Body Image and Self-Care in HIV-Infected MSM
| Status: | Recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 18 - 65 |
| Updated: | 4/2/2016 |
| Start Date: | February 2013 |
| Contact: | Aaron J Blashill, PhD |
| Email: | ablashill@partners.org |
| Phone: | 617-643-2148 |
The purpose of this study is to develop and test counseling strategies for men who have sex
with men (MSM) who are living with HIV and are experiencing body dissatisfaction.
Two phases will be conducted throughout the course of the study.
Phase 1: Develop an intervention for HIV-infected MSM that addresses body dissatisfaction
and self-care. (NOTE: currently, only Phase 1 will be recruiting participants, Phase 2 will
not be active for several months)
Because of the prospective syndemic relationship between body dissatisfaction and
depression, the investigator will integrate the most efficacious interventions for body
dissatisfaction, depression, adherence, and sexual risk reduction, and tailor them to
HIV-infected MSM. The investigator will then conduct an iterative process of pilots and exit
interviews about feasibility, acceptability, and the strengths and weaknesses of the
intervention until the intervention is maximized. Up to 9 participants will be involved in
Phase 1.
Phase 2: Conduct a two-arm randomized control trial comparing the newly developed
intervention to a treatment-as-usual condition.
As a first step in addressing the efficacy of the newly developed intervention, the
investigator plans on randomizing up to 60 participants into either the newly-developed
intervention or a treatment-as-usual condition. Participants will be assessed at baseline, 3
months (acute outcome), and 6 months postrandomization. The primary outcome variable is body
image disturbance. Depression, HIV sexual transmission risk behaviors, and highly active
antiretroviral therapy (HAART) adherence will serve as secondary outcomes.
Study hypotheses for the two phases include:
1. The investigator will be able to develop and implement a feasible intervention that
integrates addressing and relieving body dissatisfaction with increasing health related
behavior change in MSM with HIV. Adequate recruitment (at least 80% of goal) and
retention (at least 80% to follow up) in the trial will be an indicator of success for
this aim.
2. Those who receive the intervention will show improvements in health behavior outcomes
(medication adherence, HIV transmission risk behavior) and will show reduced body
dissatisfaction and depressive symptoms.
with men (MSM) who are living with HIV and are experiencing body dissatisfaction.
Two phases will be conducted throughout the course of the study.
Phase 1: Develop an intervention for HIV-infected MSM that addresses body dissatisfaction
and self-care. (NOTE: currently, only Phase 1 will be recruiting participants, Phase 2 will
not be active for several months)
Because of the prospective syndemic relationship between body dissatisfaction and
depression, the investigator will integrate the most efficacious interventions for body
dissatisfaction, depression, adherence, and sexual risk reduction, and tailor them to
HIV-infected MSM. The investigator will then conduct an iterative process of pilots and exit
interviews about feasibility, acceptability, and the strengths and weaknesses of the
intervention until the intervention is maximized. Up to 9 participants will be involved in
Phase 1.
Phase 2: Conduct a two-arm randomized control trial comparing the newly developed
intervention to a treatment-as-usual condition.
As a first step in addressing the efficacy of the newly developed intervention, the
investigator plans on randomizing up to 60 participants into either the newly-developed
intervention or a treatment-as-usual condition. Participants will be assessed at baseline, 3
months (acute outcome), and 6 months postrandomization. The primary outcome variable is body
image disturbance. Depression, HIV sexual transmission risk behaviors, and highly active
antiretroviral therapy (HAART) adherence will serve as secondary outcomes.
Study hypotheses for the two phases include:
1. The investigator will be able to develop and implement a feasible intervention that
integrates addressing and relieving body dissatisfaction with increasing health related
behavior change in MSM with HIV. Adequate recruitment (at least 80% of goal) and
retention (at least 80% to follow up) in the trial will be an indicator of success for
this aim.
2. Those who receive the intervention will show improvements in health behavior outcomes
(medication adherence, HIV transmission risk behavior) and will show reduced body
dissatisfaction and depressive symptoms.
Among men who have sex with men (MSM), the largest population living with HIV in the U.S.,
poor self-care behaviors occur within the context of intertwined psychosocial problems,
called syndemics. Important affected health behaviors include sexual transmission risk and
adherence to antiretroviral therapy. In major cities, one in five MSM are living with
HIV/AIDS, making these domestic MSM rates comparable to many endemic settings such as
Sub-Saharan Africa. Because of antiretroviral therapy, HIV-infected individuals are living
with the virus longer and the population of HIV-infected MSM continues to grow.
