Certain confidentiality-promoting state laws are associated with increased lifetime HIV testing among sexually active male adolescents, regardless of sexual behavior (YMSM vs. YMSWO).
State laws explicitly allowing minors to self-consent to HIV testing were associated with significantly higher odds of lifetime HIV testing among male high school students.
State laws that did not permit parental notification were associated with significantly higher odds of lifetime HIV testing.
State confidentiality protections for insured dependents were associated with the largest increase in odds of lifetime HIV testing among the law types examined.
States lacking age clauses (i.e., no minimum age to self-consent to sexual health services) were associated with significantly lower odds of lifetime HIV testing.
YMSM status did not moderate the association between confidentiality-promoting state laws and lifetime HIV testing.
The study used multilevel logistic regression to examine associations between state-level confidentiality laws and HIV testing in a large, representative sample of male adolescents.
Confidentiality concerns are identified as a well-established barrier to sexual health services for adolescents, and are considered likely greater for YMSM due to multilevel stigma.
This research suggests that the laws in a state governing whether teenagers can privately access sexual health services — without parental knowledge or consent — are meaningfully linked to whether teenage boys get tested for HIV. Using a large, nationally representative survey of over 17,000 sexually active male high school students across 23 states, researchers found that teens in states with stronger privacy protections (such as laws allowing minors to consent to their own HIV test, laws blocking mandatory parental notification, and laws protecting the insurance privacy of dependents) were more likely to have ever been tested for HIV. The strongest association was with insurance confidentiality protections, where students in those states had 40% higher odds of having been tested. Interestingly, the researchers also found that laws without a minimum age requirement for self-consenting to sexual health services were actually associated with lower HIV testing rates — the opposite of what might be expected — suggesting that not all policies framed as confidentiality-promoting work equally in practice. Importantly, these associations were similar for young men who have sex with men (YMSM) and those who only have sex with women, meaning the legal environment appears to matter for all sexually active male teens, not just those at traditionally higher HIV risk. This research suggests that state-level legal policies around confidentiality in healthcare can have real-world effects on whether adolescents seek out HIV testing. Given that confidentiality is a known barrier to teens accessing sexual health services, these findings highlight the potential public health value of policies that protect minors' privacy when seeking sexual health care, including HIV testing.
Aivadyan C, El-Bassel N, Chang M, Santelli J, Philbin M, Wu E. (2025). Associations Between State Laws Regulating Minors' Access to Confidential Sexual Health Services and Lifetime HIV Testing Among U.S. Male High School Students.. AIDS and behavior. https://doi.org/10.1007/s10461-024-04574-x