Reducing sexual risk behaviors and alcohol use among HIV-positive men who have sex with men: A randomized clinical trial.

Abstract

This randomized clinical trial (N = 253) evaluated the efficacy of a theory-based intervention designed to reduce both alcohol use and incidence of unprotected sexual behaviors among HIV-positive men who have sex with men with alcohol use disorders. An integrated, manualized intervention, using both individual counseling and peer group education/support, was compared with a control condition in which participants received resource referrals. The intervention was based on the transtheoretical model’s stages and processes of change, and motivational interviewing was used to enhance client readiness for change. Major findings include treatment effects for reduction in number of drinks per 30-day period, number of heavy drinking days per 30-day period, and number of days on which both heavy drinking and unprotected sex occurred. Practitioners employing this intervention may achieve enhanced client outcomes in reduction of both alcohol use and risky sexual behavior.

The Effectiveness of MI4MSM: How Useful is Motivational Interviewing as an HIV Risk Prevention Program for Men who have Sex with Men? A Systematic Review

“…Implicit in MI, as in most psychosocial models of behavior change, is the assumption that risk behaviors are largely under the control of the individual (Fisher & Fisher, 2000), and the intervention therefore risks failing to address the full range of factors that influences MSM's sexual behaviors, such as the strong interpersonal and social forces (see, e.g., Berg, 2008;Muñoz-Laboy & Dodge, 2007;Tieu et al, 2011). Among the three included studies in this systematic review that assessed the effectiveness of MI on both AOD use and sexual risk behaviors, two found an effect for AOD use but not sexual risk behaviors (Morgenstern et al, 2007;Velasquez et al, 2009), and the third found no effect for either outcome type (Morgenstern et al, 2009). Also previous efforts to reduce sexual risk behaviors using MI have yielded mixed results.…”

“…Further, lack of provider MI training is an unlikely explanation of the limited effectiveness demonstrated. Across the 10 studies, therapists providing MI had received extensive MI training; several included training by MINT members (e.g., Picciano et al, 2001;Velasquez et al, 2009). A recent systematic review by Lundahl and colleagues (2010) found that level of MI training did not influence the success of MI.…”

“…The metaanalytic findings in this systematic review suggest that their substance use and party drug behavior may be more amenable to change than risky sexual behavior. In one of the included studies (Velasquez et al, 2009), HIV-positive men in the MI arm significantly reduced both their number of drinks per day and heavy drinking days compared with MSM in the control arm, but not rate of unprotected sex, which at 12 month follow-up was actually higher among intervention men. Because use of al-cohol and other drugs is a modifiable behavior that often reduce inhibitions and act as a trigger for engagement in high-risk sexual behaviors that can ultimately result in STI/HIV transmission, its role in HIV prevention should continue to be explored.…”

“…Authors who failed to reply were sent two follow-up e-mails. Of those contacted, four authors or their colleagues provided the requested information (EXPLORE Study Team, 2004;Morgenstern et al, 2007;van Kesteren et al, 2007;Velasquez et al, 2009).…”

Risk Behaviors Among HIV-Positive Gay and Bisexual Men at Party-Oriented Vacations

“…Past behavioral interventions among HIV-positive MSM have targeted sexual risk (Coleman et al, 2009;Kalichman et al, 2001;McKirnan et al, 2010;Serovich et al, 2009;Simon Rosser et al, 2010;Williams et al, 2008) or sexual risk and drug use (Fisher et al, 2006;Lapinski et al, 2009;Mausbach et al, 2007;Rotheram-Borus et al, 2004;Velasquez et al, 2009;Wong et al, 2008). Many of these interventions have shown at least modest success in achieving their intended outcomes.…”