Family Matters: The Support of Parents to Change Black Male’s Attitudes Towards HIV

Abstract

This study explored the associations between family (mother and father support), peers, and individual factors (self-efficacy) and how these relationships influence HIV attitudes among African American males 12 to 19 years of age, with an average age of 16 years. For this study, we used restricted data obtained from Wave I of the National Longitudinal Study of Adolescent to Adult Health (ADD Health). Descriptive statistics suggest that most of the sample had negative attitudes towards HIV. Bivariate regression analysis followed by a linear regression analysis was conducted to identify the factors that were associated with HIV attitudes. Major findings from regression analysis indicate that mother support, father support, self-efficacy, and age, predicted HIV attitudes. Mother support positively predicted positive HIV attitudes and surprisingly, father support negatively predicted HIV attitudes. Our findings can be used to better inform HIV prevention and intervention programs to help Black males stay healthy.

Background

Human Immunodeficiency Virus (HIV) is a public health problem that disproportionately impacts African Americans. African Americans only represent 13% of the population within the United States; yet, they account for nearly half (42%) of the people living with the disease (Centers for Disease Control and Prevention [CDC], 2018a). Moreover, African Americans account for 43% of the deaths resulting from HIV (The Kaiser Family Foundation, 2019). While new HIV diagnoses have decreased among all groups, in 2017, African Americans continued to reflect 44% of the new HIV/AIDS cases (CDC, 2018b; The Kaiser Family Foundation, 2019). Further, African American adolescents and young adults, ages 13–24, account for more than half of the new cases of HIV for this age group (The Kaiser Family Foundation, 2019). According to the CDC (2018b), African American male adolescents and adults accounted for 73% of all of the new diagnoses. Besides, African American adolescent and adult males are eight times more likely to contract the infection than their White peers. Consequently, there is an urgent need to implement culturally salient strategies that prevent the spread of HIV in this population (Harris et al., 2019).

Introduction

Sexual Risk Factors

African American adolescents experience developmentally unique transitions that further elevate their risk of contracting Human Immunodeficiency Virus (HIV) among those who are heterosexually active (Lindberg et al., 2019; Mahat et al., 2016). Adolescents mature from the interdependence of childhood to the independence of adulthood, undergoing a time when they experience impulsivity and beginning to experiment sexually without fully understanding the consequences of their actions (Mahat et al., 2016). African American adolescent males begin sexually exploring at relatively earlier ages than males from other ethnic groups (Lindberg et al., 2019). In fact, African American adolescent males are four times more likely to report having their initial experience with sexual intercourse before the age of 13 (Lindberg et al., 2019; Randolph et al., 2017). African American adolescent males are also more likely to experience sexual intercourse without utilizing a condom, have multiple sexual partners and father more children than their peers (Córdova et al., 2016; Harris et al., 2019). As such, African American adolescent males are more likely to contract sexually transmitted infections (STIs), which correlate with an increased risk of contracting HIV (Córdova et al., 2016). Each time that they engage in unprotected sex, their risk of contracting HIV increases (Harris et al., 2019).

Contextual Risk Factors

Sociodemographic and structural factors in relation to the neighborhoods adolescents reside in may also conflate and further increase their risk. Indicators including systemic and institutionalized anti-Blackness racism that underpins the poverty, low educational attainment, and under- and unemployment that Black families experience have also been associated with certain behaviors that correlate with contracting HIV (Jones et al., 2009; Jones et al., 2017). Environmental contexts, including overcrowded and blighted urban areas with prevalent and pervasive economic instability, high rates of neighborhood crime, as well as the absence or limited presence of biological fathers residing within the home, have all been cited as markers influencing sexual risk-taking behaviors among adolescents (Alleyne-Green et al., 2016; Bowleg et al., 2013; Denning et al., 2011; Harris et al., 2019; Thomas et al., 2008). The systemic anti-Blackness racism that underpins neighborhoods and inhibits their ability to secure the same contextual stability that their White peers enjoy, further exacerbates the adverse health outcomes reflected among this population (Jones et al., 2009). Adolescents who reside in these areas are also more likely to experience health inequities related to service access and are less likely to have the resources necessary to make good decisions related to their sexual health (Jones et al., 2009; Jones et al., 2017). This leads to poorer health outcomes, specifically an increased risk of contracting HIV and poor maintenance among those who have already contracted the infection (Boyer et al., 2017).

