Parents who were more willing to support their adolescent hypothetically using PrEP tended to describe high-quality relationships, acceptance of SGD identities, sex positivity of sexual health communication, and general positivity about PrEP.
Key Findings
Methods
Approximately half of interviewed parents were more willing to hypothetically support their adolescent using PrEP.
34 in-depth interviews were conducted with parents of adolescents recruited from four U.S. urban clinical sites between 2018 and 2019.
19 of 34 parents (56%) were categorized as more willing to support PrEP use.
Parents were diverse with respect to race/ethnicity: 68% Black/African American and 18% Hispanic.
Most parents were cisgender men (44%) or cisgender women (41%).
Applied thematic analysis informed by two theories was used to determine parents' hypothetical willingness (more vs. less willing).
Results
Four themes related to parental willingness to support adolescent PrEP use were identified.
The four themes were: (1) relationship quality, (2) acceptance of sexual and gender-diverse (SGD) identities, (3) sex positivity of sexual health communication (SHC), and (4) general positivity about PrEP.
More willing parents tended toward higher relationship quality, more acceptance of SGD identities, more sex positivity, and PrEP positivity.
Less willing parents tended toward the opposite ends of each theme.
Analysis focused on identifying differences between more versus less willing parents.
Results
Higher parent-adolescent relationship quality was associated with greater parental willingness to support adolescent PrEP use.
Relationship quality was identified as one of the four key themes differentiating more versus less willing parents.
More willing parents tended to describe high-quality relationships with their adolescents.
Less willing parents tended to describe lower-quality relationships.
Results
Acceptance of sexual and gender-diverse (SGD) identities was associated with greater parental willingness to support PrEP.
Acceptance of SGD identities was one of the four identified themes.
More willing parents tended toward more acceptance of SGD identities.
Less willing parents tended toward less acceptance of SGD identities.
Results
Sex positivity of sexual health communication was associated with greater parental willingness to support adolescent PrEP use.
Sex positivity of SHC was identified as one of the four key themes.
More willing parents tended to exhibit more sex-positive sexual health communication with their adolescents.
Less willing parents tended toward less sex-positive sexual health communication.
Results
HIV risk perception did not consistently impact parental willingness to support adolescent PrEP use.
Both more and less willing parents largely perceived their adolescent's HIV risk as low.
This finding suggests that perceived HIV risk is not a reliable differentiator between more and less willing parents.
This is notable given that PrEP is specifically indicated for individuals at elevated HIV risk.
Background
PrEP use among U.S. adolescents at risk for HIV has been low despite PrEP being safe and highly effective.
The paper characterizes PrEP as 'a safe and highly effective prevention method' for HIV.
Low adolescent PrEP uptake in the U.S. is identified as the motivating problem for this study.
Little was previously known about how sexual health communication and parent-adolescent relationship quality influence parental support for adolescent PrEP use.
What This Means
This research suggests that whether parents are willing to support their teenager using PrEP — a medication that prevents HIV infection — is strongly connected to the quality of their relationship with their teen, how open they are to LGBTQ+ identities, and how comfortably they talk about sex. Researchers interviewed 34 parents from diverse racial and ethnic backgrounds at urban health clinics, and found that just over half (56%) said they would be willing to support their teen using PrEP. Parents who were more willing tended to have warmer, more open relationships with their teens, were more accepting of different sexual and gender identities, and had more positive attitudes about discussing sex and about PrEP itself.
Interestingly, the research suggests that parents' sense of whether their teen was personally at risk for HIV did not reliably separate willing from unwilling parents — both groups generally believed their teenager's HIV risk was low. This is notable because PrEP is specifically recommended for people at elevated HIV risk, suggesting that low perceived risk alone does not explain why some parents are reluctant to support PrEP.
These findings matter because adolescents in the U.S. who could benefit from PrEP are not using it at high rates, and parents play an important role in their teenager's healthcare decisions. This research suggests that efforts to increase adolescent PrEP use may need to address broader family dynamics — including relationship quality, openness about sexuality, and attitudes toward LGBTQ+ youth — rather than focusing solely on communicating HIV risk information to parents.
Rusley J, Knopf A, Guthrie K, Toma E, Arrington-Sanders R. (2026). Parent-Adolescent Relationship Quality, Sexual Health Communication, and Willingness to Support Pre-Exposure Prophylaxis for HIV: A Qualitative Study.. The Journal of adolescent health : official publication of the Society for Adolescent Medicine. https://doi.org/10.1016/j.jadohealth.2025.09.022