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

Abstract

Among men who have sex with men (MSM), the principal risk practice for HIV infection is unprotected anal intercourse, often engaged in under the influence of alcohol and other substances. Both behaviors are targeted through the much-used counseling approach motivational interviewing (MI). We conducted a systematic review of the effectiveness of behavioral interventions adapting the principles and techniques of MI on HIV risk behaviors for MSM. Ten randomized controlled trials, which included 6,051 participants at baseline, were eligible for inclusion. Nine outcomes, of which seven were for sexual behavior outcomes, were sufficiently similar to compute meta-analyses. With the exception of one outcome, drinks per day at short-term follow-up, there were no significant differences between the groups receiving MI and the control groups. The effectiveness of MI as a prevention strategy for HIV risk behaviors among MSM is uncertain and continued work to craft more effective HIV prevention programming for this group should be done.

A randomized controlled trial utilizing motivational interviewing to reduce HIV risk and drug use in young gay and bisexual men.

“…Although all participants benefitted from having received their respective interventions (MI or education), those in the MI condition demonstrated significantly greater reductions in both substance use and UAI over the one year follow-up period. These findings are contrary to a recent review of MI-based interventions to prevent HIV risk for GBM (Berg et al, 2011). …”

“…Despite support for the efficacy of MI in reducing risk behavior in HIV-seropositive populations (Naar-King, Parsons, & Johnson, 2012), research is inconclusive regarding the effects of MI for HIV-negative GBM. Although Project Explore, a randomized controlled trial (RCT) testing the efficacy of MI over 10 sessions for HIV-negative GBM, found significant intervention effects on HIV incidence and UAI (Koblin, 2004), some recent reviews have questioned the efficacy of MI for reducing risky sex among GBM (Berg, Ross, & Tikkanen, 2011; Lundahl & Burke, 2009; Smedslund et al, 2011), while others have found that MI was more effective in reducing substance use than UAI among adult GBM (Berg et al, 2011; Morgenstern et al, 2009). Despite some evidence of MI reducing risky behaviors for certain sub-populations, further investigation is needed to determine its efficacy among HIV-negative substance-using YGBM.…”

The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development

“…Table 1 also shows the ongoing methodological problems associated with the existing evidence. These relate to issues such as conflicting and limited evidence: 43 on the one hand, the heterogeneity of populations included in studies and, on the other hand, where population criteria is more tightly specified, the small number of studies available for review. 48,62 Many of the studies available suffer from high or unclear risk of bias.…”

“…58 However, overall, these evidence syntheses do suggest cautious support for the efficacy of behavioural interventions among MSM. 34,43,49,55,56,58,59,62 Moreover, they suggest that evidence-based interventions have larger effects than non-evidence-based interventions. …”

HIV Risk Reduction Interventions Among Substance-Abusing Reproductive-Age Women: A Systematic Review

“…Second, the two reviewers independently extracted data and determined quality assessment ratings for each article. Third, the two reviewers compared their extracted data and quality assessment ratings to assess inter-rater reliability as has been done in previously published systematic reviews (Berg, Ross, & Tikkanen, 2011; Lloyd & Operario, 2012). Next, a third or fourth reviewer provided input regarding the disagreement.…”