Roughly half of new sexually transmitted infections (STIs) every year are among young adults and teens, and all states, to varying degrees, allow minors to independently access STI testing and treatment without a guardian’s consent.
But a new study published today by the American Academy of Pediatrics (AAP) shows that most adolescents don’t know they have the legal right to access this confidential treatment.
That lack of knowledge is, itself, a barrier to care, said lead author Kimberly M. Nelson, PhD, MPH, a clinical psychologist at Boston University.
Untreated STIs can have long-term health consequences, including chronic pain and infertility. But Nelson told CIDRAP News some teens are unwilling or unable to involve their guardians in their sexual health care.
“For some youth it might not be safe,” she said.
Patchwork of state laws
Nelson and her collaborators surveyed 5,888 teens, ages 13 to 17, about minor consent laws in their jurisdiction. There were at least 50 respondents per state and the District of Columbia.
State laws vary by age and medical service, according to a 2022 analysis. North Dakota doesn’t allow minors who are younger than 14 to receive confidential testing and treatment. In California, the cutoff is 12. Kansas and New York have no age restrictions. Arizona, Connecticut, and Alaska restrict only preventive care, such as pre-exposure prophylaxis for HIV.
Teens were asked whether they could receive STI and HIV services without a guardian’s permission, and whether they had been tested for HIV and STIs in the past year.
The survey found that over half of teens didn’t know whether they had the right to independently consent to STI and HIV care.
Also, living in a state that allows confidential treatment makes little difference. The survey found 11% of survey respondents who received an STI test within the past year lived in a state where they didn’t need a guardian’s consent, vs. 9.4% who needed permission.
However, knowledge of these legal rights made a big difference. Teens were more than twice as likely to have gotten STI testing if they were aware they could do so independently. The difference between knowing their legal rights and not knowing was 19.7% and 9.4%.
The survey found the association between knowledge and testing was strongest among teens who reported that they learned of their legal rights from school or healthcare providers.
Privacy gaps remain
A teen’s ability to consent is just part of the confidentiality continuum, and these laws alone are “insufficient,” noted a commentary, also published today by AAP, by researchers who did not contribute to the survey.
Most minors are insured through their parents, and as the commentary explains, privacy breaches can occur via healthcare portal messages and medical bills.
Nelson agreed that confidentiality gaps remain. She said that even if clinicians are aware that they can provide medical care to a teen without a guardian’s consent, they might not be comfortable doing so.
“There’s no part of the law that says providers or organizations have to give minors this ability to test without their guardians’ permission,” she said.
To encourage STI testing and treatment among adolescents, Nelson said organizations need to design systems that are youth-friendly, including clinics that cover the cost of sexual healthcare for minors.