Mother-Son Communication About Sex and Routine Human Immunodeficiency Virus Testing Among Younger Men of Color Who Have Sex With Men

Parent Facilitation of Condom Access and HIV Testing Associated with Improved Sexual Health Outcomes for Sexual Minority Young Men

Sexual minority young men experience a high HIV incidence. Parent-based interventions are promising for prevention efforts, but further research is needed to identify specific, replicable parental behaviors associated with improved sexual health outcomes for sexual minority young men. We assessed parental behaviors in the domains of facilitating access to condoms, providing instruction in condom use, and supporting HIV testing, and tested whether parental behaviors were associated with sons' condom use self-efficacy and intentions to get tested for HIV. Data came from the baseline assessment of a pilot trial of a parent-based HIV prevention program, and participants were dyads (n = 61) of sexual minority young men (M. age: 16.87; 46% racial/ethnic minority) and their parents (M. age: 44.31; 26% racial/ethnic minority). Parents and sons reported on parental behaviors in each domain. Results indicated that parents' facilitation of access to condoms was associated with sons' condom use self-efficacy, and parents' facilitation of HIV testing was associated with sons' HIV testing intentions. Findings were robust across both parent and son reports of parental behaviors. Parental condom use instruction was unrelated to sons' condom use self-efficacy. Findings suggest that parent-based HIV prevention programs for sexual minority young men should encourage parents to provide instrumental assistance to their sons in accessing condoms and HIV testing. There is a need for further research to identify underlying mechanisms.

Attitudes Toward Using and Willingness to Use a Hypothetical Online Sex Communication Intervention for Parents of Sexual and Gender Minority Adolescents

Although parents of sexual and gender minority (SGM) adolescents play a critical role in communicating about sexual health to their children, most parents have reported that they are unknowledgeable and uncomfortable talking about sexual health to their SGM adolescent. Because of the limited availability of sex education programs for parents of SGM adolescents, the study aimed to (1) describe the attitudes toward using and willingness to use a hypothetical online sex communication intervention for parents of SGM adolescents and (2) examine factors associated with willingness to use such an intervention. Parents of SGM adolescents from across the United States (N = 385) completed an online survey from March 10-16, 2023. Most participants were open to participating in a hypothetical online sex communication program and had positive attitudes toward it. Logistic regression results showed that participants who overall agreed a hypothetical online parent-based sex education intervention would be helpful and of interest had higher odds of being overall willing to participate in such a hypothetical intervention. Additionally, participants with higher income levels were also more likely to be willing to participate in a hypothetical program. Results from this exploratory study suggest that most parents of SGM adolescents have positive attitudes toward a hypothetical online parent-based sex education program and are willing to participate in it, highlighting a need to develop sex education programs tailored to the needs and preferences of parents of SGM adolescents. Additionally, equitable access to such programs is necessary especially regarding income level.

Differences in the sexual health information parents/guardians give their adolescent sexual minority sons by outness

Introduction

Parents and guardians are a potentially valuable source of sexual health information for adolescent sexual minority males (ASMM). The current study examines what sexual health topics ASMM report discussing with a parent/guardian and whether topics differ by outness about sexual attraction to other males.

Methods

ASMM (N=154; ages 14-17) in the United States completed the baseline of an online sexual health intervention pilot in 2020. They reported which of twelve sexual health topics they discussed with a parent/guardian and if they had disclosed their sexual attraction to other males. Associations between topics discussed and outness to a parent/guardian were examined with Firth logistic regression.

Results

Eighty-eight (57%) participants reported being out to a parent/guardian. Six sexual health topics were significantly more likely to be discussed if participants were out. The three categories with the largest differences by outness were how to: discuss with a partner what they would not like to do sexually (aOR = 7.0, 95% CI: 2.0-24.6), use condoms (aOR = 5.9, 95% CI: 2.3-15.1), and prevent HIV/AIDS (aOR = 3.5, 95% CI = 1.4-8.7).

Conclusions

Interventions on parental/guardian provision of sexual health information are needed to ensure ASMM receive relevant sexual health knowledge.

Family-Related Factors and HIV-Related Outcomes Among Black Young Men Who Have Sex with Men in Mississippi

Given their disproportionate HIV incidence, there is a critical need to identify factors related to HIV risk among Black young men who have sex with men (YMSM) in the southeastern United States. This study investigated the association of family factors and HIV-related outcomes among Black YMSM in Mississippi ages 14-20 (n = 72). Multivariable regression models evaluated associations of family factors and outcomes. Greater parent/child communication about sex was associated with fewer lifetime male sex partners and lower odds of lifetime anal sex. Greater parental monitoring was associated with greater likelihood of future condom use. Sexual orientation disclosure was associated with more lifetime male sex partners. Parental monitoring and parent/child communication about sex were protective, suggesting that family-based interventions are promising for HIV prevention among Black YMSM in Mississippi. Results also indicated that YMSM who are "out" to family are important to reach, and families could be useful in encouraging healthy behaviors.

