August 2016
The Pursuit of Positive Carles Diaz Boada & Carlos Acosta
AECS - Catalonia, DENEM - Brazil npo@aecs.org, ra.scora.pamsa@gmail.com
Bugchasing has been described as a new subculture practice, usually present amongst men who have sex with men (MSM) that consists on the desire of acquiring the Human Immunodeficiency Virus (HIV) voluntarily. 1 This practice has alarmed many public health scholars as in a first line it is a counteraction towards many public health efforts towards eliminating HIV infection. Furthermore, it raised curiosity of many mental health professionals with the combination of “misbehavior”, disease and social development. 2 Even though there is not too much data about it, experts believe tendencies are this practice to rise, not necessarily because there are more chasers, but because it is now a stronger social practice as well as medical advances on HIV therapeutics increase global survival. The actual concern to public health and sociology experts is not intercourse between people living with HIV and individuals who don’t. The core of the discussion is a common practice among bug chasers that is called “barebacking” which stands for unprotected anal sex. Barebacking in this case functions as a main vector for HIV acquisition3. It is important to note that not all bug chasers perform barebacking and that this practice is not only seen among the bugchasing community, therefore barebacking is not a solid link to explain the reasons why people become bug chasers. Another point to discuss is that most bugchasing occurs in collective practices. People generally gather in bareback parties and conversion ceremonies (event to convert someone from HIV negative status to positive) to practice bugchasing, which can be seen as a controlled space of acquisition of HIV or, epidemiologically, as a promoting factor of prevalence of new sexually transmitted infections (STIs). On the other hand, another topic to focus on is that this practice can be related, and usually overlapped, with “chemsex” which stands for the intake of recreational drugs to aim self-inhibition and have sex with multiple www.ifmsa.org
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partners for hours, or even days. At this point, while public health agencies are studying and developing measures to confront this issue, medical practitioners have to face its consequences. Whereas some of them think of a mental health approach, others try to handle it by educating their patients about the risks of this practice, independently of their HIV status. The fact is that the reasons why people bugchase are multifactorial. Therefore, there is more than one possible intervention to comprehensively address this matter. Some of the reasons we know are sexual arousal to riskful situations, group affiliation, stigma visibility or avoidance of condom use in future intercourses4. As we can see, some of these people lack of information about STIs, but others have made a thoughtful choice. Even though we have to care about everyone’s health, we still have to respect individuals’ freedom to choose the sexual practices they want to take part in. So at the moment, the most attainable intervention as medical students is to raise awareness and deliver proper sexual education amongst vulnerable groups. References 1. Moskowitz DA, Roloff ME. The existence of a Bug Chasing Subculture. Culture, Health and Sexyality. 2007;9:347-57. 2. Berkman LF, Kawachi I. “A Historical Framework for Social Epidemiology,” in Social Epidemiology, ed. L.F. Berkman and I. Kawachi (New York: Oxford University Press, 2000). 3. Tomso G. Bugchasing, barebacking and the risks of care. Lit Med. 2004 Spring;23(1):88-111 4. Hogarth L. The gift [documentary]. Dream out loud; 2003.