First, it is important to understand the difference between STDs (Sexually Transmitted Diseases) and STIs (Sexually Transmitted Infections). While some sex education programs or other health information resources might use these two terms interchangeably, it is important to note that they are in fact different. STIs and STDs come with different conditions and have different health implications.

Although STDs and STIs are not interchangeable, the term STI is more frequently used by doctors and other clinical health professionals because the acronym includes a larger variety of infections. According to the American Sexual Health Association, a growing number of public health experts believe the term STD can mislead people because “disease” suggests a person has an obvious medical problem, which is not always the case. For this reason, the term “infection” is often considered more accurate [1].

People often assume that STDs are more serious than STIs, as the word “disease” conjures up more threatening images than “infection.” An STI occurs when things such as bacteria, viruses, and parasites enter the body and begin to multiply. They are usually transmitted during sexual activities through an exchange of bodily fluids or skin-to-skin contact where the infection is active [1]. Skin-to-skin transmission can only take place when the infection in question lives on the skin. This distinction is important to explain to your children since visual signs of STIs or STDs can exist on areas surrounding the reproductive organ and are not exclusively found on those organs themselves.

Sexual transmission speaks to the process of transference of a sexually transmitted disease or infection from one person to the other via sexual contact. This can include the touching of reproductive organs, mouths, or anuses, or in some infections like monkeypox, merely close skin contact. It does not always have to include contact with body fluids. You cannot contract STDs or STIs from surfaces like toilet seats, for example.

STDs are diseases that result from STIs and therefore can suggest a more serious problem [1]. STDs start out as infections, and become STDs when the original infection begins to cause symptoms. After pathogens enter the body, they begin multiplying, and when these pathogens disrupt normal body functions or damage structures in the body, they become STDs [1]. However, some STIs may never develop into diseases. For example, some HPV cases go away on their own without causing health problems. In these instances, HPV is an STI. If the HPV infection develops into genital warts or cervical cancer, then it is considered an STD [1]. Although general perception places greater severity on STDs, individuals who are living with STIs are still likely to experience the same levels of embarrassment and shame surrounding their sexual health.

Each year, 20 million new cases of STDs are diagnosed in America and the CDC reports that half of those infected are people ages 15 to 24 [1]. Antibiotics and antiviral medications can cure some of them, while others have no cures and can require ongoing treatment and management [1]. Syphilis, gonorrhea, chlamydia and trichomoniasis are all treatable and have medical cures [24]. Hepatitis B, herpes simplex virus (HSV or herpes), HIV, and human papillomavirus (HPV) do not have cures. Yet, these four conditions are all manageable with consistent medical treatments [24].

Most of these diseases can be managed so that the virus within the person remains undetectable or untransmittable. Most STIs and STDs are preventable and the risk of contracting them can be seriously reduced with vaccines and safer sex behavior. Consult your PCP (Primary Care Provider) about preventative vaccines, like the HPV vaccine, which your child might be eligible for. Even though the risks of HPV may be greater for females, vaccinating males can also help reduce transmission. Doing so is not signalling anything either to the physician or to your child about your expectations concerning their sexual behavior – most doctors will (or should) consider it a sign that you are an informed and responsible parent who is making provision for the future health of your offspring and public health. STIs and STDs pose some of their most serious health risks when they remain unmonitored and untreated.

Individuals with untreated cases, and people who have experienced higher rates of STIs/STDs, have a higher likelihood of passing their condition to others. Additionally, the longer someone’s condition remains untreated, the CDC states that their STI or STD may result in lasting damage to health, including reproductive problems, chronic pain, cancer, fetal and perinatal issues, and increased risk of contracting HIV [1,2]. If the data on STIs/STDs suggests anything about sexual health, it’s that risk factors compound, and each high-risk scenario that a young person might find themselves in increases the risk of the next [3].

Including untreated or active STIs and STDs, there are other recorded factors that contribute to the likelihood of HIV transmission amongst young people. Alcohol and drug use can increase the likelihood of HIV transmission, especially drugs that involve intravenous injection. Plus, drugs and alcohol are known to promote less thoughtful behavior and diminish communication, which can lead to fewer safe-sex practices. This can include forgetting to use a condom or using a condom incorrectly, not disclosing one’s STI or STD status, and less observation and awareness during a sexual activity, which can cause individuals to miss physical signs of infection or disease. It is a matter of concern that use of condoms by teens is becoming less frequent, despite the emphasis on condom use in public education programs: in one study, 49% of sexually active males under 18 say they did not use a condom the last time they had anal sex [27].

