1. Effectiveness of Motivational Interviewing on
HIV risk behaviors among men who have
sex withKunnskapsesenterets of the
men: A systematic review
bestnye PPT-mal
available evidence
Rigmor C Berg, Ph.D., CHES
Michael W. Ross, Ph.D.; Ronny Tikkanen, Ph.D.

2. I - BACKGROUND
 MSM 53% of all new HIV infections in U.S. (CDC, 2010)
 MSM most affected by HIV in EU/EEA (van de Laar et al., 2009)
 UAI principal risk behavior for HIV among MSM (CDC, 2010)
 UAI often in conjunction with alcohol, drugs (AOD) (e.g.
Folch et al., 2010; Hirshfield et al., 2004; Stall et al., 2001)
 Meta-analysis: 87% increased risk of HIV (RR 1.87) when
consuming alcohol prior to/the time of sexual relations
(Baliunas et al., 2010)
 Syndemic condition of HIV and AOD use among MSM
create behavioral health service challenges
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3. I - BACKGROUND
 Motivational Interviewing (MI) = "directive, client-centred
counseling style for eliciting behavior change by helping
clients to explore and resolve ambivalence" (Miller and
Rollnick, 2002 p25)
 5 key techniques:
♦ expressing empathy ♦ developing discrepancy
♦ avoiding argumentation ♦ rolling with resistance
♦ supporting self-efficacy (Miller and Rollnick, 1991)
 Variable effectiveness of MI across populations, target
problems, and settings (e.g. Lai et al., 2010; Lundahl et al., 2010;
Smedslund et al., 2011)
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4. II - OBJECTIVE
 Conduct a systematic review of the effectiveness of
behavioral interventions adapting the principles and
techniques of MI on HIV-risk behaviors for MSM
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5. III - METHODS
 Systematic review (transparent, reproducible)
 Search: 9 e-databases, Google Scholar,
motivationalinterview.net, Motivational Interviewing
Newsletter / MINT Bulletin, literature lists of 14 MI
reviews, literature lists of included studies, experts
 Independent and paired screening, appraisal of
methodological quality, data extraction
 Data analysis:
– relative risk (RR)
– mean difference (MD)
– meta-analysis (pooled)
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6. IV - RESULTS: 10 included studies
 10 RCTs (1 cluster RCT)
 6051 MSM (9 RCTs from U.S., 1 C-RCT from
Netherlands), in reports published 2001-2010
 Methodological quality:
Adequate sequence generation?
Allocation concealment?
Blinding?
Incomplete outcome data addressed?
Free of selective reporting?
Free of other bias?
0% 25% 50% 75% 100%
Yes (low risk of bias) Unclear No (high risk of bias)
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7. IV - RESULTS (1)
 114 effect estimates from 32 unique outcomes were
extracted from the studies  10 were statistically
significant at study level
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8. IV - RESULTS (2)
 1 study (Explore, 2004) biological endpoint, acquisition
of HIV infection: odds ratio 0.84  15.7% lower in MI
group than control group (NS)
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9. IV - RESULTS (3)
 UAI with non-primary partner: NS
Risk Ratio Risk Ratio
Study or Subgroup log[Risk Ratio] SE Weight IV, Random, 95% CI IV, Random, 95% CI
Picciano 2007 0.00995 0.1947 81.8% 1.01 [0.69, 1.48]
van Kesteren 2007 0.157 0.413 18.2% 1.17 [0.52, 2.63]
Total (95% CI) 100.0% 1.04 [0.73, 1.47]
Heterogeneity: Tau² = 0.00; Chi² = 0.10, df = 1 (P = 0.75); I² = 0%
0.1 0.2 0.5 1 2 5 10
Test for overall effect: Z = 0.21 (P = 0.83) Favours MI Favours control
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10. IV - RESULTS (4)
 UAI with primary partner: NS
Risk Ratio Risk Ratio
Study or Subgroup log[Risk Ratio] SE Weight IV, Random, 95% CI IV, Random, 95% CI
Picciano 2007 0.5988 0.236 63.7% 1.82 [1.15, 2.89]
van Kesteren 2007 -0.2357 0.496 36.3% 0.79 [0.30, 2.09]
Total (95% CI) 100.0% 1.34 [0.61, 2.95]
Heterogeneity: Tau² = 0.20; Chi² = 2.31, df = 1 (P = 0.13); I² = 57%
0.1 0.2 0.5 1 2 5 10
Test for overall effect: Z = 0.74 (P = 0.46) Favours MI Favours control
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11. IV - RESULTS (5)
 UAI short-term follow-up: NS
MI Control Std. Mean Difference Std. Mean Difference
Study or Subgroup Mean SD Total Mean SD Total Weight IV, Random, 95% CI IV, Random, 95% CI
Mausbach 2007 2.88 0.98 96 2.74 1.06 112 42.1% 0.14 [-0.14, 0.41]
Picciano 2001 1.55 2.44 46 2.57 8.49 43 18.1% -0.16 [-0.58, 0.25]
Velasquez 2009 3.99 6.34 82 3.91 6.11 120 39.8% 0.01 [-0.27, 0.29]
Total (95% CI) 224 275 100.0% 0.03 [-0.14, 0.21]
Heterogeneity: Tau² = 0.00; Chi² = 1.43, df = 2 (P = 0.49); I² = 0%
-10 -5 0 5 10
Test for overall effect: Z = 0.36 (P = 0.72) Favours MI Favours control
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12. IV - RESULTS (6)
 Drinks per day (short term): Sign.
