{"id":221641,"date":"2023-02-03T11:11:00","date_gmt":"2023-02-03T16:11:00","guid":{"rendered":"https:\/\/www.bu.edu\/sph\/?post_type=bu-article&#038;p=221641"},"modified":"2023-02-05T21:41:20","modified_gmt":"2023-02-06T02:41:20","slug":"minor-consent-laws-for-sti-hiv-services-increased-across-us-but-limitations-persist","status":"publish","type":"bu-article","link":"https:\/\/www.bu.edu\/sph\/news\/articles\/2023\/minor-consent-laws-for-sti-hiv-services-increased-across-us-but-limitations-persist\/","title":{"rendered":"Minor Consent Laws for STI\/HIV Services Have Increased Across US, but Limitations Persist"},"content":{"rendered":"\t<div class=\"wp-block-editorial-leadin sphnews-block-editorial-leadin is-style-text-over-image has-media has-box has-media-focus-center-middle has-text-position-x-left has-primary-theme\">\n\t\t<div class=\"container-lockup\">\n\n\t\t\t<div class=\"wp-block-leadin-media\">\n\t\t\t\t\n\t\t\t\t<img width=\"2560\" height=\"1707\" src=\"\/sph\/files\/2023\/02\/consent2-scaled.jpg\" class=\"\" alt=\"Doctor holding a clipboard, showing it to her child patient and explaining something. Focus on the front (stethoscope and doctor&#039;s uniform), patient out of focus in the background\" loading=\"lazy\" srcset=\"https:\/\/www.bu.edu\/sph\/files\/2023\/02\/consent2-scaled.jpg 2560w, https:\/\/www.bu.edu\/sph\/files\/2023\/02\/consent2-636x424.jpg 636w, https:\/\/www.bu.edu\/sph\/files\/2023\/02\/consent2-1024x683.jpg 1024w, https:\/\/www.bu.edu\/sph\/files\/2023\/02\/consent2-768x512.jpg 768w, https:\/\/www.bu.edu\/sph\/files\/2023\/02\/consent2-1536x1024.jpg 1536w, https:\/\/www.bu.edu\/sph\/files\/2023\/02\/consent2-2048x1365.jpg 2048w, https:\/\/www.bu.edu\/sph\/files\/2023\/02\/consent2-755x503.jpg 755w, https:\/\/www.bu.edu\/sph\/files\/2023\/02\/consent2-1500x1000.jpg 1500w, https:\/\/www.bu.edu\/sph\/files\/2023\/02\/consent2-900x600.jpg 900w, https:\/\/www.bu.edu\/sph\/files\/2023\/02\/consent2-450x300.jpg 450w, https:\/\/www.bu.edu\/sph\/files\/2023\/02\/consent2-600x400.jpg 600w, https:\/\/www.bu.edu\/sph\/files\/2023\/02\/consent2-1920x1280.jpg 1920w, https:\/\/www.bu.edu\/sph\/files\/2023\/02\/consent2-1200x800.jpg 1200w\" sizes=\"(max-width: 2560px) 100vw, 2560px\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\n\t\t\t\n\t\t\t\t<div class=\"container-words-outer\">\n\n\t\t\t\t\t\n\t\t\t\t\t<div class=\"container-words-inner has-opacity-70\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"wp-prepress-tag\">youth<\/span>\n\t\t\t\t\t\t\t\t<h1 class=\"head\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<br><strong>Minor Consent Laws for STI\/HIV Services Have Increased Across US, but Limitations Persist<\/strong>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/h1>\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t<h4 class=\"deck\"><br>As of 2021, all 50 states and Washington, DC allow youth to consent independently to some or all of these services, but the laws remain complex and varied, and confidentiality protections are rare.<\/h4>\n\t\t\t\t\t\t\n\t\t\t\t\t<\/div>\n\n\t\t\t\t<\/div>\n\n\t\t\t\n\t\t<\/div>\n\n\t\t\n\t<\/div>\n\n\t\n<div class=\"wp-prepress-component-metabar js-block-editorial-metabar sphnews-prepress-layout-metabar\">\n\t<div class=\"wp-prepress-component-metabar-wrapper\">\n\t\t\t\t\t<div class=\"wp-prepress-component-metabar-date\">February 3, 2023<\/div>\n\t\t\n\t\t\t\t<div class=\"wp-prepress-component-metabar-credits\">\n\t\t\t\t\t\t\t\t<ul data-credit-type=\"By\">\n\t\t\t\t\t\t<li><a href=\"https:\/\/www.bu.edu\/sph\/news\/authors\/jillian-mckoy\/\">Jillian McKoy<\/a><\/li>\n\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"wp-prepress-component-metabar-share js-bu-prepress-share-tools\">\n\t\t\t<span class=\"icon-twitter\"><span>Twitter<\/span><\/span>\n\t\t\t<span class=\"icon-facebook\"><span>Facebook<\/span><\/span>\n\t\t\t<span class=\"icon-action\"><\/span>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\t\n\n\n<p>Increasing sexually transmitted infection (STI) and HIV testing, treatment, and preventive services use among adolescents is key to decreasing STI and HIV rates among this population in the United States. Youth are <a href=\"https:\/\/www.cdc.gov\/std\/life-stages-populations\/adolescents-youngadults.htm\" target=\"_blank\" rel=\"noreferrer noopener\">disproportionately<\/a> <a href=\"https:\/\/www.cdc.gov\/healthyyouth\/youth_hiv\/hiv-information-and-youth.htm\" target=\"_blank\" rel=\"noreferrer noopener\">burdened<\/a> by these health conditions, particularly among sexual, gender, and racial minorities, and this burden has only <a href=\"https:\/\/www.politico.com\/news\/2022\/03\/12\/covid-std-crisis-00015717\">worsened<\/a> over the course of the pandemic.