Review: Perry Halkitis, Leo Wilton and Jack Drescher (ed) Barebacking: Psychosocial and Public Health Approaches: Haworth Medical Press: Binghamton, 2005 In the United States, 'barebacking' (deliberate unprotected anal sex) is becoming a serious problem. What can we learn from a recent book on this issue from that country? According to this recent publication, barebacking was first discussed within community media in the mid-nineties, in the context of debates within Poz magazine and the New York Times Magazine. Unfortunately, it didn't remain theoretical, and did not remain restricted to HIV+ gay male supporters. Acceptance of the practice spread to HIV- gay men too, and now there are barebacking websites, sex parties, and resurgent HIV/AIDS and STIs in its wake. HIV - gay men risk seroconversion, while HIV+ gay men risk superinfection with STIs and/or treatment-resistant mutant HIV. Why does this happen? One answer might well be the role of the Internet as a pathway for communication about sex for men who have sex with men. Whereas pre-Net sexual interaction involves visual cues, verbal discussion and some degree of socialisation into safe sex culture, the Internet reduces visual nonverbal behavioural cues and doesn't offer socialisation experiences into safe sex. And yes, crystal methamphetamine is involved here as well, and prompts excessive risktaking behaviour, short-circuiting cognitive and behavioural inhibitions against unsafe sex. Polydrug abuse may worsen this overall picture. In the United States, there is now a distinct barebacking subculture, which fortunately appears to be largely restricted to the United States. According to what research is available, most 'barebackers' are fortysomething, white professional HIV+ gay men, whether top or bottom, and have multiple sexual partners. Fortunately, anecdotes about negative gay men who actively puruse infection ('bug chasers') appear to be just that. When it comes to in-depth therapeutic behavioural intervention, some background information emerges about how barebacking has gained a toehold within US gay male communities. It appears to be correlated to low HIV+ self-esteem, isolation from community organisations and perceptions of lack of appeal to others. By contrast, barebacking propaganda depicts it as a mark of intimacy, trust and caring. Negative and positive barebackers try to restrict sex to other negative or positive barebackers, but rely on anecdotal and subjective indicators about safe sex and risk to do so. As one might guess, most male sex workers refuse outright to have unprotected sex, although the research here doesn't mention about how they might differentiate work sex from non-work relationship sex. Some HIV/AIDS researchers have produced a useful tool in this context, which is known as the Unprotected Anal Intercourse Attitude Inventory. Barebacking is strongly related to low self-esteem, inaccurate or contradictory perceptions of risk from unsafe sex, rationalised risktaking, AIDS fatigue, needs for intimacy, diminished self-control and absence of self-assertion, fatalism and condom-related sexual dysfunction. Some contributors to the volume reviewed describe possible anti-barebacking interventions. These might involve examination of HIV-negative self-perceptions, integration within community organisations that promote safe sex, correction of inaccurate or ambiguous perceptions about safe sex and risk, and examination of psychological stressors around safe sex. While this is an otherwise excellent collection of papers on this issue, unfortunately, there are two problems. Firstly, there appear to be no contributions from representatives of HIV+ community organisations about outreach from their groups to men who have sex with men who might be at risk of barebacking. Secondly, it discusses negotiated (un)safety, which is irritating, when it didn't work as a measure of risk reduction in Australia, where it originated, and serves as a source of ambiguity and confusion about safe sex, relationships and risks. Read it, and take steps to oppose barebacking if the subject arises in your friendship or social networks, or personal relationships. Craig Young - 10th September 2006