149. Caregiver Perspectives on Explanation of Benefits Forms, Confidential Sexual Health Care, and Communication with Adolescents

Adolescent sexual minority and/or gender diverse assigned males (ASM/GDM) are an understudied group at high risk of acquiring sexually transmitted infections (STIs) including HIV. One barrier to sexual health for youth is challenging sexual health communication (SHC) with caregivers (e.g., parents, trusted adults), whereas SHC that is open and inclusive (e.g. non-judgemental, inclusive of identities outside cisgender and heterosexual norms) has been shown to decrease adolescent STI risk. Explanation of benefits (EOB) forms–letters sent by insurance companies to policyholders which can disclose sensitive health information about a minor to caregivers–have been cited in prior studies as a barrier to confidential sexual health care. However, few studies have evaluated caregivers’ perspectives on EOBs in the context of confidential care, STI/HIV prevention, and sexual health communication. We conducted individual in-depth interviews via video-conference with N=12 English-proficient caregivers of assigned males in the US. We included caregivers regardless of their child’s sexual orientation or gender identity, given some ASM/GDM have not disclosed their identities or behaviors. Interviewers used a semi-structured guide that included a sample EOB form and a hypothetical scenario–a caregiver receives an EOB after their adolescent seeks confidential STI testing. Caregivers were asked to share their perspectives in general, and also if the adolescent was their own child. A detailed debrief was written immediately following the interview, and content analysis of the debriefs was used to determine preliminary data relevant for future work. Caregivers were primarily between the ages of 35 and 50 (n=8), assigned female (n=8), cisgender (n=12), non-Hispanic (n=11), and White (n=8). Most caregivers were aware of EOBs (n=9). Most (n=7) had open and inclusive SHC, while some (n=5) had either less open and inclusive or minimal SHC. Most caregivers had nuanced and complex perspectives on EOBs and SHC, especially when considering the value of confidential sexual health care and their desire to monitor and supervise their child. Some valued both similarly, while others valued one more than the other. For example, one caregiver had open and inclusive SHC with their child, acknowledged the value of confidential sexual health care, and felt EOBs would allow her to monitor her child’s health in a positive way. Additionally, the caregivers who reported a desire to discuss the EOB with their child (n=6) largely expressed one or both of the following sentiments: disappointment that their child would seek STI testing without telling them first, and/or skepticism at the value of confidential sexual health care. Caregivers have complex and wide ranging perspectives on confidentiality, communication, and insurance forms such as EOBs in the context of sexual health care for their adolescent male children, and for adolescents in general. Future work should address EOBs as key factors in efforts to improve sexual health outcomes for adolescents.