Parenting and Sexual Risk

Parental monitoring is largely a protective factor for adolescents’ sexual risk-taking behaviors, especially when there is a quality parent–child relationship (Jones et al., 2017). Extant literature reveals that adolescents who perceive that their parents are monitoring their behaviors are less likely to participate in sexually risky behaviors, namely, unprotected sex, multiple sexual partners without knowing their sexual history, and exposure to bodily fluids (Dittus et al., 2015; Jones et al., 2017; Mahat et al., 2016). Parental monitoring includes parents knowing their children’s companions, whereabouts, and activities (Dittus et. al, 2015). The literature indicates that parental monitoring is negatively associated with adolescents’ sexual activity and is positively associated with condom utilization (Dittus, et al., 2015; van Campen & Romero, 2012). Of note is that parental monitoring mitigates sexual risk-taking when there is quality parent–child communication regarding sex and sexual activity rather than positive communication in general (Jones et al., 2017). Jones and colleagues (2015) examined the impact that quality of the parent–child communications by observing 55 dyads and found that children whose lectured them about sexual activity had an increased likelihood of engaging in sex. While parental monitoring has been found to be a more effective deterrent to engaging in sexual risk-taking behaviors among younger adolescents, the quality of the parent–child relationship is critical to this understanding (Jones et al., 2015; Mahat et al., 2016).

Mother Support

Existing literature is replete with studies that examine mother–daughter sex communication; however, there is limited research reflecting promising outcomes from mother–son dialogues about sex. In fact, adolescent males whose mothers provide support, specifically communicate and bond with them, are less likely to take sexual risks that lead to unprotected sex, unwanted pregnancies, and contracting HIV and other STIs (Harris et al., 2013; Mahat et al., 2016; Zhang et al., 2018). African American mothers generally assume the role of communicator within the African American family structure. This means that they are often the ones who initiate and lead the conversation with their sons about sexual risk-taking behavior, including condom use, the dangers of HIV and other STIs, and the challenges of unplanned pregnancies (Zhang et al., 2018). These mother–son discussions have led to improved decision-making skills in adolescent males regarding their sexual health. Zhang et al. (2018) examined a culturally salient intervention that focused on mother–son communication among 525 African American mothers and their sons and found that consistent communication regarding sexual health during their sons’ early adolescent years increased the likelihood of consistent condom use, birth control utilization, fewer sexual partners, delayed sexual onset, and even resulted in mothers giving their sons condoms. Furthermore, the literature reveals that a positive mother–son bond further decreases sexual risk-taking behaviors among adolescent males and consequently improves their overall sexual health (Zhang et al., 2018).

Father–Son Sex Communication

The existing literature, although limited, reveals promising outcomes of father–son communication about sex. African American adolescent males whose fathers communicate with them about sex generally experience lower sexual risk-taking behaviors (Baker et al., 2018; Harris et al., 2019). African American adolescents whose fathers openly converse with them about sex will often abstain, delay initial sexual experiences, and employ protective measures when they do decide to become sexually active (Baker et al., 2018; Randolph et al., 2017). Recent literature illuminates the effects of the nature and quality of father–son discussions among African American dyads. Harris et al. (2019) examined the impact that father–son talks about sex had on 100 adolescent African American males’ risk-taking behaviors. They conducted a structural equation model and found that sons between the ages of 16 and 21 years who are emotionally connected and have open communication about sexuality and sexual practices with their fathers are less likely to take sexual risks and more likely to practice safe sex.

