Applied Research Project Paper

Assessment of motivations for “bug chasing”and “gift giving” in the male homosexual population: A systematic review

Cari. M Cooper

B.S Western Michigan University, 2011

Master in Public Health

Concordia University, Nebraska

December 2014

Table of Contents

List of Figures………………………………………………………………………………35–42[A1][A2][A3]

1.Three major themes for participating in bug chasing and gift giving 36

2. Sexuality and intimacy motives ……………………………..…………………………36

3. Feelings of Belonging…………. ……………………………………………………….40

4. Psychological factors as motives[A4]………………………………………………………43

Chapter 1: Introduction to the Applied Research Project ...... 1

Statement of the Problem…………………………………………………………………..4

Thesis Statement...... 5

Research Questions and Hypotheses……………………………………………….5–6

Theoretical Base ...... 6

Definition of Terms………………………………………………………………..6–7

Assumptions...... 7

Limitations...... 7

Summary and Transition……………………………………………………………………8

Chapter 2: Literature Review...... 8–27

First Heading………………………………………………………………………………….9

Chapter 3: Research Method...... 27

First Heading……………………………………………………………………………….27

Research Design and Approach...... 27

Setting and Sample…………………………………………………………………...28

Data Collection and Analysis…………………………………………………………28

Instrumentation and Materials……………………………………………………………..28

Chapter 4: Results...... 29

First Heading…………………………………………………………………………….…29

Chapter 5: Discussion, Conclusions, and Recommendations …………………………...41

First Heading………………………………………………………………………………..43

Interpretation of Findings...... 45

Summary ……………………………………………………………………………..46

Recommendations for Action...... 45

Recommendations for Further Study……………………………………………………..46

References…………………………………………………………………………………..49

Abstract

This review examined the practices of “bug chasing” and gift giving,” which is the intentional acquisition and transmission of HIV. More specifically, this study investigated the reasons and motives of those who participate in the practice of bug chasing and gift giving (BC/GG)in the effort to better understand this population. Previous research has shown various possible reasons why this population of men partake in this practice and subculture, this review focused on pin pointing previous reasoning as well as investigated if there are any new motives or reasons why individuals decide to become involved in this controversial practice. BC/GG are the practices comprising asubculture that is specific to gay and bisexual males. These men seek out unprotected anal sex, usually on the internet in the effort to find a partner that can either obtain (bug chaser) or give (gift giver) the HIV virus to another individual. The methods used in this review were a qualitative analysis. This analysis was used to determine the motives and reasons as to why those who participate in bug chasing and gift giving do so. These findings will be useful to public health practitioners who design programs to prevent the spread of HIV. They may help to guide content and provide direction for future research on the motives for the practices of “bug chasing” and “gift giving.”

Introduction

The first reported cases of what eventually mutated into the HIV virus in humans, was simian immunodeficiency virus (SIV) that infects wild chimpanzees. This was originally called HIV 1. There was also a similar virus that was originally called HIV 2, which was found in the Sooty Mangabey, an Old World monkey that once lived in West Africa. The HIV 1 and HIV 2 virus eventually became a case of zoonosis. Zoonosis is when a disease or infection can naturally transmit from vertebrate animals to humans and vice versa. (WHO, 2014). The HIV 1 infection is believed to have jumped to the human species on three separate occasions creating three separate strains of HIV 1 called the M, N, and O strains. SIV was a weaker strain of HIV 1 that both bushmeat hunters and bushmeat vendors commonly acquired during the hunting process. Theirimmune systems would usually suppress this virus with in a few weeks. It is believed that in order for the SIV to mutate into HIV, that quick transmissions from person to person was needed, giving the virus time for the mutation process. The beginning of the HIV epidemic is believed to have come about from the colonization and growth of African cities.

Although HIV originally jumped species through zoonosis, the HIV virus is now only transmitted from human to human. Only certain fluids in the human body can transmit the HIV virus. These include blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, and breast milk. In order to spread the HIV virus, the virus must come into contact with a mucus membrane, damaged tissue or directly injected into the bloodstream. Sexual contact and sharing needles, syringes, or rinse water to inject drugs are the main culprits that spread HIV. Anal sex is the highest-risk behavior with receptive anal sex (bottoming) being the riskiest of all sexual acts. Vaginal sex is the second highest risk behavior in regards to spreading HIV. It is also possible to contract it through breast milk passed along to a baby, being stuck with a HIV-contaminated needle or object, blood transfusions, or eating pre-chewed food from a person with HIV. The HIV virus can also be contracted by being bitten by an HIV infected person where the skin is broken, any type of oral sex, exchange of bodily fluids through broken skin, wounds or mucous membranes, or in very rare cases, through kissing an HIV infected person where blood is exchanged through sores or bleeding gums, (CDC, 2014).