Do Say Gay: Inclusive Sexuality Discussions for Out, Closeted, Questioning, and Straight Youth

INTRODUCTION

Debates questioning the soundness of inclusive elementary school discussions that acknowledge sexual and gender diverse people are harmful to gay, bisexual, or queer (GBQ) males. With parents as sexual socialization agents, examining sex communication at home is critical for promoting inclusive health information for all youth.

METHOD

We examined how GBQ youth (n = 30), aged 15-20 years, conceptualized inclusive sex communication with parents and the value of open sexuality discussions.

RESULTS

Most of the sample identified as gay (76.7%) and diverse (13.3% Asian, 13.3% Black/African American, 33.3% Latino). Participants discussed sexual health with their parents and perceived its significance for GBQ, questioning, and heterosexual children.

DISCUSSION

Findings can inform interventions that promote inclusive sex communication between parents and children to promote acceptance of sexual and gender diversity and sexual health for all youth.

“You are not alone”: Family-based HIV risk and protective factors for Hispanic/Latino men who have sex with men in San Juan, PR

Hispanic/Latino men who have sex with men (MSM) have the second largest HIV infection rate in the United States and Puerto Rico (PR) has ranked number five with the greatest number of Hispanics living with HIV. This study aims to understand how family affects HIV risk and protective factors for young adults. PR MSM ages 21 through 30 in San Juan, PR completed semi-structured interviews exploring the influence interpersonal family relationships have on HIV risk and protective factors. PR MSM (N = 15) completed a semi-structured in-depth individual interview. NVivo was used for administering a thematic analysis based on the transcripts in the original language of the interview, 14 in Spanish and one in English. The following five general themes emerged from the data analysis: 1) Immediate versus Extended Family; 2) The Matriarch; 3) Fractured Paternal Relationships; 4) Siblings Influence; and 5) Fictive Kin–Creating My Own Family. Findings suggest that the immediate family play an integral role in enhancing HIV protective factors for PR MSM as young adults. This study highlights the importance for developing family-based interventions that reinforce cultural beliefs and values through a strengths-based approach towards enhancing HIV protective behaviors for PR MSM.

Assessing Different Types of HIV Communication and Sociocultural Factors on Perceived HIV Stigma and Testing among a National Sample of Youth and Young Adults

In the United States, racial/ethnic and sexual youth and young adults (YYA) of color are disproportionately affected by HIV. Subsequently, YYA experience HIV stigma and engage in increased risk behaviors and reduced HIV testing. HIV communication has been identified as a potential buffer to HIV stigma, resulting in health-seeking behaviors, such as HIV testing. In this study, we respond to a meaningful gap in the literature by examining different types of HIV communication and their impact on HIV stigma and HIV testing in a diverse sample of YYA. We analyzed secondary data from the Kaiser Family Foundation National Survey of Teens and Young Adults on HIV/AIDS. A 40-question, web-based survey was conducted with 1437 youth (ages 15-24). Recruitment included a dual sampling method from households with: (1) listed phone numbers, (2) unlisted phone numbers, (3) telephones, (4) no telephone, and (5) only cell phone access. The purpose of the survey was to establish participants' HIV knowledge, communication, experiences, and testing behaviors. Findings suggested an association between intimate-partner HIV communication, increased HIV testing, and reduced HIV stigma. We also identified differentials in HIV testing and stigma based on gender, income, age, and sexual minority status, explained by HIV communication. Further research is needed that examines ways to use intimate-partner HIV communication to reduce stigma and increase HIV testing among YYA of different sociodemographic characteristics and sexual orientations.

Parent-Child Sex Communication Prompts, Approaches, Reactions, and Functions According to Gay, Bisexual, and Queer Sons

Minimal research on parent-child sex communication between parents and gay, bisexual, and queer (GBQ) adolescent sons prevents the formulation of interventions that would buffer or brake this youth population's risks for HIV/STI. We sought to describe the perspectives of GBQ adolescent males on this process and the potential ways they think parents can address their sons' informational needs, including countering youth access of sexually explicit media. We conducted 30 semi-structured interviews with GBQ male youth aged 15-20 years. Thematic and content analysis revealed four central themes: prompts and triggers, parents' approaches, sons' reactions, and the functions assigned to sex communication. Parents can be sources of reliable sexual health information and may be leveraged for future HIV/STI risk reduction work.

Father-Teen Talks about Sex and Teens' Sexual Health: The Role of Direct and Indirect Communication

Family talks about sex can protect against teens' risky sexual behavior, but most research has focused on the role of mothers. The current study included cross-sectional survey data from 728 adolescents in the 11th and 12th grades (Mage = 17.00, SD = 0.90) in the United States. Structural equation modeling (SEM) was used to assess associations between teens' direct and indirect talk, defined as less straightforward ways to communicate one's sexual values, with fathers about sex, and teens' sexual behaviors. There were no significant direct associations between father-teen talk about sex and teens' sexual behavior. However, teen gender moderated associations between indirect father-teen communication and teens' sexual behavior. The results suggest the need to assess indirect talk about sex in studies of family sexuality communication and to further investigate the role of teens' identities in determining the influence of father-teen talk about sex on teens' sexual behavior.

