Two previous randomized controlled clinical trials have shown the effectiveness of a single-session cognitive intervention, personalized cognitive counseling (PCC), in decreasing HIV risk among men who have sex with men (MSM; Dilley et al., 2002; Dilley et al., 2007). PCC is a counseling technique based on social cognitive theory and the stages of change model and incorporates techniques from cognitive therapy and motivational interviewing. Theoretically, PCC encourages the client to examine his self-justifications, or rationalizations, at the time of intercourse, so he will better understand the thinking behind his decision to have unprotected anal sex. Upon exploring self-justifications that increased risk, we hypothesize that men became more self-aware of the ways in which they made sexual decisions and were thereby better prepared to more realistically assess risk in future sexual situations and make different decisions to decrease their HIV risk. This case study analyzes the PCC intervention of 2 HIV-negative men who have high-risk unprotected sex with men of uncertain HIV status. We present excerpts from the recordings of the interventions to better understand how the technique works. We believe that PCC can be a powerful tool in changing HIV risk behavior and merits more application and study to decrease HIV transmission.