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

美国青少年的未成年人同意法和艾滋病毒预防

• 批准号: 10516733
• 负责人: Kimberly M Nelson
• 金额: $ 62.07万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-12-25 至 2024-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10516733
• 关键词: 17 year old; AIDS prevention; Address; Adolescent; Affect; Age; Amendment; Awareness; Behavior; Behavioral; Centers for Disease Control and Prevention (U.S.); Comprehension; Consent; Data; Data Set; Decision Making; Disclosure; District of Columbia; Effectiveness; Evaluation; Exposure to; Family; Fright; Goals; Growth; HIV; HIV disparities; HIV risk; Health Personnel; Health Promotion; Health behavior; Healthcare; Human immunodeficiency virus test; Incidence; Intention; Knowledge; Laws; Legal; Link; Methodology; Minor; Perception; Play; Policies; Population; Prevention; Prevention strategy; Public Health; Recommendation; Reporting; Research; Research Personnel; Rights; Risk; Role; Services; Sexual Health; Sexual and Gender Minority Youth; Sexually Transmitted Diseases; Specific qualifier value; Statutes and Laws; Strategic Planning; Surveys; Testing; Time; United States; United States National Institutes of Health; Youth; adolescent health; condom use rate; design; ethnic minority; gender minority; health organization; longitudinal dataset; minority children; pre-exposure prophylaxis; prevention service; racial minority; screening; sex; sexual minority; sexually active adolescent; testing services; transmission process; treatment services; uptake

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.

项目总结/摘要 人类免疫缺陷病毒（HIV）严重影响美国13-17岁的青少年。 青少年的其他性传播感染率也很高，这增加了感染艾滋病毒的风险 采集和传输。性、性别和种族/民族少数的青少年不成比例地 影响。增加艾滋病毒/性传播感染检测和暴露前预防（PrEP）的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，很少有青少年接受 HIV/STI检测或PrEP。保密问题是HIV/STI检测和PrEP使用的重大障碍 在青少年中。为了消除这些担忧，许多州颁布了允许未成年人放弃 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。 旨在保护青少年免受不必要的披露给他们的父母，从而增加对 艾滋病毒/性传播感染检测和准备-缺乏研究评估这些法律如何与行为和 年轻人是否了解这些法律。我们提出的研究通过追求三个目标来解决这一差距。 首先，评估艾滋病毒/性传播感染检测、治疗和预防方面的轻微同意法的纵向变化， 1985年至今，我们团队中的法律的专家将对州未成年人进行有史以来第一次纵向内容分析 同意法。一个纵向数据集，指定和量化法律随时间和州的变化， 创建并公开提供。第二，我们将纵向评估微小变化的影响。 关于青少年艾滋病毒/性传播感染检测和治疗的知情同意法。为此，我们将纵向法律的 第一次创建的数据集旨在收集全国家庭成长调查中的青少年健康行为数据。 使用差异中的差异方法，我们将评估未成年人同意的变化是否 法律与青年总体和性别、种族/民族的艾滋病毒/性传播感染检测和治疗的变化有关 性少数地位。第三，我们将评估当前知识和对 未成年人同意法、艾滋病毒/性传播感染检测和通过横断面在线调查在青少年中进行的PrEP吸收 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）。调查将 检查：（1）对当前未成年人同意法的了解和看法;（2）艾滋病毒/性传播感染检测和PrEP 知识和吸收;（3）向青年传播这一信息的最佳做法。分析将 对所有青年以及按性别、性别、种族/族裔和性少数地位分列的青年进行调查。本研究将（1） 提供迄今为止对未成年人同意立法的最全面、方法上最严格的评估;（2） 首次确定这些法定保护如何随着时间的推移影响检测和治疗;以及（3）确定 对这些法律的认识和理解，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PrEP获取。