Despite Increased Minor Consent Laws for STI, HIV Services, Barriers Persist

Although all 50 states and Washington, DC, allow youth to consent independently to some or all sexually transmitted infection (STI) and HIV services, new research has found that youth are disproportionately burdened by these health conditions and that burden only worsened during the pandemic.

Minor consent laws allow underage youth to obtain STI and HIV services without their parents’ permission, but these laws are complex, substantially limited, and vary by state. Additionally, many adolescents are unaware that these laws exist.

Improving clinician and patient understanding of the history and limitations of these laws is necessary to evaluate their impacts on access to care, inform clinical practice, identify gaps in legal protections, and increase health equity among adolescents in the United States. In a new study, investigators examined how minor consent laws for STI and HIV testing, treatment, and preventive services have changed over the past century in all 50 states and Washington, DC.

According to the findings, the number of states allowing minors to consent independently to STI and HIV services has increased considerably, although these laws remain unclear or narrow in scope in many states. Many laws also allow physicians to decide which information they disclose to guardians or fail to address inadvertent breaches of confidentiality through insurance billing and claims. Such disclosures may reveal information about gender identity, sexual activity, or sexual orientation, which could put these individuals at risk of rejection or abuse by their guardians.

“Although there have been substantial gains in minor’s legal ability to independently consent to STI/HIV testing, treatment, and prevention services in the US in the last century, there remains significant room for improvement in these laws,” said study lead and corresponding author Kimberly Nelson, PhD, MPH, in a press release. “Minors have gained the right to consent to STI/HIV testing and treatment without needing a guardian’s permission in all 50 states and DC, but their ability to consent independently to STI/HIV prevention services—including the HPV vaccine and pre-exposure prophylaxis (PrEP) for HIV—is still lacking in many states.”

In their study, investigators analyzed state health laws, judicial opinions, and regulations between 1900 and 2021. They categorized minor consent laws by general health care; STI/HIV testing, treatment, and prevention; and PrEP or postexposure prophylaxis (PEP). They found that between 1900 and 1959, the laws were extremely limited and likely reflected increasing concerns that STIs hindered childbearing and marriage. Only 9 states had consent laws around STI testing and treatment, and only 1 state—Rhode Island—had regulations addressing STI prevention services.

The largest increase in states allowing minors to consent to STI services occurred during the 1960s and 1970s, evolving alongside social advances, such as the Civil Rights Movement, and sexual health advances, such as birth control pills. Laws continued to increase over the following decades, and by 2021, minors could consent independently to STI/HIV testing and treatment in all 50 states and Washington, DC, STI prevention services in 32 jurisdictions, and HIV prevention services in 33 jurisdictions.

However, confidentiality protections are still rare and varied in most states, regardless of regions and political party lines. All 50 states and Washington, DC allowed minors to consent independently, but only 13 states mandate confidentiality for STI services, and only 14 states mandate confidentiality for HIV services. Many of these laws also grant exceptions, such as the ability for physicians to disclose minors’ information if a test is positive or if they are contacted by the adolescent’s parent or guardian.

For instance, physicians in Massachusetts can disclose minors’ health information to their guardian if they have a life-threatening condition or face amputation of a limb. The only states that provide mandatory confidentiality laws with no exceptions are Connecticut, Florida, Illinois, Nevada, New York, Virginia, and Wyoming.

The study also found that only 5 states have attempted to protect minors’ health care payer information from disclosure to guardians. Based on all the findings, the authors urge legal and policy changes that will ensure additional protections for youth.

“Minors who are unable or unwilling to involve their guardians when they are seeking STI/HIV services deserve to have access to these critical services and while these laws help, they do not fully address all of the potential barriers that minors face,” Nelson said in the press release. “Policymakers should seek to improve these laws to address their complexity, reliance on clinician interpretation, and the substantial confidentiality concerns that remain.”

REFERENCE

Minor Consent Laws for STI/HIV Services Have Increased Across US, but Limitations Persist. News release. Boston University School of Public Health; February 3, 2023. Accessed February 23, 2023. https://www.bu.edu/sph/news/articles/2023/minor-consent-laws-for-sti-hiv-services-increased-across-us-but-limitations-persist/