Since the mid-to late 1990’s the widespread concern and talk about HIV/AIDS has slowed down considerably, however the HIV/AIDS virus continues to be a serious public health issue. In 2011, worldwide there were 2.5 million new cases of HIV. Currently there are approximately 34.2 million people living with HIV in the world. Since this virus has been discovered there have been nearly 30 million deaths from the virus, (CDC, 2014). Up to 25% of the new cases of HIV are estimated as being transmitted throughBB/GG practices.(Weiss, 2006).[A5]

Background and Need

Barebacking is unprotected, anal sex. Although barebacking is a risky behavior that can cause one to contract the HIV/AIDS virus, those who practice barebacking alone are not seeking to become HIV- positive. (Die’guez, Ventuneac, Bauermeister, Dowsett, Dolezal, Remien, 2009).[A6] Many of those who participate in barebacking use strategies to reduce their rates of becoming infected with HIV, such as strategic positioning (engaging in insertative rather than receptive sex), (Reisner et, al, 2008). Another method some of those who engage in barebacking use to reduce their risk of HIV/AIDs is called serosorting. In this method individuals are looking for others who share the same serostatusas their own such as HIV-negative. Those who bug chase, however, are specifically looking for HIV- positive partners with the intent to become HIV-positive. Gift givers are those who are aware of their HIV-positive serostatus and willing to intentionally infect others. In regards to BC/GG, the practices and the subculture are distinct. Involvement in the subculture includes, motive, desire, reasoning as well as a distinct identity for those who participate in the practice. Charging is the idea that those who are HIV-positive (poz) are electric in nature or thought of as “high voltage,” also those who are HIV-positive, who are taking anti-viral medications,are thought of as having a “weaker voltage.” Being poz or electrical in nature is described as hot, radioactive, or nuclear, suggesting a quality associated with vitality and life. The idea of reproduction is appealing to some of those in the BC/GG subculture. Here receiving the gift can be described as pregnancy, where the idea of “breed and seed” and “impregnate” strengthen the dynamics of gift giving, gender roles, and identities of those involved. Gift givers take the dominant, top; active role while the bug chaser takes the bottom or more passive role. Lastly, brotherhood and belonging is a reason why many individuals are attracted to, or belong to, the subculture of BC/GG. This practice is said by some to bring people together and expand a social group. The notion of brotherhood evokes images of men coming together in a mutual, caring and supportive way that does not include women, (Graydon, 2007). [A7]

Although those who are involved in the practice of BC/GG see this practice as not just a practice but also a subculture, many others do not agree. Many in the general population have cultural anxieties about themselves and their sexual pleasures. Individuals who take risks for sexual pleasure, particularly those that involve the risk of HIV transmission, may be threatening to many who feel any amount of risk is both unacceptable and selfish, if not suicidal, in the age of AIDS, (Tomso & Gregory, 2009).

In this systematic review, the literature was used to identify the major themes related to the reasons why men in the gay and bisexual community participate in BC/GG and other factors associated with these practices. Following that, a documentary was used to identify themes and motives for those who identified themselves as being associated with the BB/GG subculture or practice (Hogarth, 2003).

Statement of Problem

The main concern about the practice of BC/GG is the potential spread of HIV. This practice can increase the rates of HIV/AIDs in those that partake, but how is this affecting the rest of the gay, lesbian, bisexual and transgender (GLBT) population as well as the general public. Whenever a deadly virus or disease is being spread, regardless of intent, researchers need to investigate to possibly protect the safety of public health. The spread of HIV/AID will also not just affect those who intentionally became infected but the entire healthcare system. Regardless if an individual desires to become HIV-positive, this will affect the cost of services for the individual. These newly infected individuals will need expensive antiviral drugs and most likely increased visits to a physician. As the disease progresses, they will need further care, surgeries and stays at the hospital. The next potential problem with the practice ofBB/GG is the spread of other sexually transmitted infections (STI’s) If participants of this practice are participating in unprotected sex, the spread of other STI’s is a public health concern as well. Someone may desire to become HIV- positive but did they also desire to get genital herpes as well? Once again, if this practice increases the rates of other STI’s, health care costs are once again going to rise. STI’s require medication and medical attention and in the case of an infection such as genital herpes medication is typically taken daily for the rest of the person’s life to try to reduce the incidence of outbreak.

