Cognitive-behavioral HIV risk-reduction interventions are effective in reducing rates of unprotected sexual behavior in both gay men and heterosexuals. Increasing evidence, including the PI's earlier work, suggests that many interventions fail to enroll individuals who are engaging in the riskiest of behaviors. That is, many potential participants may not be sufficiently motivated to change, or to even consider the possibility that they have problem behaviors that could benefit from an intervention. We hypothesize that HIV risk reduction programs that include an individualized motivational component that helps potential participants prepare to change will result in significantly higher rates of participation in an intervention program. Drawing on the transtheoretical model of stages of change and the motivational interviewing techniques of Miller and Rollnick, we have developed such a program and propose to test its efficacy in this randomized clinical trial. Because men who have sex with men and who also use alcohol and drugs are more likely to engage in high risk behaviors and have a greatly elevated risk of HIV infection, recruitment efforts will target men at gay bars. Over a 4-year period, more then 600 men will be recruited to complete an assessment that includes a psychiatric interview and a series of questionnaires that provide data on psychological characteristics, sexual behavior, and substance use. They will then be randomized to attend a feedback session where they receive either standard """"""""informational"""""""" feedback or an """"""""enhanced motivational"""""""" session. During the enhanced session, a clinician will review results from their assessment, help the individual identify reasons for change, and elicit self-motivating statements from the individual. All individuals will be invited to participate in a 6-week cognitive-behavioral intervention, their sexual behavior and substance use monitored over an 8 month period. We hypothesize that men randomized to the enhanced motivational session will be more likely to participate in interventions. Additional analyses will examine (a) whether intervention attendees differ from refusers in terms of substance use, sexual behavior, and psychological characteristics, and (b) whether attendees who had received the enhanced motivational session differ from those randomized to the standard session. Changes in sexual behavior and substance use following the intervention will also be assessed.
