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3. Impact of Parent-Adolescent Relationship Quality and Sexual Health Communication on Parental Willingness to Support Adolescent Use of Pre-Exposure Prophylaxis for HIV: Lessons for Post-Pandemic Sexual Health Interventions

      Purpose

      Pre-exposure prophylaxis (PrEP) is a safe and highly effective method of HIV prevention, yet PrEP use among US adolescents at risk for HIV has been low. Sexual health communication between parents and adolescents has been shown to decrease teen pregnancy and increase condom use, but data are scarce on the impact of communication on PrEP use. We wanted to understand parents’ perspectives on PrEP and the role of parent-adolescent relationship quality and sexual health communication on parents’ willingness to support their adolescent using PrEP (“PrEP willingness”), to inform post-pandemic interventions to improve PrEP uptake among adolescents at risk for HIV.

      Methods

      We conducted N=34 in-depth interviews (IDIs) with parents of adolescents recruited from clinical sites in four US cities (Tampa, FL; Baltimore, MD; Chicago, IL; Denver, CO) as part of a larger, multi-center study on adolescents’ and parents’ involvement in HIV prevention research. IDIs were conducted by research staff using a semi-structured interview guide. IDIs were recorded, transcribed, and de-identified. A coding structure was developed using a step-wise iterative process as follows: 1) Initial codes were generated from interview guide topics; 2) literature review was used to provide theoretical foundations for codes on “relationship quality” and “sexual health communication”; 3) three authors (JR, RAS, AK) independently applied initial codes to two transcripts, iteratively discussing coding conceptualizations and discrepancies, and revised the coding structure accordingly; 4) the first author trained the fourth author using four transcripts, discussing coding discrepancies and revising coding structure. Preliminary themes were identified using applied thematic analysis, a rigorous and inductive process of identifying and examining themes from textual data.

      Results

      Parents were almost universally supportive of PrEP as a theoretical HIV prevention method for all populations. Two groups of parents emerged: “low” and “high” willingness to support their own adolescent using PrEP. Low willingness parents tended to either 1) not be aware of their child’s sexual experiences, and/or 2) perceive their child as being at low risk for HIV transmission. High willingness parents expressed more open and specific sexual health communication with their child and used supportive and engaged language when describing their relationship with their child. Few parents in either the low or high willingness groups reported concerns about the efficacy or safety of PrEP, but those who did cited side effects more often than other concerns. Parents were supportive of clinic and school-based supports for parents and adolescents to improve sexual health communication and HIV prevention efforts.

      Conclusions

      Parents were largely supportive of PrEP as a general approach to HIV prevention, and largely willing to have their own adolescent use it. Parents with more engaged and supportive relationships, and those with more specific and open sexual health communication tended to express more PrEP willingness. Future work should focus on incorporating parents into PrEP uptake interventions given their key roles in adolescents’ sexual health, while acknowledging pandemic-related changes to parents’ and adolescents’ relationships and contexts.

      Sources of Support

      National Institute of Mental Health (1K23MH123335-01, PI: Rusley) and the Adolescent Trials Network for HIV/AIDS Interventions (ATN, U01 HD040533 and U01 HD 040474).