The Role of Family Support and Communication on PrEP Attitudes and Stigma Among Black Men who Sex with Men (BMSM).

BACKGROUND: This study addresses the gap in the literature on protective factors for preexposure prophylaxis (PrEP) stigma and attitudes among Black men who have sex with men (BMSM) and young adults using the Developmental Assets Framework to examine how external assets (eg, family support, open family communication, and communication with parents about sex and drugs) can help reduce stigma and increase positive attitudes toward PrEP use. METHODS: A cross-sectional survey was administered to participants (N = 400, mean age = 23.46, standard deviation = 2.59) using Amazon Mechanical Turk, social media sites, and community-based organization. A path analysis was conducted to examine associations between stigma and positive attitudes toward PrEP among external assets (family support, communication with parents about sex and drugs, and open family communication). RESULTS: Communication with parents about sex and drugs was positive and directly associated with PrEP stigma (ß = 0.42, P < 0.001). Family support was negative and indirectly associated with stigma associated with PrEP (ß = -0.20, P < 0.001). CONCLUSIONS: This is the first study to use a developmental asset framework to assess positive PrEP attitudes and stigma among young BMSM. Our results underscore that parents have an influence on human immunodeficiency virus prevention behaviors for BMSM. In addition, their influence can be both positive by helping lowering PrEP stigma and negatively lowering PrEP attitudes. It is critical that we develop culturally competent human immunodeficiency virus and sexuality prevention and intervention programs for BMSM and their families.

"Whenever you're ready to talk about it": Prompts and barriers to inclusive family sex communication with gay, bisexual, and queer sons.

Despite growing evidence that parent-child sex communication (PCSC) is a positive strategy for adolescent sexual health outcomes, there is little research about what prompts and impedes these conversations among parents of gay, bisexual, and queer (GBQ) adolescent sons. Using interview data from a multi-method qualitative study, we analyzed parental perspectives (N=15) on non-heteronormative sex communication with GBQ adolescent sons. Our results revealed that parents are most likely to engage in sex communication if they established open communication with their child, accepted their child's sexual orientation, encouraged safe sex practices, and were knowledgeable about LGBTQ issues. Conversely, parents who experience communication discomfort were unable to engage in inclusive and comprehensive sex conversations, thus creating a barrier to effective sex-positive communication. These findings have implications for future research and interventions that promote parents' ability to successfully facilitate conversations about sexual health with their sexuality diverse children.

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.

Leveraging Resilience-supportive Strategies to Enhance Protective Factors in Young Sexual Minority Men: A Scoping Review of HIV Behavioral Interventions Implemented in High-income Countries.

Behavioral HIV interventions focused on strengthening young sexual minority men's (SMM) internal (assets) and external (resources) protective factors are promising, yet their evaluation as resilience-supportive strategies to minimize or negate HIV-related risks remain understudied. The objective of this scoping review was to describe resilience-supportive intervention strategies that have been used to achieve desired HIV behavioral outcomes and to identify how these strategies have been evaluated using a resilience analytic framework. Our scoping review uncovered 271 peer-reviewed articles, of which 38 were eligible for inclusion based on our review criteria. The majority of interventions relied on social support strategies as their primary resilience-supportive strategy. A third of interventions reviewed analyzed their findings from a deficits-focused model, another third used compensatory resilience models, and the remaining interventions employed a hybrid (i.e., deficit and compensatory model) strategy. None of the interventions evaluated their intervention effects using a risk-protective model. From our synthesis regarding the current state of research around resilience-informed interventions, we propose strategies to inform the design of resilience-supportive approaches and make recommendations to move the field forward on how to develop, implement, and measure young SMM's resiliency processes.

Women's views on communication with health care providers about pre-exposure prophylaxis (PrEP) for HIV prevention.

