PROJECT SUMMARY Young men who have sex with men (YMSM; age 18-34) are disproportionately burdened by HIV. Minority stress and its “downstream” effects in YMSM, including mental health issues, sexual risk behaviors, and suboptimal HIV testing, contribute to the syndemic risks surrounding HIV. Mindfulness-based interventions (MBIs), adapted for HIV prevention among YMSM and internet-based delivery to maximize reach and engagement, could offer an innovative and scalable method to address this public health issue. Consistent with NCCIH’s scientific priority in Disease Prevention and Health Promotion across Lifespan, the current project aims to develop an internet-delivered MBI for HIV prevention among distressed, high-risk YMSM. Specifically, this K23 will provide support for an early phase, exploratory clinical trial by adapting mindfulness-based stress reduction (MBSR) and conducting a feasibility trial among YMSM. Candidate: Dr. Sun is a clinical scientist with a research background in HIV prevention and mental health concerning minority populations and marginalized communities. In recent years, she has pursued clinical and research development in mindfulness. Building on her prior work, she is applying for a five-year K23 Career Development Award to obtain training, mentorship, and research experience to become an expert in adapting and evaluating internet-delivered MBI to address HIV-related health disparities and an independent investigator capable of R01 funding. Mentoring: A stellar team of senior investigators serve on the advisory panel. Drs. Don Operario and Judson Brewer are co-primary mentors, who have complimentary expertise in HIV prevention for MSM and internet-based MBI for behavioral health. Three co-mentors bring expertise in internet-based HIV intervention with young adults (Dr. Larry Brown), mindfulness for population health (Dr. Eric Loucks), and stress physiology (Dr. Audrey Tyrka). Research: Guided by the ADAPT-ITT model, the proposed project aims to (1) adapt MBSR for distressed, high risk YMSM and internet-delivery using focus groups with YMSM (n=30) and stakeholders (n=16), (2) refine the intervention protocol by administering adapted materials to distressed, high risk YMSM (n=18) and stakeholders (n=16) via theatre testing, and (3) examine the feasibility and acceptability of the adapted iMBI for HIV prevention by randomizing 40 distressed, high-risk YMSM to the iMBI (n=20) and a Health Education condition (n=20). The study will examine recruitment and retention, intervention adherence (e.g., attendance, at-home practice), completion of assessment (HIV testing, sexual risk behaviors, hair sample collection, mental health, minority stress and coping), and acceptability of the intervention. Trainings: Dr. Sun will receive training in MBSR, intervention adaptation and implementation for YMSM and internet-delivery, and a biopsychosocial-based understanding of stress through coursework, seminars, workshops, directed readings, and mentored research. Guided by an excellent mentorship team, these training and research experiences will establish the candidate’s career as an expert in HIV-related behavioral health and iMBI for minority health. The candidate is institutionally supported by Brown University School of Public Health.

PROJECT NARRATIVE The HIV epidemic disproportionately affects young adult gay, bisexual, and other men who have sex with men (YMSM; age 18-34), a population largely impacted by stigma (i.e., minority stress) and mental health issues, both create a “syndemic” condition surrounding sexual risk behaviors and suboptimal HIV testing. Mindfulness-based interventions (MBIs) are efficacious in reducing psychological distress and promoting behavioral health, and successful adaptation of MBI for content and internet-delivery may offer an innovative, transdiagnostic, and scalable approach to reach YMSM and address this public health issue. Using an evidence-based adaptation model (ADAPT-ITT) for HIV behavioral health, the current project aims to systematically adapt mindfulness-based stress reduction (MBSR), an empirically-supported intervention with efficacy, to the context of HIV prevention and minority stress reduction via internet-based delivery among distressed, high risk YMSM, followed by a randomized feasibility trial.