Study after study concludes that psychosocial problems/intertwined syndemics such as
depression, substance abuse, and childhood sexual abuse significantly contribute to poor
self-care behaviors such as sexual risk behaviors among MSM. Despite this, one reason for
the modest effects of behavioral interventions for HIV is that they generally do not address
the unique and varied psychosocial context of living with HIV for various risk groups. One
example of a highly prevalent psychosocial problem among HIV-infected MSM is dissatisfaction
with one's appearance. Body dissatisfaction is frequently syndemic to depression in
HIV-infected MSM and is related to both sexual transmission risk and HAART non-adherence.
Recent evidence indicates that MSM with high body dissatisfaction are 60% less likely to use
condoms during anal intercourse compared to MSM with low body dissatisfaction.
The goal is to study multiple health behaviors in the context of psychosocial problems among
HIV-infected and uninfected MSM. This includes designing and testing interventions aimed at
reducing health problems (e.g., sexual risk, medication adherence, self-care) and
co-occurring mental health disorders/syndemics. In this context, the current research plan,
focusing on body dissatisfaction, depression, sexual risk reduction and HAART adherence
provides one example of applying this goal to a discrete syndemic-oriented intervention
development research project. This has relevance for both behavioral interventions for
adherence and HIV risk behavior in MSM, which may be moderated by syndemics, but also has
important application for the eventual roll-out of emerging biomedical prevention
interventions. For example, HIV chemoprophylaxis (pre-exposure prophylaxis; PrEP) has
recently been shown to reduce HIV transmission risk in high risk MSM. If this or other
biomedical interventions are adequately disseminated to the highest risk MSM, the field will
likely need plans for addressing mental health and, potentially, substance use, in the
context of prescribing biomedical agents.
poor self-care behaviors occur within the context of intertwined psychosocial problems,
called syndemics. Important affected health behaviors include sexual transmission risk and
adherence to antiretroviral therapy. In major cities, one in five MSM are living with
HIV/AIDS, making these domestic MSM rates comparable to many endemic settings such as
Sub-Saharan Africa. Because of antiretroviral therapy, HIV-infected individuals are living
with the virus longer and the population of HIV-infected MSM continues to grow.
Study after study concludes that psychosocial problems/intertwined syndemics such as
depression, substance abuse, and childhood sexual abuse significantly contribute to poor
self-care behaviors such as sexual risk behaviors among MSM. Despite this, one reason for
the modest effects of behavioral interventions for HIV is that they generally do not address
the unique and varied psychosocial context of living with HIV for various risk groups. One
example of a highly prevalent psychosocial problem among HIV-infected MSM is dissatisfaction
with one's appearance. Body dissatisfaction is frequently syndemic to depression in
HIV-infected MSM and is related to both sexual transmission risk and HAART non-adherence.
Recent evidence indicates that MSM with high body dissatisfaction are 60% less likely to use
condoms during anal intercourse compared to MSM with low body dissatisfaction.
The goal is to study multiple health behaviors in the context of psychosocial problems among
HIV-infected and uninfected MSM. This includes designing and testing interventions aimed at
reducing health problems (e.g., sexual risk, medication adherence, self-care) and
co-occurring mental health disorders/syndemics. In this context, the current research plan,
focusing on body dissatisfaction, depression, sexual risk reduction and HAART adherence
provides one example of applying this goal to a discrete syndemic-oriented intervention
development research project. This has relevance for both behavioral interventions for
adherence and HIV risk behavior in MSM, which may be moderated by syndemics, but also has
important application for the eventual roll-out of emerging biomedical prevention
interventions. For example, HIV chemoprophylaxis (pre-exposure prophylaxis; PrEP) has
recently been shown to reduce HIV transmission risk in high risk MSM. If this or other
biomedical interventions are adequately disseminated to the highest risk MSM, the field will
likely need plans for addressing mental health and, potentially, substance use, in the
context of prescribing biomedical agents.
Inclusion Criteria:
- HIV-seropositive
- Prescribed ART for at least the last two months
- Reports having sex with men in the past 12 months
- Reports current body dissatisfaction (a score of 2.48 or more on the Body Image
Disturbance Questionnaire)
- Age 18 and older
- Capable of completing and fully understanding the informed consent process and the
study procedures
Exclusion Criteria:
- Over age 65
- Significant mental health diagnosis requiring immediate treatment (e.g., unstable
bipolar disorder; any psychotic disorder)
- Has received cognitive behavioral therapy for body dissatisfaction within the past 12
months
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