Parent-Adolescent Relationship Quality, Sexual Health Communication, and Willingness to Support Pre-Exposure Prophylaxis for HIV: A Qualitative Study

Abstract

Purpose: Pre-exposure prophylaxis (PrEP) for HIV is a safe and highly effective prevention method, yet use among U.S. adolescents at risk for HIV has been low. Little is known about how sexual health communication (SHC) and the quality of parent-adolescent relationships influence parents' hypothetical willingness to support their adolescent using PrEP. Methods: We conducted 34 in-depth interviews with parents of adolescents recruited from four U.S. urban clinical sites between 2018 and 2019. We then used applied thematic analysis informed by two theories to determine parents' hypothetical willingness (more vs. less willing) and to identify related themes, focusing on differences between more versus less willing parents. Results: Parents were diverse with respect to race/ethnicity (68% Black/African American, 18% Hispanic). Most were cisgender men (44%) or women (41%). Approximately half (n = 19, 56%) were more willing. Four themes related to willingness were identified: (1) relationship quality, (2) acceptance of sexual and gender-diverse (SGD) identities, (3) sex positivity of SHC, and (4) general positivity about PrEP. Responses from more willing parents tended toward higher relationship quality, more acceptance of SGD identities, more sex positivity, and PrEP positivity; conversely, less willing parents tended toward the opposite ends of each theme. HIV risk perception did not consistently impact willingness, as both more and less willing parents largely perceived their adolescent's HIV risk as low. Discussion: Parents who were more willing to support their adolescent hypothetically using PrEP tended to describe high-quality relationships, acceptance of SGD identities, sex positivity of SHC, and general positivity about PrEP.