One mixed methods study analyzed the quality of father–son sex communication among 28 father–son dyads. Baker et al. (2018) utilized three focus groups in a barbershop and found a negative correlation between positive father–son relationships and sons’ sexual risk-taking behavior. The authors also found that while most fathers and sons agreed that they could talk about anything related to sex, fathers’ and sons’ experiences regarding the quality of those conversations were quite disparate. Although fathers believed that they had thorough and quality conversations with their sons about safe sex, their sons perceived these same conversations as stilted, brief, and uncomfortable. Generational differences may account for mixed findings among the studies. Despite these differences, findings revealed that these talks not only mitigated adolescents’ sexual risk-taking but also provided a foundation for improving overall communication among African American fathers and sons.

Self-efficacy

Self-efficacy has been fundamental in promoting HIV prevention. Self-efficacy is a person’s belief in his or her ability to control the outcomes of a situation (Bandura, 1982). The term has been expanded to include sexual self-efficacy which has been operationalized to explain the ways that adolescents feel confident enough to employ HIV preventative measures to maintain their sexual health (Closson et al., 2018). Both terms imply that the more that adolescents perceive having control over their sexual experiences, the greater the likelihood of them feeling empowered to employ their sense of agency and implement effective strategies to remain sexually healthy. As such, adolescents who reflect high levels of sexual self-efficacy are more likely to employ condom negotiation and communicate with their partners about their sexual history because they understand their perceived risks of contracting HIV (Closson et al., 2018; Sullivan et al., 2017). van Campen and Romero (2012) conducted a study with ethnic minority youth utilizing multivariate regression analysis and found that those who had high sexual self-efficacy were more likely to intentionally engage in sexually healthy behaviors. Findings also indicate that this sense of sexual self-efficacy appears to increase with age. In a study that examined 140 adolescent males’ and females’ self-efficacy, Mahat et al. (2016) found that both the males’ and females’ sexual self-efficacy increased with age.

The Present Study

There is a dearth of literature on parent–child support (communication, bonding, etc.) among Black mothers and fathers and their sons; parental support might be important in positively increasing HIV attitudes among African American adolescents. The influence of parental support on HIV attitudes is a significant gap in the research literature. Therefore, the purpose of this study was to examine the support of mothers and fathers (communication and bonding), condom self-efficacy, peer knowledge about sex, and other factors on African American male’s attitudes towards HIV.

Methods

This study used secondary data for the current analysis from the National Longitudinal Study of Adolescent to Adult Health also known as Add Health is a longitudinal cohort study designed to explore health from the period of adolescence to adulthood (Carolina Population Center). The study design has been described in detail elsewhere (Sieving et al., 2001). Briefly, the nationally representative sample contains individuals who were in 7th–12th grade in the United States during 1994–1995. Wave I of the in-home survey (1994–1995) collected data from more than 20,000 adolescents and their parents regarding their social and demographic characteristics, households, risk behaviors, friendships, and health status. The current analysis includes participants with sample weights at Wave I.

Measures

Dependent variable

HIV attitudes.

This three-item scale (ranging from 1 = almost no chance to 5 = almost certain) asked the respondents the following questions: (a) “If you contracted the AIDS virus, would you suffer a great deal?” (b) “Would it be a big hassle to do the things necessary to completely protect yourself from getting a sexually transmitted disease (STD)?” and (c) “If sometime soon you had sexual intercourse for a whole month, as often as you wanted to, without using any form of protection, what is the chance that you would contract the AIDS virus?” These items were reverse-scored so that a higher score indicated more of the attribute named in the label. The Cronbach’s alpha for this scale was 0.87.

Independent variables

Mother support.

Communication from mothers consisted of a four-item scale (ranging from 0 = no to 1 = yes) asking these items to the respondents: (a) “Did you talk about someone you’re dating or a party you went to?” (b) “Did you talk about schoolwork or grades?” (c) “Did you have a talk about any personal problems you were facing?” and (d) “Did you talk about other things you’re doing at school?” Mother–adolescent bonding consisted of a three-item scale (ranging from 1 = strongly disagree to 5 = strongly agree) asking the respondents the following: (a) “Most of the time, your mother is warm and loving towards you,” (b) “Overall, you are satisfied with your relationship with your mother,” and (c) “You feel close to your biological mother.” The Cronbach’s alpha for this scale was 0.89.

