Tyrel J Starks

• PhD
• Professor at City University of New York - Hunter College

Objetivos: La eficacia colectiva es un factor protector potencial poco estudiado para el cambio de comportamiento en la salud. Este estudio amplía investigaciones anteriores sobre la infección por VIH y COVID-19 para probar las asociaciones con la vacunación contra la viruela símica (mpox) y los síntomas de depresión y ansiedad entre hombres de min...

Qualitative content analysis of an HIV testing and communication skill-building session explored the development of sexual agreements and HIV risk prevention strategies among emerging adult (18 to 24 years old) sexual minority men (SMM) to inform HIV testing services for younger SMM in relationships. In total, 29 intervention sessions were transcri...

Objective: Circulating antivaccine tropes in online platforms are linked to low vaccination uptake, including for COVID-19 vaccines. Motivational interviewing (MI) is an effective intervention to increase vaccination rates. Community-oriented Motivational Interviewing (COMI) expands MI to online groups. We examine COMI processes—manifestations of c...

Couples HIV testing and counseling (CHTC) emerged as an early HIV prevention intervention for male couples in the US. Understanding how couples speak to a testing counselor may enhance CHTC training and delivery. Raters analyzed CHTC sessions involving 66 adult cisgender male couples and noted three distinct styles. When co-speaking, partners colla...

Research has clearly documented high rates of human immunodeficiency virus (HIV) infection among transfeminine (TF) people (including trans women). This research has largely overlooked nonbinary people assigned male at birth (NBAMAB) despite their gender fluidity. This study examined similarities and distinctions in the occurrence and frequency of...

Background To reduce substance use and sexual HIV transmission risk among sexual minority men (SMM) requires the development of interventions tailored for those in relationships. In the past 5 years, there have been considerable advances in the development of motivational nterviewing (MI) with couples. The Couples Health Project (CHP) is the first...

Dyadic research among male couples is of increasing interest to researchers, as relationship factors have been implicated in a variety of physical and mental health outcomes. A small evidence base suggests samples of same-gender couples that participate in research may be biased toward those with better relationship quality. Unfortunately, this res...

Texting has become a primary mode of communication across relationship types, particularly amongst women, despite its vulnerability to miscommunication and associated social consequences. Whereas there is a robust literature on the mechanics and the importance of constructive communication, little is known about how these findings generalize to tex...

Few studies have examined developmentally relevant sources of resilience, such as peer social support, among young sexual minority men (SMM) of color experiencing discrimination and mental health distress. To address this gap in the literature, we examined the role of peer social support in the association between discrimination and mental health d...

Adolescent sexual minority males (ASMMs) are 3–4 times more likely to experience depression or anxiety than their heterosexual peers. ASMMs in romantic relationships may be at higher risk of developing anxiety and depression symptoms, yet studies examining relationship quality as a predictor of mental health ASMMs are limited. Partnered ASMMs (n =...

The development of tailored interventions that address drug use and sexual risk taking among sexual minority men (SMM) in relationships has garnered increasing interest over the past 20 years. Motivational interviewing (MI) has demonstrated promise in both individual and couples-based applications. The Personal Values Card Sort activity is commonly...

The majority of new HIV infections in the US occur among sexual minority men (SMM) with older adolescent and emerging adult SMM at the highest risk. Those in relationships face unique HIV prevention challenges. Existing sexual HIV transmission risk interventions for male couples often encounter implementation challenges and engaging younger SMM ear...

Objectives: Substance use, including drug and alcohol misuse, is associated with myriad health conditions, including higher risk for HIV infection. While preliminary evidence suggests that higher levels of relationship functioning can buffer against the deleterious health consequences of discrimination on mental health broadly, such protective ass...

Background The past 15 years have seen increasing attention to relationship factors among sexual minority male (SMM) couples at high risk for HIV infection. Research has largely focused on HIV prevention outcomes. Outcomes relevant to SMM living with HIV have received relatively less attention. Purpose This study evaluated associations between rel...

The literature differentiates between two domains of machismo: traditional machismo and caballerismo. Research has largely focused on measuring machismo among English speakers. We evaluated whether Estrada’s (2011) 2-factor model of machismo was invariant across language (English vs. a direct Spanish translation). A series of multigroup confirmator...

