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.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Mentored Patient-Oriented Research Career Development Award (K23)
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Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
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Grossman, Cynthia I
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Massachusetts General Hospital
United States
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Blashill, Aaron J; Oleski, Jessica L; Hayes, Rashelle et al. (2016) The Association Between Psychiatric Disorders and Frequent Indoor Tanning. JAMA Dermatol 152:577-9
Ehlinger, Peter P; Blashill, Aaron J (2016) Self-perceived vs. actual physical attractiveness: Associations with depression as a function of sexual orientation. J Affect Disord 189:70-6
Koethe, John R; Jenkins, Cathy A; Lau, Bryan et al. (2016) Rising Obesity Prevalence and Weight Gain Among Adults Starting Antiretroviral Therapy in the United States and Canada. AIDS Res Hum Retroviruses 32:50-8
Jampel, Jonathan D; Murray, Stuart B; Griffiths, Scott et al. (2016) Self-Perceived Weight and Anabolic Steroid Misuse Among US Adolescent Boys. J Adolesc Health 58:397-402
Blashill, Aaron J; Tomassilli, Julia; Biello, Katie et al. (2016) Body Dissatisfaction Among Sexual Minority Men: Psychological and Sexual Health Outcomes. Arch Sex Behav 45:1241-7
Wilhelm, Sabine; Greenberg, Jennifer L; Rosenfield, Elizabeth et al. (2016) The Body Dysmorphic Disorder Symptom Scale: Development and preliminary validation of a self-report scale of symptom specific dysfunction. Body Image 17:82-7
Blashill, Aaron J; Williams, Alison; Grogan, Sarah et al. (2015) Negative appearance evaluation is associated with skin cancer risk behaviors among American men and women. Health Psychol 34:93-6
Newcomb, Michael E; Bedoya, C Andres; Blashill, Aaron J et al. (2015) Description and Demonstration of Cognitive Behavioral Therapy to Enhance Antiretroviral Therapy Adherence and Treat Depression in HIV-Infected Adults. Cogn Behav Pract 22:430-438
Zhang, Chunyu; Blashill, Aaron J; Wester, Stephen R et al. (2015) Factor Structure of the Gender Role Conflict Scale-Short Form in Chinese Heterosexual and Gay Samples. Psychol Men Masc 16:229-233
Safren, Steven A; Perry, Nicholas S; Blashill, Aaron J et al. (2015) The cost and intensity of behavioral interventions to promote HIV treatment for prevention among HIV-positive men who have sex with men. Arch Sex Behav 44:1833-41

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