Too Many Youth and Their Doctors Are Unaware of Minor Consent Laws
All US states permit minors to self-consent to STI and HIV testing and treatment, but a lack of knowledge about these varied and often conflicting laws have driven youth to forego important medical care.
Youth ages 13-17 in the United States are significantly burdened by sexually transmitted infections (STI) and HIV, but many adolescents forego testing, treatment, and prevention services for these health conditions because they’re concerned that a parent or guardian may find out.
Minor consent laws provide underage youth the legal ability to obtain these services without their parents’ permission, but these laws and the confidentiality protections around them vary by state—and many youth are not aware of their right to self-consent, according to a new study led by Kimberly Nelson, associate professor of community health sciences at the School of Public Health.
Published in the journal JAMA, the study found that all 50 states, plus Washington, DC, allowed minors to self-consent to STI and HIV testing and treatment, as of October 2021. The majority of states permitted this consent to youth with no minimum age requirement, but a handful of states—such as Vermont, North Dakota, and Washington—only grant this capacity to adolescents when they reach ages of 12 or 14.
The results also showed that more than 30 states allowed minors to consent independently to STI and HIV prevention, including human papillomavirus vaccination and HIV preexposure and postexposure prophylaxis, but in 14 states, minors had to meet specific conditions (such as risk of death or other health issue as a result of delayed care) to consent independently.
“Ensuring that clinicians, researchers, and minors understand and trust these minor consent laws is essential for reducing barriers to STI and HIV care for adolescents and promoting sexual health and equity in the US,” says Nelson, corresponding author of the study.
These findings stem from a five-year, $2.7 million grant that Nelson received from the National Institute of Mental Health in 2020 to conduct the first-ever content analysis of minor consent laws for HIV and other STI services in the US. Researchers say the current laws are dated, lack details, or provide conflicting information.
In addition to a lack of knowledge among both youth and their doctors about minor consent laws, most states also do not adequately address confidentiality obligations for physicians, the new study found. Without proper knowledge of minor consent laws and procedures in place for navigating them, physicians could accidently disclose these services in electronic health records or insurance billing, the researchers say.
“Trainings, policies, and procedures that support and routinize the application of these statutes and address confidentiality loopholes are critical for both clinicians and adolescents to benefit from them,” Nelson says.
The study was co-authored by Alexandra Skinner (Sargent’19, SPH’20) of the Department of Health Law, Policy & Management at the time of the study. The senior author was Kristen Underhill of Cornell Law School.