Background Couples HIV testing and counseling (CHTC) is now a standard of care prevention strategy recommended by the Centers for Disease Control and Prevention for sexual minority men (SMM) in relationships. Despite standard recommendations that couples complete CHTC every 6-12 months, no study has empirically evaluated the effects associated with...

Studies conducted early in the COVID-19 pandemic - before vaccines were widely available - indicated that drug use may have declined among sexual minority men (SMM). This study evaluated drug use trends in the second year of the pandemic. Cross-sectional responses from cisgender SMM living in the US and recruited online (n = 15,897) were grouped fo...

Introduction: Heavy alcohol use among people living with HIV in sub-Saharan Africa can hinder the success of HIV treatment programmes, impacting progress towards United Nations Programme on HIV/AIDS goals. Primary partners can provide critical forms of social support to reduce heavy drinking and could be included in motivational interviewing (MI)...

Background The past two decades have seen expanding interest in the application of motivational interviewing (MI) with couples. Thus far, the literature detailing the development of MI with couples has focused primarily on elucidating counselling processes and techniques or on evaluating intervention effects. To date, no published studies have exam...

Younger sexual minority men (YSMM) remain at high risk for HIV infection and substance use increases this risk. This study evaluated the effectiveness of a (4-session) motivational interviewing (MI) intervention to reduce substance use and sexual risk taking when delivered at two community-based organizations (CBOs) in the New York City metropolita...

We examined the association between everyday discrimination and HIV testing patterns—current (≤ 6 months), recent (7-12 months), and delayed (> 12 months or never tested)—among partnered Latino/x sexual minority men (SMM). Multinomial regression analyses revealed that in the full sample (N = 484) experiencing discrimination based on sexual orientat...

UNSTRUCTURED Couples HIV testing and counseling (CHTC) is now a standard of care prevention strategy recommended by CDC for sexual minority men (SMM) in relationships. Despite standard recommendations that couples complete CHTC every 6 to 12 months, no study has empirically evaluated the effects associated with CHTC retesting. Understanding the ben...

Sexual awareness is an understudied phenomenon, despite its known effects on mental health. Little is known about the predictors of sexual awareness, including how early sexual debut and early engagement with online dating and hookup apps might impact the development of sexual mindfulness. Given the conceptual overlap between mindfulness and sexual...

Purpose While associations between adverse childhood experiences (ACEs) and intimate partner violence (IPV) have been well-documented, few studies have identified relationship factors that buffer this association. Even fewer studies have examined these relationships among Latino sexual minority men (SMM). To address this gap, we tested a model in w...

Purpose: Despite the fact that adolescence represents a distinct developmental period wherein dating and sexual relationships are emergent, much of what is known about substance use, sexual agreements, and sexual risk behaviors among adolescent sexual minority males (ASMM) is extrapolated from research on adults. This study tested associations bet...

Mental health disparities are well documented among sexual minority men (SMM) and generally attributed to sexuality-based minority stress. Separate research has established that being in a main or primary partner relationship—particularly one of high quality—is associated with better mental health. The current study tested an integrated model predi...

Objective: The objective of this paper is to examine how state-level characteristics relate to social support and mental health outcomes among Latino sexual minority men in the U.S. Methods: Multilevel linear regression analyses were used to estimate the effect of social support and contextual-level characteristics on mental health and alcohol u...

Sexual minority men (SMM) have accounted for the majority of infections during the 2022 outbreak of the orthopox virus known as mpox (previously "monkeypox") in the US. This study examined correlates of mpox vaccination. Between July 28 and September 22, 2022, adult cisgender SMM (n = 2,620) not previously diagnosed with mpox responded to recruitme...

For many partnered sexual minority men (SMM), PrEP decisions are shaped by their relationships. Recent innovations in HIV risk reduction interventions tailored for partnered SMM include the integration of video-based communication skill building. The purpose of the current study was to examine the responses of 37 SMM in relationships with cismale p...

This text outlines the principles, processes, and practice of Motivational Interviewing with couples derived by Dr. Starks through his research over the past decade. Informed by interdependence theory, the approach positions the couple as the client. Relationship functioning—the degree to which partners are satisfied with, committed to, and investe...