A Review of Parent- and Family-based Prevention Efforts for Adolescent Dating Violence

Prevention efforts for adolescent dating violence (ADV) have largely focused on adolescent-based interventions with little emphasis on parent- and family-based interventions, despite the integral role parents serve in adolescent relationship development. This literature review provides an overview of the existing parent- and family-based intervention efforts for ADV. This review highlights that some programs are geared toward a universal audience, whereas others are more targeted towards populations believed to be at greater risk for ADV. Some programs primarily target parents, whereas others integrate parent-based components into primarily adolescent-focused or comprehensive programs. Aspects to consider when selecting a program are discussed, as well as future directions. Suggested future directions involve broadening existing parent- and family-based programming for ADV to include a focus on secondary and tertiary prevention, gender differences, and gender and sexual minorities. This review also highlights the need for existing programs to expand their evaluation of behavioral outcomes and comparison of programs to one another.

Spirituality and Parenting among Women Experiencing Intimate Partner Violence

PURPOSE

While spirituality and parenting have been examined among caregivers experiencing adversity, less research has explored these factors among mother survivors of intimate partner violence (IPV). Given the potentially protective role of spirituality, understanding how parenting is associated with spirituality is important.

METHOD

The current study explored parenting practices, parent-child communication, and spirituality among 175 women caregivers who had experienced recent IPV. Hierarchical linear regression was used to examine associations between maternal age, education, HIV status, and illicit substance use (model 1); child age and gender (model 2); parent-child comfort communicating about sexual practices, IPV, HIV/AIDS, and substance use (model 3); and positive and negative parenting practices (model 4) with spirituality.

RESULTS

Findings suggested positive parenting practices, greater comfort talking about IPV, and greater discomfort talking about substance use were associated with higher spirituality.

CONCLUSIONS

Results highlight the value of parenting and communication strategies among women caregivers experiencing recent adversity.

Topics for Inclusive Parent-Child Sex Communication by Gay, Bisexual, Queer Youth

The purposes of this study were to identify the sexuality-related topics parents and gay, bisexual, or queer (GBQ) adolescent males discussed at home and to describe the topics GBQ adolescent males recommend for parents to discuss with future cohorts of GBQ youth. Minimal research on parent-child sex communication with sexual minority adolescents prevents the development of interventions that would benefit adolescent males with same-sex attractions, behaviors and identities. As part of a multimethod qualitative study, we interviewed 30 GBQ adolescent males ages 15-20 and asked them to perform card sorts. From a list of 48 topics, we explored sexuality-related issues GBQ males were familiar with, the topics they discussed with a parent, and topics they suggested parents address with GBQ males at home. Most participants reported that parents assumed them heterosexual during sex talks prior to GBQ adolescent males' coming out. Participants challenged the heteronormative scripts used by parents when discussing sex and health. Participants identified sexuality topics that parents did not routinely cover during sex talks, but that GBQ youth felt would have been useful for them growing up with emergent identities. A non-heteronormative approach to parent-child sex communication is recommended to provide appropriate guidance about sex and HIV/STI prevention to this youth population. Our findings highlight a need to reconfigure parental sexuality scripts to be more inclusive when assisting GBQ males navigate adolescence.

“I just trust what Google says, it’s the Bible”: Exploring young, Black gay and other men who have sex with men’s evaluation of sexual health information sources in Toronto, Canada

While sexual health literature identifies youths’ sexual health information sources and its impact on their sexual practices, little is known about the way youth evaluate the credibility of this information. This knowledge gap is significant among young, Black gay and other men who have sex with men (YBGM) who belong to intersectional populations disproportionately impacted by HIV and other STIs. We conducted a qualitative study using constructivist grounded theory to explore YBGM’s approaches to evaluating sexual health information sources’ credibility. Intersectionality and the socioecological model informed our analysis. We explored connections between social locations (e.g., race, sexual orientation) and socio-ecological environments and how their impact shaped YBGM’s evaluation of sexual health information. Findings revealed evaluation strategies varied by source: friends, the internet and healthcare providers. Friends’ information was deemed credible if they were older, shared social locations and provided embodied testimonials. Testimonials mirrored oral-traditions specific to Black populations where oral narratives help disseminate sensitive information in a culturally relevant way. Website selection was informed by YBGM’s social locations and ranged from being implicitly trusted to assessed by its association with established healthcare organizations. Many participants’ acceptance of healthcare providers’ information revealed patient-client power imbalances and a perception that providers’ actions reflected their institutions’ sexual health policies. Findings highlight a need for sexual health services to create culturally effective ways to disseminate information that accounts for the histories, contexts, and approaches YBGM use to identify credible sources of sexual health information.

HIV Preexposure Prophylaxis Among Adolescents in the US: A Review

IMPORTANCE

Many adolescents and young adults in the US are disproportionately affected by HIV. Several others who are uninfected are at risk and in need of effective preventive strategies. The uptake rate of preexposure prophylaxis (PrEP) for HIV prevention has remained low among US adolescents. This review assesses the current status of PrEP uptake among at-risk adolescents aged 13 to 19 years and recommendations for improving PrEP access, uptake, and future needed directions, including specific recommendations for health care professionals.

