It started with a simple concept. Design a program targeted at older gay and bisexual men who were at risk for contracting HIV. It was early in 2008 and the statistics told a disturbing story. After many years of declining HIV infection rates, there was a pronounced uptick in the number of gay and bi men over 40 years old who were becoming HIV positive. There were several factors at play which could be responsible for the trend. There was the growing popularity of the internet for meeting sex partners, often bringing together men from vastly different demographics. These men might not have known each other well and also might not have shared the same beliefs about safe sex practices, STD disclosure, and how to negotiate safer sex with one another. There was also increased availability and use of ED treatments which allowed for more opportunities to transmit various STDs. And, of course, alcohol and other substances which were often part of sex within the community. Add to this an overall lessening of the fear of HIV as a life threatening condition, and there was a formula that would explain the phenomenon.
But why did older gay and bi men seem to be impacted so greatly by this conglomeration of factors? The answer, it seemed, was simple. Older gay and bi men were much more likely to feel varying levels of anxiety, isolation, and depression especially as it related to their place within the community. Their social networks, critical for providing support and companionship, were often in disrepair on completely non-existent. These men may have been finding themselves back in the dating scene after coming out of a long term relationship. Others were just coming out later in life. The pressure of meeting people and forming relationships in what continues to be a youth focused culture was leading to these men having more issues around self-esteem and confidence. These feelings of “not fitting in” often led to the use of alcohol and other substances to ease anxiety which, in turn, led to greater risk taking when it came to sexual safety.
Armed with this information, Fenway Health in cooperation with the Massachusetts Department of Health developed 40 and Forward. The six week program includes equal parts education, group support, and social events that help participants break the isolation/anxiety/depression cycle and begin the process of mending their social networks and addressing other factors that impede their ability to lead more fulfilling lives. The group was designed foremost to have a comfortable and welcoming environment. Dinner is served at the weekly meetings and the curriculum is designed to be very interactive and conversational, much like having dinner with friends. Participants are encouraged to get to know each other and work together in group exercises and in the planning of a social event which is open to all 40 and Forward alumni. This way, 40 and Forward participants have the opportunity to meet dozens of men who have participated in the program, and are often great candidates for companionship, friendship, and more. Jon Vincent, Program Director for Prevention, Education and Screening at Fenway commented on the program, “HIV prevention is a starting point for a group like this, but it is really about much more. For thousands of years gay people have been forced into corners in our societies. Whether it’s perpetuated by fear, stigma, disease, or even envy, until recently-- and still not completely, gay people have felt the divide, the burden of being different. Many men of my vintage and older didn’t benefit from much in terms of social inclusion. For many of us, we carry the memories of those less evolved times into our adult lives. 40 and Forward is a direct attempt to take some of the loneliness and hurt out of making new relationships. In this way, men can enter into friendships, partnerships and marriages without the continued heavy burden of what for many of us were difficult years-- the coming of age times.”
Over its five year history, the program has proved very effective based on survey data provided by the participants. The program helps in reducing levels of depression, isolation, and anxiety. Practical skills like proper condom use and tools for discussing safer sex with partners all showed positive trends. If the data wasn’t encouraging enough, one can also point to the thriving alumni group and the many events the group organizes from movie nights to Sunday brunches and everything in between. The group has a presence on Facebook and Google so there is always daily chatter between members. The quarterly social events organized by the newest group still attract alumni members all the way back from the original group. Still as innovative as it was five years ago, 40 and Forward continues to embrace, educate, and enlighten Boston’s gay and bi over forty circuit. The 40 and Forward experience was summed up by former participant and active alumni, Wayne Malin. “40 and Foward is a great group. I'm pretty shy and quiet (Chuck had me pegged from the beginning) but I lost my shyness quickly. All the guys were friendly, open and accepting and made me completely comfortable. I made quite a few new friends I would have never met otherwise. Also all the events and get-togethers we had were great too.”
For those interested in participating in an upcoming 40 and Forward group, or for more information, give Chuck Giovanniallo a call at 617.488.9720 or email cgiovanniello@fenwayhealth.org.
