Body Image and Self-care in HIV-infected MSM

描述（由申请人提供）：这是一项修订后的、以前广受欢迎的K23提案，涉及在综合征（共发的心理社会问题）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。MSM构成，到目前为止，在美国艾滋病毒感染者中人数最多（H60%）。对MSM进行行为干预的效果不明显，可能是因为他们通常不解决这一人群独特而多样的心理社会背景。一项又一项的研究得出结论，共同发生的综合征导致自我护理行为不良，包括性风险和HAART不依从性，并可能干扰MSM 1 -7的干预措施的吸收。一个未充分研究的艾滋病毒感染的男男性行为者心理问题的例子是对自己的外表不满。据估计，31%的艾滋病毒感染的男男性行为者对身体的不满程度升高8，这是抑郁症、性传播风险和HAART不依从性的共同特征。候选人：我是马萨诸塞州总医院/哈佛医学院的博士后研究员，发表了15篇关于心理社会问题的同行评议论文（12篇为第一作者），如男男性行为者的身体不满和抑郁，HAART依从性和艾滋病毒性传播风险行为。目前的建议将使我获得所需的技能，以实现我的目标，成为一个独立的研究人员，研究共同发生的社会心理和自我保健问题之间的男男性接触者生活和感染艾滋病毒的风险。指导：Steven Safren博士是主要的导师，在解决艾滋病毒自我护理干预措施中的心理社会问题方面具有专业知识，包括抑郁症，HAART依从性和艾滋病毒预防。Kenneth Mayer博士和Sabine Wilhelm博士是二级导师，他们各自的研究领域是艾滋病毒预防和身体不满干预措施，为导师团队增添了相当多的独特专业知识。研究人员：作为一个例子，一种方法来整合改善自我保健行为，同时解决一个重要的心理社会综合指标，我将开发一种新的干预措施，解决身体的不满，抑郁症的综合征，二级艾滋病毒预防，艾滋病毒感染的男男性接触者之间的HAART坚持。通过指导，这种干预措施将通过最初的迭代过程开发，然后在随机对照试验中进行试点。培训：我将接受直接辅导，以解决自我护理（艾滋病毒预防和坚持）方面的心理社会问题，制定和测试侧重于心理社会问题和自我护理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（和他的其他赠款）直接相关，我可以参与其中，并观察与综合征相关的迭代干预发展。我还将接受高级统计分析的培训，参加临床试验，纵向建模，定性分析和缺失数据的课程。

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.