A study of new HIV diagnoses in the US based on transmission in 2019 found that 65% of new cases were a product of male-to-male sexual contact, 23% heterosexual contact, 7% injection drug use, and 4% male-to-male sexual contact along with injection drug use [5]. A CDC report, updated in 2019, has provided the following statistics to help measure and understand the risk of transmission per type of sexual exposure [3]. These percentages represent the chances of HIV transmission during a single act of unprotected sex with an HIV-positive person:

• 1.38% per act of receptive anal intercourse
• 0.11% per act of insertive anal intercourse
• 0.08% per act of receptive penile-vaginal intercourse
• 0.04% per act of insertive penile-vaginal intercourse

The risk of HIV transmission from oral sex is negligible, although other STIs are more readily transmitted that way. To put these figures in perspective, the odds of your teen contracting HIV from one or two sexual encounters are very low, even if their partner is HIV-positive and unaware of it. The odds of a given partner being HIV-positive are also low: among 13-24 year old males who have had sex with other males, 0.71% have been diagnosed with HIV (i.e. less than one in a hundred), although the actual rate of HIV-positivity must be somewhat higher, as about 45% of young men in that category have never been tested, whether because they consider themselves at low risk, don’t have access to testing, or just don’t care [25]. However, if your teen becomes involved in a regular sexual relationship with someone, particularly if the relationship involves anal sex, it is important that they know how to protect themselves and ask their partner about sexual history and HIV-status, as multiple sexual encounters greatly increase the risk that one of them might infect. The risk also goes up if one has unprotected sex with multiple partners.  

All of the risks decrease by 99.2% with the dual use of condoms and antiretroviral treatment (ART) of the HIV-infected partner [6]. ART is a treatment for people living with HIV that helps them to live longer, healthier lives and significantly minimizes the likelihood of giving the virus to someone else. Both male and female condoms, which refer to whether the condom goes around, atop, or inside the reproductive organ, can reduce HIV transmission by as much as 94% [7]. For those who practice anal sex, it is recommended that condoms are accompanied with a compatible lubricant to prevent slipping and tearing, which will decrease a condom’s effectiveness [7]. Even though most condoms come with lubrication in the wrapper and on the condom itself, adding more lube increases both pleasure and condom effectiveness.

Water-based or silicone-based lubricants are always safe to use with any kind of condom. Oil-based lubes such as Vaseline should never be used with latex condoms. Oil can damage latex condoms and cause friction which will cause them to break. However, oil-based lubes are compatible with non-latex plastic condoms. When condoms and lube are used together for anal sex, reported condom breakage has been shown to decrease from 21.4% to 3% [7].

Condoms have been shown to be very effective in preventing other STIs that are passed through genital contact. STIs like gonorrhea, chlamydia, and syphilis are actually transmitted more easily than HIV, but correct condom use still significantly reduces their likelihood of transmission. Consistent and correct use of male latex condoms was found to be 71% effective in reducing gonorrhea, up to 66% effective in reducing syphilis, and up to 75% effective in reducing transmission of chlamydia and trichomoniasis [7]. Herpes varies in its presentation and can be entirely asymptomatic. Therefore, it is difficult to conclusively determine the extent to which condoms reduce genital herpes transmission. However, recent analyses indicate that individuals who use male latex condoms during more than 75% of their sexual encounters cut their risk of genital herpes in half [7]. Oral herpes, or HSV-1, can be transferred during oral sex. Using flavored condoms during oral sex can prevent this transmission. Research also shows that condom use significantly reduces transmission of the human papillomavirus (HPV). HPV, which takes many different forms, can cause cervical, anal, and penile cancer [7].

Although the risk of your teen contracting HIV or syphilis is relatively low, other STIs are more common and sometimes undetectable except by testing. Over 3% of young people aged 15-19 test positive for chlamydia each year, regardless of sexual orientation [26]. Untreated, chlamydia may result in infertility for females and chronic forms of inflammation, including reactive arthritis, for both males and females. We recommend that STI testing be part of the annual wellness exams you obtain for your teen children, even if you believe that your teen is not sexually active. If it will help your teen agree to testing, you can request that the physician treat any positive condition confidentially.

