Current HIV prevention intervention approaches aimed at reducing HIV risk behavior among MSM in the United States are the metaphorical equivalent of early AZT monotherapy to treat HIV infection. Current behavioral change technologies produce modest and statistically significant effect sizes, but typically only for short periods of time. Increasing the effect sizes of current intervention trials represents an important task moving forward, and integrating the treatment of mental health problems that frequently co-occur as syndemics may be one important way to do this.
Other steps may improve the effect sizes of existing interventions. One possibility would be to conduct in-depth qualitative interviews with men who did not change during an HIV prevention intervention and men who did change. Interviews may allow for greater understanding of positive change and strengths-based processes, as well as of barriers and obstructers that impede changes in men whose levels of HIV risk stays the same. Another possibility would be to conduct meditational analyses of proven interventions, with a view toward identifying the variables that predicted the most change and disentangling these from those variables that did not account for much change at all. After this type of analysis was completed, one could examine the intervention content, augment those activities that seemed to be associated with greater change processes, cut down those intervention components that did not seem to contribute to change, and end up with a more empirically guided and tailored form of the intervention. Retesting the efficacy of the revised intervention might well yield more impressive effect sizes.
As stated above, psychosocial and mental health problems, which are disproportionally prevalent for MSM, may moderate the ability of existing prevention efforts to reduce HIV risk. Hence, in this article, we argue for conceptualizing HIV prevention efforts in MSM as prevention “cocktails” that address psychological and behavioral mechanisms that interact to produce elevated risk for HIV and that incorporate a more holistic framework to address MSM’s sexual health and overall well-being. Although potentially more costly than interventions that are easier to administer, addressing co-occurring psychosocial risk factors may not only improve the mental health of those at risk for HIV but also should improve effect sizes of current HIV prevention interventions and allow for more effective uptake of these interventions.