Father support.

Communication from fathers consisted of a four-item scale (ranging from 0 = no to 1 = yes) asking the same items to the respondents as in the mother-related scale: (a) “Did you talk about someone you’re dating or a party you went to?” (b) “Did you talk about schoolwork or grades?” (c) “Did you have a talk about any personal problems you were facing?” and (4) “Did you talk about other things you’re doing at school?” Father–adolescent bonding consisted of a three-item scale (ranging from 1 = strongly disagree to 5 = strongly agree) asking the respondents the following: (a) “Most of the time, your father is warm and loving towards you,” (b) “Overall, you are satisfied with your relationship with your father,” and (c) “You feel close to your biological father.” The Cronbach’s alpha for this scale was 0.89.

Self-efficacy.

This three-item scale (ranging from 1 = very unsure to 5 = very sure) asked the respondents the following questions: (a) “How sure are you that you could plan ahead to have some form of birth control available?,” (b) “If you wanted to use birth control, how sure are you that you could stop yourself and use birth control once you were highly aroused or turned on?,” and (c) “How sure are you that you could resist sexual intercourse if your partner did not want to use some form of birth control?” These items were reverse-scored so that a higher score indicated more of the attribute named in the label. The Cronbach’s alpha for this scale was 0.72.

HIV testing.

This single-item scale (ranging from 0 = no to 1 = yes) asked: “Have you been tested for HIV/AIDS in the past 12 months?”

Peers influence.

This three-item scale (ranging from 1 = strongly disagree to 5 = strongly agree) asked the respondents the following questions: (a) “Are your closest friends quite knowledgeable about how to use a condom correctly?,” (b) “Are your closest friends quite knowledgeable about the rhythm method of birth control and when the ‘safe’ time occurs during the month for a woman to have sex and not get pregnant?,” and (c) “Are your closest friends quite knowledgeable about the withdrawal method of birth control?” These items were reverse-scored so that a higher score indicated more of the attribute named in the label. The Cronbach’s alpha for this scale was 0.84.

Age.

Age was treated as a continuous variable.

Chances of contracting HIV.

This single-item scale (ranging from 1 = almost no chance to 5 = almost certain) asked the respondents the following question: “Suppose that sometime soon you had sexual intercourse for a whole month, as often as you wanted to, without using any protection. What is the chance that you would get the AIDS virus?”

Knowing someone with HIV.

This single-item scale (ranging from 1 to 99) asked the respondents the following question: “How many people do you know who have AIDS?”

Data Analysis

A stratified sample of sexually active African American males between the ages of 12 to 19 (N = 1,177) was used in this study. Table 1 presents a univariate analysis of the variables in the study. Second, a bivariate analysis (Table 2) was conducted to test the linear relationship between the independent variables: mother support, father support, self-efficacy contraception, peer knowledge about sex, chances of contracting HIV, knowing someone with HIV, HIV testing, and age and the outcome variable: HIV attitudes. In order to examine the research question, a linear regression was conducted to investigate whether the independent variables: mother support, father support, self-efficacy contraception, peer knowledge about sex, chances of contracting HIV, knowing someone with HIV, and age predicts the dependent variable: HIV attitudes (Table 3). All analyses were conducted using STATA 16.

Table 1.

Demographic (N = 1,137).

Variable	Mean	SE
HIV attitudes	3.80	0.03
Mother support	4.30	0.04
Father support	4.00	0.07
Condom use self-efficacy	4.50	0.04
Peer knowledge about sex	2.27	0.02
Chances of contracting HIV	3.81	0.06
Knowing someone with HIV	0.67	0.07
Age	16.6	0.05
HIV testing	Proportions
Yes	0.08	0.01
No	0.92	0.01

Table 2.

Bivariate Regression Analysis of HIV Attitudes.