Research and statistics surrounding STI, STD, and HIV cases amongst young people often have sociopolitical and socioeconomic implications. Black/African American people are most affected by HIV [5]. In 2019 Black/African American people accounted for 42% of all new HIV diagnoses, Hispanic/Latino people accounted for 29%, and White people 25% [5]. Young Black/African American gay and bisexual men are even more severely affected, representing 50% of new HIV diagnoses among young gay and bisexual men in 2019 [5]. Across the board, young gay/bisexual men and transgender women are the most profoundly affected by HIV [8]. Transgender women have a 12x higher risk of HIV transmission and gay or bisexual men have a 22x higher risk than the general population [8]. In 2019 young gay and bisexual men accounted for 83% of all new HIV diagnoses in people aged 13 to 24 [5].

The first case of HIV/AIDS was identified in 1981 [9]. HIV and AIDS are not the same thing nor are they interchangeable. Acquired immunodeficiency syndrome (AIDS) is a chronic and potentially life-threatening condition that is caused by the human immunodeficiency virus (HIV) [10]. HIV damages an individual’s immune system and interferes with their body’s ability to fight infection and disease. HIV is an STI. By the time HIV progresses to become AIDS, it is classified as an STD. By the end of 1991 over 1 million Americans had been infected with HIV, 206,392 people were suffering from AIDS and 133,233 people had died from the disease [11]. Remaining untreated, HIV typically turns into AIDS in about 8 to 10 years [11]. Due to the development of and increased access to antiviral treatments and other preventative medications, most people with HIV in the United States do not develop AIDS.

The public health response to the AIDS epidemic of the 80’s and early 90’s was narrowly focused, allowing the disease to burrow into socially disadvantaged communities within society [11]. We continue to see this impact today in the racial and socioeconomic divisions of infections, HIV and otherwise. People living with HIV and AIDS were once seen as dangers to society, non-human, and often shunned. HIV/AIDS contributed strongly to the social exclusion and institutional violence towards gay and trans individuals. While stigmas have decreased as education has increased, the weight of this disease still weakens our approach to competent education and weighs on the shoulders of those most at risk.

We now have the tools to prevent/manage HIV. It is all about education and access. Today, antiviral treatments and preventions have shaped the course of sexual health history. In 2014, the CDC reported a 19% decrease in HIV diagnoses since 2005 [9]. The ability of people younger than 18 (generally, the legal definition of a minor) to consent to a range of sensitive health care services—including sexual and reproductive health care, mental health services, and alcohol and drug abuse treatment—has expanded dramatically over the past several decades [12]. Visit this website for a map of minor-consent laws across the United States: https://www.guttmacher.org/state-policy/explore/overview-minors-consent-law

Yet, STIs, STDs, and HIV still pose a threat to young adults and adolescents in America. In 2007, the CDC reported that at least 50% of new HIV infections occurred in persons 15-25 years of age, the majority of whom were likely infected in their teens [13]. In recent years, STDs have increased. The CDC’s “Sexually Transmitted Disease Surveillance Report,” covering data from 2018 found that rates of syphilis have increased by 71%, gonorrhea by 63%, and chlamydia by 19% since 2014 [1]. The CDC attributes this to a declining use of condoms, especially among young people and men who have sex with men [1].

While the resources exist for us to make STIs, STDs, and HIV manageable and minimally infectious, our ability to enforce these positive changes depends on our commitment to access and education. See our installment on Sex Education (LINK) to understand more about the failings of sex education and the ways that it has a direct impact on youth sexual health.

If your teen is a sexually active gay or bi-sexual male who may be involved with more than one partner or even with a single partner whose HIV status is unknown, you might want to recommend that they consider pre-exposure prophylaxis (PrEP). PrEP is a pill that is taken to help keep people HIV negative [14]. PrEP greatly reduces the risk of contracting HIV from sex (99%) or injection drug use (74%) when taken as prescribed [15]. PrEP is much less effective when it is not taken as prescribed [15]. For a young person who might be particularly forgetful, it could be helpful to set up a system for them to ingest their medication. There exist some phone apps specifically for reminding people to take PrEP or other daily medications. You can also simply set a daily alarm on someone’s smart phone or make medicine a part of breakfast.

