How MSM manage HIV-risk behavior within the online “party and play” (PnP) subculture

1. How MSM manage HIV-risk behavior within the online “party and play” (PnP) subculture Greg Rebchook, Ph.D. Alberto Curotto, Ph.D. Center for AIDS Prevention Studies Supported by NIMH Center Grant #MH42459

2. Rationale for this study • At the last conference, we presented qualitative data about the role of the Internet in the lives of MSM (n=91). • We had NOT captured the experiences of men who use the Internet to “party and play.” • So, we conducted a small follow-up study to learn more about these men’s experiences.

3. Methods • Online survey and interviews ($40 compensation) • Interviews conducted in real time via IM • Interview themes included: • Likes and dislikes about the Internet • Internet’s effect on one’s life and community • How the Internet is used for sexual purposes • Description of participants’ • online chats and subsequent sexual encounters • drug use, PnP, and barebacking experiences • on- and off-line discussions about condom use, safer sex, and HIV • Perceptions of how the Internet is related to PnP • Perceptions of how PnP and the Internet are related to HIV risk • Recommendations for HIV-prevention programs

4. Participants • Participants recruited from M4M chatrooms (mostly AOL) • Recruiter entered chatrooms popular with men who party • profile described project and linked to a detailed project homepage • brief public invitation once every hour • waited for potential participants to initiate contact. • No on- or offline advertising • Eligibility screening • Male-identified and at least 18 years old • In-person sexual activity with a man met online (past 2 months) • Used “party” drugs during sex (past 2 months)

5. Demographics • N=23 • Age (mean=35, range 18 to 54) • Race/ethnicity (this group was much whiter than that of the original study) • 78% white – 4% AP/I • 9% Latino/Hispanic – 9% Did not indicate • Geography • 35% Pacific – 22% Eastern States • 17% South – 9% Midwest • 9% Southwest – 9% Mountain States • 65% urban • 22% suburban • 13% small town/rural

6. 65% college degree (at least) Sexual orientation 91% gay 9% bisexual HIV status 78% negative 22% positive Relationships 39% had boyfriend, but none was in a mutually monogamous relationships > 6 months Sexual behavior—from survey data (previous 2 mos.) Mean number of sex partners = 11 70% reported unprotected anal sex 87% had in-person sex with an online partner 75% reported unprotected anal intercourse during at least one of those encounters Characteristics

7. Drug use (previous 6 months)

8. WARNING!!! S: Sexual Situations L: Crude, Indecent Language

9. The Internet and PnP “it [the Internet] introduced me to a whole aspect of gay life I otherwise would have never known about… Party and Play… that’s how I first found out about people who do drugs and stay up for days having sex and sex parties” ID258 | 36, white, HIV-negative, uses crystal several times/month, all hookups in the previous 4-8 months have been for PnP

10. The Internet and PnP • Most participants felt that the Internet made it easier to find others to PnP with “I can’t imagine walking up to someone in a bar and asking him if he parties… but online it’s so easy” ID258 | 36, white, HIV-negative, uses crystal several times/month, all hookups in the previous 4-8 months have been for PnP • Others pointed out that PnP is not unique to online environments—that it’s popular everywhere • But even many of these men said that they met most of their partners online

11. Attitudes towards & strategies for preventing HIV infection • Preventing HIV infection/transmission was very important to many participants • Some successfully avoided unprotected anal sex • “I don’t fuck or get fucked without a rubber.” • ID261 | 40, white, HIV-negative, uses crystal several times/month • “I’ll always use a condom if fucking… at least I’ve done so no matter how much I’ve partied… I often don’t want to… but the desire to not get HIV/hepatitis is stronger” • ID276 | 38, white, negative, uses cocaine several time/month • “I could be really fucked-up, man, but I always use condoms when I’m getting fucked… but remember, I always did it safely, kiddo.” • ID271 | 29, white, HIV-negative, uses crystal several times/month

12. Attitudes towards & strategies for preventing HIV infection • Preventing HIV infection or transmission was very important to many participants • Others intended to avoid unprotected sex but had it anyway • “I did have unsafe sex, anal penetration not to orgasm without a condom, however did manage to stop the behavior and disengaged from the scene”. • “[I have] fairly stringent safe-sex practices, even while partying.” • ID268 | 46, white, HIV-positive, used crystal a few times in last 6 months, cocaine about once a month

13. Attitudes towards & strategies for preventing HIV infection • Preventing HIV infection or transmission was very important to many participants • Some negative guys only top during unprotected sex • “Occasionally a partner will ask me to bareback top even if he knows there will be no reciprocity. I don’t always do it but I have done it. I try to withdraw before coming even though I know that’s not really effective.” • ID265 | 42, white, HIV-negative, uses crystal about once a month

14. Attitudes towards & strategies for preventing HIV infection • Preventing HIV infection/transmission was very important to many participants • Some positive guys “sero-sort” when having unprotected sex • “the ones who are negative, I generally don’t interact with” • ID259 | 26, white, HIV-positive • Other positivesonly bottom with negative partners during unprotected sex (strategic positioning) • “I BB when the bottom wants it that way and he must be poz and know I am … always [use condoms] if neg, but I hardly top neg men” • ID269 | 49, white, HIV-positive, PnP a few times in past 6 mos.

