Confidentiality Protections for Minors Seeking STI, HIV Services Vary Across US

In a research letter published in JAMA, authors assessed existing minor consent laws surrounding sexually transmitted infection (STI) and HIV services in the United States, comparing confidentiality protection measures across the 50 states and the District of Columbia.

A significant reason why some adolescents do not seek out these services is confidentiality, including concern that a parent or guardian will find out, especially if the child is on their health insurance plan.

To address this barrier and encourage STI/HIV testing, treatment, and prevention, states have enacted statutes granting minors legal capacity to consent to these services without the involvement of their parent or guardian.

“Although reviews of STI/HIV minor consent laws exist, many are dated, have unclear methodology, provide conflicting information, or lack details needed to serve adolescents, researchers, and clinicians,” the authors of the letter wrote.

In this assessment, laws were divided into consent to:

• health care generally
• STI testing, treatment, or prevention
• HIV testing, treatment, or prevention
• HIV preexposure (PrEP) or postexposure prophylaxis (PEP)

Most states defined age of minority as younger than 18, with Alabama and Nebraska defining it as younger than 19, and Mississippi and Pennsylvania defining it as younger than 21.

As of 2021, in all 51 jurisdictions across the states and the District of Columbia, minors can independently consent to STI/HIV testing and treatment.

Most states allow all minors to consent to STI (n = 43) and HIV (n = 42) testing and treatment without a minimum age. In the remaining states, minors can consent to STI/HIV testing and treatment starting between ages 12 and 14 years, depending on the state.

For prevention, minors can consent to STI prevention services in 33 states, and HIV prevention services in 35 states. Additionally, 14 states established criteria individuals must meet in order to consent independently.

The following conditions must be met to some degree for minors to be legally able to consent to care in these 14 states:

• In the clinician’s judgment, delaying care would substantially increase the risk to the minor’s life or health
• Reasonable efforts have been made to obtain the consent of the minor’s parent or guardian
• Patient believes themself to have a relevant illness or disease
• Patient believes themself to have a relevant illness or disease, or must be in a public clinic
• Patient believes themself to have a relevant illness or disease, or theclinician believes the minor was sexually assaulted

Approximately half of states have the following disclosure rules for clinicians:

• Clinician discretion if the minor is aged younger than 14 years
• Clinician must disclose the minor’s health information to the parent or guardian if the condition of the minor endangers their life or a limb
• Clinician discretion if failure to inform the parent or guardian would seriously jeopardize the health of the minor patient
• Clinician discretion if STI/HIV test result is positive
• Clinician discretion if contacted by the minor’s parent or guardian

Additionally, surgical or nonsurgical care must be deemed “essential to the health or life of such child in the opinion of the performing physician and a consultant physician if one is available” in some states.

“Trainings, policies, and procedures that support and routinize the application of these statutes may empower clinicians to rely on them more confidently in practice,” the authors said. “Ensuring that clinicians, researchers, and minors understand and trust these minor consent laws may expand access to STI/HIV services for youth.”

Reference

Nelson KM, Skinner A, Underhill K. Minor consent laws for sexually transmitted infection and HIV services. JAMA. 2022;328(7):674-676. doi:10.1001/jama.2022.10777