Since the beginning of the HIV epidemic in the USA, effective interventions to reduce HIV risk among cisgender women have been lacking. Although oral HIV pre-exposure prophylaxis (PrEP) is effective in pharmacologically preventing HIV infection, there is a gap between the recommended use of PrEP and PrEP uptake among eligible women. This study aimed to identify the role of patient-provider communication in PrEP decision-making among women considering PrEP. Semi-structured in-depth interviews were conducted with 41 PrEP-eligible women in Philadelphia and New York City. A thematic analysis of the responses was conducted, and a conceptual model developed and confirmed as analysis continued. Of the women interviewed, 53.6% were African American and 29.3% were Latina. Women noted that having a trusting relationship with their health care provider, receiving a tailored recommendation for PrEP based upon their specific needs and using their health care provider as support were crucial facilitators of PrEP decision-making. Lack of provider knowledge about PrEP, perceived health care provider stigma about their drug use and sexual activity, and lack of care continuity were all identified as barriers to effective communication. Study findings can inform future interventions to enhance patient-provider communication about PrEP and increase PrEP uptake among women.

Family Sex Communication Among Arab American Young Adults: A Mixed-Methods Study.

There is a significant gap in understanding the sexual health of Arab Americans. The purpose of this study is to explore family sex communication among Arab American young adults and its association with gender and sexual attitudes. We used a parallel mixed methods design and administered an electronic survey (N = 100); a subsample of 24 participants participated in five focus groups. We observed convergence in the findings. Participants reported rare occurrences of family sex communication, with women reporting less comfort than men. Family sex communication was often "unspoken," and reinforced prevailing social norms. Gender differences were reported based on sex communication topics. The most common source of sex information was peers/friends. Focus group participants perceived their parents to be more conservative and less knowledgeable about sex than they were. Future research on strategies to bridge generational differences is needed to promote family-based sex communication, given the multiple teachable moments at home.

The interplay of familial warmth and LGBTQ+ specific family rejection on LGBTQ+ adolescents' self-esteem.

INTRODUCTION: Our study sought to assess the interplay of family dynamics, namely familial warmth and LGBTQ+ specific rejection, and its association to self-esteem in a non-probabilistic sample of LGBTQ+ adolescents in the United States. METHODS: Stratified by (1) cisgender and (2) transgender and non-binary LGBTQ+ adolescents (N = 8774), we tested multivariable regression analyses to assess the association between familial warmth and LGBTQ+ specific family rejection, adjusted for sociodemographic characteristics. We then conducted a sub-analysis with LGBTQ+ adolescents who reported being out to any family member about their LGBTQ+ identity; specifically, we tested a series of multivariable regression models to assess whether levels of LGBTQ+ specific family rejection attenuated the association between familial warmth and self-esteem. RESULTS: Full sample models indicated a positive association between familial warmth and self-esteem. Findings from our sub-analysis indicated that familial warmth remained positively linked to self-esteem and family rejection was negatively associated with self-esteem. Family rejection was a statistically significant moderator, attenuating the association between familial warmth and self-esteem. With respect to being out about one's sexual orientation, these findings were robust across gender stratification groups. CONCLUSIONS: Families of origin serve as sources of stress and resilience for LGBTQ+ adolescents. Our findings contribute support to arguments that familial warmth and LGBTQ+ specific rejection are not mutually-exclusive experiences among LGBTQ+ adolescents. We provide recommendations for multilevel interventions to leverage activities that support positive family dynamics and self-esteem among LGBTQ+ adolescents.

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.

Parents ASSIST: Acceptability and Feasibility of a Video-Based Educational Series for Sexuality-Inclusive Communication between Parents and Gay, Bisexual, and Queer Sons.

Young men who have sex with men (YMSM) between the ages of 13 and 24 are a key population for HIV prevention. The parents of gay, bisexual, and queer (GBQ) adolescent males and the sex communication they have with their sons has yet to be explored as an HIV prevention intervention. We developed an online video series called Parents ASSIST (Advancing Supportive and Sexuality-Inclusive Sex Talks) to educate parents about sexual health topics pertinent to GBQ males. We pilot tested the series with a sample of 54 parents of GBQ males using a single-group post-test design. Participants viewed the videos and completed a survey measuring the acceptability and feasibility of an online video series to educate parents. Most of the parents (70.4%) believed that the videos would make parents more likely to initiate talking about sex with their sons. The results suggest that online videos are an acceptable way for parents to learn about GBQ sexual health topics.

