Parents’ Perspectives About Adolescent Boys’ Involvement in Biomedical HIV Prevention Research

Abstract

Research on the use of pre-exposure prophylaxis (PrEP) among adolescents at high risk for HIV is urgently needed, and parents’ perspectives on these studies are essential for guiding the responsible conduct of adolescent PrEP research. We conducted interviews with 30 parents of adolescent boys (50% known/presumed heterosexual; 50% sexual minority) to understand their views of research risks and benefits and parental permission regarding their son’s involvement in a hypothetical PrEP adherence trial. Parents identified several health and educational benefits of the study and expressed that waiving parental permission would overcome barriers to accessing PrEP, particularly for youth who may benefit most. Among their concerns were medication non-adherence and risk compensation. Parents provided suggestions to facilitate informed, rational, and voluntary participation decisions and protect youth’s safety if parental permission was waived. These findings can inform ways to increase parental trust in PrEP research and create adequate protections for adolescent participants.

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References

  1. Centers for Disease Control and Prevention [CDC]. (2016). Diagnoses of HIV infection among adolescents and young adults in the United States and 6 dependent areas 2010–2014. HIV surveillance supplemental report. Retrieved from http://www.cdc.gov/hiv/library/reports/surveillance/.

  2. Chavez, N. R., Williams, C. Y., Ipp, L. S., Catallozzi, M., Rosenthal, S. L., & Breitkopf, C. R. (2016). Altruistic reasoning in adolescent–parent dyads considering participation in a hypothetical sexual health clinical trial for adolescents. Research Ethics, 12, 68–79. doi:10.1177/1747016115587963.

    Article  PubMed  Google Scholar 

  3. Dedoose. (2015). Web application for managing, analyzing, and presenting qualitative and mixed method data. Los Angeles, CA: SocioCultural Research Consultants, LLC. Retrieved from https://www.dedoose.com/.

  4. Department of Health and Human Services. (2009). Code of Federal Regulations, Title 45 Public Welfare, Part 46 Protection of Human Subjects. Retrieved from http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.html.

  5. Fisher, C. B., Arbeit, M. R., Dumont, M. S., Macapagal, K., & Mustanski, B. (2016). Self-consent for HIV prevention research involving sexual and gender minority youth: Reducing barriers through evidence-based ethics. Journal of Empirical Research on Human Research Ethics, 11, 3–14. doi:10.1177/1556264616633963.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Flicker, S., & Guta, A. (2008). Ethical approaches to adolescent participation in sexual health research. Journal of Adolescent Health, 42, 3–10. doi:10.1016/j.jadohealth.2007.07.017.

    Article  PubMed  Google Scholar 

  7. Garofalo, R., Hotton, A. L., Kuhns, L. M., Gratzer, B., & Mustanski, B. (2016). Incidence of HIV infection and sexually transmitted infections and related risk factors among very young men who have sex with men. Journal of Acquired Immune Deficiency Syndromes, 72, 79–86. doi:10.1097/QAI.0000000000000933.

    Article  PubMed  Google Scholar 

  8. Garofalo, R., Mustanski, B., & Donenberg, G. (2008). Parents know and parents matter; is it time to develop family-based HIV prevention programs for young men who have sex with men? Journal of Adolescent Health, 43, 201–204. doi:10.1016/j.jadohealth.2008.01.017.

    Article  PubMed  Google Scholar 

  9. Gilbert, A. L., Knopf, A. S., Fortenberry, J. D., Hosek, S. G., Kapogiannis, B. G., & Zimet, G. D. (2015). Adolescent self-consent for biomedical human immunodeficiency virus prevention research. Journal of Adolescent Health, 57, 113–119. doi:10.1016/j.jadohealth.2015.03.017.

    Article  PubMed  Google Scholar 

  10. Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research. Chicago, IL: Aldine Publishing Company.

    Google Scholar 

  11. Grant, R. M., Lama, J. R., Anderson, P. L., McMahan, V., Liu, A. Y., … iPrEx Study Team. (2010). Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. New England Journal of Medicine, 363, 2587–2599. doi:10.1056/NEJMoa1011205.

    Article  PubMed  Google Scholar 

  12. Harden, K. P. (2014). A sex-positive framework for research on adolescent sexuality. Perspectives on Psychological Science, 9, 455–469. doi:10.1177/1745691614535934.

