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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Study Section
Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
Program Officer
Grossman, Cynthia I
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San Diego State University
Schools of Arts and Sciences
San Diego
United States
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Gholizadeh, Shadi; Rooney, Benjamin M; Merz, Erin L et al. (2018) Body Image and Condomless Anal Sex Among Sexual Minority Men Living with HIV. AIDS Behav 22:658-662
Blashill, Aaron J; Calzo, Jerel P; Griffiths, Scott et al. (2017) Anabolic Steroid Misuse Among US Adolescent Boys: Disparities by Sexual Orientation and Race/Ethnicity. Am J Public Health 107:319-321
Blashill, Aaron J; Safren, Steven A; Wilhelm, Sabine et al. (2017) Cognitive behavioral therapy for body image and self-care (CBT-BISC) in sexual minority men living with HIV: A randomized controlled trial. Health Psychol 36:937-946
Calzo, Jerel P; Blashill, Aaron J; Brown, Tiffany A et al. (2017) Eating Disorders and Disordered Weight and Shape Control Behaviors in Sexual Minority Populations. Curr Psychiatry Rep 19:49
Blashill, Aaron J; Pagoto, Sherry (2017) Effect of Legislation on Indoor Tanning Prevalence in Alabama. Am J Public Health 107:966-968
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
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; Tomassilli, Julia; Biello, Katie et al. (2016) Body Dissatisfaction Among Sexual Minority Men: Psychological and Sexual Health Outcomes. Arch Sex Behav 45:1241-7
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

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