Variables HIV Attitudes	Coefficient	SE	P-values	95% CI Interval
Father support	0.11	0.08	0.15	[−0.08–0.54]
Mother support	−0.25	0.13	0.05*	[−0.52–0.01]
Peer knowledge about sex	0.22	0.16	0.15	[−0.08–0.54]
Condom use self-efficacy	0.35	0.10	0.01***	[0.15–0.55]
HIV testing	−0.60	0.30	0.05*	[−1.19–0.02]
Chances of contracting HIV	−0.22	0.08	0.06**	[0.06–0.38]
Knowing someone with HIV	−0.05	0.03	0.11	[−0.12–0.01]
Age	0.20	0.07	0.05**	[0.06–0.34]

Note.

^*p < 0.05,

^**p < 0.01,

^***p < 0.001.

Table 3.

Black Males on HIV Attitudes (N = 696).

HIV Attitudes
Mother support	0.44	0.24	0.05*	0.01	0.89
Father support	−0.38	0.11	0.01***	−0.60	−0.15
Peer knowledge	−0.20	0.13	0.13	−0.46	0.06
Self-efficacy	0.36	0.18	0.03**	0.02	0.72
Age	0.44	0.13	0.01***	0.17	0.72
Chances of contracting HIV	−0.15	0.12	0.23	−0.39	0.09
Knowing someone with HIV	0.15	0.09	0.18	−0.03	0.33
HIV testing	−0.85	0.51	0.10	−1.88	0.18

Note.

^*p < .05,

^**p < .01,

^***p < .001.

Results

Descriptive statistics.

Table 1 summarizes descriptive statistics which includes proportions, means, and standard errors. For African American males who stated being sexually active, the mean age was 16 (M = 16.18, SE = 0.19 and the average age of sexual debut was 12 (M = 12.38, SE = 0.17). The average attitude towards HIV was above average and positive (M = 3.83, SE =0.02). Young men reported high support from their mothers (M = 4.30; SE = 0.04) and their fathers (M = 4.00; SE = 0.07). African American males reported average condom use self-efficacy (M = 24.50, SE = 0.04).

Bivariate regression.

A bivariate regression analysis (Table 2) was conducted between the independent variables and the outcome variable. Our findings revealed that mother support was statistically significant and positively predicted HIV attitudes among Black males (B = 0.17, p < 0.001). Condom use self-efficacy was also statistically significant and positively predicted favorable attitudes towards HIV (B = 0.35, p < 0.001). HIV testing was statistically significant, predicted negative attitudes towards HIV (B = −0.60, p < 0.05). Chances of contracting HIV negatively predicted negative attitudes towards HIV (B = −0.22, p < 0.01). For every one-unit increase in age, there was a 20% increase in positive attitudes towards HIV (B = 0.20, p < 0.05).

Linear regression.

A linear regression analysis (Table 3) was used to test whether mother support, father support, peer knowledge, self-efficacy about sex, HIV testing, age, knowing someone with HIV, and chances of contracting HIV significantly predicted Black males’ attitudes towards HIV. The predictors in the model were able to account for 14% of the variance in HIV attitudes and was statistically significant (F (10, 59) = 4.04, p < 0.001, R² = 0.14). Our results indicated that support from mothers was statistically significant and predicted positive attitudes towards HIV (B = 0.44, p < 0.05) when all other variables were held constant. Father support was surprisingly statistically significant and predicted negative attitudes towards HIV for Black males (B = −0.38, p < 0.01). The results also indicated that for every one-unit increase in self-efficacy, there was a 64% increase in positive attitudes towards HIV (B = 0.36, p < 0.03). For every one-year increase in age, there was a 55% increase in positive attitudes towards HIV (B = 0.44, p < 0.01)

Discussion

While African American males remain disproportionately affected by HIV, the research identifies that HIV testing rates and other preventive measures as ways to curtail new infections among this population remain low. Identifying protective health behaviors, such as engaging African American parents (mothers, fathers) and their sons in conversations that include sexual health topics (condom use, HIV, PrEP, etc.) might be one way to reduce African American male’s risks for HIV infection and create healthier relationships between parents and their sons (Boyd et al., 2018). The purpose of this study was to explore the role of mother and father support and other contextual factors on the HIV attitudes of African American males. Centering the importance of mother and father support, peer knowledge, self-efficacy and other contextual factors on HIV attitudes of African American males can potentially inform HIV prevention and intervention programs to help young African American males stay healthy.