Researchers have linked circulating misinformation in online platforms to low COVID-19 vaccine uptake. Two disparate literatures provide relevant initial guidance to address the problem. Motivational Interviewing (MI) effectively reduces vaccine hesitancy in clinical environments; meanwhile, social scientists note inoculation, rebuttal, and appeals...

This text outlines the principles, processes, and practice of Motivational Interviewing with couples derived by Dr. Starks through his research over the past decade. Informed by interdependence theory, the approach positions the couple as the client. Relationship functioning—the degree to which partners are satisfied with, committed to, and investe...

This text outlines the principles, processes, and practice of Motivational Interviewing with couples derived by Dr. Starks through his research over the past decade. Informed by interdependence theory, the approach positions the couple as the client. Relationship functioning—the degree to which partners are satisfied with, committed to, and investe...

This text outlines the principles, processes, and practice of Motivational Interviewing with couples derived by Dr. Starks through his research over the past decade. Informed by interdependence theory, the approach positions the couple as the client. Relationship functioning—the degree to which partners are satisfied with, committed to, and investe...

This text outlines the principles, processes, and practice of Motivational Interviewing with couples derived by Dr. Starks through his research over the past decade. Informed by interdependence theory, the approach positions the couple as the client. Relationship functioning—the degree to which partners are satisfied with, committed to, and investe...

This text outlines the principles, processes, and practice of Motivational Interviewing with couples derived by Dr. Starks through his research over the past decade. Informed by interdependence theory, the approach positions the couple as the client. Relationship functioning—the degree to which partners are satisfied with, committed to, and investe...

This text outlines the principles, processes, and practice of Motivational Interviewing with couples derived by Dr. Starks through his research over the past decade. Informed by interdependence theory, the approach positions the couple as the client. Relationship functioning—the degree to which partners are satisfied with, committed to, and investe...

This text outlines the principles, processes, and practice of Motivational Interviewing with couples derived by Dr. Starks through his research over the past decade. Informed by interdependence theory, the approach positions the couple as the client. Relationship functioning—the degree to which partners are satisfied with, committed to, and investe...

This text outlines the principles, processes, and practice of Motivational Interviewing with couples derived by Dr. Starks through his research over the past decade. Informed by interdependence theory, the approach positions the couple as the client. Relationship functioning—the degree to which partners are satisfied with, committed to, and investe...

This text outlines the principles, processes, and practice of Motivational Interviewing with couples derived by Dr. Starks through his research over the past decade. Informed by interdependence theory, the approach positions the couple as the client. Relationship functioning—the degree to which partners are satisfied with, committed to, and investe...

This text outlines the principles, processes, and practice of Motivational Interviewing with couples derived by Dr. Starks through his research over the past decade. Informed by interdependence theory, the approach positions the couple as the client. Relationship functioning—the degree to which partners are satisfied with, committed to, and investe...

This text outlines the principles, processes, and practice of Motivational Interviewing with couples derived by Dr. Starks through his research over the past decade. Informed by interdependence theory, the approach positions the couple as the client. Relationship functioning—the degree to which partners are satisfied with, committed to, and investe...

This text outlines the principles, processes, and practice of Motivational Interviewing with couples derived by Dr. Starks through his research over the past decade. Informed by interdependence theory, the approach positions the couple as the client. Relationship functioning—the degree to which partners are satisfied with, committed to, and investe...

Regular HIV testing is an essential component of the HIV prevention and care cascade. Sexual minority males (SMM) account for most new HIV infections in the US and testing rates among SMM vary substantially across the lifespan. Research has largely overlooked the developmental context of HIV testing. The current study compared correlates of HIV tes...

Rates of HIV diagnoses among young Black and Latino sexual minority men (SMM) have continued to increase since 2011; meanwhile, overall rates in the USA have decreased. Despite their importance, academic and medical institutions have often struggled to engage and recruit racial and ethnic minority SMM in HIV prevention services and research. The cu...

Latinx sexual minority men (LSMM) have higher rates of HIV incidence than most other ethnic and racial groups. Given that transmission risk is higher among primary partners, it is critical to identify factors that would facilitate partner recruitment into couples-based sexual health research studies. The present study utilizes a sample of index par...

