Sexual risk taking behaviour in men who have sex with men: psychological health, relationships with risk and a motivational interviewing intervention.

Background. Despite widespread health promotion campaigns, men who have sex with men (MSM) continue to be disproportionately infected with the human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) in Australia. Recent increases suggest MSM are involved in sexual risk behaviour that is placing them and other men at risk of HIV/STI transmission. There is some evidence that mental health, substance use and psychological variables are related to sexual risk taking. The aim of phase one of this study was to describe the psychological well-being in MSM accessing a sexual health and infectious diseases clinic and to examine predictors of sexual risk taking behaviours. The aim of phase two was to evaluate the effectiveness of a brief Motivational Interviewing (MI) intervention in reducing unprotected anal intercourse and number of sexual partners in MSM with sexual risk behaviours. Methods. A convenience sample of 250 MSM attending for routine care (HIV positive n = 52, HIV negative n = 198) were recruited from a large metropolitan sexual health and infectious diseases (ID) clinic. Participants completed self-report questionnaires including sociodemographic questions, substance use, impulsivity, sexual sensation seeking scale and the Personality Assessment Screener (PAS). Those identified as having high sexual risk behaviours from these assessments and who agreed to participate were randomised to receive a two-session MI intervention (n = 20) or to a standard care control group (n = 21). The MI intervention incorporated a 30-45 minute face-to-face session plus 15 minute telephone booster session. The self-reported frequency of unprotected anal intercourse and number of sexual partners was determined at one and four-months follow-up. V Results. Approximately one-third (n = 83) of the total sample scored in the clinically significant range on the PAS total score. The correlation between Negative Affect/Mood (27% clinically significant) and Suicidal Thinking (29% clinically significant) domains was highest with overall Psychological Distress (r = .53, p <0.00). Multivariate analysis revealed that high sexual risk behaviour was independently positively associated with the number of sexual partners over the previous three months and sexual sensation seeking scores. A negative association was found between high sexual risk behaviour and Negative Affect (mood), Negotiation Skills and daily alcohol intake. The MI intervention group showed significant reductions in unprotected anal intercourse and number of sexual partners over the study period. The proportion of men with UAI was not significantly different between groups at one month post-test (p = .188). However, the MI intervention group reported significantly greater reductions in unprotected anal intercourse at four-months post-test (p = .041). The MI intervention group also reported significantly greater reductions in sexual partners at one- and four- months post-test relative to the control group. Conclusions. A subgroup of MSM attending primary health services display clinically significant psychological distress that warrants attention. The use of psychological screening in addition to sexual health assessment of MSM attending sexual health and ID clinics may provide valuable information for improving the well-being of these men. MI shows promise in reducing sexual risk behaviours (unprotected anal intercourse and number of partners) in MSM at high-risk of HIV/STI transmission. MI is a time-limited and brief intervention that is easily delivered in primary care settings during routine care.