OBSERVATIONS

Of the 37 377 new HIV diagnoses made in 2018, 7734 diagnoses (21%) occurred in adolescents and young adults aged 12 to 24 years; of these, 1707 diagnoses (22%) occurred in adolescents aged 13 to 19 years. The greatest burden of HIV is found among young African American men who have sex with men, accounting for two-thirds of all HIV infections in adolescents and young adults. Preexposure prophylaxis awareness and engagement are lowest in adolescents with the greatest risk for HIV. Adolescent primary care clinicians and specialists do not routinely offer HIV testing as recommended by the Centers for Disease Control and Prevention or routinely assess sexual risk exposures of patients through sexual history taking. Clinicians' decision to prescribe PrEP for adolescents is often guided by their perceptions of the patient's HIV risk and their knowledge and acceptance of PrEP guidelines. State laws on consent, confidentiality, and the rights of the adolescent to independently access PrEP outside of parental influence differ across jurisdictions, often limiting access and uptake.

CONCLUSIONS AND RELEVANCE

Use of PrEP in adolescents at risk for HIV is an important component of HIV prevention. Optimizing uptake includes improving clinicians' knowledge about HIV risk and prevention strategies, enhancing sexual history taking and risk assessment through training and retraining, and improving PrEP knowledge and acceptance of prescribing among clinicians. Leveraging the ubiquity of social media, encouraging family support, and performing research aimed at finding lifestyle-congruent formulations can help mitigate HIV transmission in adolescents at greatest risk for HIV.

Same-Sex Attraction Disclosure and Sexual Communication Topics within Families

Few studies compare family communication about sex and relationships for sexual minority youth versus hetero-sexual teenagers. Further, existing studies often focus on mothers, overlooking fathers and extended family. Our survey of 952 adolescents aged 14-21 included 115 adolescents disclosing non-heterosexual attraction. Mothers offered more sexual protection methods messages to their non-SM teens, whereas fathers talked less with SM teens about risks of sex and relational sex. Most participants identified mothers, sisters, and female cousins, with male SMs having the highest number of disclosures to family members, whereas female and non-binary SMs confided in fewer family members or no one.

Parent-Adolescent Sex Communication with Sexual and Gender Minority Youth: An Integrated Review

INTRODUCTION

Sexual and gender minority (SGM) youth experience adverse sexual health outcomes at higher rates than their heterosexual and cisgender peers. Although parent-adolescent sex communication (PASC) is associated with improved sexual health outcomes among heterosexual youth, less is known about PASC with SGM youth.

METHODS

Studies describing experiences of SGM youth and parents during PASC and/or health outcomes of PASC were reviewed.

RESULTS

Eleven studies met inclusion criteria, and six themes emerged. These included: (1) limited communication and barriers to communication, (2) impact of SGM disclosure on communication, (3) HIV and/or sexually transmitted disease-focused communication, (4) heteronormative communication, (5) outcomes of communication, and (6) youth preferences for PASC.

DISCUSSION

Parent-adolescent sex communication was complicated by barriers to communication and was limited, heteronormative, and influenced by SGM disclosure. Parent-adolescent sex communication may improve sexual health outcomes, but adequate parental education and guidance is lacking. This review identifies ways that health providers can foster positive and inclusive PASC.

Family Characteristics in Sex Communication and Social Support: Implications for Emerging Adult Men Who Have Sex with Men's PrEP Engagement

While emerging adulthood (ages 18-25) is marked by increased independence from parents, parental support remains a strong correlate of positive sexual health outcomes for heterosexual youth. With the emergence of pre-exposure prophylaxis (PrEP), few studies have examined the potential for parent-child sex communication and PrEP adoption among emerging adult men who have sex with men (MSM). We aimed to describe the extent to which parents/family characteristics play supportive roles in emerging adult MSM's current PrEP use. PrEP-indicated participants (N = 222) were recruited via social media to complete an online survey. Multivariable logistic regression assessed associations between emerging adult MSM's current PrEP use and comfort with parent-child sex communication, family social support, family outness, and family prioritization, adjusted for sociodemographic variables. Thirty percent of participants reported current PrEP use. Only 20% reported moderate/high comfort with parent sex communication, 80% reported any family sexual identity disclosure, 70% reported moderate/high family social support, and 70% ranked family as a high/very high priority. Our multivariable model demonstrated an association between comfort with parent-child sex communication with current PrEP use only (AOR= 1.55, 95% CI 1.04-2.32). Our findings support that parents of emerging adult MSM possess a critical potential to reduce their sons' risk of HIV and promote PrEP uptake. Interventions that facilitate parents' efficacy to foster affirming, non-judgmental environments and discussions about their child's sexual behaviors, attractions/relationships, and health (e.g., PrEP) may be impactful in reducing the high HIV incidence rate that burdens emerging adult MSM.