<\/p>\n\n\n\n<p>Minor consent laws provide underage youth the ability to obtain these services without their parents\u2019 permission, but these laws are complex, substantially limited, and vary by state, and many adolescents <a href=\"https:\/\/www.bu.edu\/sph\/news\/articles\/2022\/too-many-youth-and-their-doctors-are-unaware-of-minor-consent-laws\/\" target=\"_blank\" rel=\"noreferrer noopener\">are unaware<\/a> that these laws even exist.<\/p>\n\n\n\n<p>Understanding 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 US adolescents, according to a new study led by a School of Public Health researcher.<\/p>\n\n\n\n<p><a href=\"https:\/\/ajph.aphapublications.org\/doi\/10.2105\/AJPH.2022.307199\" target=\"_blank\" rel=\"noreferrer noopener\">Published in the <em>American Journal of Public Health<\/em><\/a>, the study examined how minor consent laws for STI and HIV testing, treatment, and preventive services have changed over the last century in all 50 states and Washington, DC.<\/p>\n\n\n\n<p>The number of states allowing minors to consent independently to STI and HIV services increased considerably, but in many states, these laws remain unclear or narrow in scope, allow doctors to decide which information they disclose to guardians, or fail to address inadvertent breaches of confidentiality through insurance billing and claims.<\/p>\n\n\n\n<p>These disclosures may reveal information about youths\u2019 gender identity, sexual activity, or sexual orientation, which could put them at risk of rejection or abuse by their guardians.<\/p>\n\n\n\n<p>\u201cAlthough there have been substantial gains in minor&#8217;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,\u201d says study lead and corresponding author <a href=\"https:\/\/www.bu.edu\/sph\/profile\/kimberly-nelson\/\">Kimberly Nelson<\/a>, associate professor of community health sciences. \u201cMinors have gained the right to consent to STI\/HIV testing and treatment without needing a guardian&#8217;s permission in all 50 states and DC, but their ability to consent independently to STI\/HIV prevention services\u2014including the HPV vaccine and pre-exposure prophylaxis (PrEP) for HIV\u2014is still lacking in many states. Clinicians need to be aware of the intricacies of these laws to help minor patients navigate which services they are allowed to independently consent to, as well as payment and insurance loopholes to confidentiality.\u201d<\/p>\n\n\n\n<p><br>For the study, Dr. Nelson and colleagues analyzed state health laws, judicial opinions and regulations between 1900-2021, categorizing minor consent laws by general healthcare; STI\/HIV testing, treatment, and prevention; and PrEP or postexposure prophylaxis (PEP).<\/p>\n\n\n\n<p>Between 1900-1959, the laws were extremely limited, and likely reflected increasing concerns that STIs hindered childbearing and marriage. Only nine states had consent laws around STI testing and treatment, and only one state\u2014Rhode Island\u2014had regulations that addressed STI prevention services.<\/p>\n\n\n\n<p>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 then continued to increase steadily over the next decades, and by 2021, minors could consent independently to STI\/HIV testing and treatment in all 50 states and DC, STI prevention services in 32 jurisdictions, and HIV prevention services in 33 jurisdictions.<\/p>\n\n\n\n<p>But confidentiality protections are still rare and varied in the majority of states, across regions and political party lines, from California, to Alabama, to Iowa. All 50 states and DC allow minors to consent independently to STI\/HIV testing and treatment, but only 13 states mandate confidentiality for STI services, and only 14 states mandate confidentiality for HIV services\u2014and many of these laws grant exceptions, such as the ability for doctors to disclose minors\u2019 information if a test is positive or if they are contacted by the adolescent\u2019s parent or guardian.<\/p>\n\n\n\n<p>In Massachusetts, doctors can disclose minors\u2019 health information to their guardian if they are in a life-threatening condition or face amputation of a limb. The only states that provide full mandatory confidentiality laws with no exceptions are Connecticut, Florida, Illinois, Nevada, New York, Virginia, and Wyoming. <\/p>\n\n\n\n<p>The study also showed that only five states have attempted to protect minors\u2019 healthcare payor information from disclosure to guardians.