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.

Are Sexual Minority Stressors Associated with Young Men who Have Sex with Men's (YMSM) Level of Engagement in PrEP?

Sexual minority stressors (community homophobia, sexuality-related discrimination, and internalized homonegativity) are negatively associated with accessing HIV prevention services among men who have sex with men (MSM). Few studies have tested minority stressors' associations with PrEP engagement among high-HIV risk young MSM (YMSM). Therefore, we assessed the associations between PrEP-indicated YMSM's progression along the PrEP continuum and their experiences of minority stress. N = 229 YMSM completed a web-survey on PrEP-related behaviors and minority stress. Adjusted for covariates, we developed two partial-proportional odds models examining the associations between PrEP continuum progression and minority stressors, as a composite, and community homophobia, sexuality-related discrimination, and internalized homonegativity, respectively. Our multivariable model demonstrated minority stress levels to be negatively associated with PrEP continuum location (AOR = 0.76, 95% CI: 0.58-0.99). Broken down, discrimination was positively associated with reporting being at an advanced location along the continuum (AOR = 1.39, 95% CI: 1.06-1.82). Internalized homonegativity was negatively associated with continuum location between PrEP-aware participants with no intention to initiate and participants who intended to initiate PrEP (AOR = 0.45, 95% CI: 0.27-0.77) and between those who intended to initiate and those who had ever used PrEP (AOR = 0.39, 95% CI: 0.22-0.69). Our findings suggest that minority stress, especially internalized homonegativity, remains a barrier to PrEP among PrEP-indicated YMSM. Sexuality-related discrimination was associated with PrEP continuum progression, suggesting potentially well-developed, adaptive coping skills (e.g., ability to locate sexuality-affirming providers). Coupled with stigma reduction efforts, HIV prevention services aiming to promote PrEP should incorporate internalized homonegativity screenings and referrals into sexuality-affirming resources for PrEP-indicated YMSM.

Assessing the Role of Gay Community Attachment, Stigma, and PrEP Stereotypes on Young Men Who Have Sex with Men's PrEP Uptake.

Negative stereotypes about pre-exposure prophylaxis (PrEP) hinder PrEP uptake among young men who have sex with men (YMSM). Prior research suggests community homophobia may be linked to negative PrEP attitudes. Conversely, individuals with high gay community attachments (GCA) may have more access to credible PrEP information/resources. Among 285 YMSM recruited online, we estimated structural equation models to test competing conceptual models that inform pathways from perceived stigmas, GCA, and negative PrEP stereotype endorsements to PrEP uptake. In Model A, perceived stigma was directly associated with PrEP uptake, partially mediated by stereotype endorsement (ß = - 0.05; 95% CI [- 0.09, - 0.01]) and GCA (ß = - 0.06; 95% CI [- 0.11, 0.02]). In Model B, perceived stigma was associated with PrEP uptake (ß = - 0.07; 95% CI [- 0.14, - 0.01]) through stereotype endorsement among high GCA YMSM. Complemented by anti-stigma initiatives, PrEP outreach for YMSM should utilize sex-positive messaging and disentangle negative PrEP stereotypes within gay-centric social spaces.

RESUMEN: Los estereotipos negativos sobre la profilaxis pre-exposición (PrEP) dificultan su uso entre hombres jóvenes que tienen sexo con otros hombres (YMSM). Investigaciones anteriores sugieren que la homofobia comunitaria puede estar relacionada a las actitudes negativas sobre PrEP. En cambio, personas con alto apego a la comunidad gay (GCA) pueden tener más acceso a información y recursos creíbles sobre PrEP. Entre los 285 YMSM reclutados en línea, estimamos varios modelos de ecuaciones estructurales para contrastar las asociaciones entre los estigmas percibidos, la GCA, los estereotipos negativos sobre PrEP, y el uso de PrEP entre diversos modelos conceptuales. En el Modelo A, el estigma percibido se asoció directamente con el uso de PrEP, siendo parcialmente mediado por el endoso a estereotipos (ß = − 0.05; IC del 95% [− 0.09, − 0.01]) y GCA (ß = − 0.06; IC del 95% [− 0.11, 0.02]). En el Modelo B, el estigma percibido se asoció con el uso de PrEP (ß = − 0.07; IC del 95% [− 0.14, − 0.01]) a través de los estereotipos entre YMSM con puntajes altos en GCA. Complementado con iniciativas contra el estigma, el alcance de la PrEP para YMSM debe utilizar mensajes de sexo positivo y desenredar los estereotipos negativos de PrEP dentro de los espacios sociales centrados en la comunidad gay.

