The aim of this paper is to present a review of the literature on the key issues impacting on the decisions, by men who have sex with men, to use, or not use, condoms for anal intercourse. 250 publications were accessed, reviewed, read and sorted; 200 of these were research based and 50 were opinion pieces of work. In addition, 240 of the 250 had undergone a peer review process.
The review presented here shows that men who have sex with men communities are a heterogeneous group and their reasons for engaging in unprotected anal intercourse are inter-related and diverse. Six main themes related to sexual risk behaviour and condom use were identifi ed: the availability of HIV treatments, physical issues, psychosocial issues, intentional practices, internet and substance use. Nurses need to understand these factors if they are to effect positive changes in condom use and address the complex challenges inherent in tackling increased rates of HIV infection.
Keywords: gay men's health; men's health; men who have sex with men; condom use; sexual risk behaviour
At the end of 2005 there were approximately 15,310 people living with HIV in Australia and the incidence of AIDS was 1.3 per 100,000 people, the same as in the United Kingdom and much lower than in the United States (14.3 per 100,000 in 2004) (Neville & Henrickson, 2008). These same authors quote fi gures for New Zealand as being even lower, with an estimated 1400 people living with either HIV or AIDS.
The worldwide view of HIV/AIDS is that it is an epidemic affecting women, men, young people, sex workers, injecting drug users, men who have sex with men, prisoners and babies born with HIV (UNAIDS, 2006). However, in western countries such as the USA and New Zealand the HIV epidemic disproportionately affects men who have sex with men (AIDS Epidemiology Group, 2006; Peterson & Bakeman, 2006). Since HIV was fi rst identifi ed and confi rmed globally by researchers to be sexually transmitted, condoms have unanimously been recommended for protection against HIV transmission in men who have sex with men who engage in anal intercourse (Shernoff, 2006). Within this group are men who do not use condoms during intercourse, a factor that is linked to a signifi cant number of HIV infections but which receives little attention from western media (Aguinaldo & Myers, 2008).
The term men who have sex with men is used in public health, general and specialist sexual health literature to describe men who identify as gay, bisexual and/or heterosexual but report engaging in sexual activity with other men (Young & Meyer, 2005). Consequently, men who have sex with men may be married to women, have sexual relationships with both men and women, be in a longterm exclusive relationship with another man, or may be in a committed same sex relationship but not be sexually exclusive. In addition, men who have sex with men may engage in a variety of safe, safer or unsafe sexual practices. Some of these practices include not using condoms within their primary relationships but doing so when having casual sex with secondary partners, or using condoms for all sexual activities regardless of the relationship or not using condoms at all.
The literature reviewed in this paper provided the background to a qualitative descriptive study commissioned by the New Zealand AIDS Foundation (Adams & Neville, 2008). A thorough overview of current knowledge about a particular topic is integral to the research process as it determines what is currently known about the topic under investigation (Schneider, Whitehead, & Elliott, 2007). The aim of this paper is to present a review of the literature on the key issues impacting on decisions by men who have sex with men to use, or not use, condoms for anal intercourse.
IDENTIFICATION OF THE LITERATURE
Guidelines, as summarised by Hayes et al. (2006), were utilised for accessing literature. …