Some pathologize those who take sexual risks as being self-destructive, suicidal, damaged individuals. Savage (1999) suggested that “for some gay men, danger is a permanent fetish” Others condemn the judgmental culture as once again wanting to cast gay desire and gay sexuality as sick and perverse.

At this point it will be useful to clarify some terms. Many people use the phrases “unprotected” and “unsafe” sex interchangeably. This is inaccurate and confusing. Unsafe sex refers to when an HIV-negative man has UAI with either a partner of unknown HIV status or with a partner he knows to be HIV-positive, thus opening the possibility of HIV transmission and new infection. Unprotected sex is anal intercourse without a condom between two HIV-negative men. Monogamous male–male relationships where both partners know that they are HIV-negative are not at risk for transmission of HIV even if they do not use condoms, provided that they have sex only with each other or only have safer sex with any outside sexual partners. “If there is no virus or other pathogen to transmit, the sex is not unsafe”. These men obviously trust each other to sustain sexual fidelity. The “if ” of “if they have sex only with each other” is a very big one.

Originally, social scientists used the term “barebackers” to refer to men who intentionally seek out condomless anal sex, as distinct from men who have UAI due to poor planning or accidents. Some write that for a behavior to be barebacking two crucial criteria must be met: intentionality, and the potential for the risk of viral transmission. Researchers often hear people say that there are many situations in which sex without condoms is not barebacking. If people in a monogamous couple where both are HIV-negative do not use condoms, most do not describe this as barebacking. Similarly, people who get caught in a moment of passion and once in a blue moon have unintentional unprotected sex, or who have sex with condoms but they break, or people who were drunk one night and did not use a condom are not said by the above researchers to engage in bareback sex.

As barebacking has become more prevalent in the gay community, the perception and definition of it has evolved. “Whereas the term originally was used to describe engaging in premeditated, consciously chosen unprotected anal sex, it has now been incorporated into colloquial discussions to describe the unintentional, unprotected ‘slip-ups’ that occur”). Halkitis, Greene, and Mourgues (2005) discuss that among a sample of New York gay men there is a wide variety of meanings given to and understandings of the ways that the term barebacking is used. Mansergh and colleagues (2002) propose defining the term “barebacking” (for both HIV-negative and HIV-positive men who have sex with men [MSM]) as “intentional anal sex without a condom with men who are not a primary partner (that is, not someone the individual lives with or sees often and to whom the individual feels a special emotional commitment)”

There is evidence that sex without condoms is the relatively infrequent act of a relatively large number of gay men (rather than the very frequent act of a few) and that it is often moderated by relationship status as well as HIV status (Coxon & McManus, 2000). Despite the risks — or perhaps because of the risks — it holds a certain mystique in some segments of a community that had to learn to be afraid of sex all over again. One does not have to look very hard to find Internet sites devoted to the glorification of barebacking. A walk through a gay sex club may reveal men openly engaging in barebacking.

It is important to state and to reiterate, that even anal sex with a condom is not 100 percent risk free for preventing HIV transmission. Condoms may have a tear or hole in them; they are often incorrectly used and can break.