A growing body of research illustrates that sexual minority men (SMM) experience elevated rates of intimate partner violence (IPV) compared to heterosexual individuals. Researchers have examined the relationship between minority stress and IPV victimization among sexual minority men. A majority of the IPV research identifying risk factors associate...

A randomized controlled trial evaluated the preliminary efficacy of a dyadically-delivered motivational interviewing (MI) intervention to reduce drug use and sexual risk in a sample of 50 sexual minority (cis)male (SMM) couples. In each couple, at least one partner was aged 18–29; reported drug use and sexual HIV transmission risk; and was HIV-nega...

This pilot randomized controlled trial evaluated the feasibility, acceptability, and preliminary efficacy of expressive writing to reduce HIV-related sexual risk taking and symptoms of drug dependence among emerging adult gay and bisexual men (EAGBM) through linguistic mechanisms involving use of words associated with cognitive processing (e.g., th...

This study evaluated preliminary reliability and validity evidence for novel scores that extend the motivational interviewing treatment integrity (MITI) coding system to assess elements unique to motivational interviewing (MI) with couples. We recruited 20 cismale couples where at least one partner was aged 18–29; reported substance use; and was HI...

The current study examined the relevance of relationship functioning to partners’ agreement or consensus about joint effort surrounding COVID-19 prevention. Interdependence theory has been widely used to understand how relationship partners influence health behavior, including how sexual minority male (SMM) couples regulate HIV risk. Couples with b...

Background The past decade has seen increasing attention directed to the development of HIV prevention interventions for male couples, driven by epidemiological data indicating that main or primary – rather than causal – partnerships account for a substantial number of HIV infections in this population. Couples HIV testing and counseling (CHTC) has...

A lack of clarity exists regarding associations between sexting – an increasingly common form of sexual communication – and sexual risk taking. This is particularly relevant for younger, heterosexually-active women who are at elevated risk for sexually transmitted infections and may be likely to consent to sexting that is unwanted in response to pa...

Cisgender men are frequently vectors for HIV transmission among transgender women. Despite this, the correlates of sexual risk among these men remain under-examined. The purpose of the present study was to explore potential differences in relationship characteristics, sexual risk-taking, and risk-reduction strategies among cisgender men partnered w...

This study evaluated the effectiveness of Project PLUS, a 6-session Motivational Interviewing and Cognitive Behavioral intervention to reduce substance use and improve antiretroviral therapy (ART) adherence among PLWH. In a quasi-experimental design, 84 participants from a network of three comprehensive care clinics in New York City received the in...

The Latinx community in the USA continues to be disproportionately burdened by the HIV epidemic, especially among Latinx sexual minority men (LSMM). Research indicates that up to two-thirds of new HIV infections occur among men who have sex with men (MSM) within primary partnerships. One promising biomedical approach for HIV prevention includes com...

Background: Drunk texting is an understudied phenomenon, despite its ubiquity and evidence suggesting it may be implicated in heavy drinking. Research on texting motivations and use of the phone as a tool for self-regulation also represent newly emerging areas of study. Objective/Method: The goal of the current study was to examine how drunk textin...

Purpose The study explored the unique associations of individual identity-based discrimination and relationship-based discrimination with mental health among sexual minority male couples. It also examined whether couples’ relationship functioning moderated associations between relationship-based discrimination, the experience of one’s romantic rela...

The association between “illicit drugs” (e.g., cocaine/crack, methamphetamine, gamma-hydroxybutyrate-GHB, ketamine, and ecstasy) and condomless anal sex (CAS) with casual partners is well established for sexual minority men (SMM). Recent evidence from adult SMM has indicated that marijuana is associated with the occurrence of CAS with casual partne...

Sexual minority men (SMM) disproportionately experience psychosocial risk factors and comorbid health concerns (e.g., HIV infection) that increase their vulnerability to COVID-19 infection and distress. The current study applied a socioecological approach to the Health Belief model to understand associations among perceived risk, optimistic bias (a...

One- to two-thirds of new HIV infections among sexual minority men occur within the context of main partnerships. This has led to increasing attention to the rules and boundaries male couples form around sex with outside partners as a mechanism to manage HIV risk. These rules and boundaries have generally been operationalized either as a sexual agr...