15. Attitudes towards & strategies for preventing HIV infection • Preventing HIV transmission was very important to many participants • Many positive guys prioritize disclosing their HIV status • “I let them know my status and let them decide if they want me to use a condom or not. If I don’t, I don’t cum in them.” • ID272 | HIV-positive, uses crystal about 10 times a month, and only has sex when partying. • “I mention clearly in my profiles that I am poz.” • ID279 | 43, white, HIV-positive, used crystal a few times in the past 6 months but used to do it a couple of times a month.

16. Attitudes towards & strategies for preventing HIV infection • Preventing HIV transmission was very important to many participants • Others rarely or never use condoms, and report that partying has a major dis-inhibiting effect on their behavior • “my inhibitions are just gone…” • ID256 | 21, white, HIV-negative, uses crystal several times/month • “It [partying] makes me uninhibited just like most other guys” • ID257 | 25, HIV-negative, a “binge” partier (used 5 times the week before, but none in the prior 6 months) • “Well it [partying] heightens the passions and lowers the inhibitions, and the intersection of the two is the danger zone. you find yourself either not caring or outright wanting to cross the line.” • ID263 | 24, white, HIV-negative

17. Attitudes towards & strategies for preventing HIV infection • Preventing HIV infection or transmission was very important to many participants • Some successfully avoided unprotected anal sex • Others intended to avoid unprotected sex but had it anyway • Some negative guys choose to be only the top during unprotected sex • Some positive guys “sero-sort” when having unprotected sex • Others only bottom with negative partners during unprotected sex (strategic positioning) • Many positive guys prioritize disclosing their HIV status • Others rarely or never use condoms, and report that partying has a major dis-inhibiting effect on their behavior • Very few show no concern or thought to HIV prevention, even if how they try to protect themselves isn’t necessarily an effective strategy

18. Social norms & Peer pressure Any prevention program, however, must take into account the norms that characterize the environment in which risk behaviors take place: “the internet plays a role in sexual risk taking… people who hook up find ‘strength’ in numbers… meaning they feel OK about taking sexual risks because they’ve just made a ‘friend’ who is as willing as they are to practice unsafe sex…” ID258 | 36 white, HIV-negative, uses crystal several times/month, all of his hookups in last 4-8 months have been for PnP.

19. Social norms & Peer pressure To many guys who PNP, bareback sex is the assumed norm: “in the party and play world, barebacking is almost a given” ID258 | 36 white, HIV-negative, uses crystal several times/month, all of his hookups in last 4-8 months have been for PnP. “after we both had bareback sex... I expressed my discomfort... it was understood we both liked it bareback... we never really discussed it further than that” “I almost always engage in bareback sex when partying... it’s usually understood by both parties... as usually gay men who are tweaking and planning on fucking... they usually prefer it bareback” ID273 | 30, white, untested, uses crystal every 3 months or so but used to PnP a lot

20. Social norms & Peer pressure Some reported rejection due to their unwillingness to BB (but, in some cases, there may have been issues of sero-sorting at play): “I have been to some PnP parties and left in disgust because of the unsafe sex going on and I have been ASKED to leave a PnP event because I WON’T get fucked raw” ID252 | 54, white, HIV-negative, uses crystal several times/week “on a couple of occasions, when I have replied that I use condoms, the guys have then refused to meet. that is a fascinating and growing phenomenon.” ID260 | 24, white, HIV-negative

21. Conclusions “To some degree the internet is the great equalizer, in the sense that it creates a level playing field in which people of all races, ages, income levels, geographies, etc., can interact in ways that were never possible before the internet” ID260 | 28, white, HIV-negative The Internet facilitates the creation of social/sexual networks, and norms can be established and reinforced in these networks. When norms about PnP, BB, condoms, etc. do not support safer behaviors, these very networks can become the route through which HIV and other STDs can be transmitted… but, don’t give up!

22. Conclusions (continued…) Even though these narratives indicate that PnP has a powerful and compelling role in facilitating unprotected sexual behavior, there is still a role for non-judgmental HIV prevention programs: “it offends me that some assholes have said to me… oh I must not care about myself or have any self esteem ’cuz I would pnp or bareback… that is wrong to say that.” Most of the participants were still greatly concerned about the possibility of contracting or transmitting HIV during their PnP encounters—so, there is an opportunity for HIV-prevention professionals to work with men who PnP to help them find strategies that effectively protect them and their partners, because they do care about themselves and their communities.

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