Without Condoms: Unprotected Sex, Gay Men and Barebacking Review
If you work with gay men as a health care provider, especially as a psychotherapist or health department prevention case manager, this book is a must. It is directed at professionals, and is quite scholarly, with thirty-three pages of references. However, the fact that the author talks about his own experience as a clinical social worker in private practice, and also the fact that he, himself has HIV, makes the book all the more compelling. It is extremely thorough (with one exception), and explores, in depth, the many reasons that gay men choose to have sex without condoms. The conclusion is that there is no simple answer, and clinicians need to individualize their assessments. No broad brush can put the crystal meth party boy in the same category as the committed couple who stop protection. "Barebacking" can be too easily demonized. The bare, unvarnished fact is that the majority of gay men are not 100% safe, 100% of the time. As health care workers we must be realistic, and look for other interventions besides, "Just say no". In this vein Shernoff discusses the "harm reduction model", offering very specific suggestions. Our challenge is to accept our clients where they are, without condemnation, if we are to truly engage them in a process of change. At the same time we must acknowledge it can be a challenge to witness what seems to us to be provocative behaviors. Shernoff explores his own reactions to his clients' confessions, and how he deals with them; encouraging all of us to do the same.
The one exception to this extremely thoughtful and in-depth examination has to do with Shernoff's cursory treatment of sex addiction. He devotes less than a page to the subject, and describes it as "controversial" and "based on a heteronormative concept". Sorry, I beg to differ: it is based on an addictions concept. If you substitute "sex" for "alcohol" in the criteria for alcoholism, the many parallels are obvious. In no way does this mean that the sex gay men have, even in a casual context, is a sex addiction, just as a gay bar patron is not necessarily an alcoholic - but in some cases both meet the criteria of addictive behaviors. The significance of this is that groups such as Sex Addicts Anonymous and the 12-Step process can offer significant support for alternative ways to cope with life, and better choices for harm reduction. For more information the interested reader can get another perspective from Robert Weiss's book, Cruise Control: Understanding Sex Addiction in Gay Men (LA: Alyson Books, 2005).
This, however, is a very minor drawback to an otherwise exhaustive examination of the issues. I have worked in this field since the beginning of the AIDS epidemic both as a private therapist and health department consultant. Even with an extensive background and experience this book had much to say to me, and much that I could apply to my own practice. If you work in a related field, this should be required reading.
Michael E. Holtby, LCSW, BCD
Without Condoms: Unprotected Sex, Gay Men and Barebacking Overview
After years of activism, risk awareness, and AIDS prevention, increasing numbers of gay men are not using condoms, and new infections of HIV are on the rise. Using case studies and exhaustive survey research, this timely, groundbreaking book allows men who have unprotected sex, a practice now known as "barebacking," to speak for themselves on their willingness to risk it all.
WithoutCondoms takes a balanced look at the profound needs that are met by this seemingly reckless behavior, while at the same time exposing the role that both the Internet and club drugs like crystal methamphetamine play in facilitating high-risk sexual encounters. The result is a compassionate, sophisticated and nuanced insight into what for many people is one of the most perplexing aspects of today's gay male culture and life style. Michael Shernoff digs deep and forces us to see that the AIDS epidemic is not over. We must now ask the hard questions and listen to the voices that answer. The stakes are too high to ignore.
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