Gold noted that the self-statements gay men use to describe their high- transmission risk sexual encounters were often rationalizations that may increase the transmission rate of HIV [1]. Gay men in his studies often minimized the risk of each contact, and both HIV-positive and –negative men largely assumed their partners shared their serostatus. In exploring the driving factors underlying continued risk by repeat negative testers, Dilley, et al. [2], noted that these self-justifications (SJs) might be used to develop successful interventions for use with MSM, and developed Personal Cognitive Counseling (PCC) as an intervention that combines challenging these SJs with the responsive, non-judgmental approach of Motivational Interviewing [3]. We have demonstrated that this is an effective approach in reducing the number of partners and proportion of high transmission risk sex among HIV-negative men [2,3], and are currently concluding a clinical trial applying this approach to HIV-positive men.

In both clinical trials, pilot work developed a Self-Justification Questionnaire (SJQ) specific to each population. The following results are the most common SJs identified through the use of this questionnaire in two clinical trials, the first with HIV-negative men [3], and an ongoing application of this intervention with HIV-positive men.

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