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In-office health interventions, while generally effective for those who receive them (21), may not sufficiently target the most at-risk individuals who are often not linked to services (22-24).Gay and bisexual men are significantly more likely to delay or avoid seeking health services compared to heterosexual men due to perceived provider bias and a relative lack of visibility of competent services for this population (25).Gay, bisexual, and other men who have sex with men represent the population most severely affected by HIV in the U. This period of profound change encompasses decision-making about educational achievements, job and career choices, relationship and family formation, and future goals.Attitudes and behaviors surrounding sexual risk and substance use are still being crystallized, and their co-occurrence is highly normative during this period.

The in-office Young Men’s Health Project (7, 27-29) delivered motivational interviewing across four one-hour sessions to reduce substance use and sexual risk-taking behavior among 204 young (ages 18-29) gay and bisexual men.

Results of these interviews uncovered numerous reasons for their lack of full engagement, including the perceived lack of convenience and accessibility of an in-office intervention.

Additionally, those interviewed expressed enthusiasm for the possible development of a modified version of the study to be delivered online, capable of overcoming barriers to convenience and accessibility as well as promoting greater comfort to participants who may be reluctant to discuss sensitive health issues in person.

In our own prevention intervention research, we were intrigued that one-quarter of the young gay and bisexual men recruited for an in-office motivational interviewing intervention to reduce HIV risk and related substance use behavior refused to participate in the intervention component, but agreed to be followed for assessment visits across the 12-month study.

Our team initially interviewed 14 participants enrolled in this study--the Young Men’s Health Project--to determine factors that led to their intervention non-participation or drop out, despite their retention for follow-up assessment visits.

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