Background Both marijuana and other illicit drugs (e.g., cocaine/crack, methamphetamines, ecstasy, gamma-hydroxybuterate, and ketamine) have been linked to the occurrence of condomless anal sex (CAS) with casual partners among sexual minority men (SMM) and these associations largely generalize to partnered SMM. Software advances now permit testing...

While the literature on sexual arrangements has expanded considerably, less is known about sexual arrangements among ethnically diverse populations, particularly Latinx sexual minority men (LSMM). Relationship research may overlook culturally salient correlates (e.g., ideals of masculinity or immigration-related factors) of sexual arrangements. The...

Considering the lack of validated stigma reduction interventions for youth living with HIV (YLWH), we evaluated effects of the Healthy Choices intervention on HIV-related stigma among YLWH. We analyzed data from the Adolescent Medicine Trials Network protocol 129, multi-site randomized controlled trial, applying latent growth curve modeling with tw...

Sexual minority men (SMM) remain at high risk of HIV infection in the United States, and for those in relationships, dyadic functioning may contextualize prevention decisions. Pre-exposure prophylaxis (PrEP) for HIV prevention was previously limited to tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) until the FDA approved tenofovir alafenamid...

Despite the prominence of self-efficacy as a predictor of antiretroviral therapy (ART) adherence, relatively little work has examined domain-specific associations with steps in the care continuum or the possibility that substance use may have domain-specific associations with self-efficacy. This study analyzed data from a sample of 174 people livin...

Couples HIV Testing and Counseling (CHTC) is now a standard of care for partnered sexual minority men. While adolescent sexual minority men (ASMM; ages 15-19) face disproportionate HIV risk, the emergent nature of relationships and communication skills may present challenges to accessing and engaging in CHTC. This study utilized qualitative data fr...

As of October 2020, the coronavirus disease 19 (COVID-19) pandemic has accounted for over 210,000 deaths in the United States. Sexual and gender minority populations are more likely to work in essential industries while bearing a disproportionate burden of the virus. Constructs consistent with Protection Motivation Theory (perceived severity, vulne...

Background: The association between drug use and condomless anal sex (CAS) is well documented among sexual minority men (SMM). Less is known about whether this association generalizes to marijuana and across relationship status and sexual agreements groups (single, partnered monogamous, partnered open -outside partners permitted, and partnered mon...

Youth living with HIV (YLWH; aged 16–24) are at elevated risk of alcohol and drug use. Studies in older populations have identified patterns or profiles of multiple substance use differentially associated with mental health and anti-retroviral therapy (ART) adherence. No studies of YLWH have yet examined such patterns. A sample of 179 YLWH, reporti...

Sleep health, a crucial component and predictor of physical and mental health, has likely been adversely impacted by the stress and disruption wrought by the COVID-19 pandemic. This brief report sought to assess self-reported sleep quality among sexual minority men across the U.S.A. in the early months of the pandemic. In a cross-sectional online s...

Importance Youth living with HIV make up one-quarter of new infections and have high rates of risk behaviors but are significantly understudied. Effectiveness trials in real-world settings are needed to inform program delivery. Objective To compare the effectiveness of the Healthy Choices intervention delivered in a home or community setting vs a...

Objective: The objective of the present study was to test pathways implied by Disempowerment Theory to predict intimate partner violence (IPV) among men in a same-sex relationship. Background: Sexual minority men in relationships experience rates of IPV comparable with heterosexual women, yet most research on IPV focuses on heterosexual couples. Di...

Sexual minority men (SMM)—and young SMM in particular—are disproportionately affected by HIV. Secondary distribution of HIV self-testing (HIVST) kits—wherein patients deliver kits to partners—is a novel strategy to increase HIV testing access. Using quantitative data, we assessed willingness to distribute HIVST kits to recent sex partners among a U...

Background Sexual minority men who use drugs have high sexual HIV transmission risk. Sexual interactions may also increase COVID-19 risk.This study compared marijuana use, other illegal drugs use (i.e. cocaine/crack, methamphetamine, MDMA/ecstasy, GHB, and ketamine) and sexual behavior with casual partners among sexual minority cismen active on soc...

