Nurses Can Help Parents Talk to Their Teens About HIV Risk

Heather Boerner

November 13, 2016

ATLANTA — The parent–child sex talk is almost always awkward. But with rising rates of HIV, especially in young black men who have sex with men, it has become essential, experts said here at the Association of Nurses in AIDS Care 2016.

"Because gay and bi sons are coming out earlier, there is more time for parents to know that their sons are gay and to actually live in the same home," said Dennis Flores, PhD, ACRN, from the University of Pennsylvania in Philadelphia.

"That means that parents have an opportunity to address health behaviors while they still have a captive audience — before their child turns 18 and goes off to the big city, or wherever," he told Medscape Medical News.

And nurses at pediatric and adolescent health centers can help, said Dr Flores. They can help parents understand that their child might not be heterosexual, and help normalize this, and provide resources that will help parents talk to their children about sexual-health risks that are specific to men who have sex with men, he explained.

High Incidence, Low Rates of Care

Data from the Center for Disease Control and Prevention Youth Behavior Risk Survey showed that young people who identify as gay, lesbian, bisexual, or "unsure" are more likely to have ever had sex, more likely to have had sex before age 13, and more likely to have sex with four or more people — all of which increase risk for HIV.

That risk behavior is reflected in HIV incidence data. Globally, people 15 to 24 years of age account for 35% of new HIV infections. In the United States, that means that nearly 79,000 people younger than 25 are living with HIV, according to 2014 data. But unlike the overall HIV care continuum, in which 85% of people living with HIV know their status, only 40% of adolescents who are living with HIV have been diagnosed. Even fewer — 25% — have been linked to care, and only one in 10 youth living with HIV remain engaged in care. Of all the young people in the United States living with HIV, only 6% have achieved viral suppression.

Parents are not sexual and reproductive health experts and we shouldn't try to make them that.

The good news is that 40 years of research in sex communication shows that parental guidance on sexual health can delay age of first sex and decrease sexual risk behaviors, said Vincent Guilamo-Ramos, PhD, MPH, RN, LCSW, ACRN, from the NYU Silver School of Social Work in New York City.

"Parents are not sexual and reproductive health experts and we shouldn't try to make them that," Dr Guilamo-Ramos told Medscape Medical News. "We need them to be parents and convey what their views are and try to understand their teen's world. That's how they become really effective."

There are ways to do this within current clinical guidelines and patient-confidentiality regulations, he explained.

Parents: An Untapped Resource

In a cohort of 30 men who have sex with men 15 to 20 years of age, Dr Flores found that sexual attractions emerged at 10.5 years, and children first saw sexual images at 10.9 years. They did not, however, see sexual material related to men who have sex with men until they were 13.5 years. The average age for first sexual-orientation disclosure was 15.4 years.

The majority of the study participants said they discussed sexual issues with their parents rarely or only occasionally, and when they did, the discussions were often prompted by benchmarks of older adolescence, such as going to prom or leaving for college. When the conversation was triggered by a son coming out to his parents, the conversations were, Dr Flores said, "reactive" and informed by old data about HIV and AIDS.

This "offended" the teens, he said.

Still, study participants gave parents higher scores for communication if they attempted to talk to them about same-sex sexual health, even if the talk was clumsy. As to who they wanted to help them navigate emerging same-sex attractions and safer sex, it was not an aunt or a peer or even "your local ANAC member" — it was parents.

"Parents are the preferred source of information," Dr Flores reported, admitting that he was surprised by this information. "The first five people said it, and then the next 10. And it became clear there was no question. Parents are a huge untapped resource."

Because nurses have good contact with parents, "this is a potential site of intervention," he said.

Appropriate Sex Education

Dr Flores is beginning another study to look at where nurses can intervene to help parents talk to their sons about same-sex attraction. One finding from his current study is that youth are educated about condoms in the context of preventing pregnancy. There was no talk of the combination of condoms and lubrication in the context of receptive anal sex.

"Can you imagine a dad saying, 'Use lube and condoms because the rectal mucosa would be better served if you use lube?'" asked Dr Flores.

In areas like this, where parents are unprepared, nurses can step in and provide guidance, both Dr Flores and Dr Guilamo-Ramos pointed out.

After the panel, Sandra Fagan, RN, a nurse at a Ryan White clinic in Auburn, Alabama, said she was excited and concerned by the discussion. She sees first hand that the young men who have sex with men who come in with parents have much better outcomes. However, those are few and far between, she said. Most are coming in with a friend or partner, and many are coming in with what she called "alarming rates" of syphilis, gonorrhea, and Chlamydia.

"This is kind of an LGBT utopia they're talking about here, which I appreciate and wish we had more of," said Fagan. "But the MSM I'm seeing have no parental support. Obviously, I and the social workers are not reaching them at the level we need to be reaching them at."

Still, she said, she is leaving the panel inspired. "I wish that this optimistic view of family support were more universal," she added.

This study was funded by the Duke University School of Nursing, the Jonas Center for Nursing Excellence, the National Institute of Nursing Research, and Penn Nursing Science at the University of Pennsylvania School of Nursing. Dr Flores, Dr Guilamo-Ramos, and Ms Fagan have disclosed no relevant financial relationships.

Association of Nurses in AIDS Care (ANAC) 2016: Abstract I-10. Presented November 12, 2016.


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