Ensuring Confidential Access to HIV Testing, Treatment and Prevention for Minors and Young Adults
Adolescents, Young Adults and HIV Infection: Prevention and Treatment, 2017
Posted: 24 Aug 2017
Date Written: May 1, 2017
Most underage youths (“minors”) lack medical privacy. Pursuant to state laws, the majority of minors are unable to self-consent to their own healthcare. In healthcare decision making, laws require the consent of a third-party decision-maker, such as a parent or guardian (“caregiver”). Although caregiver involvement is desirable in many contexts, it can create a significant barrier to reaching minors and young adults in the context of HIV testing, treatment, and prevention. This chapter focuses on foundational legal and ethical implications of HIV testing, treatment and prevention for adolescents and young adults. I divide challenges into three interrelated dimensions: consent, confidentiality, and cost. Discourse focuses principally on identifying the legal and ethical barriers unaccompanied minors and young adults experience when accessing HIV-related care.
Part A of this chapter focuses on statutory exceptions to the general caregiver consent rule, proposes a framework for understanding them, and applies that framework to HIV testing, treatment, and prevention (including HIV pre-exposure prophylaxis, with the goal of expanding access for self-consenting minors). Part B explores the challenge of ensuring confidentiality for adolescent minors and young adults by surveying protections of and limitations on patient privacy. Cornerstone discussions pertain to HIPAA, Title X, and insurance billing and claim communications (commonly known as "EOBs”). In Part C, the barrier of financing HIV-related care in the post-ACA healthcare environment is explored, focusing on eliciting the disparities caused by the partial expansion of Medicaid among U.S. states. In Part D, recommendations for clinicians and advocates are proposed.
Keywords: Adolescent, Consent, Parental Consent, Confidentiality, HIV, HIV/AIDS, HIV Pre-Exposure Prophylaxis, PrEP, Prevention, Treatment, Mature Minor, Title X, Youth
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