HIV prevention fatigue: Program engages men who have heard it all before
With the HIV epidemic well into its fourth decade, many gay and bisexual men in their 30s, 40s and 50s have spent much of their adult lives being bombarded with HIV and safer sex messages. And as a result, they can get tired of hearing and thinking about it.
The research community has a name for this: prevention fatigue, described as “an attitude that HIV prevention messages, programs, outreach, or counseling services have become tiresome,” explains Jamila Stockman, MPH, and colleagues in an article about prevention fatigue in San Francisco published in JAIDS.
“Considering that HIV is likely to be with us for decades to come, some amount of prevention fatigue may be inevitable,” they conclude. It becomes a problem, they say, if people translate prevention fatigue into riskier behaviors, like forgoing STI and HIV testing, failing to adhere to HIV medication regimens or having unprotected sex with partners whose HIV status they don’t know.
“We saw this a lot in the community, primarily among gay men, a real emotional fatigue in maintaining safe sex practices,” said Stefan Rowniak, MSN, PhD, an assistant professor at the University of San Francisco and nurse practitioner at San Francisco City Clinic who has conducted research on what he terms safe sex fatigue. “Not only has it been written about a lot, but it’s something that I experience on a daily basis working at my clinic; Men who just really feel like they don’t want to continue using condoms with everybody for a variety of reasons.”
An innovative program in San Francisco acknowledges and addresses prevention fatigue, while helping gay and bisexual men improve sexual health and wellbeing. Bridgemen, a program of San Francisco AIDS Foundation, carefully weaves education and discussions about sex and health into events that bring men together socially and for community service projects. An adaptation of the evidence-based program Mpowerment, the program capitalizes on the frequently expressed desire of middle-aged gay men to leave a lasting legacy.
“For many straight people, having and raising children is a way to leave a lasting legacy. But it’s different for gay men since many don’t end up having or raising kids. So they look for another way to have a lasting positive impact,” said Bridgemen program manager Jared Hemming.
Bridgemen is organized through a dedicated website, Facebook group and Meetup page and now includes almost 1,500 members. People who join the group can pick and choose from a variety of social and volunteer events organized each month. Previously, Bridgemen have participated in volunteer events like beach clean-ups and have served food for local LGBT elders. The group also organizes social events like attending art openings held at a local HIV and STI clinic and educational events like “F** Like A Porn Star” where group members are encouraged to talk openly about sex and health.
“Bridgemen brought me back to life, socially,” said Alex Ray, a Bridgemen member since January of 2015. “When I first joined, I was kind of isolated and shut down. I didn’t feel connected to people, to San Francisco or to the gay community even though I’ve lived here in San Francisco for 23 years. Bridgemen helped me get out and meet people in the community who are actively involved; who care about things larger than themselves, and that’s been really refreshing.”
Bridgemen organizers make sure that there are opportunities for guys to talk about sex, relationships, HIV and new prevention strategies like PrEP. And they’re quick to help link guys with more information or referrals when it’s called for.
“We’ve had people join Bridgemen after seroconverting (becoming HIV-positive), to get the social and emotional support they’re looking for during what can be a stressful experience,” said Hemming.
Between 2011 and 2014, over 2,000 men attended social events and 475 men volunteered at service projects. A recent marketing campaign, which ran online and in public spaces around San Francisco, introduced 6 Bridgemen “trading card characters” and recruited almost 100 new members.
At the HIV Prevention Conference in Atlanta, Georgia this month, Hemming and community coordinator Michael Donofrio presented results from a study of 119 Bridgemen members. The evaluation found that the program had a significant impact on factors that impact HIV risk. Half of participants reported that being a part of Bridgemen improved their ability to talk to other men, half improved their knowledge of HIV, 40% increased HIV and STI testing frequency, and about a third reported improvement in their ability to negotiate sex.
Participating in seven or more Bridgemen events was associated with significant improvement in all of these areas.
“It oftentimes happens that HIV programs don’t focus on building a supportive community—but this is essential. Bridgemen shows that with thoughtful planning, it’s possible to engage men in HIV education and prevention through a social and community service-oriented group,” said Hemming.
Learn more about Bridgemen, and get involved, at www.bridgemen.org.