Faculty Proceedings, Presentations, Speeches and Lectures


Sex, Drugs, and Therapy: A Critical Examination of Moderating Factors Affecting CBT Treatment Outcomes for Reducing HIV and SUD Risk Behaviors Among Gay and Bisexual Men

Event Title

ABCT (Association for Behavioral and Cognitive Therapies) 2020 54th Annual Convention

Event Location


Document Type


Presentation Date


Date Range

2020-11-17 to 2020-11-22


Gay and bisexual men (GBM) are disproportionately affected by substance use disorders (SUDs) and the Human Immunodeficiency Virus (HIV). In response, several attempts have been made in testing the effectiveness of multiple cognitive behavioral (CBT) interventions for reducing risky sexual and substance use behavior. However, there is a paucity of knowledge regarding the risk factors that moderate treatment outcomes. As such, a comprehensive literature review was conducted to examine existing interventions and identify factors that may impact treatment outcomes. A computerized search of peer-reviewed journals was completed using PsycINFO and Google Scholar bibliographical databases spanning the years 2005 to 2017. The following key terms and combinations of these were utilized: “gay,” “HIV,” “interventions,” “CBT”, and “SUD.” Studies were excluded if they were not randomized clinical trials, included female participants, or were applicable only to a specific ethnic minority group. Following an extensive review of available research to date, four CBT-based interventions tailored to the GBM population were effective in reducing health risk behaviors and four risk factors were identified. However, there were mixed findings in treatment outcomes based on specific protocols and moderating factors, particularly HIV-status and internalized homonegativity (IH). The ESTEEM protocol showed significant improvements in HIV-negative GBM, but not HIV-positive GBM, but CBT tailored to GBM (GCBT) was effective in both groups. The level of implicit IH also moderated treatment outcomes for health risk behavior. Outcomes also differed as a result of different interventions. For instance, GCBT was more effective in reducing risky sexual behavior rapidly, but reduction in substance use behaviors were retained significantly better following CBT+CM. Anxiety and depressive symptoms were co-occurring and improved significantly across all studies. Given the limited and mixed pool of research studying the effects of different CBT interventions on health risk behaviors in GBM, health professionals are faced with uncertainty as to how best serve this population. Because HIV and SUDs are highly pervasive and often co-occur in GBM, it is necessary to increase awareness of effective therapeutic interventions to help reduce and prevent future risk. The implications of this review highlight the importance of developing a holistic therapeutic approach that accounts for risk factors that may influence treatment outcomes. Since little is known about these factors, it is an area of further study that can provide health professionals with a way to advance current CBT interventions for GBM.