PrEP reaches maximum protection from HIV for receptive anal sex (bottoming) after about 7 days of daily use [15]. Used as protection for receptive vaginal sex and injection drug use, PrEP reaches maximum protection after about 21 days of daily use [15]. There is minimal data available for insertive anal sex (topping) or insertive vaginal sex [15]. PEP (post-exposure prophylaxis) is a combination of medications that you can take after a possible exposure to HIV if you are not on PrEP or have missed taking PrEP as prescribed. PEP is most effective the sooner it’s started and must be started within 72 hours of the exposure. PEP is taken daily for 28 days [14].

PrEP On-Demand, also known as PrEP 2-1-1 or event-driven PrEP, is an alternative to taking PrEP once a day [16]. A person who is at risk of HIV transmission can take two pills anywhere between 2 to 24 hours before a sexual encounter and one pill 24 hours and 48 hours later [16]. A 2020 study published in Clinical Infections Diseases followed 279 male participants who used PrEP On-Demand for a total of 3 months and after a one-year follow-up found that there were no new cases of HIV transmission from the patients using the 2-1-1 regimen [16,17]. The pros of this approach are that it eliminates the need to take HIV prevention medication every single day which, depending on a young person’s schedule and lifestyle, might be difficult to adhere to [16]. Another advantage is the ability to purchase less of the drug, if health insurance or price are a restricting factor for participants [16].

Doctors agree that PrEP 2-1-1 is a viable HIV prevention strategy for male, or transgender female, patients who participate in infrequent sex with partners who are either living with HIV or whose HIV status is unknown. This is particularly ideal for younger adults who might be having more infrequent sex, yet it does not account for spontaneous, or impromptu encounters [18]. PrEP On-Demand has only been studied on cis-gender males participating in receptive or insertive anal sex; it has not been studied for HIV prevention in women, transgender women, or transgender men, yet there are implications for its use in these populations. Therefore, to qualify for PrEP On-Demand, you must: be a cisgender male who participates in sex with other men, require HIV prevention medication infrequently, and benefit from flexible dosage as opposed to daily medication [16].

A patient would not qualify for PrEP On-Demand if they have active hepatitis B, are put in unpredictable situations that put them at risk for HIV transmission (such as not being able to take the first two pills between 2 to 24 hours before sex) or share needles with people who may be HIV positive [16]. It is also important to consider that trans patients, and sometimes even women, have the potential to experience more resistance and discrimination in medical settings, including, but not limited to, their exclusion from PrEP and PEP studies

Two types of medications have been approved for use as PrEP: Truvada and Descovy. In 2017 the FDA and CDC approved Truvada for use in both adults and adolescents weighing at least 77 lbs [8]. For participants under 18, this regimen is not approved for receptive vaginal sex [8]. In 2019 the FDA approved Descovy for adults and at-risk adolescents weighing at least 77 lbs [8]. Only approved for cisgender males and transgender females; it also excludes patients who have receptive vaginal sex [8].

Truvada: https://www.truvada.com/truvada-safety/important-safety-information

Descovy: https://www.descovy.com/#isi

Side effects like diarrhea, nausea, headache, fatigue, and stomach pain have been reported, but usually go away over time [15]. There was a trial conducted on men ages 15 to 17 who were using PrEP. Their data was then compared to a control group of patients aged 18 to 22 [8]. The effectiveness of PrEP for both groups was about the same [8]. The biggest variance in effectiveness was adherence to the regimen [8]. 12.5% of the 200 trial participants stopped taking PrEP due to side effects. These side effects were most common during the “start-up” period of taking PrEP. Generally, these issues subside after a few weeks. Some of the other side effects reported included rash, loss of appetite and weight loss, lethargy and trouble sleeping [8]. There has been reversible bone density loss detected in male adults using PrEP. Studies regarding adolescents are not as established. Generally, doctors will closely monitor bone density for young people on PrEP [8]. Patients taking PrEP will be tested for hepatitis B and kidney function levels, as Truvada may cause damage if pre-existing kidney issues exist [1,19]. You will often be tested for HIV before being prescribed PrEP to ensure that the individual receiving the treatment is not already infected.

