Speaking as an MD, I want all of your gay sons to be extremely cautious and reluctant about sex, because of the health consequences. Your concerns are legitimate, because the risk is real. As loving parents I hope that you will all let your children know how important it is to you, as parents, that they inform themselves and protect themselves.
For the rest of this article I am going to try to be clinical and direct. HIV is a serious risk, and although it is not as deadly as it used to be, it is still a very difficult chronic disease to live with. For this reason I don’t want to see anybody get infected with it. I am not going to discuss what kind of relationships are the most moral or bring the most happiness. I am only going to discuss approaches to avoiding HIV, and hopefully do so without judgment.
As parents you have to decide what is appropriate for you to discuss with your sons. Encourage them to inform themselves. Extract promises that they will protect themselves. There are a few points that I think a lot of young people miss, so I am going to mention them here, in case some of you are going to discuss these things with your sons (which I encourage). You don’t have to get into the nitty gritty with them, because that information is available on the internet, but you may want to have a talk with them about risk, and how to lower it.
If you do not feel that you need this information feel free to skip this. This may be more information than some of you need at this time. I hope this does not seem overwhelming, but I want to provide this to those of you who may need it.
The truth of the matter is this–the easiest way to be infected with HIV is through unprotected anal sex. There are currently 4 choices for avoiding infection: 1) avoid anal sex, 2) only have anal sex with an uninfected partner (monogamy) 3) condoms 4) prophylaxis (PrEP). I will speak to each of these. Then I will discuss drugs and alcohol, which mix poorly with sex, because they make it much harder to be vigilant and careful.
Option #1: Avoid anal sex. I think this is excellent choice, especially for teens. If they decide to be sexually active, there are still other safer activities.
Option #2: Monogamy is a great strategy for avoiding HIV. However, I really want young adult couples to be very reluctant to have unprotected sex, even when they are in a newer monogamous relationship. I think any relationship or marriage needs a good, long period of protected sex before throwing out the condoms. It turns out that most people who are infected, are infected by a person they are in a relationship with. Marriage equality has provided a helpful institution for gay people to navigate their relationships, but since the consequences are high, I encourage young couples to agree from the outset that they will still use protected sex for 1-5 years, even within a marriage. (Most gay men would find my viewpoint overly cautious…but it is still my advice). What gay couples need to learn is that honesty is actually even more important than fidelity. Lots of people make mistakes, but lying about these mistakes can have terrible consequences.
Option #3: Condoms. Every study has proven that sex education lowers sexual activity among teens. Informing your teen about safe sex will not cause him to be sexually active! In fact, good information will help him choose to wait, but if he does decide to have sex, he is much more likely to avoid infection if he knows about condom use.
Option #4: PrEP. This is prophylaxis against HIV which is a daily anti-viral pill. It would be essential to anybody who is in a relationship with an HIV+ person, although personally I would also use a condom. Obviously, some people use this pill so they can feel better about having unprotected sex. I encourage people to use condoms, but I can’t make their decisions for them, and I would rather have them taking the PrEP if they are choosing not to use condoms. Moreover, if your son has any kind of impulse disorder that could include sexual acting out, such as some types of bipolar disease or drug abuse, then I would encourage them to use PrEP.
Option “Worst case scenario”: You should also be aware that there is also a prophylaxis for people who think they might have been exposed very recently. It is a regimen of antivirals that should be implemented immediately after exposure to HIV. It is kind of like the morning after pill, because this treatment is there for times when somebody makes a big mistake by having unprotected passive anal intercourse, or having a condom break, or is exposed through accidental needle exposure (esp healthcare workers) or even rape. This regimen must be started very shortly after exposure, ideally within 24 hours or less (even 6 hours is better), but certainly within a day or two. It is a difficult regimen with lots of side effects. It is worth the side effects to avoid an even more difficult disease, but it is not a good idea to count on it as a replacement for safe sex. Knowing how to access this treatment quickly in case of an emergency would be a good idea for any sexually active person because of accidents such as broken condoms.
What young people need to know is that they need to be prepared. They need to realize that our defenses go down in these situations, and we get totally irrational during sex. We start to think things like “he is worth dying for”, or “if he is infected, then I want to be infected”. The only way to manage this, is to be very aware that these thoughts are going to happen in the heat of the moment, and they must be totally prepared and committed to not letting down their guard. This is one of the big reasons I encourage teens to wait until adulthood before becoming sexually active, because it is really, really difficult for anybody to manage, much less a teen. But whether they are teens or adults, I want them to be very, very determined and very, very careful.
Drugs and alcohol are a terrible idea if you mix them with sex. It makes it even more likely that you will set aside caution. Bad decisions are made when under the influence. If your son does drink or use drugs, please make him promise that he will never mix it with sex.
I might add that low self-esteem, depression and feeling rejected by family or community also makes it easier to make bad decisions about sexual behavior. The Family Acceptance Project has shown that LGBT people who have rejecting families have an exponentially higher risk of contracting HIV at some point in their life. Familiarize yourself with the suggestions from the Family Acceptance Project. Make sure that if your son has depression or unresolved issues that are impacting his self-esteem that he gets treated with an affirming therapist
I hope this information doesn’t seem overwhelming. I hope your sons will make wise decisions about their relationships for the sake of their happiness but also for the sake of their life and health. I hope all of them have parents who are invested in these discussions with them. I suspect a lot of them will resist these discussions, but in this case they would hopefully see that it is coming out of genuine love rather than judgment.
Footnote: There is a lot to be gained from vaccination against HPV. Boys aren’t routinely vaccinated, but any gay male teen should have the vaccine as soon as possible. It is best done several years before they are sexually active (but it would also be beneficial to any adult gay male who has had little or no sexual experiences).