Abstract
Stimulant-using gay, bisexual, and other men who have sex with men (GBMSM) are disproportionately overrepresented in the HIV epidemic and are a high priority population for pre-exposure prophylaxis (PrEP), a medication that is up to 99% effective in reducing HIV transmission among GBMSM when taken as prescribed. Motivational Interviewing (MI) is an evidenced-based, collaborative intervention that strengthens an individual’s own motivation and commitment to change. The current study leverages data from the PrEP Readiness Interventions for Supporting Motivation trial, which tested the feasibility, acceptability, and preliminary effectiveness of combinations of MI and contingency management in 70 stimulant-using GBMSM. The 2-session MI intervention focused on PrEP use and certain concomitant risk behaviors. Sessions were coded using the MI Skill Code (MISC) 2.5, a quality measure of therapeutic processes. Using 82 transcribed sessions (93%) completed by the 44 participants (session one N = 44; session two N = 38), therapeutic process data was coded using the MISC 2.5 to pursue the following aims: (1) characterize within-participant differences in study participant change talk and sustain between sessions one and two; (2) examine the associations of between-participant differences in sexual minority stress and syndemic burden with MISC global scores, change talk, and sustain talk; and (3) determine the associations of MISC global scores, change talk, and sustain talk with stimulant use, CAS, PrEP clinical evaluation, and PrEP photo verification in the three months following the MI intervention. Analyses showed that participants engaged in more change talk and sustain talk in session two compared to session one. Findings demonstrate that mobilization of change talk may be greater in sessions that provide a menu of options and that sustain talk has an influence on self-reported PrEP clinical evaluation. The current study was limited based on sample; however, the clinical implications for this high priority population are worthy of further investigation.