Body Image and Self-care in HIV-infected MSM

描述（由申请人提供）：这是一份经过修订的、先前广受好评的K23提案，旨在解决在综合症（共同发生的社会心理问题）背景下男男性行为者（MSM）的健康风险行为，特别关注身体形象障碍和抑郁症。到目前为止，男同性恋者是美国艾滋病毒感染者中人数最多的（60%）。行为干预对男同性恋者的影响不大，可能是因为他们通常没有解决这一人群独特而多变的社会心理环境。一项又一项研究得出结论，同时发生的综合症导致自我保健行为不良，包括性风险和HAART不依从性，并可能干扰对MSM1-7的干预措施的吸收。感染艾滋病毒的男男性行为者的一个未被充分研究的社会心理问题是对自己外表的不满。据估计，感染艾滋病毒的男男性接触者中有31%对身体的不满程度较高，这与抑郁、性传播风险和HAART治疗依从性不一致。候选人：我是麻省总医院/哈佛医学院的博士后，发表了15篇同行评议的论文（其中12篇是第一作者），内容涉及男同性恋者的身体不满和抑郁、HAART治疗依从性和HIV性传播风险行为等社会心理问题。目前的建议将使我获得所需的技能，以实现我的目标，成为一名独立研究员，研究艾滋病毒感染者和有感染艾滋病毒风险的男同性恋者之间共同发生的社会心理和自我保健问题。指导：主要导师Steven Safren博士在艾滋病毒自我保健干预措施背景下解决社会心理问题方面具有专业知识，包括抑郁症、HAART治疗依从性和艾滋病毒预防。Drs。Kenneth Mayer和Sabine Wilhelm是二级导师，他们各自在艾滋病毒预防和身体不满干预方面的研究专长为指导团队增加了相当多的独特专业知识。研究：作为将改善自我保健行为与解决重要的社会心理综合症指标相结合的方法的一个例子，我将开发一种新的干预措施，解决艾滋病毒感染的男男性接触者的身体不满、抑郁症综合症、二级艾滋病毒预防和HAART依从性。在指导下，这种干预将通过最初的迭代过程发展，然后在随机对照试验中进行试点。培训：我将接受直接指导，处理自我保健背景下的社会心理问题（艾滋病毒预防和坚持），开发和测试以社会心理问题和自我保健为重点的干预措施的迭代过程，以及传播。这与我的主要导师的K24奖（以及他的其他资助）直接相关，我可以参与其中，并观察与综合症相关的迭代干预开发。我还将接受高级统计分析方面的培训，学习临床试验、纵向建模、定性分析、缺失数据等课程。

DESCRIPTION (provided by applicant): This is an amended, previously well-received, K23 proposal addressing health risk behaviors in men who have sex with men (MSM) within the context of syndemics (co-occurring psychosocial problems), and a particular focus on body image disturbance and depression. MSM constitute, by far, the largest number (H60%) of individuals with HIV in the U.S. Modest effects of behavioral interventions for MSM may be because they generally do not address the unique and varied psychosocial context for this population. Study after study concludes that co-occurring syndemics contribute to poor self-care behaviors including, sexual risk and HAART non-adherence, and may interfere with uptake of interventions for MSM1-7. One example of an understudied psychosocial problem among HIV-infected MSM is dissatisfaction with one's appearance. It is estimated that 31% of HIV-infected MSM have elevated body dissatisfaction8, which is syndemic to depression, sexual transmission risk, and HAART non-adherence. CANDIDATE: I am a postdoctoral fellow at Massachusetts General Hospital/Harvard Medical School with 15 peer-reviewed publications (12 first-authored) on psychosocial problems such as body dissatisfaction and depression among MSM, HAART adherence, and HIV sexual transmission risk behaviors. The present proposal will allow me to acquire needed skills to achieve my goal of becoming an independent researcher studying co-occurring psychosocial and self-care problems among MSM living with and at risk for acquiring HIV. MENTORING: Dr. Steven Safren, the primary mentor, has expertise in addressing psychosocial problems in the context of interventions for self-care in HIV, including depression, HAART adherence, and HIV prevention. Drs. Kenneth Mayer and Sabine Wilhelm are secondary mentors and add considerable unique expertise to the mentoring team, with their respective research specializations in HIV prevention and body dissatisfaction interventions. RESEARCH: As an example of a way to integrate improving self-care behaviors while addressing an important psychosocial syndemic indicator, I will develop a novel intervention which addresses body dissatisfaction, syndemic to depression, secondary HIV prevention, and HAART adherence among HIV-infected MSM. With mentorship, this intervention will be developed through an initial iterative process, and then piloted in a randomized control trial. TRAINING: I will receive direct mentoring in addressing psychosocial problems in the context of self-care (HIV prevention and adherence), the iterative process of developing and testing interventions that focus on both psychosocial problems and self-care, as well as dissemination. This is directly tied to my primary mentor's K24 award (and his other grants), on which I can be part of, and observe the iterative intervention development related to syndemics. I will also receive training in advanced statistical analysis, take courses on clinical trials, longitudinal modeling, qualitative analysis, and missing data. PUBLIC HEALTH RELEVANCE: MSM represent, by far, the largest group of individuals living with HIV in the U.S., and for public health interventions to be effective with this population, the will need to address the real-life set of psychosocial problems that this group faces. In addition to quality of life concerns, studying the role of body dissatisfaction is relevant for the treatmen of depression, as well as secondary prevention and management of HIV, as body dissatisfaction has been linked to increased depression, sexual transmission risk and HAART non-adherence. However, to date, no intervention exists which incorporates body dissatisfaction into HIV-care with MSM.