This article advances the view that motivational strategies can augment the effectiveness of skills-based HIV-risk reduction interventions. We articulate the empirical and theoretical rationale for a motivational approach, and describe how we developed a motivationally-based HIV-risk reduction intervention. We describe the strategic exercises as well as the therapeutic style that constitutes this approach. We then present detailed reviews of three clinical trials that have evaluated HIV-preventive motivational interventions; these trials provide promising evidence for the integration of motivational approaches with traditional skills-based approaches. We recognize the limitations of existing research, and provide suggestions for future research.