Thesis Statement

Identifying themes and motives that are common in “pro-bug chasing andgift giving” research and documentaries will assist researchers and prevention personnel in better understanding the male gay and bisexual population hoping to receive or transmit HIV.

Purpose of the Study

The purpose of this review was to access current literature as well as a documentary available on the topic to identify the motives as to why individuals participate in the subculture or practice of BB/GG. It was believed that by specificallyidentifying motives this will aid researchers and those in HIV prevention in their understanding of these practices and how to prevent them.

Research Questions

What are the psychological or social motives and reasons an individual gets involved with either the subculture or practice of bug chasing?

Hypothesis1. There is a distinct group of motives that can be identified in the literature that those involved in the BC/GG practices and subculture have in common.

Null Hypothesis1. There is not a distinct group of motives that can be identified in the literature that those involved in the BC/GG practices and subculture have in common. The reasons are too varied to identify any major themes.

Theoretical Base

This study was a qualitative study.A Health Behavior Belief theorywas used to analyze the previous research data from studies, articles and a documentary to identify common themes and motives for BC/GG. This review will access perceived severity, perceived susceptibility and perceived benefits to access why individuals chose to participate in the subculture or practice of BC/GG.

Definition of Terms

Bug chasing: is defined as HIV-negative gay men who actively, voluntarily seek out others who can infect them with HIV. They represent a newly emerging underground culture within the men who have sex with men (MSM), community who share their own values and behaviors surrounding HIV infection (Grov & Parsons, 2006).

Giftgiving:an HIV-positive individual willing to infect other individuals with the HIV virus. (AIDScience, 2003).

HIV-Either of two retroviruses that infect and destroy the helper T cells of the immune system causing the marked reduction in their numbers that is diagnostic of AIDS

AIDS- a disease of the human immune system that is characterized cytologically especially by reduction in the numbers of CD4-bearing helper T cells to 20 percent or less of normal thereby rendering the subject highly vulnerable to life-threatening conditions (as Pneumocystis carinii pneumonia) and to some (as Kaposi's sarcoma) that become life-threatening and that is caused by infection with HIV commonly transmitted in infected blood especially during illicit intravenous drug use and in bodily secretions (as semen) during sexual intercourse

Barebacking-unprotected anal intercourse.

Assumptions

It was assumed that participants that were interviewed in previous research or who appeared in the documentary were honest and represented themselves truthful

Limitations

The main limitations of this reviewwere the limited information and research on the subculture and practice of BB/GG. Most of the previous studies and reviews as well as “The Gift” documentary are also from several years ago, no real recent information or advancements were found on this topic, which causes some limitations due to the uncertainty if the subculture and practice of BC/GG has changed over the last few years.

Delimitations

I chose the goals of confirming the literature or identifying themes and motives on current studies, articles and a documentary because the majority of the research done previously on this subject was done in the mid-1990’s to the mid-2000s. Not much has been written on the topic since that time. This reviewincludedarticles and a documentary on the topic of BB/GG to determine current motives for these risky behaviors..

Significance of the Study

This study will fill a gap in the literature by determining the current reasons and factors associated with the intentional receipt and transmission of HIV. By identifying thecommon themes and motives for BC/GG in research written on the subject. Public health professionals can determine the best way to develop alternatives for this risky health behavior as well as understand the subculture in order to assist those who may need other services such as support, counseling or therapy to stop themselves from participating in a as a subculture and practice that is deadly and can increase the rates of HIV/AIDS as well as other STI’s. Since this practice involves a serious and deadly virus, more research is needed to potentially protect the public’s health in regards to the status of both HIV as well as other STI’s.

