This study investigated how HIV specialist nurses communicate with men who have sex with men with HIV during routine consultations with a focus on sexual health counseling in the Netherlands. In this multicenter observational study, 16 video-recorded consultations from four HIV treatment centers were analyzed. Verbatim transcriptions were analyzed to assess the topics discussed, the duration of consultations, time spent on sexual health counseling, and specific issues covered. Communication skills were evaluated through a predefined framework. The findings indicated inconsistent coverage of sexual health, varied topics, and a lack of structure. Various communication skills and techniques were applied inconsistently. Given these findings, we recommend implementing communication strategies during routine consultations to improve the quality of sexual health counseling, especially for men who have sex with men with HIV. This is essential to improve the quality of sexual health counseling for persons with HIV, especially men who have sex with men.