There are a patchwork of laws across the country that make it difficult to implement discussions of PrEP in sex education, let alone school settings. This is tremendously difficult to regulate due to the thousands of school districts in the country. Additionally, HIV and sex education are often regulated at the school district level and these decisions are going to be heavily influenced by the social position of that school district. This leaves parents and young people to find information and resources on their own. As of 2017 there was only one state in the US mandating that schools provide its students with education on PrEP [4]. As of 2017, 37 states, including DC, required HIV and STI education, which means they could potentially begin teaching teens about PrEP [4].

Just like any other subject in school, teachers/community authority figures must know about PrEP before they can teach someone else about it. There is cultural competency involved in talking about HIV and STIs. See our installment on sex education and the poverty of LGBTQ related information for further understanding of the disparities within schools. (LINK) These issues lead to the inaccessibility and lack of conversation around PrEP. The more we continue to not talk about PrEP, the more preventable cases of HIV will rise among young people. See below for some resources to educate you and your children about PrEP:

• There are co-pay and other payment plans that you can apply for listed here: https://www.pleaseprepme.org/payment
• https://www.youtube.com/watch?v=JFcCYcZQelo
• Ready, Set, PrEP: https://readysetprep.hiv.gov
• Southern Aids Coalition: https://southernaidscoalition.org
• My Brother’s Keeper: https://mbkinc.org
• Online ways to get PrEP: https://www.pleaseprepme.org/online-providers
• PrEP Daily Navigators: https://prepdaily.org/navigator-list/
• PrEP Basics: https://www.pleaseprepme.org/youth
• HRC (Review of FAQs asked by providers who might be resistant to prep): https://www.hrc.org/resources/what-to-do-if-your-provider-says-no-to-prep
• List of online ways to access PrEP or help to gain access to PrEP: https://www.pleaseprepme.org/online-providers

The way that you choose to communicate about STIs, STDs, and HIV will influence the way that your children are able to communicate about their own sexual health to others. It is incredibly important that you are explicitly thoughtful in the language and information you present to them. Do not use the language of “dirty” and “clean” in relation to someone’s STD/STI status. Having an STI or an STD is a common experience and does not reflect a person’s cleanliness, behavior, or imply that they are negligent or irresponsible. The more you know, the easier it will be to explain it to someone else.

For general tips on talking to your kids about difficult subjects, here are some helpful links: https://www.moms.com/talk-teenagers-about-sensitive-topics/  https://www.commonsensemedia.org/articles/how-to-talk-to-kids-about-difficult-subjects   https://raisingchildren.net.au/teens/communicating-relationships/tough-topics/difficult-conversations-with-teens.

Of course, sexually transmitted diseases are a particularly uncomfortable topic, as is much relating to sex. Therefore, to break it down for you, below are some notes you can keep in mind during these conversations and some basic outlines for promoting the best results in both their physical and mental health. Some of these points might even be useful in initiating your own conversation within your family.

For parents:

Disclosing one’s own status can be a helpful way to soften the mood before inquiring about someone else’s. For example, as a parent you can lead with your own experience. Have you ever tested positive for an STI or STD? Have you had conversations with partners who have had STIs and STDs? How did you manage these situations? Was there anything you found helpful or are there things you wish you had done better? Creating space for vulnerability can have a huge impact on another person’s ability to share.

For teens:

Ideally, conversations about sexual health should happen before sexual activity takes place. See our Consent and College installment about how open communication is sexy! You cannot provide informed consent to your partner if they have not shared their sexual health status with you, and vice versa. Yet, it is important to consider the hormones, nerves and other emotions that often accompany sexual activity. Then consider adding the pressure of sharing what is for some people a very vulnerable and sometimes shameful secret. In short, nobody is perfect. Yet, it is still important to try your hardest to be present and open about the details that matter.

So, when do you tell someone else? This question is subjective. It will differ for each person. The simplest answer is to have this conversation when you feel that you are interested in having sexual relations with someone and there is a possibility/likelihood of it happening. This could mean on a first date that you think will lead to a second or even within the 5 minutes before initiating a one-night stand at a party. It will be helpful to talk in a private and comfortable setting. It is always helpful to have these conversations when you are sober and of “sound mind.” Remember, emotions can be mind-altering as well. It is ideal to have these conversations in person and when both of you are feeling calm and not distracted.

