Gay Youths: Parental Relationships and HIV Risk
Gay men are estimated to comprise 2% of the U.S. population yet account for an estimated 61% of recent new HIV infections. Despite ongoing prevention efforts, gay youths continue to engage in sexual behaviors that place them at disproportionately high risk. Investigators have identified risk factors associated with unsafe sex among young gay men including mental illness, substance use, misinformation about transmission, and having older sexual partners. However, an important but insufficiently explored influence is that of parental relationships. Parental rejection is not uncommon for these youth, and those who experience it may be more likely than their non-rejected peers to engage in unprotected sex. Further, accepting family relationships may be related to lower rates of high-risk sexual behavior among gay youths. However, more information is needed about the nature of parental influences and how parent-child interactions impact sexual behavior so that practitioners can harness these influences in their HIV prevention efforts.
Methods:
To this end, a comparative analysis was undertaken with samples from two qualitative studies: 1) a Chicago-based study of 21 HIV-positive youths exploring their perceptions and contexts of HIV risk; 2) a study of 36 NJ and NYC young gay men, (4 who were HIV positive), examining the role of family relationships and HIV risk. The combined sample consisted of 19 Black, 19 White, and 19 Latino respondents (N=57) ranging in age from 16-24. Respondents in both studies were asked what influenced their choices about current and previous HIV-risk behaviors. Probes were used to explore the nature of family influences when they emerged. A grounded theory analysis framework that included open and axial coding, memo writing, and peer debriefing was utilized to develop the conceptual frame. An independent coder coded samples of the data into key categories.
Results:
Thirty-two respondents described positive and negative influences of family relationships on their decisions about safer sex. Youths reporting positive influences described open communication with parents, acceptance from their parents for their sexual orientation, frequent reminders to use condoms, and a sense of obligation to parents to stay healthy. Those claiming no influence reported that parents avoided discussing the subject due to discomfort with the topic, and/or a history of family conflict. Participants who believed family relationships contributed to their choices to engage in unsafe sex had rejecting parents and were overrepresented among youths who were HIV positive. Many of these rejected respondents reported feeling forced to seek financial and emotional support from extra-familial sources including exploitive older partners with whom they engaged in unsafe sex.
Implications:
These findings begin to identify the spectrum of influential family interactions on gay youths and the need to target these relationships as a tool for HIV prevention. More specifically, they suggest the need for HIV prevention specialists, including social workers, family therapists, and public health workers to carefully assess and when possible work to repair and strengthen family relationships of young gay males, while working closely with and carefully monitoring those who have been rejected.