Archives of Sexual Behavior

, Volume 44, Issue 7, pp 1833–1841 | Cite as

The Cost and Intensity of Behavioral Interventions to Promote HIV Treatment for Prevention Among HIV-Positive Men Who Have Sex with Men

  • Steven A. SafrenEmail author
  • Nicholas S. Perry
  • Aaron J. Blashill
  • Conall O’Cleirigh
  • Kenneth H. Mayer
Special Section: Sexual Health In Gay And Bisexual Men


Recently, behavioral prevention interventions for HIV have been criticized as being ineffective, costly, or inefficient. In this commentary, using HIV-positive men who have sex with men (MSM) as an illustrative high-risk population, we argue that the opposite is true—that behavioral interventions for HIV prevention, if implemented with the populations who need them, are affordable and critical for future prevention efforts. We base this argument on recent evidence showing that (1) adherence to antiretroviral treatment (ART) for prevention purposes is necessary to suppress HIV replication and reduce transmissibility, (2) individuals living with HIV have multiple psychosocial concerns that impact self-care and moderate the potential effectiveness of health behavior interventions, and (3) intensive interventions targeting both concerns together (psychosocial and HIV care) can show clinically significant improvement. We follow by comparing the cost of these types of interventions to the cost of standard clinical treatment for HIV with ART and demonstrate a cost-savings of potential intensive behavioral interventions for, in this case, HIV-positive MSM who have uncontrolled virus. Keeping this evidence in mind, we conclude that individual intervention must remain a mainstay of HIV prevention for certain critical populations.


HIV Intervention Prevention Cost Syndemic Sexual orientation 



Support for author time on the article came from National Institutes of Health Grants K24MH094214 and P30AI060354 awarded to the first author and K23MH096647 to the third author.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Steven A. Safren
    • 1
    • 2
    • 3
    Email author
  • Nicholas S. Perry
    • 1
    • 5
  • Aaron J. Blashill
    • 1
    • 2
    • 4
  • Conall O’Cleirigh
    • 1
    • 2
  • Kenneth H. Mayer
    • 2
    • 6
  1. 1.Behavioral Medicine Service, Department of PsychiatryMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Fenway HealthBostonUSA
  3. 3.Department of PsychologyUniversity of MiamiCoral GablesUSA
  4. 4.Department of PsychologySan Diego State UniversitySan DiegoUSA
  5. 5.Department of PsychologyUniversity of UtahSalt Lake CityUSA
  6. 6.Department of General MedicineBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonUSA

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