Minor Consent Laws for Sexually Transmitted Infection and HIV Services

Nelson, Kevin; Skinner, Alexandra; Underhill, Kristen

doi:10.1001/jama.2022.10777

Cited by 13 publications

(8 citation statements)

References 3 publications

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“…Additionally, rural physicians may require training in how to disclose to parents/guardians that their minor tested positive for HIV, especially if they are required to by state law or decide to own their own. 32 This study found that rural respondents were overall less comfortable in all of the PrEP-related clinical activities than urban respondents. This might be unsurprising as rural SMM have indicated their local PCPs are unknowledgeable about PrEP, are reluctant to prescribe it, and are uncomfortable talking about sex.…”

Section: Discussionmentioning

confidence: 65%

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HIV pre‐exposure prophylaxis awareness, practices, and comfort among urban and rural family medicine physicians

Owens

2022

The Journal of Rural Health

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Purpose: HIV rates are increasing in rural areas, and adolescents are disproportionately affected. HIV pre-exposure prophylaxis (PrEP) is a daily pill that is effective at preventing HIV; however, PrEP uptake among adolescents is low. PrEP is dependent on primary care providers (PCPs) prescribing it, but research has overwhelmingly sampled urban PCPs. This study compared the PrEP awareness, practices, and comfort between rural and urban family medicine physicians. Methods: A total of 256 family medicine physicians in the United States were recruited from a Qualtrics panel to complete an online cross-sectional survey between July 15 and August 9, 2022. Participants completed items assessing their demographic characteristics and PrEP awareness, practices, and comfort. A chi-square test of independence and multiple logistic regression were used to determine rural/urban differences. Findings: Rural family medicine physicians were less comfortable than urban family medicine physicians in providing sexual risk reduction counseling to adolescents, telling an adolescent patient their HIV test result was HIV positive, and implementing all of the PrEP clinical activities for adolescents. Conclusions: Education, skill-building, and collaborative partnership interventions could improve the comfort levels of rural family medicine physicians in implementing the PrEP guidelines for their adolescent patients. Future research is needed to understand the factors that explain the differences in PrEP-related attitudes and practices between urban and rural family medicine physicians. Results from such studies could inform provider-based interventions that ultimately increase PrEP use and decrease HIV rates among rural adolescents.

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Section: Discussionmentioning

confidence: 65%

“…Rural physicians need to be trained in how to disclose an HIV‐positive result to adolescent patients. Additionally, rural physicians may require training in how to disclose to parents/guardians that their minor tested positive for HIV, especially if they are required to by state law or decide to own their own 32 …”

Section: Discussionmentioning

confidence: 99%

HIV pre‐exposure prophylaxis awareness, practices, and comfort among urban and rural family medicine physicians

Owens

2022

The Journal of Rural Health

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“…42 Peer navigators can also assist young people in engaging with complex healthcare institutions, 52 with peer organizations collaborating with NGOs and CBOs to advocate shifts in institutional norms to promote youth-friendly practices, such as ensuring thorough implementation of minor consent regulations to protect adolescents' confidentiality in accessing PrEP. 53 Finally, a practice-based HIV prevention framework illustrates the counterproductive impacts of Thai government regulations announced in October 2022, which discontinue government funding to reimburse civil society groups for the costs of PrEP and HIV testing of individuals not covered by Universal Health Care. 10,54 With an estimated 60% to 70% of PrEP in Thailand provided through civil society organizations -including the preponderance of gay and transgender people who choose to avoid discrimination and stigma from HCPs in government clinics despite having Universal Health Coverage -this policy reversal in effect discontinues coverage for the majority of people currently receiving PrEP.…”

Section: Discussionmentioning

confidence: 99%

Multilevel Factors Impacting PrEP Engagement Among Young Gay Men and Young Transgender Women in Thailand: A Qualitative Analysis

Newman

Tepjan²,

Fongkaew

et al. 2023

J Int Assoc Provid AIDS Care

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Half of new HIV infections in Thailand are among young people, the majority of whom are young gay and other men who have sex with men (YMSM) and young transgender women (YTGW). Amid low pre-exposure prophylaxis (PrEP) coverage, we explored practice-based factors that impact PrEP engagement among YMSM and YTGW. In 2018, we conducted 4 focus group discussions with 20 YMSM and 5 YTGW, and 22 in-depth interviews (5 in 2022) with healthcare providers (HCPs), community-based organization (CBO)/nongovernmental organization (NGO) staff, and peer educators. The inclusion of PrEP in universal healthcare coverage, including YMSM and YTGW, is a substantial facilitator of PrEP use; however, systemic barriers at microsocial (lack of communication about PrEP from HCPs, teachers, parents), mesosocial (healthcare-service fragmentation, lack of PrEP-competent HCPs), and macrosocial levels (annual quotas on free HIV-testing, HIV- and sexual-stigma) constrain and disincentivize adolescents’ engagement with PrEP. National scale-up of youth-friendly and LGBT-affirmative CBO/NGO clinics, HCP training, and tailored programs to support adolescents’ adherence may promote PrEP engagement among YMSM and YTGW in Thailand.

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“…In Reply State laws that enable minors to consent independently to health care have important limitations, including those raised by Mr Kels. Minor consent regimes are complex and often require simultaneous application of multiple statutes, which makes the laws difficult to interpret and trust.…”

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confidence: 95%

Consent Laws for Minors Regarding Sexually Transmitted Infection and HIV Services—Reply

Underhill

Nelson

2022

JAMA

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Minor Consent Laws for Sexually Transmitted Infection and HIV Services

Abstract: This study examines current minor consent laws for sexually transmitted infection/HIV services and related confidentiality protections in all 50 states and the District of Columbia.

Cited by 13 publications

References 3 publications

HIV pre‐exposure prophylaxis awareness, practices, and comfort among urban and rural family medicine physicians

HIV pre‐exposure prophylaxis awareness, practices, and comfort among urban and rural family medicine physicians

Multilevel Factors Impacting PrEP Engagement Among Young Gay Men and Young Transgender Women in Thailand: A Qualitative Analysis

Consent Laws for Minors Regarding Sexually Transmitted Infection and HIV Services—Reply

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