Mother Support

In our study, we found that mother support (communication, bonding) positively impacted HIV attitudes of African American males. Our findings note important factors other than condom use, delayed sexual intercourse, and unplanned pregnancies (Harris et al., 2013; Mahat et al., 2016; Zhang et al., 2018), to include HIV attitudes that may positively impact HIV prevention. Previous research has found that mothers are more likely to talk to their daughters about sex, whereas fathers are more likely to talk to their sons (Sneed et al., 2013; Santa Maria et al., 2014); however, in general, mothers are more likely than fathers to engage with their children about sex (Raffaelli et al., 1998). Potentially, mother support extends beyond just communication, and bonding but also includes trust, which may, in turn, have a positive impact on the relationship with their son. This relationship may allow sons to be able to communicate their sexual behaviors to their mothers. Moreover, positive mother support may also mean that African American mothers are understanding and receptive to such sexual communication with their sons, which may reduce negative attitudes towards HIV, and other STDs and an increase in positive health behaviors such as HIV testing and consistent condom use. This is important because prior literature states that positive mother–son bonding decreases sexual risk behaviors among males, which is important for a population that is burdened by HIV (Zhang et al., 2018).

Father Support

We also found that father support (communication, bonding) negatively predicted HIV attitudes among African American males. This is not consistent with the current, although limited literature that father support has a positive influence on African American males’ sexual risk behavior. Furthermore, past studies have found that African American fathers who had conversations with their sons about sex were more likely to abstain from sex, delay initial sexual experiences, and employ protective mechanisms (Baker et al., 2018; Harris et al., 2019; Randolph et al., 2017). Other research has found that father–son sexual communication can potentially help reduce risky sexual behaviors and increase HIV testing rates. Harris et al. (2019) conducted a study with 96 Black fathers and their sons aged 16–21 years to examine neighborhood characteristics, and father–son closeness and bonding, father–son communication, sexual permissiveness, condom attitudes, and sexual risk behaviors. The authors found that Black father–son closeness and parental bonding was associated with father–son communication, which in turn was negatively associated with sons’ permissiveness and positively related to condom attitudes. However, father support may not always extend to HIV, due to some fathers having communicated negative messages to their sons about how HIV is contracted based on their limited knowledge of the disease. African American fathers may not feel comfortable in talking about HIV or other STDs, and their child might not feel comfortable enough to share their experiences around sex that may put them at risk for HIV due to their father’s views on sex and sexuality.

Self-efficacy

Our results revealed that an increase in self-efficacy led to positive attitudes towards HIV for African American males. This is consistent with the current literature that adolescents who perceived themselves to have sexual control over their sexual experiences are less likely to engage in negative sexual risk behaviors, more likely to converse with their partners about their sexual history and negotiate condom use (Closson et al., 2018). Black males who are efficacious about condom use and believe they can control their sexual desires (Bandura, 1982), may have a positive attitude towards HIV because they feel empowered to protect themselves from HIV and other STDs. Through their own vicarious experiences, Black males may perceive their parents’ experiences and attitudes around sex as a sustained effort to staying healthy, which reinforces their efforts in doing the same. Sustaining self-efficacy may be a collective effort with young males and their parents, which may lead to Black males having positive HIV attitudes because of the belief to protect themselves.

Age

In our study, we found that older youth had positive attitudes towards HIV. This is consistent in the literature that older adolescents are more likely to engage in HIV prevention (Boyd et al., 2018). Older youth might feel more comfortable talking about sex, sexuality, and have more knowledge around HIV, which may decrease the negative attitude towards HIV. Furthermore, older youth might also have more sexual experiences that cause them to engage in HIV testing and the importance of routine testing, which also increases the likelihood of them having a positive attitude towards HIV.

