Drug Counseling for Sexual Minority Men in Relationships
New study of treatment that integrates attention to interpersonal relationships.
Posted March 15, 2026 | Reviewed by Kaja Perina
I have written previously about drug use and the HIV epidemic among LGBTQ+ people and sexual minority men specifically. Our recent study (Starks et al., 2026) published in The Journal of Acquired Immune Deficiency Syndromes indicates that a brief (4-session) counseling intervention tailored for sexual minority men in relationships resulted in significantly better drug use and HIV prevention outcomes compared to a highly competitive control condition.
It is unusual for a counseling intervention to focus on substance use and sexual health in an integrated way. There are existing treatments for drug use, and treatments for disorders of sexual arousal and orgasm , and there are public health interventions that address sexual health. Unfortunately, there are very few interventions that bring these outcomes together.
At least one intervention that addressed drug use and sexual risk taking showed promising effects on both outcomes in a sample of sexual minority men (Parsons et al., 2014). Unfortunately, the intervention did not work as well for those in relationships (Starks & Parsons, 2018). Designed primarily with single people in mind, it did not explicitly address the influence of relationship partners on drug use and sexual decision making .
It is even more rare to focus on drug use and sexual behavior in counseling for those in relationships. Motivational interviewing with couples (Starks, 2022) has demonstrated the potential to reduce drug use and address sexual risk taking (Starks et al., 2022); however, it requires the participation of both partners in a relationship. For those who are unable or unwilling to convince their partner to join them for the intervention session, this makes receipt of the intervention impossible (Starks et al., 2019).
We used a randomized controlled trial to test an individually delivered intervention that was tailored specifically for sexual minority men in relationships.
That emphasis on communication skill building may in part explain why the intervention resulted in significant immediate reductions (3 months after baseline) in drug use among those who had relatively poor communication prior to intervention.
Relationship quality mattered too. The intervention significantly reduced drug use 3 months after baseline among those who were highly satisfied with their relationship.
Finally, pre-exposure prophylaxis (PrEP) uptake among those in the treatment condition was more positive over the one-year follow-up period.
What we learn from this
Drug use can be associated with sex and sexual HIV transmission in various ways. Intoxication may alter decision making, inhibiting the use of prevention strategies (e.g., missing a dose of PrEP medication ). For some, intoxication may enhance sexual pleasure and decrease sexual anxiety . Drug use may even be normative in some sexual contexts (e.g., party-and-play or chemsex). See here for more.
If drug use is connected to sex and sexual health for you – look for a counselor who can talk to you about it. Counselors who want to provide affirmative care to LGBTQ+ individuals should be prepared to address sexual decision making and sexual health in a robust manner. This includes assessing the variety of ways in which substance use might be connected to sexual health for members of this community. It also includes exploring sexual motivations that enhance or inhibit drug use.
Counseling can be helpful even if your partner is not part of the picture. Our intervention was intentionally created to be relevant for couples when only one partner is willing or able to participate in the intervention sessions. The needs of people in relationships can best be addressed through access to a combination of services for individuals as well as couples.
Cain, D., Sauermilch, D., & Starks, T. J. (2023). Client responses to video-based communication skills training involving PrEP and HIV: tailoring an individual sexual health intervention for sexual minority men in realtionships. AIDS and Behavior , 27 (8), 2463–2477. https://doi.org/10.1007/s10461-023-03985-6
Parsons, J. T., Lelutiu-Weinberger, C., Michael, B., & Golub, S. A. (2014). A randomized controlled trial utilizing motivational interviewing to reduce HIV risk and drug use in young gay and bisexual men. Journal of Consulting and Clinical Psychology , 82 (1), 9–18. https://doi.org/https://doi.org/10.1037/a0035311
Starks, T. J. (2022). Motivational interviewing with couples: A framework for behavior change developed with sexual minority men . Oxford University Press. https://doi.org/https://doi.org/10.1093/med-psych/9780197549643.001.0001
Starks, T. J., Adebayo, T., Kyre, K. D., Millar, B. M., Stratton, M. J., Jr., Gandhi, M., & Ingersoll, K. S. (2022). Pilot randomized controlled trial of Motivational Interviewing with sexual minority male couples to reduce drug use and sexual risk: The Couples Health Project. AIDS and Behavior , 26 (2), 310–327. https://doi.org/10.1007/s10461-021-03384-9
Starks, T. J., Hillesheim, J. R., Castiblanco, J., Robles, G., Kyre, K. D., & Cain, D. (2026). Adapted motivational interviewing reduces substance use and sexual risk taking among partnered sexual minority men aged 18 to 35: Results of the PARTNER study. Journal of Acquired Immune Deficiency Syndromes , 101 (4), 376–386. https://doi.org/10.1097/QAI.0000000000003813
Starks, T. J., & Parsons, J. T. (2018). Drug use and HIV prevention with young gay and bisexual men: Partnered status predicts intervention response. AIDS and Behavior , 22 , 2788–2796. https://doi.org/https://doi.org/10.1007/s10461-018-2091-8
Starks, T. J., Robles, G., Pawson, M., Jimenez, R. H., Gandhi, M., Parsons, J. T., & Millar, B. M. (2019). Motivational Interviewing to reduce drug use and HIV incidence among young men who have sex with men in relationships and are high priority for pre-exposure prophylaxis (Project PARTNER): Randomized controlled trial protocol. JMIR Research Protocols , 8 (7), e13015. https://doi.org/10.2196/13015
Starks, T. J., Stewart, J. L., Gupta, S. K., Hillesheim, J. R., & Cain, D. (2024). A qualitative analysis of shared values and motivation for change expressed by sexual minority men in relationships: Use of the Personal Values Card Sort activity during motivational interviewing sessions address drug use and sexual health. AIDS and Behavior , 28 (9), 3080–3092. https://doi.org/10.1007/s10461-024-04392-1
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Tyrel Starks, Ph.D., is a Professor of Psychology at Hunter College of The City University of New York.
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This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.