What If My Dad Finds Out!?: Assessing Adolescent Men Who Have Sex with Men's Perceptions About Parents as Barriers to PrEP Uptake

Abstract

Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy for high-risk adults and recently was given US FDA approval for use among adolescents. Yet, the barriers to medication uptake for this population are unique when compared to adult populations, as parents may be just as likely as prescribers to be gatekeepers to access. To better understand the role of parents in adolescents' attitudes towards PrEP, we surveyed 491 adolescent men who have sex with men (AMSM) ages 13-18, using forced choice and open-ended response questions. We measured perceived parent-PrEP supportiveness, hypothetical parent reactions to a request to initiate PrEP, and perceived positive and negative aspects of taking PrEP without parents knowing. A mixed-methods approach was employed. Results indicated a majority of AMSM had heard of PrEP and most reported their parents would be unsupportive of their taking PrEP. Teens perceived their parents would likely be angry, accusatory, and punitive if PrEP use was discovered, and that accessing PrEP independent of parents might increase their health autonomy, agency, and prevent awkward conversations about sex. Furthermore, a path model revealed that fears of parental reaction and poor self-efficacy to communicate with parents about PrEP significantly contributed to participants feeling PrEP was not "right" for them, and as a corollary, less interest in starting PrEP. The study suggests that improving parental knowledge of PrEP and encouraging parents to begin the conversation about PrEP could help increase uptake in AMSM.

Keywords: Adolescents; Family communication; HIV prevention; Parents; PrEP.

Figure 1.. Path model of the relationships between AMSM-parent perceived reactions (normative beliefs) regarding PrEP and their direct and indirect effects on intending to start PrEP (behavioral intention).

The model (N=488) explains 27.0% of the variance, χ²(15) = 288.56, p<.001. CFI =.98. RMSEA estimate = 0.04, 90%CI = 0.00–0.07. Values along the arrows represent the direct standardized coefficients. Parenthesized values represent the standard error of the coefficients. For each indirect effect, we report the statistically significant indirect standardized coefficient (p<.05), the standard error, and the biased-corrected 95% confidence intervals based on 5,000 samples. ^a Indirect standardized coefficients were derived from the multiplication of the direct standardized coefficients within a path, from start to finish. ns = Not significant (statistically).

Figure 1.. Path model of the relationships between AMSM-parent perceived reactions (normative beliefs) regarding PrEP and their direct and indirect effects on intending to start PrEP (behavioral intention).

The model (N=488) explains 27.0% of the variance, χ²(15) = 288.56, p<.001. CFI =.98. RMSEA estimate = 0.04, 90%CI = 0.00–0.07. Values along the arrows represent the direct standardized coefficients. Parenthesized values represent the standard error of the coefficients. For each indirect effect, we report the statistically significant indirect standardized coefficient (p<.05), the standard error, and the biased-corrected 95% confidence intervals based on 5,000 samples. ^a Indirect standardized coefficients were derived from the multiplication of the direct standardized coefficients within a path, from start to finish. ns = Not significant (statistically).