Summary and Transition

HIV/AID’s is a serious virus that has affected and ended the lives of millions of people worldwide. Now that it is understood how this virus is transmitted and spread from human to human, it is necessary to continue to educate the general public on the ramifications of this deadly virus. The practice of BC/GG is potentially increasing the rates of HIV and other STI’s. It is also possible that this practice is increasing rates of depression and mental disorder in those who participate. We must conduct further research on these practices in order to develop public health solutions to prevent potential adverse outcomes of them. A thorough review of the literature will follow in Chapter 2, with the research design in Chapter 3. In Chapter 4, the results of the study will be provided and a discussion and the conclusions of the study will be presented in Chapter 5.

Chapter 2: Review of the Literature

This literature reviews addresses motivesof those who participate in the subculture and practices of BC/GG. Psychological factors involved in those who have engaged in in either bug chasing or gift giving practices were examined to edduce repeating themes. It is believed that becoming HIV-positive leads to increased rates of depression and an increase in mental disorders. A main focus of this study is determining why those involved in the subculture and practice participate in BC/GG. Some reasons in the literature are a sense of freedom, liberation, a true sense of brotherhood or a feeling of belonging to a population? (Graydon, 2007), This review explains what is involved in the subculture and practice of BC/GG and the risky behaviors associated with it.(Graydon, 2007),

Psychological & Social FactorsRelated toMotives for BC/GG [A8]

Living with HIV/AIDs can come with many psychological effects. (Kalichaman,el, at, 2005), conducted a study that, in large part, was dedicated to examination of whether those who used the internet to find specific serostatus partners could be characterized by psychological and social factors, or if they have been more generally related to sexual risk practices themselves. This study focused on those individuals who were seeking sex partners with specific sterostatuses on the internet as well as on sexual compulsivity. This study examined if those who used the internet to look for sex partners scored higher on a Sexual Compulsivity Scale than others. This study lastly focused on possible associations of seeking sex partners online with depressive symptoms, social support, optimism, and sensation-seeking behaviors. The sample of this study consisted of 142 men recruited from community services in Atlanta, Georgia, who were living with HIV. Participants in this study were both sexually active and internet users. People living with HIV/AIDS in Atlanta were recruited by using flyers posted in local infectious disease and HIV/AIDS clinics. Data for this study was collected from April 2002 to August 2004. Participants of this study completed an inventory about lifetime and recent use of the Internet that included questions on what topics they searched while using the Internet. The researchers used a 3-month recall measure on participants that recorded their total sexual frequencies of unprotected sex that was summed with partner’s serostatus. Participants completed the Center for Epidemiological Studies Depression Scale (CES-D) to access their depressive symptoms. To access optimism, this study used the Beck Hopeless scale which consists of a six-item scale. Researchers developed a specific 10-item assessment questionnaire to determine participant’s level of sensation seeking. Lastly, researchers developed another 10-item questionnaire to assess participant’s levels of sexual compulsivity. The data analyses compared men who had used the Internet to seek sex partners within the last three months with men who had not used the Internet for these purpose in that time period. Comparisons were made using logistic regression with 95% confidence intervals (CIs) to determine significance. The results of this study found several differences between the groups that did use the internet to seek sex partners, compared to the group that did not. Those who used the internet but not for seeking sex partners were significantly younger, had higher educations levels, higher incomes, more likely to be Caucasian, were living with HIV for fewer years and reported less HIV symptoms. The subsample of those who were using the internet to find sex partners had a higher rate of African Americans 75%, with 80% earning less than $20,000 annually, most knowing they were HIV-positive for an average of nine and a half years, and with a greater reported amount of current HIV symptoms. The results of this study found that men who used the Internet to seek sex partners reported greater symptoms of depression and less optimism than their counterparts who did not seek sex partners online. Differences in the two groups in regards to depressive symptoms and optimism correlated with participant’s education, CD4 cell counts, use of the internet for sexual entertainment and sexual compulsivity. In contrast to this study’s expected outcome, both groups scored equally in regards to sexual compulsivity. The biggest limitation of this study is the urban setting of Atlanta. Atlanta has a current African American population of 54%, (U.S. Census Bureau, 2014), which is much higher than most large cities; therefore the results may be biased and have a sample that in not representative of the general population. This study does seem to show evidence that those who seek sex partners via the internet have higher rates of depression, less social support, and slightly lower levels of optimism.