MI Control Std. Mean Difference Std. Mean Difference
Study or Subgroup Mean SD Total Mean SD Total Weight IV, Random, 95% CI IV, Random, 95% CI
Morgenstern 2007 2.07 2.87 42 3.52 3.95 47 31.1% -0.41 [-0.83, 0.01]
Velasquez 2009 1.77 3.04 82 2.91 4.03 120 68.9% -0.31 [-0.59, -0.03]
Total (95% CI) 124 167 100.0% -0.34 [-0.58, -0.11]
Heterogeneity: Tau² = 0.00; Chi² = 0.16, df = 1 (P = 0.69); I² = 0%
-4 -2 0 2 4
Test for overall effect: Z = 2.86 (P = 0.004) Favours MI Favours control
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13. IV - RESULTS (7)
 Drinks per day (long term): NS
MI Control Std. Mean Difference Std. Mean Difference
Study or Subgroup Mean SD Total Mean SD Total Weight IV, Random, 95% CI IV, Random, 95% CI
Morgenstern 2007 2.09 2.01 42 2.47 3.12 47 33.6% -0.14 [-0.56, 0.27]
Velasquez 2009 1.02 1.54 77 1.29 1.83 102 66.4% -0.16 [-0.45, 0.14]
Total (95% CI) 119 149 100.0% -0.15 [-0.39, 0.09]
Heterogeneity: Tau² = 0.00; Chi² = 0.00, df = 1 (P = 0.95); I² = 0%
-4 -2 0 2 4
Test for overall effect: Z = 1.23 (P = 0.22) Favours MI Favours control
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14. V - SUMMARY
 Study level: Few differences between groups, but …
 Rate of HIV acquisition in Explore study almost 16%
lower in first 18 months of follow-up in MI group 
clinically important result
 Of 9 meta-analyses, 1 showed sign diff between groups:
drinks per day (short term follow up)
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15. VI - DISUSSION
 MI effective as intervention for excessive drinking?
 MI less effective in changing MSM’s sexual risk behaviors
than other risk behaviors?
– Sexual behavior is shared activity and decision,
private
– Assumption of psychosocial models of behavior
change that risk behaviors largely under control of the
individual
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16. VII - CONCLUSIONS
 Effectiveness of MI as an intervention strategy for unsafe
sexual and substance use behaviors among MSM is
uncertain
 MI largely equivalent to other active and minimal
treatments for problem behaviors involving substance
use and unsafe sex among MSM
 Continued work to craft more effective HIV prevention
programming for MSM should be done
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17. IV - ACKNOWLEDGEMENTS
 Colleagues: Michael W. Ross, Ronny Tikkanen, Jan
Odgaard-Jensen, Karianne T Hammerstrøm
 Researchers who sent us information: Drs Thomas L.
Patterson, Kirk von Sternberg, Beryl L. Koblin, and
Marla Husnik. Special thanks to Dr van Kesteren
who shared the unpublished report of her study
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18. THANK YOU
Contact details:
Rigmor ”Rimo” C Berg rigmor.berg@nokc.no
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