    Article  PubMed  Google Scholar 

  13. Hruschka, D. J., Schwartz, D., St.John, D. C., Picone-Decaro, E., Jenkins, R. A., & Carey, J. W. (2004). Reliability in coding open-ended data: Lessons learned from HIV behavioral research. Field Methods, 16, 307–331. doi:10.1177/1525822x04266540.

    Article  Google Scholar 

  14. Jago, R., & Bailey, R. (2001). Ethics and paediatric exercise science: Issues and making a submission to a local ethics and research committee. Journal of Sports Science, 19, 527–535. doi:10.1080/026404101750238980.

    Article  Google Scholar 

  15. King, H. L., Keller, S. B., Giancola, M. A., Rodriguez, D. A., Chau, J. J., Young, J. A., … Smith, D. M. (2014). Pre-exposure prophylaxis accessibility research and evaluation (PrEPARE Study). AIDS and Behavior, 18, 1722–1725. doi:10.1007/s10461-014-0845-5.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Knopf, A. S., Gilbert, A. L., Zimet, G. D., Kapogiannis, B. G., Hosek, S. G., Fortenberry, J. D., & Ott, M. A. (2016). Moral conflict and competing duties in the initiation of a biomedical HIV prevention trial with minor adolescents. AJOB Empirical Bioethics. doi:10.1080/23294515.2016.1251506.

    PubMed  PubMed Central  Google Scholar 

  17. Macapagal, K., Coventry, R., Arbeit, M. R., Fisher, C. B., & Mustanski, B. (2017). “I won’t out myself just to do a survey”: Sexual and gender minority adolescents’ perspectives on the risks and benefits of sex research. Archives of Sexual Behavior, 46, 1393–1409. doi:10.1007/s10508-016-0784-5.

    Article  PubMed  Google Scholar 

  18. Miller, K. S., Kotchick, B. A., Dorsey, S., Forehand, R., & Ham, A. Y. (1998). Family communication about sex: What are parents saying and are their adolescents listening? Family Planning Perspectives, 30, 218–222.

    Article  PubMed  Google Scholar 

  19. Miller, R. L., Forte, D., Wilson, B. D., & Greene, G. J. (2006). Protecting sexual minority youth from research risks: Conflicting perspectives. American Journal of Community Psychology, 37, 341–348. doi:10.1007/s10464-006-9053-4.

    Article  PubMed  Google Scholar 

  20. Moilanen, K. L. (2015). Predictors of parental consent for adolescent participation in sexual health-related research. Journal of Empirical Research on Human Research Ethics, 10, 157–168. doi:10.1177/1556264615575510.

    Article  PubMed  Google Scholar 

  21. Moilanen, K. L. (2016). Why do parents grant or deny consent for adolescent participation in sexuality research? Journal of Youth and Adolescence, 45, 1020–1036. doi:10.1007/s10964-016-0445-y.

    Article  PubMed  Google Scholar 

  22. Mustanski, B. (2011). Ethical and regulatory issues with conducting sexuality research with LGBT adolescents: A call to action for a scientifically informed approach. Archives of Sexual Behavior, 40, 673–686. doi:10.1007/s10508-011-9745-1.

    Article  PubMed  Google Scholar 

  23. Mustanski, B. (2015). Future directions in research on sexual minority adolescent mental, behavioral, and sexual health. Journal of Clinical Child and Adolescent Psychology, 44, 204–219. doi:10.1080/15374416.2014.982756.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Mustanski, B., Coventry, R., Macapagal, K., Arbeit, M. R., & Fisher, C. B. (2017). Sexual and gender minority adolescents’ views on HIV research participation and parental permission: A mixed-methods study. Perspectives on Sexual and Reproductive Health, 49, 111–121. doi:10.1363/psrh.12027.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Mustanski, B., & Fisher, C. B. (2016). HIV rates are increasing in gay/bisexual teens: IRB barriers to research must be resolved to bend the curve. American Journal of Preventive Medicine, 51, 249–252. doi:10.1016/j.amepre.2016.02.026.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Mustanski, B., Swann, G., Newcomb, M. E., & Prachand, N. (2017). Effects of parental monitoring and knowledge on substance use and HIV risk behaviors among young men who have sex with men: Results from three studies. AIDS and Behavior. doi:10.1007/s10461-017-1761-2.