Social Networks Moderate the Syndemic Effect of Psychosocial and Structural Factors on HIV Risk Among Young Black Transgender Women and Men who have Sex with Men

The interaction between the cumulative effect of psychosocial and structural factors (i.e. syndemic effect) and social networks among young Black transgender women and men who have sex with men (YBTM) remains understudied. A representative cohort of 16-29 year-old YBTM (n = 618) was assessed for syndemic factors [i.e. substance use; community violence; depression; poverty; justice system involvement (JSI)], social network characteristics, condomless anal sex (CAS), group sex (GS), and HIV-infection. The syndemic index significantly increased the odds of CAS, GS, and HIV-infection, and these effects were moderated by network characteristics. Network JSI buffered the effect on CAS, romantic network members buffered the effect on GS, and network age and proportion of family network members buffered the effect on HIV-infection. The proportion of friend network members augmented the effect on GS and HIV-infection. Future research to prevent HIV among YBTM should consider social network approaches that target both structural and psychosocial syndemic factors.

Demographic, Regional, and Political Influences on the Sexual Health Care Experiences of Adolescent Sexual Minority Men

Purpose: Adolescent sexual minority men (ASMM) are affected disproportionately by HIV, and little is known about their utilization of sexual health care services. We aimed to examine demographic, regional, and political influences on the sexual health care experiences of a unique sample of racially diverse ASMM from across the United States. Methods: Data were collected between April 2018 and February 2019 as part of the baseline survey of an ongoing pragmatic trial of a suite of HIV prevention interventions for ASMM. At the time of analysis, 699 participants had completed baseline and were included in multivariable analyses examining demographic, regional, and political differences in perceived access to and experiences of sexual health care. Results: The majority of ASMM reported not having had various sexual health care experiences in the past 12 months (70.8%-85.7%, respectively), and a large proportion reported low-to-moderate perceived access to such services where they live (37.8%-64.1%, respectively). Some groups were significantly less likely to report perceived access to, or having had, certain sexual health care experiences, including ASMM in their early- to mid-teens and those who lived in rural areas, the South, and Republican state-level political climates. Conclusion: These analyses indicate that ASMM underutilize sexual health care and point to specific groups with the lowest rates of engagement. To address the sexual health needs of ASMM, structural changes need to be made in the sociopolitical arena (e.g., federal nondiscrimination legislation) and medical system (e.g., mandated training in LGBTQ care) that will reduce LGBTQ-related stigma and increase access to needed care.

Parent-Adolescent Communication About Sex and Condom Use Among Young Men Who Have Sex With Men: An Examination of the Theory of Planned Behavior

Background

Young men who have sex with men (YMSM) are at disproportionate risk for HIV infection. Parent-adolescent communication about sex, particularly mother-adolescent communication, protects against adolescent sexual risk behavior. However, it is unclear whether these findings generalize to YMSM.

Purpose

The current study used the theory of planned behavior as a framework to examine how YMSM perceptions of parent-adolescent communication about condoms are associated with determinants of condom use and condomless anal sex among YMSM.

Method

YMSM ages 14-18 (M = 16.55) completed an online survey (n = 838). Associations between several domains of parent-adolescent communication about condoms (i.e., frequency and specificity, quality, and negative emotionality) and condom-related attitudes, norms, perceived behavioral control, and intentions, as well as instances of condomless anal intercourse (CAI), were examined with structural equation modeling.

Results

Multiple facets of mother-adolescent communication were associated with attitudes about condoms, subjective norms for condom use, perceived behavioral control, intentions to use condoms, and indirectly, instances of CAI. Father communication was not associated with determinants of condom use behavior.

Conclusions

Parent-adolescent communication about condoms is associated with determinants of condom use behavior among YMSM, and mother communication exerted an indirect influence on HIV-related sexual risk behaviors. Interventions designed to enhance parent- adolescent communication about condoms could prove efficacious in reducing HIV infections among YMSM.

Sex Education and HIV Testing Among Young Men Who Have Sex With Men: Findings From the 2006-2010 and 2011-2015 National Survey of Family Growth

BACKGROUND

Young men who have sex with men (YMSM) are disproportionally affected by HIV and exhibit low levels of HIV testing. The purpose of this study was to examine the relationship between sex education and subsequent HIV testing among YMSM.

METHODS

Data from sexually active men aged 15-24 years at interview in the 2006-2010 or 2011-2015 National Survey of Family Growth. Sex education included 3 contexts [formal institutions (eg, schools), parents, and health care providers] and specific topics. Outcome variables were ever- and recent-HIV testing. Multivariate models were adjusted for sociodemographics, and data were weighted to account for the complex survey sampling design.

RESULTS

A total of 323 sexually active YMSM met inclusion criteria. Overall, 42.4% had ever-tested for HIV and 16.9% tested in the previous 12 months. YMSM were more likely to have ever-tested for HIV if they talked with a parent/guardian about how to prevent HIV/AIDS [adjusted prevalence ratio (aPR) = 1.48; 95% confidence interval (CI): 1.07 to 2.06], talked with a health care provider about how HIV/AIDs is transmitted (aPR = 1.64; 95% CI: 1.13 to 2.38), sexually transmitted diseases (aPR = 1.49; 95% CI: 1.02 to 2.19), condom use (aPR = 1.61; 95% CI: 1.13 to 2.30), and the importance of HIV testing (aPR = 1.83; 95% CI: 1.22 to 2.73).

