Social science research as well as a rise in sexually transmitted diseases and new HIV infections among men who have sex with men point to increasing numbers of gay men engaging in unprotected anal intercourse without condoms, a practice called "barebacking." There is some evidence that barebacking is linked to the rise of crystal methamphetamine use (by men of all races and socioeconomic groups) and surfing the Internet to locate sex partners, although these are not the only factors contributing to this phenomenon. This article summarizes current research findings on sexual risk taking among gay men, discusses psychosocial issues that contribute to barebacking, and suggests a harm-reduction approach to clinical work with gay men who bareback as an effective method of addressing the behavior.