    Google Scholar 

  27. Newcomb, M. E., Clifford, A., Greene, G. J., & Mustanski, B. (2016). Parent perspectives about sexual minority adolescent participation in research and requirements of parental permission. Journal of Adolescent Health, 59, 443–449. doi:10.1016/j.jadohealth.2016.05.014.

    Article  PubMed  Google Scholar 

  28. Ott, M. A., Rosenberger, J. G., & Fortenberry, J. D. (2010). Parental permission and perceived research benefits in adolescent STI research. Journal of Empirical Research on Human Research Ethics, 5, 57–64. doi:10.1525/jer.2010.5.2.57.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Pace, J. E., Siberry, G. K., Hazra, R., & Kapogiannis, B. G. (2013). Preexposure prophylaxis for adolescents and young adults at risk for HIV infection: Is an ounce of prevention worth a pound of cure? Clinical Infectious Diseases, 56, 1149–1155. doi:10.1093/cid/cis1020.

    Article  PubMed  Google Scholar 

  30. Pasternak, R. H., Geller, G., Parrish, C., & Cheng, T. L. (2006). Adolescent and parent perceptions on youth participation in risk behavior research. Archives of Pediatrics and Adolescent Medicine, 160, 1159–1166. doi:10.1001/archpedi.160.11.1159.

    Article  PubMed  Google Scholar 

  31. Pratto, F., Sidanius, J., Stallworth, L. M., & Malle, B. F. (1994). Social dominance orientation: A personality variable predicting social and political attitudes. Journal of Personality and Social Psychology, 67, 741–763. doi:10.1037//0022-3514.67.4.741.

    Article  Google Scholar 

  32. Rosenthal, S. L., de Roche, A. M., Catallozzi, M., Breitkopf, C. R., Ipp, L. S., Chang, J., … Hu, M. C. (2016). Parents’ and adolescents’ attitudes about parental involvement in clinical research. Journal of Pediatric and Adolescent Gynecology, 29, 372–377. doi:10.1016/j.jpag.2016.01.119.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Santelli, J. S., Smith Rogers, A., Rosenfeld, W. D., DuRant, R. H., Dubler, N., Morreale, M., … Schissel, A. (2003). Guidelines for adolescent health research. A position paper of the Society for Adolescent Medicine. Journal of Adolescent Health, 33, 396–409.

    PubMed  Google Scholar 

  34. Thoma, B. C., & Huebner, D. M. (2014). Parental monitoring, parent–adolescent communication about sex, and sexual risk among young men who have sex with men. AIDS and Behavior, 18, 1604–1614. doi:10.1007/s10461-014-0717-z.

    Article  PubMed  PubMed Central  Google Scholar 

  35. United Nations General Assembly. (1989). Convention on the rights of the child (A/RES/44/25). New York, NY. Retrieved from http://www.un.org/documents/ga/res/44/a44r025.htm.

  36. White House Office of National AIDS Policy. (2015). National HIV/AIDS strategy for the United States: Updated to 2020. Retrieved from https://aids.gov/federal-resources/national-hiv-aids-strategy/nhas-update.pdf.

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Acknowledgements

This study was supported by R01MD009561 from the National Institute on Minority Health and Health Disparities (PIs: Mustanski and Fisher). Brian A. Feinstein's time was supported by a grant from the National Institute on Drug Abuse (1F32DA042708). We acknowledge the NIH supported Third Coast Center for AIDS Research for creating a supportive environment for HIV/AIDS research (P30AI117943). The content in this manuscript is solely the responsibility of the authors and does not reflect the views of the National Institutes of Health. We are grateful to Kai Korpak, Maggie Matson, and Arielle Zimmerman for their assistance with participant recruitment, interview transcription, and coding. We also would like to thank our participants, who generously gave us their time and from whom we learned so much.

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Correspondence to Brian Mustanski.

Appendix: Interview Script

Appendix: Interview Script

Description of PrEP Adherence Study

We’ll be discussing a study that involves taking a medication called PrEP, which stands for pre-exposure prophylaxis. Have you heard of PrEP before?

Interviewer Note: Get a Sense of Parent’s Knowledge About PrEP Before Continuing

PrEP is a medication that prevents people from getting HIV. It is a pill that is taken the same time each day. PrEP is very effective when taken daily, but like any medication there are short-term side effects, like upset stomach, loss of appetite, or mild headache, and possible long-term side effects that are no worse than daily aspirin use. It has been approved for adults by the U.S. FDA (Food and Drug Administration), and studies testing PrEP in teenagers are underway.

