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. First, electronic databases were broadly scanned. These included Medline, CINAHL, Web of Science, Social Science Citation Index, Scopus, Academic Search Elite, IBSS, PsycINFO, PubMed and Sociological Abstracts. Initially key words such as men who have sex with men, condoms, sex and HIV were used to assess the extent of the literature available. Subsequently, the search strategy was refi ned to include only those articles published in English from the years 1995 onwards. Empirical studies, review articles, abstracts, book chapters and entire books were accessed through the use of the following key words: condom(s), condom use, men who have sex with men, gay, bisexual, HIV-positive, sexual risk behaviour, HIV/sexually transmitted infection/transmission/ prevention, anal intercourse, bareback(ing)*, safe sex, and unsafe sex.
To reduce gaps in the automated search caused by indexing lags in the electronic data bases, manual searches by the research team were also undertaken. For example, reference lists were scanned for additional publications, and government and professional organisation websites were searched. …