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.

Parents ASSIST (Advancing Supportive and Sexuality-Inclusive Sex Talks): Iterative Development of a Sex Communication Video Series for Parents of Gay, Bisexual, and Queer Male Adolescents.

Effective parent-child sex communication enhances heterosexual youths' efficacy to engage in health promotive behaviors, yet there is scarce research on parent-child sex communication with gay, bisexual, and queer (GBQ) sons during adolescence. Our aim is to describe the development of Parents ASSIST, a web-based series of animated videos for parents of GBQ adolescent males focused on (a) parental education about sexual health topics pertinent to this population's same-sex concerns, (b) modeling of communication skills for parents to broach and sustain inclusive discussions at home, and (c) norming the role of providers as reliable sources of support when parents seek GBQ-related health information. Community-based advisory boards, comprised of parents and health care providers, respectively, informed the intervention development. Based on study notes and the research team's reflections, we present lessons learned that focus on content-based and logistical challenges that arose during the intervention development process. This study extends practice and patient education by providing an innovative, primary intervention that partners with parents of an underserved youth population.

Awareness and Perceived Accuracy of Undetectable = Untransmittable: A Cross-Sectional Analysis With Implications for Treatment as Prevention Among Young Men Who Have Sex With Men.

The Undetectable = Untransmittable (U=U) campaign was launched in 2016 to simultaneously reduce human immunodeficiency virus (HIV) stigma and raise awareness about treatment as prevention. This research note assesses HIV-negative young men who have sex with men's U=U awareness and perceived accuracy to inform this population's combination HIV prevention strategies.

Stigma Diminishes the Protective Effect of Social Support on Psychological Distress Among Young Black Men Who Have Sex With Men.

Addressing stigma remains a pressing HIV priority globally. Young Black men who have sex with men (YBMSM, ages 18-30; N = 474) completed an in-person baseline survey and reported their experiences of externalized stigma (i.e., racial and sexuality discrimination), internalized stigma (i.e., homonegativity), social support, and psychological distress (i.e., anxiety and depression symptoms). We used structural equation modeling to test the association between stigma and psychological distress, and examined whether social support mediated the relationship between stigma and psychological distress. Recognizing that these associations may differ by HIV status, we compared our models by self-reported HIV status (n = 275 HIV negative/unknown; n = 199 living with HIV). Our findings suggest that YBMSM who experience stigma are more vulnerable to psychological distress and may have diminished buffering through social support. These effects are accentuated among YBMSM living with HIV, highlighting the need for additional research focused on the development of tailored stigma reduction interventions for YBMSM.

Facilitators and Barriers to HIV Screening: A Qualitative Meta-Synthesis.

Accomplishments in biomedical research and technology, combined with innovative community and clinically based interventions, have expanded HIV testing globally. However, HIV screening and receipt of results remains a challenge in some areas. To optimize the benefits of HIV screening, it is imperative that there is a better understanding of the barriers to and motivators of testing for HIV infection. This study is a meta-synthesis of the qualitative literature on HIV screening and receipt of results; 128 unique publications had implications for HIV screening and receipt of results. A socioecological perspective provided an appropriate approach for synthesizing the literature. Three levels of influence emerged: individual attributes, interpersonal attributes, and broader patterns of influence. Findings were reviewed and found to have implications for continued engagement in the HIV treatment cascade. Recommendations to enhance HIV screening and to ensure receipt of results are proposed and discussed.