Many gay and bisexual men who came out to their parents in the last 20 years got the "HIV talk" almost immediately. Parents — whether you have gay, bi, or straight children — are often concerned about health and want to frankly discuss sexual safety, no matter how awkward the talk. Now some in-the-know parents are talking to their HIV-negative sons about using the drug Truvada as a PrEP, or pre-exposure prophylaxis, a strategy that helps prevent HIV infection.
Important as it is, this conversation still might not be easy. Here are some pointers to help you and your son start talking about PrEP.
1. Do your research.
PrEP has, lamentably, been surrounded by a lot of misinformation in public conversations. So read up about it first to help separate fact from fiction. Luckily, there's solid research on PrEP published by reputable sources like the Centers for Disease Control and Prevention and medical journals. A major research study called iPrEx found that for people who take a PrEP pill daily, their estimated level of protection from HIV is 99 percent (better than condoms).
Of course, there's more research to be done than just effectiveness; there are any number of things your son might wonder about, including side effects, effectiveness of condoms, or even if he is considered among the populations that PrEP is suitable for (not all gay or bisexual men or transgender women are, and it depends on if they're in a mutually monogamous relationship with another HIV-negative partner). Doing your research helps quell your anxieties, not to mention showing your child that you're serious and how much you care.
2. Check in with yourself about your own biases and assumptions beforehand.
While you're doing that research, you're likely going to come up against a discouraging reality: There's a lot of stigma surrounding those who choose to use PrEP. You might see the phrase "Truvada whore" tossed about or implications that PrEP users are promiscuous or giving themselves license to not use condoms.
Are these ideas that you might share, even if it's way deep down in a little part of you? It's hard to not internalize such negativity when living in a society that tends toward slut-shaming those who take charge of their sexual lives. Do yourself and your child a favor: Work it out before you approach discussing PrEP with him. The worst thing that could happen is that you could perpetuate the stigma surrounding PrEP, which is counterproductive to your goal of making your child aware of healthy options for HIV prevention.
3. Avoid shaming.
Which brings us to a related point: Keep shame out of the conversation around PrEP. Keep your focus sex-positive. Your child may face his detractors if he chooses to use PrEP — again, it's not easy to avoid those who disparage its use by characterizing it as a way to increase, rather than manage, risky behavior — so he needs to know you're on his side.
Granted, if you're bringing PrEP up, it's probably something you support. But shame can still easily seep into conversations about safer sex practices if we're not vigilant. Indeed, the reason many health care officials support the use of PrEP is that, despite the common knowledge that condoms can be an effective HIV prevention method when used consistently, studies have shown that most gay and bisexual men have have condomless sex at some point (as have most straight men).
Your child may have their own shame about having engaged in risky sexual behavior like this in the past, and if they perceive any additional shaming from you about their condom practices, they may simply shut down. So remember: You love the person, even if sometimes you don't love his behavior. Keep this conversation on how you care about his present and future, not how he may have misstepped in the past.
4. If you're going to talk about sex, actually talk about sex.
It seems that no matter whether your kid is 13 or 43, talking about the specifics of sex with them can be awkward. It makes parents and kids alike squirm to talk about their most intimate acts and desires. Not to mention that society at large pressures us to believe that discussing sex out loud is somehow taboo or wrong.
The truth is, it's not. Talking about sex means you're talking about health. This is something you need to be real with yourself and with your child about, so be straightforward in your language and avoid euphemisms. Kids, no matter their age, can pick up on when you're avoiding or skirting around issues, and it sends an implicit message that you're uncomfortable or embarrassed about their sexuality.
So get comfortable ahead of time about what you're going to be discussing and what terms you're going to use — it can help to think about how a doctor might phrase things. Of course, you don't have to breach your child's privacy by asking about extraneous details unrelated to HIV risk, but get comfortable with possibly needing to say "sex," "anal," "penis," and the like.
5. Pick the right place and time.
Knowing the "right" time to have a conversation is a bit of an art. The thing about encouraging your son to take preventive health measures is that you want it to hold the right amount of gravitas — you want the issue taken seriously. But then again, you want to be light and relaxed about it, so that your son feels comfortable enough to discuss the topic and possibly even revisit it with you at some point.
So before you broach the PrEP conversation with your kid, think about how and when you've had important conversations in the past. What kind of environment makes him most relaxed and open? How long is he able to sit and talk about his personal life with you?
In general, remember these solid rules of thumb: Make it private, not too rushed, and open-ended (in other words, end the conversation with him knowing he can come to you again about it). Take your cues from him and be OK with tabling the conversation for a time when he's more open to continuing. And on that note: Don't give up.
6. Know that it's not just one big talk. It's an ongoing conversation.
You do not have to put all the pressure about your child choosing to go on PrEP onto one single conversation; in fact, you're less likely to be effective if you do. Rather, be open to revisiting the topic multiple times. If your son says he doesn't want to use PrEP, that's his choice — and it might be one he eventually reconsiders. You're really here to plant the seed and let him know his options.
After all, people tend to take time to process new information and emotions. You can expect your son to walk away from your initial conversation about PrEP and do his own thinking about it. Whatever thoughts he expresses about PrEP in his initial discussion with you will likely not be the ones he holds forever.
If you're able, find a way to ask him in your first conversation if he's open to you bringing it up again at a later date. Give him the impression you'd like this to remain an open dialogue.
7. Don't make demands.
The older we get, the more irksome it is when our parents appear to be ordering us to do something. Some grown children will even do the exact opposite of what their parent wants just to prove that they are an adult choosing their own life path. So the last thing you want to do is make it appear that you're demanding that your child take PrEP.
In the end, of course, PrEP is an option, and not a requirement, for anyone. Your job is to help your child see it as a valid choice, rather than a mystery or something to scorn. You want to be careful to not try to guilt your kid into taking health measures, because in the end, the choices he's going to stick with are the ones he feels like he made himself.
So give him the facts, let him know you care and are there to listen nonjudgmentally, and give him space to do his own decision-making.