<\/p>\n\n\n\n<p>The researchers urge legal and policy changes that will ensure additional protections for youth.<\/p>\n\n\n\n<p>\u201cMinors 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,\u201d Nelson says. \u201cPolicymakers should seek to improve these laws to address their complexity, reliance on clinician interpretation, and the substantial confidentiality concerns that remain.\u201d<\/p>\n\n\n\n<p>At SPH, the study was coauthored by <a href=\"https:\/\/www.bu.edu\/sph\/profile\/julia-raifman\/\">Julia Raifman<\/a>, assistant professor of health law, policy &amp; management, and alum Alexandra Skinner.<\/p>\n\n\n\t<aside class=\"wp-block-editorial-relatedstories is-style-card has-two sphnews-block-editorial-relatedstories\">\n\t\t<h3 class=\"wp-block-editorial-relatedstories-title\">Related<\/h3>\n\t\t<ul class=\"wp-block-editorial-relatedstories-list\">\n\t\t\t\t\t\t\t<li class=\"wp-block-editorial-relatedstories-list-item\">\n\t\t\t\t\t<article class=\"wp-block-editorial-relatedstories-article\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<figure class=\"wp-block-editorial-relatedstories-article-image\">\n\t\t\t\t\t\t\t\t\t<img width=\"600\" height=\"362\" src=\"\/sph\/files\/2022\/09\/consentform1-copy.jpg\" class=\"attachment-post-thumbnail size-post-thumbnail wp-post-image\" alt=\"\" loading=\"lazy\" \/>\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"wp-block-editorial-relatedstories-article-content\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<p class=\"wp-block-editorial-relatedstories-article-category\"><span>child health<\/span><\/p>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<h4 class=\"wp-block-editorial-relatedstories-article-title\"><a href=\"https:\/\/www.bu.edu\/sph\/news\/articles\/2022\/too-many-youth-and-their-doctors-are-unaware-of-minor-consent-laws\/\" class=\"wp-block-editorial-relatedstories-article-title-link\">Too Many Youth and Their Doctors Are Unaware of Minor Consent Laws<\/a><\/h4>\n\t\t\t\t\t\t\t<p class=\"wp-block-editorial-relatedstories-article-date\">September 9, 2022<\/p>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<\/article>\n\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t<\/aside>\n\t","protected":false},"excerpt":{"rendered":"<p>Increasing sexually transmitted infection (STI) and HIV testing, treatment, and preventive services use among adolescents is key to decreasing STI and HIV rates among this population in the United States. Youth are disproportionately burdened by these health conditions, particularly among sexual, gender, and racial minorities, and this burden has only worsened over the course of [&hellip;]<\/p>\n","protected":false},"author":15205,"featured_media":221648,"comment_status":"closed","ping_status":"closed","template":"","meta":{"bu_prepress_billboard":"","_bu_prepress_primary_term":"youth","_bu_prepress_primary_term_manual":""},"tags":[2439,2488,2178,1976,3649,3887,3574],"bu-publication":[3516],"sphnews-article-category":[3519,3525,3531],"sphnews-topic":[],"bu_edition":[],"media_type":[],"profile_tax":[2473,3310],"_links":{"self":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/221641"}],"collection":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article"}],"about":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/types\/bu-article"}],"author":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/users\/15205"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/comments?post=221641"}],"version-history":[{"count":10,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/221641\/revisions"}],"predecessor-version":[{"id":221718,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/221641\/revisions\/221718"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media\/221648"}],"wp:attachment":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media?parent=221641"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/tags?post=221641"},{"taxonomy":"bu-publication","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-publication?post=221641"},{"taxonomy":"sphnews-article-category","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/sphnews-article-category?post=221641"},{"taxonomy":"sphnews-topic","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/sphnews-topic?post=221641"},{"taxonomy":"bu_edition","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu_edition?post=221641"},{"taxonomy":"media_type","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media_type?post=221641"},{"taxonomy":"profile_tax","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/profile_tax?post=221641"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}