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By study design three quarters of participants were HIV-uninfected and engaged in condomless receptive anal intercourse. In the course of face-to-face in-depth interviews, participants were asked what led them to have their first bareback experience as well as to continue with the behavior. Qualitative analysis identified the pivotal role that sexual pleasure and intimacy have in this population and how drives for sexual satisfaction, adventure, intimacy, and love overpower health concerns and condom use recommendations. Men interested in bareback sex use a variety of defense mechanisms to account for, justify, and exonerate their behavior. HIV-prevention interventions have paid insufficient attention to libidinal drives, a crucial element of psychological functioning. Given that most human beings appear to value health over illness and that the illness risk associated with HIV infection is well known, especially among MSM in urban centers of developed countries, the practice of barebacking by uninfected MSM in a place like New York City appears at first view to be quite puzzling. Yet other behaviors e.
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