Minor Consent Laws and HIV Prevention Among Adolescents in the United States

项目摘要/摘要 在美国，人类免疫缺陷病毒(HIV)给13-17岁的青少年带来了严重的负担。 青少年的其他性传播感染(STI)的比率也很高，这会增加感染艾滋病毒的风险 采集和传输。性、性别和种族/少数民族青少年比例不成比例 受影响。增加艾滋病毒/性传播感染检测和暴露前预防(PrEP)使用是美国的关键组成部分 降低青少年艾滋病毒感染率的国家战略。尽管如此，很少有青少年收到 HIV/STI检测或PrEP。保密问题是艾滋病毒/性传播感染检测和PrEP使用的重大障碍 在青少年中。为了减轻这些担忧，许多州都颁布了法律，允许未成年人放弃 监护人同意艾滋病毒/性传播感染检测、治疗和预防服务，包括PrEP。尽管这些法律 旨在保护年轻人不受不必要的披露给他们的监护人-从而增加对 HIV/STI检测和PrEP-缺乏评估这些法律如何与行为和 年轻人是否意识到这些规律。我们提出的研究通过追求三个目标来解决这一差距。 第一，评估艾滋病毒/性传播感染检测、治疗和预防的轻微同意法的纵向变化 1985年-目前，我们团队中的法律专家将首次对国家未成年人进行纵向内容分析 同意法。指定和量化定律随时间和状态的变化的纵向数据集将 被创建并向公众开放。第二，我们将纵向评估未成年人变化的影响 关于青少年艾滋病毒/性传播感染检测和治疗的同意法。要做到这一点，我们将纵向联系法律 第一个创建的数据集旨在全国家庭成长调查中的青少年健康行为数据。 使用差异中差异的方法，我们将评估次要同意的变化 法律与青少年艾滋病毒/性传播感染检测和治疗的总体变化以及按性别、种族/族裔有关。 和性少数群体的地位。第三，我们将评估当前知识和对 通过一项横断面在线调查，青少年中的未成年人同意法、艾滋病毒/性传播感染检测和PrEP感染情况 来自所有50个州和哥伦比亚特区的青少年(N=6120，年龄13-17岁)。这项调查将 审查：(1)对现行次要同意法的知识和看法；(2)艾滋病毒/性传播感染检测和预防接种计划 知识和吸收；以及(3)向青年传播这一信息的最佳做法。分析将是 根据性别、性别、种族/族裔和性少数地位，对青年进行了总体调查。这项研究将(1) 提供迄今为止对未成年人同意立法进行的最全面、最严格的方法评估；(2) 首次确定这些法定保护措施随着时间的推移如何影响检测和治疗；以及(3)确定 认识和理解这些法律以及继续阻碍艾滋病毒/性传播感染的潜在障碍 在青少年中进行测试和获取PrEP。

PROJECT SUMMAY / ABSTRACT Human immunodeficiency virus (HIV) significantly burdens youth 13–17 years of age in the United States (US). Adolescents also have high rates of other sexually transmitted infections (STIs), which increases risk of HIV acquisition and transmission. Sexual, gender, and racial/ethnic minority adolescents are disproportionately affected. Increasing HIV/STI testing and pre-exposure prophylaxis (PrEP) use are key components of the US national strategy to decrease HIV rates among adolescents. Despite this, few adolescents have received HIV/STI testing or PrEP. Confidentiality concerns are a significant barrier to HIV/STI testing and PrEP use among adolescents. To allay these concerns, many states have enacted statutes permitting minors to waive guardian consent for HIV/STI testing, treatment, and prevention services, including PrEP. Although these laws are meant to protect youth from unwanted disclosure to their guardians—and thereby increase uptake of HIV/STI testing and PrEP—there is a dearth of research assessing how these laws relate to behavior and whether youth are aware of these laws. Our proposed study addresses this gap through pursuing three aims. First, to assess longitudinal changes in minor consent laws for HIV/STI testing, treatment, and prevention from 1985–present, legal experts on our team will conduct the first-ever longitudinal content analysis of state minor consent laws. A longitudinal dataset specifying and quantifying changes in the laws over time and by state will be created and made publicly available. Second, we will longitudinally evaluate the effect of changes in minor consent laws on HIV/STI testing and treatment among adolescents. To do this we will link the longitudinal legal dataset created in the first aim to adolescent health behavior data in the National Survey of Family Growth. Using a difference-in-difference-in-differences approach, we will evaluate whether changes in minor consent laws were associated with changes in HIV/STI testing and treatment for youth overall and by sex, race/ethnicity and sexual minority status. Third, we will assess relations between current knowledge and perceptions of minor consent laws, HIV/STI testing, and PrEP uptake among adolescents via a cross-sectional online survey of adolescents (N = 6120, ages 13-17 years) from all 50 states and the District of Columbia. The survey will examine: (1) knowledge and perceptions of current minor consent laws; (2) HIV/STI testing and PrEP knowledge and uptake; and (3) best practices for disseminating this information to youth. Analyses will be conducted for youth overall and by sex, gender, race/ethnicity and sexual minority status. This study will (1) provide the most comprehensive, methodologically rigorous evaluation of minor consent legislation to date; (2) identify for the first time how these statutory protections affect testing and treatment over time; and (3) identify awareness and comprehension of these laws, as well as potential barriers that continue to impede HIV/STI testing and PrEP access among adolescents.