Assessing the Influence of State-Level Confidentiality-Relevant HIV Laws on U.S. Adolescents' HIV Testing Practices

项目摘要/摘要 Ruth L.Kirschstein博士前个人国家研究服务奖(F31)的目的是 提供必要的研究和培训机会，为成功的职业生涯奠定基础 独立调查员，从事社区参与的、与政策相关的艾滋病毒预防研究 青春年华。与所有其他年龄段相比，美国青少年最不可能意识到自己感染了艾滋病毒 并及时与护理挂钩。增加艾滋病毒检测对改善青少年健康至关重要 艾滋病毒护理连续体每一步的结果。对于感染艾滋病毒风险不成比例的年轻关键人群， 包括男男性行为者(YMSM)、变性人青年(TGY)和注射 在药物(YPWID)方面，定期艾滋病毒检测尤为关键。以前的研究主要集中在个人层面上 与青少年艾滋病毒检测相关的因素，留下了关于结构性- 可能影响他们获得和接受艾滋病毒检测的水平因素。保密问题是一个主要的问题 青少年保健的障碍，表明与保密有关的法律可能会对 他们的测试实践。与保密有关的艾滋病毒法律在州一级各不相同，立法也有很大差异 这允许未成年人同意艾滋病毒检测，要求未成年人达到特定年龄才能放弃父母/监护人 同意，允许提供者通知父母/监护人未成年人的艾滋病毒检测，保护未成年人的机密性 作为受抚养人投保，并要求艾滋病毒检测呈阳性的个人告知他们的性行为和/或针头- 共享伙伴。实现广泛获得检测和与护理的联系--这是 国家艾滋病毒/艾滋病战略--重要的是确定结构性因素(例如，州法律)，这些因素可以 经过修改，以在人口层面上降低青少年感染艾滋病毒的风险。然而，关于这一点的研究还很少。 与保密有关的艾滋病毒法律与青少年艾滋病毒检测做法之间的关系。的目标是 拟议的研究旨在通过检查国家法律环境-保密-的影响来解决这一差距。 有关艾滋病毒的法律--关于美国青少年的艾滋病毒检测实践。这个目标一定会实现的 通过以下目的：(1)检查州法律环境对美国青少年艾滋病毒检测的影响 使用2019年青少年危险行为监测系统的州级数据，(2)评估州是否合法 气候对YMSM、TGY和YPWID的HIV检测实践有不同的影响，以及(3)获取丰富的 探索青少年对与保密相关的艾滋病毒法律如何影响其艾滋病毒检测的看法的定性数据 练习。通过密集的指导、课程作业、通过 拟议的研究和专业发展活动，F31将在(1)方面提供严格的培训 分析和解释基于人口的数据的先进量化方法，(2)收集和分析 定性数据，以及(3)实证写作和学术交流技能，将促进向 研究独立性。

PROJECT SUMMARY/ABSTRACT The purpose of this Ruth L. Kirschstein Predoctoral Individual National Research Service Award (F31) is to provide essential research and training opportunities to lay the foundation for a successful career as an independent investigator who conducts community-engaged, policy-relevant HIV prevention research among youth. Compared to all other age groups, U.S. adolescents are the least likely to be aware of their HIV infection and linked to care in a timely manner. Increasing HIV testing is essential to improving adolescents’ health outcomes at every step of the HIV care continuum. For young key populations at disproportionate risk for HIV, including young men who have sex with men (YMSM), transgender youth (TGY), and young people who inject drugs (YPWID), regular HIV testing is especially critical. Prior research has largely focused on individual-level factors associated with HIV testing among adolescents, leaving a gap in the knowledge base about structural- level factors which may affect their access to and uptake of HIV testing. Confidentiality concerns are a major barrier to health care for adolescents, suggesting that laws related to confidentiality may have an influence on their testing practices. Confidentiality-relevant HIV laws vary on the state-level, with wide variation in legislation that allows minors to consent to HIV testing, requires minors to be a specific age to waive parental/guardian consent, allows providers to notify parents/guardians of minors’ HIV testing, protects the confidentiality of minors insured as dependents, and requires individuals who test positive for HIV to inform their sexual and/or needle- sharing partners. To achieve widespread access to testing and linkage to care – a key area of focus of the National HIV/AIDS Strategy – it is important to identify structural-level factors (e.g., state laws) that can be modified to mitigate HIV risk for adolescents on a population level. However, there is a paucity of research on the relationship between confidentiality-relevant HIV laws and adolescents’ HIV testing practices. The goal of the proposed research is to address this gap by examining the influence of state legal climate – confidentiality- relevant HIV laws in the aggregate – on U.S. adolescents’ HIV testing practices. This goal will be achieved through the following aims: (1) examine the influence of state legal climate on HIV testing for U.S. adolescents using state-level data from the 2019 Youth Risk Behavior Surveillance System, (2) evaluate whether state legal climate has a differential impact on HIV testing practices for YMSM, TGY, and YPWID, and (3) obtain rich qualitative data exploring adolescent perceptions of how confidentiality-relevant HIV laws affect their HIV testing practices. Through a combination of intensive mentorship, coursework, experiential learning through the proposed research, and professional development activities, this F31 will provide rigorous training in (1) advanced quantitative approaches to analyze and interpret population-based data, (2) the collection and analysis of qualitative data, and (3) empirical writing and academic communication skills and will facilitate transition to research independence.