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: 9924815
• 负责人: Kimberly M Nelson
• 金额: $ 39.36万
• 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/9924815
• 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; Ethnic Origin; Evaluation; Exposure to; Family; Fright; Gender; Goals; Growth; HIV; 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; Race; Recommendation; Reporting; Research; Research Personnel; Rights; Risk; Role; Services; Sexual Health; Sexual and Gender Minorities; 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; condoms; design; ethnic minority population; health organization; longitudinal dataset; overtreatment; pre-exposure prophylaxis; prevention service; racial and ethnic; screening; sex; sexual HIV transmission; 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) 给美国 (US) 13-17 岁的青少年带来了巨大负担。 青少年其他性传播感染 (STI) 的发病率也很高，这会增加感染艾滋病毒的风险 采集和传输。性、性别和种族/族裔少数青少年比例过高 做作的。增加 HIV/STI 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，很少有青少年接受过 HIV/STI 检测或 PrEP。保密问题是 HIV/STI 检测和 PrEP 使用的重大障碍 青少年之间。为了减轻这些担忧，许多州颁布了法规，允许未成年人放弃 HIV/STI 检测、治疗和预防服务（包括 PrEP）的监护人同意书。尽管这些法律 旨在保护青少年免于向其监护人披露不必要的信息，从而提高对 HIV/STI 检测和 PrEP——缺乏评估这些法律与行为和行为之间关系的研究。 青少年是否了解这些法律。我们提出的研究通过追求三个目标来解决这一差距。 首先，评估有关 HIV/STI 检测、治疗和预防的未成年人同意法的纵向变化 1985 年至今，我们团队的法律专家将首次对未成年人进行纵向内容分析 同意法。纵向数据集指定和量化法律随时间和各州的变化 被创建并公开发布。其次，我们将纵向评估次要变化的影响。 关于青少年艾滋病毒/性传播感染检测和治疗的同意法。为此，我们将纵向法律联系起来 创建的数据集的第一个目标是全国家庭成长调查中的青少年健康行为数据。 我们将使用双重差异的方法来评估未成年人同意是否发生变化 法律与总体青少年和按性别、种族/民族划分的艾滋病毒/性传播感染检测和治疗的变化有关 和性少数地位。第三，我们将评估当前知识与认知之间的关系 通过横断面在线调查了解未成年人同意法、艾滋病毒/性传播感染检测以及青少年的 PrEP 接受情况 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）。该调查将 检查：(1) 对现行未成年人同意法的了解和看法； (2) HIV/STI检测和PrEP 知识和吸收； (3) 向青少年传播这些信息的最佳做法。分析将是 针对整个青少年并按性别、性别、种族/族裔和性少数群体身份进行。本研究将 (1) 提供迄今为止对未成年人同意立法最全面、方法上最严格的评估； (2) 首次确定这些法定保护措施如何随着时间的推移影响检测和治疗； (3) 识别 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 青少年中的检测和 PrEP 获取。