13. Beyond the Talk: Caregivers Perspectives on Sexual Health Communication with Their Adolescent, Relationship Quality, and HIV Pre-exposure Prophylaxis (Prep)

Adolescent sexual minority and/or gender diverse assigned males (ASM/GDM) are at higher risk of acquiring HIV in their lifetimes than their heterosexual and cisgender peers. Pre-exposure prophylaxis (PrEP) uptake has been low in this group, and prior work has highlighted barriers to uptake including confidentiality concerns and suboptimal sexual health communication with caregivers (e.g., parents, trusted adults). We aimed to understand the perspectives of caregivers on sexual health communication barriers and facilitators, PrEP awareness, and willingness to consider PrEP for their adolescent. We conducted individual in-depth interviews via videoconference with (N=12) caregivers in the US who had at least one adolescent who was assigned male sex at birth. We included caregivers regardless of their child’s sexual orientation or gender identity to capture a full range of experiences of sexual health communication given some ASM/GDM have not disclosed their identities or behaviors to their caregivers. Participants were recruited via social media advertisements, during primary care or gender specialty care clinical visits, and through information delivered by a community-based organization serving sexual minority and gender diverse youth. Interviews were facilitated using a semi-structured guide. A detailed debrief was written immediately following the interview with emphasis on categories including sexual health communication, relationship quality, and knowledge and attitudes about PrEP. Written debriefs were reviewed and summarized using a content analysis approach to determine preliminary topics of interest relevant for future work. Caregivers (N=12) were largely between the ages of 35 and 50 (n=8), assigned female at birth (n=8), and asserted woman identity (n=8). All 12 were cisgender. Most were non-Hispanic (n=11), and race included White (n=8), Black/African American (n=2), and American Indian/Alaska Native (n=2). Preliminary topics of interest were as follows: 1) Most caregivers had not heard of PrEP. 2) Very few caregivers discussed anal sex or HIV prevention in their sexual health communication, and none discussed PrEP. 3) After a brief description of PrEP, most were willing to consider it for their adolescent, and all were willing to learn more. 4) While most caregivers had proactive and open communication with their child about sexual health, some had little or no communication; all were willing to learn strategies to improve their sexual health communication. 5) The few caregivers with a close relationship and communication inclusive of sexual minority and gender diverse-related topics were all willing to support their child using PrEP. Despite a lack of knowledge about PrEP and communication about it with their adolescent, caregivers were generally receptive to learning about PrEP and considering it for their child. Future work should consider facilitating inclusive sexual health communication between caregivers and ASM/GDM that incorporates HIV prevention strategies such as PrEP.