Loneliness, HIV status, unmet intimacy needs, alienation from the gay community, and love might well warrant consideration as well. Environmental stressors such as racism, homophobia, and economic disadvantage may play a role in the rise of barebacking. Internalized homophobia can contribute to barebacking by creating an unconscious sense that a gay man is unimportant and undervalued, thus increasing his sense that he is expendable, and so too are the men with whom he has sex and from whom he seeks love and validation. Many gay men of color cite social inequities that result in lower education, lack of access to health care, substance use, and poor mental health as contributing to apathy regarding sexual risk taking (CDC, 2002a Gomez, Mason, & Alvarado, 2005). Men of all ages are engaging in barebacking. Middle-age gay men who were sexually active before the onset of the AIDS crisis, are foregoing the use of condoms (Bonnell, Weatherburn, & Hickson, 2000).