Purpose Adolescent sexual minority males (SMMs) are at a high risk of contracting HIV through condomless sex. Many develop serious partnerships, and sex with main partners accounts for many new infections. Previous research with adolescent SMMs largely focused on relationship seriousness and found a positive association with sexual HIV risk. This s...

The efficacy of motivational interviewing (MI) to reduce substance use is well established; however, its use with couples has met with mixed results. The development of such interventions is particularly relevant for male couples, as rates of substance use in this population are comparatively high and use is associated with aspects of sexual relati...

Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are highly efficacious biomedical prevention strategies, which significantly reduce the risk of HIV transmission. Yet, partnered sexual minority men (SMM) continue to exhibit poorer uptake rates especially those in a non-monogamous or serodiscordant relationship for whom PrEP is re...

Gay and bisexual men (GBM) experience disproportionate rates of mental health and other negative health outcomes. For GBM in relationships, contextualizing the myriad of negative outcomes as a dyadic process may provide insight into the mechanisms through which these adverse outcomes develop. The objective of this review is to examine the current s...

Stigmatization of interracial and same-sex relationships persists, with negative consequences for relationship functioning and mental health. We extended past research to examine consequences of relationship stigma from different sources (family, friends, public) for well-being (anxiety, depressive symptoms, overall self-rated health), potential bu...

Sexual minority men are disproportionately impacted by substance use, which is associated with greater HIV transmission behaviors. Novel approaches to drug use prevention and treatment are needed. Couple-based approaches have garnered significant attention. The recruitment of couples into substance use interventions has proven challenging. We evalu...

Men who have sex with men (MSM) experience high rates of substance use and HIV infection. Main partners are the source of many (35–68%) of these new HIV infections. This study developed and examined the efficacy of two adjunct components to couples HIV testing and counseling (CHTC)—communication training (CT) videos and a substance use module (SUM)...

Dramatic decreases in HIV transmission are achievable with currently available biomedical and behavioral interventions, including antiretroviral therapy and pre-exposure prophylaxis. However, such decreases have not yet been realized among adolescents and young adults. The Adolescent Medicine Trials Network (ATN) for HIV/AIDS interventions is dedic...

Objectives We sought to determine willingness of gay and bisexual men (GBM) to give HIV self-testing (HIVST) kits with patient-delivered partner therapy (PDPT) and engage in geosocial sexual networking (GSN) app-based partner notification. Methods A nationwide sample of GBM who self-tested HIV negative (n = 786) were asked about their willingness...

Background: Young men who have sex with men (YMSM), particularly those who are partnered, are at unique risk for HIV. YMSM are among those at highest risk for HIV. Meanwhile, despite the fact that primary partners account for many-possibly most-new HIV infections, partnered men who have sex with men perceive themselves to be at much lower risk for...

Background: Young men who have sex with men (YMSM) are disproportionately at risk for HIV and sexually transmitted infections. Adapting and testing the effectiveness of the Young Men's Health Project (YMHP), an efficacious intervention designed to reduce substance use and condomless anal sex (CAS) among YMSM, at clinics in Miami, Detroit, and Phila...

Background: Research suggests that substance use among partnered sexual minority men will be inversely associated with the quality of dyadic functioning. We tested whether dimensions of relationship functioning implied within Couples Interdependence Theory (e.g., rewards, costs, barriers, alternatives, investment, and comparison to an ideal) predi...

Background: Epidemiology research is limited on the characteristics of HIV pre-exposure prophylaxis (PrEP) using couples. Setting: United States nationwide sample recruited online in 2017. Methods: HIV-negative/unknown gay, bisexual, and other men who have sex with men (GBMSM) with HIV-negative/unknown partners (n=3140) were asked about individua...

Fewer than 60,000 males—inclusive of all sexual identities—were prescribed HIV pre-exposure prophylaxis (PrEP) by mid-2017 in the United States. Efforts to increase PrEP uptake among gay, bisexual, and other men who have sex with men (GBM), in particular, are ongoing in research and practice settings, but few tools exist to support interventions. W...

Numerous factors have been shown to increase sexual risk-taking—especially among gay and bisexual men (GBM), who remain disproportionately affected by HIV and STIs. We present three lines of evidence that highlight the need to consider a previously under-explored situational factor in sexual risk-taking: tiredness. While tiredness has been shown, i...