Adolescent Perceptions of HIV Testing Access and Utilization Across Two States with Varying Laws Regulating Minors' Access to Confidential Sexual Health Services: A Qualitative Study in Connecticut and New Jersey.
Aivadyan C, Takenaka B, Rutledge J, Kershaw T • AIDS and behavior • 2025
Despite stressing the importance of confidentiality, most adolescents lacked awareness of state laws regulating minors' access to confidential sexual health services, and few thematic differences were found between states with and without mandated HIV testing confidentiality.
Key Findings
Results
Few thematic differences in HIV testing perceptions were found between adolescents in Connecticut (mandated confidentiality) and New Jersey (no mandated confidentiality).
60 sexually active adolescents aged 16-17 were interviewed across two states
30 participants from Connecticut where confidentiality for HIV testing is mandated, and 30 from New Jersey where it is not mandated
Interviews were conducted between November 2022 and June 2023
Analysis used Dedoose software guided by Andersen's behavioral model of health services use to identify thematic convergence and divergence across states
Results
Most adolescent participants were unaware of state laws regulating minors' access to confidential sexual health services, despite emphasizing the importance of confidentiality.
Lack of awareness of state laws was identified across both Connecticut and New Jersey participants
This finding held even though participants stressed confidentiality as important to their healthcare engagement
The study used a purposive sample of sexually active adolescents aged 16-17
This disconnect between valuing confidentiality and lacking legal awareness was a key area of thematic convergence across states
Results
Confidential care was identified as a key theme underlying adolescent perceptions of HIV testing access and utilization.
Confidential care was defined as having time alone with a healthcare provider during visits, the ability to self-consent to services, and the privacy of health information being maintained
This theme emerged consistently across both states
Semi-structured interviews were used to elicit participant perceptions
Confidential care was identified as a key mechanism potentially actionable for increasing HIV testing uptake
Results
Adolescents connected receipt of confidential care to increased comfort engaging in sexual health discussions, disclosing sensitive information, and testing for HIV.
Participants reported that confidential care increased comfort in discussing sexual health issues with providers
Confidential care was linked to greater willingness to disclose sensitive sexual health information
Receipt of confidential care was associated with increased likelihood of HIV testing
These associations were reported across both Connecticut and New Jersey participants
Background
Confidentiality concerns were identified as a significant barrier to sexual health service utilization for adolescents.
This finding is consistent with prior literature cited in the background of the study
The study specifically examined HIV testing as a sexual health service
Confidentiality concerns were framed as a 'key mechanism that can be acted upon to increase adolescent HIV testing uptake'
The study targeted sexually active adolescents aged 16-17, a population at elevated risk for HIV exposure
What This Means
This research suggests that teenage perceptions of HIV testing are shaped heavily by whether they believe their health information will remain private, regardless of whether their state legally requires that privacy to be protected. Researchers interviewed 60 sexually active 16- and 17-year-olds in Connecticut (where teen HIV testing confidentiality is legally required) and New Jersey (where it is not), and found surprisingly little difference in how teens in the two states thought about HIV testing access. In both states, most teens did not know what their state's laws said about their right to private health services.
What teens did consistently report, in both states, was that feeling confident their information would stay private — including having one-on-one time with a provider, being able to make their own healthcare decisions, and knowing their results wouldn't be shared without their consent — made them more comfortable talking honestly about their sexual health and more willing to get tested for HIV. This suggests the actual experience of receiving confidential care matters more to teens than what the law says on paper.
This research suggests that simply having a law mandating confidentiality may not be enough to increase HIV testing among teenagers if they don't know the law exists or don't trust it will be honored in practice. Efforts to improve adolescent HIV testing may need to focus on ensuring teens actually experience private, respectful care and on educating them about their existing rights to confidential services.
Aivadyan C, Takenaka B, Rutledge J, Kershaw T. (2025). Adolescent Perceptions of HIV Testing Access and Utilization Across Two States with Varying Laws Regulating Minors' Access to Confidential Sexual Health Services: A Qualitative Study in Connecticut and New Jersey.. AIDS and behavior. https://doi.org/10.1007/s10461-025-04738-3