CONCLUSIONS

Tailored sex education by parent(s) and health care providers related to HIV/AIDS seems to significantly increase the likelihood of HIV testing among YMSM.

"It's Almost Like Gay Sex Doesn't Exist:" Parent-Child Sex Communication According to Gay, Bisexual, and Queer Adolescent Sons

Sex communication interventions facilitate positive sexual health outcomes with heterosexual adolescents. The same has yet to be established for male youth with same-sex attractions, behaviors, and identities. Our study describes the experiences of gay, bisexual and queer-identifying adolescent males with parent-child sex communication. We conducted 30 in-depth semi-structured interviews with a diverse group of 15 to 20 year-old gay, bisexual, and queer (GBQ) males. Interview transcripts were coded and themes were identified using thematic and content analysis. Narratives revealed that sex communication with parents occurs rarely, is heteronormative in content prior to adolescent males' disclosure as GBQ, and after disclosure is reactionary and based on stereotypes that associate this population with negative health outcomes. Parents were rated poorly as sex educators by adolescent males and the findings are mixed regarding perception of parents' knowledge about GBQ-specific information. Parents and healthcare providers were identified as preferred sources of sex information by GBQ adolescent males. Sex communication with parents throughout adolescence that excludes GBQ males' same-sex concerns is a missed opportunity for targeted sexual risk reduction. There are multiple ways healthcare providers can assist parents to plan age-appropriate, sexuality-inclusive, home-based discussions about sex for this group.

Gender and Race Informed Pathways From Childhood Sexual Abuse to Sexually Transmitted Infections: A Moderated Mediation Analysis Using Nationally Representative Data

PURPOSE

Although data suggest child sexual abuse is linked with increased risk of contracting asexually transmitted infection (STI), the mechanisms through which these experiences are connected remain understudied. Moreover, there is a need to explore how race/ethnicity and gender influence these processes.

METHODS

The present study examined the mediational pathways from child sexual abuse to risky sexual behavior to STIs and further evaluated the role of depressive symptomatology and nonmedical prescription drug use on the relationship between child sexual abuse and risky sexual behavior. In addition, race and gender were examined as moderators to account for potential different effects of these mechanisms on females and males and on different racial and ethnic groups. A nationally representative sample of 4,181 youth from the Add Health dataset was used.

RESULTS

Results from a moderated mediation model indicated risky sexual behavior partially mediated the pathway from child sexual abuse to STI contraction and depressive symptomatology and nonmedical prescription drug use partially mediated pathway from child sexual abuse to risky sexual behavior. Race and gender moderated the relationship between risky sexual behavior and STI contraction.

CONCLUSIONS

Findings underscore the need for STI prevention efforts among adolescents to focus on risk factors beyond risky sexual behaviors, such as childhood sexual abuse and mental health screening that includes depressive symptomatology and nonmedical prescription drug use. In addition, findings emphasize the need to further examine the different effects on different racial/ethnic and gender subgroups, particularly black women.

Methodological Considerations for Advancing Research on the Health and Wellbeing of Sexual and Gender Minority Youth

Continued research with sexual and gender minority (SGM) youth is essential both to understand health disparities and to develop interventions targeting those disparities, but conducting rigorous, ethical research with these populations remains a substantial challenge. In addition to considerations for research with adolescents in general, such as utilizing developmentally appropriate measures and obtaining parental permission, factors unique to SGM youth must be addressed at every step of the research process. Defining the study population is complex, as is recruiting a sample once it is defined. Measurement is another challenge, given the paucity of measures developed for or validated with SGM samples. Key constructs, such as sexual orientation, gender identity, and family acceptance, are not amenable to randomization and involving minor participants' parents poses ethical concerns given the precarious home and safety situations that can arise from employing typical study procedures with youth who have a stigmatized identity. In this article, we examine some of these unique methodological challenges. Informed by theoretical and empirical literature, practical experience, and an ongoing dialogue with SGM youth themselves, we present a guide to best practices for ethical, productive research with SGM youth. By discussing existing approaches to studying SGM youth and suggesting innovative ways to approach the questions that remain, we hope to assist the research community in addressing methodological gaps to advance research on SGM youth in relation to families and schools.

A Longitudinal Examination of Factors Associated with Network Bridging Among YMSM: Implications for HIV Prevention

Social-environmental factors may be associated with social network stability, which has implications for HIV acquisition. However, the link between social-environmental factors, network composition and HIV risk has not been examined previously among a city-population based sample of young Black men who have sex with Men (YBMSM). Respondent driven sampling was used to recruit a cohort of 618 YMBSM. Respondents were evaluated at baseline, 9 and 18 months beginning June 2013. A logistic regression model was used to assess the relationship between bridging (i.e. having non-redundant contacts in one's network, indicating network instability) and social-environmental factors and HIV risk factors between respondents, and a conditional logit model was used to assess these relationships within respondents over time. Bridging was associated with adverse social-environmental factors and higher HIV risk, indicating that bridging may be on the explanatory pathway. Future studies should assess the extent to which network stability factors mitigate HIV risk.