Be aware that even if you have this conversation with a partner, you cannot always rely on being told the truth about their sexual history or health status, however sincere you think they are. Some young people are sufficiently nervous around these questions that they may not give straight answers for fear that they will be rejected, or may pretend to know their HIV status when they don’t.

If someone chooses to not have sex with another person because of their STD/STI status, that is their decision. Unfortunately, stigma and societal prejudice play into most of our decision making. It is hard not to take other peoples’ decisions, as they relate to your relationship, personally. But, if a relationship is ever terminated due to the disclosure of someone’s STI/STD status, that is a sign that the relationship did not contain enough mutual respect to be supportive. Even if your partner does admit having had a STI, there are ways to have sex safely. Conversations about STD/STI status should not be exclusive to one person volunteering their personal information. You can always ask.

If you notice something different on your body, talk to a medical professional. You can often access clinics and other services in your area. The only real way to know is to get tested. For reference or advice on self-assessment, Scarleteen has some great resources: https://www.scarleteen.com/article/bodies_relationships_sexual_health_sexuality/testing_testing_all_about_getting_tested_for, https://www.scarleteen.com/article/advice/an_infection_getting_worse_and_worse_can_i_just_wait_it_out.

Additionally, if you are having sex or physically intimate experiences with other people, part of having safer sex is remaining aware of both your and your partner’s body. If you see something that looks different or off, gently, calmly, and thoughtfully ask your partner.

For all readers:

When talking about STIs or STDs, do not be surprised if people react in a defensive way. Even your children. This says more about their learned prejudice than you. If you believe that your child is sexually intimate with someone, it can be helpful to explain that you are coming from a place of respect and care for their well-being. Teaching them about the importance of sexual safety does not necessarily signal that you approve of teenage sexual activity or are giving them license, but it is a caring response to the possibility that your child may chart their own path regardless of what you would prefer.

Do not use the threat of HIV or STIs as a reason why they should simply abstain from gay sex, as that will alienate them and cause them to reject everything you say.  Do your best not to feel as if you are in the wrong or guilty of something for having initiated the conversation. If your children are having significant difficulty with this conversation, look inside yourself for patience and creative ways to calm them down. It is your job to take on your child’s potential discomfort and lead them to a place where they can have these important conversations. If they don’t want to talk about it directly or just seem to ignore you when you attempt to talk about it, send them an e-mail with the link to this webpage.

Lastly, be kind to yourself. These conversations are difficult because we have been taught that they are shameful, embarrassing, and a sign of being deviant. This is not true.

Although most young adults and children under the age of 26 are included on a parent’s health insurance, this does not guarantee that they have access to or feel comfortable asking for competent sexual health care. As of 2017, 12.7% of sexually experienced adolescents and young adults in the US who were on a parent’s health insurance plan would not seek sexual and reproductive health care because of concerns that their parents might find out [20]. This trend was highest among persons aged 15-17 years (22.6%) [20]. Overall, these persons reported lower prevalence of receiving certain recommended STD services [20].

Findings from this study imply that confidentiality issues, particularly concerns that parents might find out, are barriers to the use of STD services among some subpopulations [20]. Some medical organizations suggest that providers have time alone with adolescent patients without a parent in the room [20]. This is also something that parents can initiate themselves. 71.1% of adolescents aged 15-17 who spent time alone with a health care provider (without a parent in the room) reported receipt of a sexual risk assessment. They are more likely to receive chlamydia testing than those who did not spend time alone (36.6% and 14.9% respectively) [20]. Having a young person spend time alone with a provider has been advised by the American Academy of Pediatrics and Society for Adolescent Health and Medicine [20].

Young people who are included in their parent’s health insurance are often reluctant to initiate conversations about getting access to PrEP due to a young person’s parents being a part of the conversation/financial obligation. It is important to note that for those who are not included in their parent’s health insurance plans, Americans under the age of 25 are the most likely to be uninsured. This poses new difficulties for acquiring sexual health treatments like PrEP and PEP [23]. See this helpful tool for finding a PrEP provider near you: https://preplocator.org. You can also potentially gain access using Telehealth, which can be particularly helpful for people who live in rural or remote areas.