Limitations

Although this study has many strengths, some limitations must be considered in the interpretation of the results. First, the study findings are limited to African American males, so our findings may not be generalizable to other populations (Boyd et al., 2020). HIV rates among male youth of color, especially African American males remain high, so they are more likely to get infected without the appropriate prevention and intervention efforts. Second, this is a secondary analysis of a national dataset collected throughout the United States. The African American males in the Add Health data were drawn from a national sample of the general population versus an indicated population of African American males with high risk of HIV. Consequently, our results may not represent youth with specific challenges or life circumstances, such as those with histories of substance misuse, homelessness, or delinquent behavior and/or incarceration (Boyd et al., 2020). Third, the use of self-reported measures in our study may have led to social desirability and recall biases. However, utilizing the sample weights in the analysis could have contributed to reducing selection bias and variance. Despite these issues, major strengths of the present study include the large number of diverse nationally representative participants and the high quality of the data. Also, this study addresses an existing gap in the literature that has implications for HIV prevention and intervention work for African American parents and their children. Prevention and intervention efforts could benefit from informative content to enhance the communication between parents and youth about sex and HIV prevention. Finally, Add Health data were collected in the early 1990s and the authors acknowledge this as a limitation in our study. There have been some advances in HIV treatment and programing since this data were collected, however; the data allowed us to investigate parental support and how it influences HIV attitudes, etc., among young Black, which has been shown in prior literature to be of strong importance (Boyd et al., 2020).

Despite these limitations, the findings from this study are noteworthy given its focus and the potential to inform more effective strategies for reducing sexually risky behaviors for this population. Also, the results suggest that communication patterns between African American males and their parents, especially their fathers’ relate to youth sexual behaviors, and further research may describe the population more comprehensively.

Future Research

HIV prevention and intervention practice and research with young Black men are keys to reduce the current burden they face. Future research, which includes a family communication measure that delineates the differences between types of communication would be prudent. To that end, the results of our study may have important implications for designing future studies with African American male youth and their families. Future research efforts need to include tailoring the study designs and the implementation of preventive interventions to reduce HIV risk behavior and other health outcomes. Future research should examine the types of communication that may help reduce the risk of HIV for Black males. Specifically, qualitative research studies that focus on Black fathers’ and sons’ comfort levels in discussing sex, as well as the frequency of their conversations might be helpful in reducing their risk. This focus could identify variables that need to be studied to further establish a justification for involving caregivers in HIV intervention and prevention for Black youth. The development of effective interventions that will deliver protection against HIV-related risks among Black males should also consider a macro and/or structural focus with strategies that promote positive communication skills (Boyd et al., 2020). In addition, future research should also focus on associations between these study variables among African American male youth who may experience system involvement, that is, child welfare and/or juvenile justice—to further investigate the themes identified in this study. Specifically, Black youth comprise about 21% of the child protective services involved population suggesting a need to devise methods to improve communication among youth, parents, and/or other caregivers (U.S. Department of Health & Human Services et al., 2018). Similarly, Black youth involvement with the juvenile justice system was 35.1% in 2014, indicating they are overrepresented more than twice that of the general population of 13.3% (National Center for Juvenile Justice [NCJJ], 2016). Consequently, investigating the parental support to increase self-efficacy associated with sexual health behaviors in these indicated populations may be a prudent next step to increasing the scope of prevention in HIV transmission. Future research should also continue to investigate how father–son support and communication can lead to dialogues beyond condom use and that includes HIV due to the burden that African American males face by this disease. In summary, future research should more holistically incorporate those variables that may help explain such hypothesized relationships.

Conclusion

Add Health provides nationally representative general population data on parent communication among African American male youth and parents who have been understudied. Our study results suggest the powerful role and presence of parents and how communication (mother and father) positively influences their children’s sexual health decisions and behaviors. Evidence from our investigation suggests that parents have a substantial role and ability to engage African American male youth in favorable ways to increase their knowledge and subsequent behavior. Consequently, interventions need to be tailored to reduce HIV-related risks among African American males and their parents about sexual health, HIV testing, and risk reduction. In addition, understanding the nuances of communication for African American male youth and their parents could carry information about other factors that could inform prevention and intervention efforts to create appropriate intervention strategies. Furthermore, implementing such efforts should promote their health and sexual health, and decrease future risk of HIV infection.