Factors promoting and impeding HIV testing among adolescents in juvenile drug court

A randomized pilot study compared Risk Reduction Therapy for Adolescents (RRTA) to treatment as usual (TAU); the present study examined whether intervention condition influenced HIV testing, barriers to HIV testing, and HIV communication among adolescents involved in juvenile drug courts overall and by sexual experience. Of 105 participants, 13.3% had HIV pre-treatment testing, whereas 27.2% (of 92 participants) indicated follow-up HIV testing. Sexually active youth in RRTA (but not in TAU) reported a significant increase in HIV testing over time. RRTA demonstrated the greatest increase in HIV testing (8% pre-treatment to 44% follow-up), but not significantly more than TAU. Prevalence of barriers to HIV testing were observed at consistent rates among adolescents who did not get tested for HIV within either treatment condition. Adolescents in both conditions reported increased communication about HIV at follow-up. HIV testing was positively associated with perceived need for testing and testing resource accessibility. Stigma remained a barrier to testing at follow-up for RRTA (22%) and TAU (21%) participants. The RRTA intervention increased HIV testing and both interventions increased adolescents' communication about HIV; however, barriers persisted, warranting treatment modification.

"I Have No Idea What's Going On Out There:" Parents' Perspectives on Promoting Sexual Health in Lesbian, Gay, Bisexual, and Transgender Adolescents

Lesbian, gay, bisexual, transgender, and other sexual and gender minority (LGBTQ) adolescents experience higher rates of negative sexual health outcomes relative to their heterosexual and cisgender peers. Healthy parent-adolescent relationships and effective parenting are robust predictors of sexual health in heterosexual adolescents, but very little is known about barriers to and facilitators of effective parenting from the perspective of parents of LGBTQ adolescents. This study conducted online focus groups with 44 parents of LGBTQ adolescents in order to describe the factors influencing effective sexual health communication and parental monitoring in this population. Parents described generally positive relationships with teens, but many noted they went through a transition process in which they struggled with their child's identity and were less supportive of their LGBTQ teen. Lack of understanding about LGBTQ-specific sexuality was a commonly endorsed barrier to effective communication, and this was most commonly endorsed by parents of cisgender girls. Parents of cisgender boys and transgender/gender-nonconforming teens described fears about long-term sexual health (i.e., sexual predators, consent) as a barrier to parental monitoring. Parents of LGBTQ adolescents need information and skills to optimize their teen's sexual health. Parent-based programs for LGBTQ adolescents are long overdue for addressing these issues.

Who counts as family? Family typologies, family support, and family undermining among young adult gay and bisexual men

Gay and bisexual men may form chosen families in addition to or in place of families of origin. However, the characteristics of these diverse families remain largely unexamined in the quantitative literature. The purpose of this study was to develop a family typology based on responses from a racially and ethnically diverse sample of young adult gay and bisexual men (YGBM) recruited from the Detroit Metropolitan Area (N=350; 18-29 years old). To explore the role of family, we then examined family social support and social undermining in relation to YGBM psychological distress within different family types. A series of multivariate regressions were used to examine associations between family social support and social undermining with depression and anxiety outcomes. The majority (88%) of YGBM included family of origin in their definitions of family and 63% indicated having chosen families. Associations between family social processes and psychological outcomes varied by type of family, suggesting that family composition shapes how perceptions of support and undermining relate to experiencing symptoms of depression and anxiety. Chosen families play a prominent role in the lives of YGBM and should not be overlooked in family research. Findings also highlight the importance of examining co-occurring family social support and social stress processes to further address psychological distress symptoms among YGBM.

Patterns of Social Affiliations and Healthcare Engagement Among Young, Black, Men Who Have Sex With Men

Little work has examined how individuals' social affiliations-the venues in which they meet friends and engage in informal social interaction-influence their engagement with public health services. We investigate how links to these local places shape access to information and exposure to health-seeking behavior. Using longitudinal data from a respondent-driven sample of 618 young black men who have sex with men (YBMSM) in Chicago, we identify different sets of social venues that connect YBMSM. We then examine how YBMSM's connections within this network influence their receipt of HIV prevention and treatment services and knowledge of pre-exposure prophylaxis (PrEP). Our results show that YBMSM's positions within Chicago's venue network shape the types of health-related services they access, net of demographic, structural, and community covariates. Men with affiliations that are linked to the city's gay enclave are most likely to know about PrEP, while men with affiliations that are predominately in the black community demonstrate improved HIV treatment outcomes. Outreach engaging MSM beyond venues in gay enclaves is needed.