• Visit this website for a list of state consent policies: https://www.guttmacher.org/state-policy/explore/overview-minors-consent-law
• State Legislation tracker: https://www.guttmacher.org/state-policy

Not all doctors who can provide sexual health care to adolescents choose to do so. This lack of willingness can take the form of discrimination towards LGBTQ patients or sexually active young people due to social stigma. Some providers choose not to provide certain preventative medications due to their bias. Most health insurance plans will cover the cost of PrEP completely [8]. As an individual or family with insurance you do not have to see your PCP for prescriptions. Continue reading for ways to seek access to PrEP/PEP without seeing your PCP.

As of 2017, one in three healthcare providers had not heard about PrEP, which means there is a chance of encountering resistance if your clinician does not have all the facts [22]. A study in 2018 asked adolescent health providers about their willingness to prescribe PrEP to youth at risk of HIV infection in the US and found that most providers were willing to do so [21]. Using an online survey of clinicians working with adolescents (aged 13-17) and young adults (aged 18-26) in the US [21]. 93.2% of providers had heard of PrEP and 57% had prescribed PrEP [21]. While almost all providers (95%) agreed that PrEP prevents HIV, fewer were willing to prescribe to young adults (77.8%) or adolescents (64.8%) [21].

• HRC (Review of FAQs asked by providers who might be resistant to prep): https://www.hrc.org/resources/what-to-do-if-your-provider-says-no-to-prep
• Online ways to get PrEP: https://www.pleaseprepme.org/online-providers

Willingness to prescribe PrEP was strongly associated with the belief that providers had enough knowledge to safely provide PrEP to adolescents and young adults, and that adolescents would be adherent [21]. We can assume, to some degree, that the discrepancy in these statistics is influenced by sex-negativity involving adolescents or young people.

All states and DC allow young people to consent to STI services [12]. 39 states and DC allow all individuals, regardless of age, to consent to STI and HIV services, while the remaining states allow certain categories of young people or those at a specified age (such as 12 or 14) and older to consent to such care [12]. 18 states allow, but do not require, a physician to inform a young person’s parents that their child is seeking or receiving STI services when the doctor deems it in the patient’s best interests [12].

The more tools you provide your child for managing their own sexual health, the more successful they will be in doing so as young adults. So, what are some other resources you can use to find your child, or help them independently find, sexual health care that best fits their interest? Most metropolitan cities will have at least one clinic dedicated to the sexual health of LGBT youth. Finding your local clinic is as easy as a Google search. For those in more rural areas, Telehealth and other online treatment plans are options. Even if you cannot find a LGBT oriented clinic near you, there are always STI testing options in your area. If you expect that your child might experience discrimination based on your regional location, it can be helpful to consider accompanying them to this visit.

[1] Tulane University. (2020, March 16). STI vs. STD: Key Differences and Resources for College Students. https://publichealth.tulane.edu/blog/sti-vs-std/

[2] National Institutes of Health. (2021, August 19). HIV and Children and Adolescents. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-children-and-adolescents

[3]. CDC. (2019, November 3). HIV Risk Behaviors. https://www.cdc.gov/hiv/risk/estimates/riskbehaviors.html

[4]. Miksche, M. (2017, December 1). How Sex Education Fails LGBTQ+ Teenagers. Them. https://www.them.us/story/lgbtq-teens-need-to-learn-about-prep

[5]. CDC. (2022, June 1). Basic Statistics. https://www.cdc.gov/hiv/basics/statistics.html

[6]. Patel, P., Borkowf, C. B., Brooks, J. T., Lasry, A., Lansky, A., & Mermin, J. (2014). Estimating per-act HIV transmission risk: a systematic review. AIDS (London, England), 28(10), 1509–1519. https://doi.org/10.1097/QAD.0000000000000298

[7]. USAID. (2015, April). Condom Fact Sheet. https://www.usaid.gov/sites/default/files/documents/1864/condomfactsheet.pdf

[8]. PrEP Daily Team. (2021, April 12). PrEP for Young People Ages 13-21: Is It Recommended? PrEP Daily. https://prepdaily.org/prep-for-young-people-ages-13-21-is-it-recommended/

[9]. MHAF. (n.d.). A Timeline of HIV and AIDS. HIV Basics. https://www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timeline

[10]. Mayo Clinic. (2022, July 29). HIV/AIDS – Symptoms and Causes. https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524

[11] Jonsen, A. R. & Stryker, J. (eds.). (1993). The Social Impact Of AIDS In The United States. National Academies Press (US).

