TABLE 3.

Themes and Example Quotes for Barriers to Communication: Midwest United States, 2009-2010

Barriers	Informant or Parent	Example Quotation
Fear and focusing on disadvantages
[ems]Concern for welfare of child		Well my fear is that I don't want to worry them. . . . kids are good like that.. .I don't care how horrible of a parent you are, they still have this inability to just forgive and love. . . . So it's hard for me to deal with just scaring the mess out them. And I know this is an issue that people who are educated in HIV and AIDs still fear. . . . To put that (HIV) on your kids with all the extra things that they go through: peer pressure, things like that. It's just unbearable to think of. It's just one added thing for them to go through. And I wouldn't wish that on any kid.
[ems]Fear of damaged self-image	Father	I think (it's hard) because they (parents) are not open with their children. The reason I say that is because some parents may think their kid may shun them. So they don't want to be ostracized by their kid.
[ems]Awkward conversations	Father	I guess it's (hard because) it's just uncomfortable dealing with the issue of sex with your own children. At least that's the biggest part for me. . . . I think it's just uncomfortable for a lot of parents to talk to their kids about sex—they don't want to talk to them.
Living in denial	Mother	Well first of all the parents have to be comfortable with themselves. They need to not be in denial. . . . Because, see, in the beginning I wasn't like that. I couldn't stand the fact that the illness was running through my veins and I hated it. I was ashamed of it—I thought it was dirty. I thought people were gonna reject me. But once I learned about the illness and once I was going to support groups and taking care of myself I didn't care what people thought. I just knew I needed to take care of myself. I think you have to get there before you can go any further.
Lacking parental role model	Mother	Well to tell you the truth, the way I was raised and the way I raised my kids, you were told “this is bad, this is good, this you don't do.” So there's never any reason to have to talk about it because I've explained to you “this is a no-no.” If (only) my parents had been able to talk with me and express with me about it before. . . because the questions that baby asks me, we would get popped in the mouth for. And it's really hard to communicate when you got everything set up as "this is bad.
	Father	We don't talk about.. .sexuality or drugs until the blister bursts and we're ready to discuss everything about it—or go into denial. I think maybe parents just want to give you a book to read, or let society teach you. It's not a societal issue though. . . . In my own home we didn't discuss a lot of things, especially sexuality and my being bisexual. . . . It was like “We're just going to ignore that.”
Being HIV-positive	Mother	It's harder (because) you've got to explain it in more detail. . . . I had a lot of rebellious kids when I did say something about it. We just went through so much with it, because there was a lot of rebellion and (a lot of) “You're dying anyway and nobody is going to be with us” when conversations about HIV came up. Then eventually, after we went through all of the storms, we were closer. We're real close now.
	Mother	It's harder because I just don't want them to know, period. . . . I just don't want them know that I'm HIV positive.
	Father	I just tell them “be careful.” It's hard because I don't use myself as an example (I don't tell them that I have HIV).
	Mother	(It's harder) because they have a negative attitude toward HIV+ people. . . the kids do. . . they have made little (HIV-related) cracks.