Project nGage: Results of a Randomized Controlled Trial of a Dyadic Network Support Intervention to Retain Young Black Men Who Have Sex With Men in HIV Care

HIV-positive young black MSM (YBMSM) experience poor outcomes along the HIV care continuum, yet few interventions have been developed expressly for YBMSM retention in care. Project nGage was a randomized controlled trial conducted across five Chicago clinics with 98 HIV-positive YBMSM aged 16-29 between 2012 and 2015. The intervention used a social network elicitation approach with index YBMSM (n = 45) to identify and recruit a support confidant (SC) to the study. Each index-SC dyad met with a social worker to improve HIV-care knowledge, activate dyadic social support, and develop a retention in care plan. Each index and SC also received four mini-booster sessions. Control participants (n = 53) received treatment as usual. Surveys and medical records at baseline, 3-, and 12-months post-intervention assessed visit history (3 or more visits over 12 months; primary outcome), and sociodemographic, network, social-psychological, and behavioral factors. At baseline, there were no differences in age (M = 23.8 years), time since diagnosis (M ≤ 2 years), clinic visits in the previous 12 months (M = 4.1), and medication adherence (68.6 ≥ 90% adherence). In multivariate logistic regression analysis, intervention participants were 3.01 times more likely to have had at least 3 provider visits (95% CI 1.0-7.3) than were control participants over 12 months. Project nGage demonstrates preliminary efficacy in improving retention in care among YBMSM. Results suggest that engaging supportive network members may improve key HIV care continuum outcomes.

Exploring the Mother-Adolescent Relationship as a Promotive Resource for Sexual and Gender Minority Youth

Research often analyzes gender minority youth and sexual minority youth as a single group, a practice that obscures differences in how gender identity and sexual orientation shape health. The present study uses intersectionality to explore similarities and differences in the relationships between minority stress theory variables in a sample of 28 gender minority and 135 sexual minority youth of color. We also explore the mother-adolescent relationship as a potential promotive resource for minority stress research with youth. Results find few differences in minority stressors, promotive resources, or health between sexual and gender minority youth. However, different patterns in the correlations between stressors, resources, and health were observed for each group, underscoring the need for researchers to consider sexual and gender minority youth as distinct groups. Furthermore, study findings suggest that the maternal relationship may be an important promotive resource for both sexual and gender minority youth.

Criminal justice involvement history is associated with better HIV care continuum metrics among a population-based sample of young black MSM

OBJECTIVE

To examine how history of criminal justice involvement (CJI) is related to HIV care continuum metrics among young black MSM 16-29 years of age.

DESIGN

Population-based survey.

METHODS

From 2013 to 2014, a representative sample of young black MSM was generated using respondent-driven sampling (RDS) in Chicago (n = 618). HIV antibody/antigen and RNA testing were performed using dry blood spots. Factors assessed in the care continuum included HIV testing, HIV diagnosis, linkage to care within 6 months, retention in care, adherence to antiretrovirals, and viral suppression. RDS-weighted regression models examined the associations between history of CJI, including frequency of CJI and durations of stay and each of the continuum metrics.

RESULTS

A final analytic sample of 618 participants was generated through RDS chains of up to 13 waves in length and with a mean of 2.1 recruits per participant. At enrollment, 40.8% had prior history of CJI and 34.6% were HIV seropositive. Of persons reporting HIV seropositive status, 58.4% were linked to care, 40.2% were retained in care, 32.2% were adherent to antiretrovirals, and 24.3% were virally suppressed. Any CJI history was associated with the overall care continuum (adjusted odds ratio = 2.35; 95% confidence interval 1.13-4.88) and was most associated with increased retention in care [adjusted odds ratio = 3.72 (1.77-7.84)]. Having one CJI experience and detention for only 1 day was associated with better retention in care compared with no or more frequent CJI.

CONCLUSION

Those with a previous history of CJI were more successful in achieving most HIV care continuum metrics. Frequent and cycling CJI, however, was detrimental to HIV care.

Psychological distress, drug use, sexual risks and medication adherence among young HIV-positive Black men who have sex with men: exposure to community violence matters

In the USA, Black males are disproportionately affected by community violence and HIV. The aim of this study was to assess whether exposures to community violence are related to psychological distress, drug use, sexual risk behaviors, and medication adherence among a sample of HIV-positive young Black men who had sex with men (YBMSM). Data are from 98 YBMSM ages 18-29 years recruited from Chicago who completed measures on demographics, exposures to community violence, psychological distress, drug use, condomless anal intercourse, and medication adherence. Rates of exposure to community violence were high and youth reported victimization and witnessing numerous types of violence in their lifetime. In adjusted logistic regression analyses, models indicate that YBMSM reporting higher levels of exposure to community violence had significantly higher rates of condomless anal intercourse in the previous 6 months (AOR: 5.33, 95%CI: 1.38-20.55). Additionally, exposure to community violence was positively associated with psychological distress, hard drug use, and use of marijuana as a sex drug. Adherence to HIV antiretroviral medication was negatively associated with community violence (AOR: 0.36, 95%CI: 0.13-0.97). Rates of exposure to community violence are especially high in urban communities. Overall findings suggest that treatment, intervention, and programmatic approaches that include initiatives to address exposure to community violence might correlate with better health-related outcomes for HIV-positive YBMSM.