as an assertive top not using a condom. You know, I always try to be [inaudible], you know like, not have no cuts or sores or lesions, you know, on my penis. These individuals felt they were proceeding in a coherent fashion and did not describe or exhibit tension between their beliefs and their behavior. But a majority did describe a contradiction between their stated strong concern to remain HIV-uninfected and simultaneous awareness that their behavior exposed them to infection.

Those who offered this type of explanation simply admitted that they were unable to carry out their prior intentions; however difficult such an acknowledgment might be, the posture permitted the participant to reaffirm the validity of his original intentions without denying or distorting the level of risk involved. Something happens. All I need is to be with a hot guy, and a good deal of my judgment gets put on hold.

An individual acknowledging powerlessness over sexual desire might regret his behavior or dislike the suggestion of weakness, but his explanation for it would remove the need to reconstruct or distort the experience as not really risky. Nonetheless, an element of self-justification often crept into these s:.

But somewhere after you—after you make the choice [to bareback], you submit to the experience, and you get wrapped up into the experience…. The contract metaphor implied an interpersonal dynamic that trumps individual decision-making, suggesting that once the speaker had taken the initial steps towards engaging in bareback sex, he no longer believed himself to be at liberty to place additional limits on the interaction. Rather, the men used present tense to indicate a recurrent or habitual situation, an outcome that is almost justified by the forces at play, i.

Other participants extrapolated from past successes to fortify their belief that the desired behavior was not, at least in their case, all that risky. Frequently, however, the comments included expressions of doubt about the reliability of the explanation offered. Although some participants described their actions as resulting from weakness, most resisted explanations that implied irrationality, lack of control, or other personal shortcomings.

Instead, they often described a process of mental or temporal compartmentalization of the conflicting ideas. Like, any of that stuff. In fact, I never do. Does that make sense? Am I going to die? Is this person positive?

A of respondents expressed confidence in their ability to remain HIV-uninfected based on their success in doing so to date. They described how they estimated the riskiness of a given act with a given partner or type of partner. In other cases they relied on inaccurate information, individual heuristics, intuitions or philosophical beliefs. With the gut feeling. By extrapolating from past success, these men fortified their belief that the desired behavior was not unacceptably risky and could be pursued in the future. Some respondents viewed the inconsistency between their intentions and their behavior as insurmountable and simply stated that they were unable to reconcile the two.

Um, but life is filled with contradictions…. Granted, I am very concerned. On occasion, respondents who acknowledged the contradiction bluntly described their discomfort in doing so. The following two exchanges are typical of many that took place as respondents explored their decision-making process:. R: You know what? I usually assume everyone is positive.

Which makes it seem even more stupid of me to fuck without a condom, but I do it. R: I think in the course of your questioning it makes me feel kind of like, oh you know what? The exchanges also highlighted the role of the research interview itself in generating an explanation for behaviors that participants might not have often considered or discussed in other settings.

Some participants described a safety strategy that included barebacking practiced under clearly defined and limited circumstances. For those whose behavior was anticipated in the risk calculation, the kinds of psychological stress reflected in many of the comments above is unlikely to arise. Just as often, however, such calculations described an ideal rather than a lived experience:.

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It happens. It happens more than once or twice. Respondents in the FIP barebacking study were aware of their enhanced risk and also described recapturing the exhilaration and thrill of sex after years of associating it with disease and loss. When asked to explain this contradiction, their replies varied: some described their inability to carry out a protective strategy; others manifested a belief in their invincibility based on past experience or compartmentalized the conflict between their concerns and their actions, either temporally or psychically.

A few simply recognized the paradox and accepted the associated discomforts. We found that Cognitive Dissonance theory offered helpful insights to our findings. However, amelioration of the dissonant tension does not require that the movement proceed toward reduced risk. By reinforcing the focus on reasoned behavior guided by individual choices, such repetitions could intensify, not weaken, their attachment to problematic strategies.

The interventions cited in the introduction suggest that merely increasing awareness of negative consequences is less effective than converting participants into active advocates for a position that is inconsistent with their own conduct.

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Inner Contradictions Among Men Who Bareback