Among men who have sex with men (MSM), the principal risk practice for HIV infection is unprotected anal intercourse, often engaged in under the influence of alcohol and other substances. Both behaviors are targeted through the much-used counseling approach motivational interviewing (MI). We conducted a systematic review of the effectiveness of behavioral interventions adapting the principles and techniques of MI on HIV risk behaviors for MSM. Ten randomized controlled trials, which included 6,051 participants at baseline, were eligible for inclusion. Nine outcomes, of which seven were for sexual behavior outcomes, were sufficiently similar to compute meta-analyses. With the exception of one outcome, drinks per day at short-term follow-up, there were no significant differences between the groups receiving MI and the control groups. The effectiveness of MI as a prevention strategy for HIV risk behaviors among MSM is uncertain and continued work to craft more effective HIV prevention programming for this group should be done.