[12] Guttmacher Institute. (2022, November 1). An Overview of Consent to Reproductive Health Services by Young People. https://www.guttmacher.org/state-policy/explore/overview-minors-consent-law

[13] Fair, C. D., Sullivan, K., & Gatto, A. (2010). Best practices in transitioning youth with HIV: Perspectives of pediatric and adult infectious disease care providers. Psychology, Health & Medicine, 15(5), 515-527, https://doi.org/10.1080/13548506.2010.493944

[14] PleasePrEPMe. (n.d.). Sexual Health for Youth: What you need to know. https://www.pleaseprepme.org/youth

[15] CDC. (2022, June 6). PrEP Effectiveness. HIV Basics. https://www.pleaseprepme.org/youth

[16] PrEP Daily Team. (2020, October 7). Understanding PrEP On-Demand for HIV Prevention. PrEP Daily. https://prepdaily.org/the-2-1-1-understanding-prep-on-demand-for-hiv-prevention/

[17] Hojilla, J. C., Marcus, J. L., Silverberg, M. J., Hare, C. B., Herbers, R., Hurley, L., Satre, D. D., & Volk, J. E. (2020). Early Adopters of Event-driven Human Immunodeficiency Virus Pre-exposure Prophylaxis in a Large Healthcare System in San Francisco. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 71(10), 2710–2712. https://doi.org/10.1093/cid/ciaa474

[18] Greene, J. (2020, June 4). On-demand HIV prevention pills worked well, study shows. Permanente Medicine. https://permanente.org/on-demand-hiv-prevention-pills-worked-well-study-shows/

[19] Highleyman, L. (2018, May 21). PrEP approved for adolescents in US. NAM aidsmap. https://www.aidsmap.com/news/may-2018/prep-approved-adolescents-us

[20] Leichliter, J. S., Copen, C., & Dittus, P. J. (2017, March 10). Confidentiality Issues and Use of Sexually Transmitted Disease Services Among Sexually Experienced Persons Aged 15–25 Years — United States, 2013–2015. Morbidity and Mortality Weekly Report (MMWR). 66(9), 237–241. http://dx.doi.org/10.15585/mmwr.mm6609a1

[21] Hart-Cooper, G. D., Allen, I., Irwin, C. E., Jr, & Scott, H. (2018). Adolescent Health Providers’ Willingness to Prescribe Pre-Exposure Prophylaxis (PrEP) to Youth at Risk of HIV Infection in the United States. The Journal of adolescent health, 63(2), 242–244. https://doi.org/10.1016/j.jadohealth.2018.03.016

[22] HRC Foundation. (2017, February). What to Do If Your Provider Says ‘No’ to PrEP. Human Rights Campaign. https://www.hrc.org/resources/what-to-do-if-your-provider-says-no-to-prep

[23] Buchholz, K. (2019, September 27). Young Americans Most Likely to Lack Healthcare Coverage. Statista. https://www.statista.com/chart/19494/uninsured-americans-by-age-group/

[24] World Health Organization. (2022, August 22). Sexually transmitted infections (STIs). https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis)

[25] Crepaz, N., Hess, K. L., Purcell, D. W., & Hall, H. I. (2019). Estimating national rates of HIV infection among MSM, persons who inject drugs, and heterosexuals in the United States. AIDS 33(4), 701-708. https://doi: 10.1097/QAD.0000000000002111

[26] Corcoran, J. L., Li, P., Davies, S. L., Knight, C. C., Lanzi, R. G., & Ladores, S. L. (2021). Adolescent Chlamydia Rates by Region, Race, and Sex: Trends From 2013 to 2017,

Journal of Pediatric Health Care, 35(2), 172-179. https://doi.org/10.1016/j.pedhc.2020.09.004

[27] Olakunde, B. O., Pharr, J. R., Adeyinka, D. A., & Danquah, P. (2019). HIV-related risk behaviors and testing among adolescent gay and bisexual boys in the United States. AIDS, 33(13), 2107-2109. https://doi.org/10.1097/QAD.0000000000002333