The Ethics of Barebacking: Implications of gay Men's Concepts of Right and Wrong in the Context of HIV

Abstract

ABSTRACT. Recent compelling evidence that HIV medication may decrease the chances of HIV transmission and acquisition bring to light once again the issue of ethical responsibilities of those infected and uninfected when engaging in sexual intercourse. Using data collected in New York City from 120 gay men who engaged in “barebacking” (operationalized as intentional unprotected anal intercourse in an HIV-risk context), we analyzed participants’ attributions of responsibility to self and/or others and how these attributions varied by HIV status. Nearly all participants concurred that ethical judgments were involved and frequently offered a two-tiered response based on the right to individual decision-making and recognition of one's responsibility not to harm others. However, respondents merged the imperative for ethical action with an implicit requirement for communication, and their descriptions of sexual negotiations suggested ambiguities and conflicting assumptions. The result was a frequent tendency to shift the ethical burden to the partner rather than oneself in the context of diminished community dialogue about HIV. New scientific knowledge about HIV transmission offers opportunities for community discussions of sexual fulfillment, rights and responsibilities.

KEYWORDS:

• HIV prevention
• gay men
• ethics
• barebacking

Acknowledgments

The authors thank Susie Hoffman, Raymond A. Smith, Rebecca Giguere, Marina Mabragaña, Tsitsi Masvaruwe, and Mobolaji Ibitoye for their kind assistance and comments. Financial support for the research reported in this article was provided by a grant from the U.S. National Institute of Mental Health (NIMH; R01 MH69333) to principal investigator Alex Carballo-Diéguez, Ph.D., and by a center NIMH grant (P30 MH43520) to the HIV Center for Clinical and Behavioral Studies at NY State Psychiatric Institute and Columbia University and principal investigator Anke A. Ehrhardt, Ph.D. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIMH or the National Institutes of Health.