Being a teenager is hard, but being the parent of a gay, bisexual or transgender teenager presents its own set of challenges. The journey is often full of difficult, awkward, and emotional moments, especially when it comes to the topic of sex. As parents, it can be hard to know how to help your children safely navigate experiences that might be very different than your own on a subject that, gay or straight, you and your teens want to avoid.
But these honest conversations about sex need to happen, and they need to include PrEP, or Pre-Exposure Prophylaxis, the daily anti-HIV medication combination that reduces the chance of infection in people most vulnerable to HIV by up to 92 percent. PrEP will become available to your children once they turn 18—it’s been approved by the Food and Drug Administration (FDA) for adults since 2012, and recommended by the Centers for Disease Control and Prevention (CDC) for uninfected people at risk of contracting HIV since 2014.
Gay, bisexual and transgender teens are considered to be more vulnerable to new HIV infections than their peers. In 2015, the CDC reported youth aged 13 to 24 accounted for more than 1 in 5 new HIV diagnoses in the U.S., despite the fact only 10 percent of sexually experienced high school students have ever been tested for HIV. Of those new diagnoses, an alarming 81 percent occurred among gay and bisexual males. And while data is sparse, it is estimated the percentage of transgender women living with HIV in the United States 22 percent or higher.
Recent studies also make it clear the message on how to prevent HIV isn’t reaching and resonating with teens. The CDC estimates that condom use has dropped nationwide, with 43 percent of all sexually active high school students not using a condom the last time they had sexual intercourse. And of all men who have sex with other men, those aged 18-24 were the least likely to know about PrEP.
But why isn’t news about this effective daily pill for prevention reaching vulnerable teens? Well, as your teen might say, it’s complicated.
The CDC has blamed inadequate sex education as a top HIV prevention challenge. They found that the number of U.S. schools required to give students instruction on HIV prevention decreased from 64 percent in 2000 to 41 percent in 2014. When prevention is discussed, conversations tend to stay general.
Whether parents want to face it, gay, bisexual and transgender teenagers also still face a stigma that keeps them from asking for information and taking steps to protect themselves. You may support your teen, but many of their future partners may not be so lucky. A lack of family support makes healthy choices for any young person more difficult, and often leads to real harm. According to San Francisco State University’s Family Acceptance Project study, young adults who reported higher levels of family rejection during adolescence were 3.4 times more likely to report having engaged in unprotected sexual intercourse, not to mention suffer from other serious health problems like depression and drug addiction.
This stigma carries over to doctors’ offices too. It’s reported that 80 percent of sexually active gay men have not talked to their primary care providers about PrEP, and three quarters don't think their provider would prescribe it.
Supportive parents who proactively engage in difficult but necessary conversations about HIV prevention play a key role in the health and safety of their teens as they journey into young adulthood and beyond. Your teen may not welcome the conversation, but they may need the life-saving protection of PrEP. And really, isn’t protecting and loving your child in the midst of the eye-rolls of adolescents what parenting your teen is all about?
But what works? How do parents engage with their teens in a constructive, supporting way? Here are five tips for talking to teens about PrEP and HIV prevention:
Inform yourself first.
Before you start talking to your teen, make sure you know what factors will impact their sexual experiences. From dating apps to drug use to STI risks, a lot has changed in the world of sex since parents were teens. What’s more, behavioral norms and sexual behaviors differ in the gay community. The CDC website offers a wide array of statistics on HIV and PFLAG has web content tailored specifically to family, friends, and allies of the LGBT community.
Prepare to talk PrEP.
The public conversation around PrEP (brand name Truvada) has been full of lots of myths and misinformation. There’s often fear about side effects, that PrEP users are promiscuous, and that it’s cost prohibitive. But the reality is PrEP is a powerful HIV prevention tool and can be combined with condoms and other prevention methods to provide even greater protection. The side effects for adults are generally minor symptoms such as headaches and upset stomach that usually resolve within the first couple weeks of starting the medication. Parents and teens should also be aware of longer term side effect risks such as bone density changes and kidney problems. Individuals who choose to start PrEP should work with their doctor to closely monitor these risks as they would with any medication. Studies are underway to determine if these same side effects hold true for younger adolescents. There are also an increasing number of ways to get PrEP at little or no cost, or to lower your insurance copays to a level that is affordable to you or your teen. Project Inform and prepfacts.org are both excellent resources for educating yourself about PrEP.
Discuss health care options.
Is your teen still going to the same grandfatherly pediatrician they’ve always seen? Offer to make them an appointment with a LGBT-friendly doctor and encourage them to be open and honest about their healthcare needs. If your teen is interested in PrEP, you can help them find a provider by discussing it with a doctor, pharmacist, or by using pleaseprepme.org or greaterthan.org. Reassure teens covered under your health insurance benefits that you are okay with claims for HIV preventive care, and offer to cover additional costs if possible. Also, while PrEP is available throughout the United States, it may be harder to access in some locations. Thinking ahead may help you get your young adult the care they need no matter where they may be living during college and beyond. One-step PrEP programs are also being developed currently. This streamlined process can be very helpful for busy teens trying to navigate the healthcare industry for the first time.
Don’t make assumptions, don’t pass judgments.
Your beliefs about adult relationships and sexuality can lead to health outcomes you would never wish upon your child. Even the most liberal, accepting parents sometimes pass judgments along to their kids. Be careful not to slip into stereotypes, and don’t assume that acceptance automatically leads to smart choices. The reality is most teens experiment and test boundaries, and the developing adolescent brain can have iffy ideas on what’s risky. Focus on giving your child a chance to live an honest life with their parents first, and know that model is something they will carry them throughout their lives.
Keep talking, and don’t be afraid to fail.
As the saying goes, if at first you don’t succeed, try, try again. It’s rare parents get through to teens the first time, and nearly impossible for parents to say things perfectly at the perfect time. Continuing to talk about sexual health and HIV prevention is the best way to make sure your kids are getting the information they need, processing it, and making the best choices possible. If you have other questions or are seeking additional support, feel free to chat with your pharmacist or doctor.
Michael Louella is Outreach Coordinator for the UW AIDS Clinical Trials Unit and defeatHIV and Community Liaison for the UW/Fred Hutch Center for AIDS Research.
Elyse Tung, PharmD, BCACP, is Director of Clinical Services at the Kelley-Ross Pharmacy at the Polyclinic (part of the Kelley-Ross Pharmacy Group)