Now I’ll tell you about a hypothetical study that researchers at a university might do with teenagers and PrEP. I’ll ask you what you think about the study, its potential benefits, and what researchers can do to make sure [teen’s name] is safe while he participates. Please keep these things in mind as I tell you more about the study.

The purpose of this study would be to see whether getting daily text message reminders would help your son remember to take PrEP every day. First, [teen’s name] would have to get your permission to participate. Assuming you agree, to make sure [teen’s name] doesn’t have HIV, researchers would give him an HIV test at the beginning of the study. If his test showed he had HIV, he wouldn’t be able to participate, but the researchers would connect him with a doctor for HIV treatment. If he did not have HIV, a study doctor would give him PrEP pills and a counselor would talk to him about safer sex.

The study would last a year. [Teen’s name] would be randomly assigned to one of two groups—one group that gets daily text message reminders to take PrEP, and the other group that gets reminders every 3 months during check ins with the researchers. Everyone has the same 50/50 chance of being in each group. To make sure the study is fair, the teens and researchers don’t choose who would get to be in which group.

After [teen’s name] enrolled in the study, he would take the pill every day. Every 3 months, all participants would have a check in with the study counselor where they receive another HIV test, talk about safe sex, how many days he didn’t take PrEP, and a reminder to take PrEP. The text message group would get reminders every day.

Once the study is over, researchers will know whether or not getting daily text messages improved teens’ ability to take the PrEP pills daily. This will help doctors in the future decide whether to offer text messaging as part of HIV prevention treatment.

Now I’m going to ask you some questions about what I just told you. Let’s assume [name of teen] wanted to participate in the study and that you gave him permission to do so.

  1. 1.

    How could he benefit from being in a study like this? How might other teens benefit from this study taking place?

  2. 2.

    What would your concerns be if [name of teen] were in this study?

  3. 3.

    What might get in the way of [name of teen] being able to understand the risks and benefits of this study?

  4. 4.

    What do researchers need to do in order to ensure the safety and well-being of [name of teen] if he was in this study?

Parental Permission Waiver for PrEP Study

Now, imagine that this study didn’t require your permission to participate

  1. 1.

    How might you feel differently if [name of teen] did NOT need your permission to participate in this study?

  2. 2.

    What would your concerns be if [name of teen] were in a study on PrEP and your permission was NOT required?

  3. 3.

    What would be the benefits to [name of teen] if your permission was not required for the PrEP study? How might other teens benefit?

  4. 4.

    If [name of teen] did not need your permission to participate in this study, what do researchers need to do in order to ensure his safety and well-being?

Questions About Teen Decision-making Strategies and Application to Research Consent

In this next set of questions, we’d like to know more about how [name of teen] makes decisions and how those strategies might be applied to his decisions to participate in research studies.

Tell me about a time [name of teen] had to make an important decision and you think he made a good decision. What skills did they draw from? Tell me what strategies he used.

Now I’m going to ask a question about how this could apply to a hypothetical study.

  1. 1.

    How could [name of teen] use that same approach you just described when making a decision about participating in a research study on PrEP?

Now tell us about a time [name of teen] had to make an important decision and you think he did not make a good decision. What strategies did they (fail to) use? What got in the way if the decision being a good one?

Now like before, I’m going to ask about how this decision-making strategy could apply to a hypothetical study.

  1. 1.

    How might [name of teen’s] process for making the bad decision you described get in the way of [name of teen]’s ability to make a good decision about participating in a PrEP research study?

  2. 2.

    What do you think could have prevented him from making the bad decision you just described? Are there similar things that the researchers can do for [teen’s name] that might help him make the best decision for himself about participating in a PrEP research study?

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Mustanski, B., Macapagal, K., Thomann, M. et al. Parents’ Perspectives About Adolescent Boys’ Involvement in Biomedical HIV Prevention Research. Arch Sex Behav 47, 1923–1935 (2018). https://doi.org/10.1007/s10508-017-1035-0

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Keywords

  • HIV prevention
  • Pre-exposure prophylaxis
  • Parents
  • Adolescents
  • Men who have sex with men