Associations Between State Laws Regulating Minors' Access to Confidential Sexual Health Services and Lifetime HIV Testing Among US Male High School Students

Confidentiality concerns are a well-established barrier to sexual health services for adolescents. These barriers are likely even greater for young men who have sex with men (YMSM), who often experience stigma at multiple levels. This study examined the relationship between state laws regulating minors' access to confidential sexual health services, sexual behavior, and lifetime HIV testing among a large, representative sample of sexually active male high school students from the 2019 state-level Youth Risk Behavior Surveillance System (23 states; N = 17,509). We used multilevel logistic regression to examine whether confidentiality-promoting state laws (i.e., states that explicitly allowed minors to self-consent to HIV testing, did not have an age clause which set a minimum age to self-consent to sexual health services, did not permit parental notification, had confidentiality protections for insured dependents) were associated with lifetime HIV testing, and whether associations differed between YMSM (n = 1,718) and young men who have sex with women only (i.e., YMSWO; n = 15,791). After adjusting for individual- and state-level characteristics, HIV testing was significantly more likely for students in states that explicitly allowed minors to self-consent to HIV testing (adjusted odds ratio [aOR]: 1.12, 95% confidence interval [CI]: 1.05-1.21, p <.001), did not permit parental notification (aOR: 1.09, CI: 1.05-1.12, p <.001), or had confidentiality protections for insured dependents (aOR: 1.40, CI: 1.34-1.45, p <.001), and significantly less likely for those in states that lacked age clauses (aOR: 0.82, CI: 0.80-0.84, p <.001). We found no evidence for moderation of these associations by YMSM status (i.e., the effects of laws being confidentiality-promoting on HIV testing did not differ significantly for YMSM and YMSWO). Findings suggest that certain confidentiality-promoting state laws may be effective at increasing HIV testing among sexually active male adolescents, regardless of sexual behavior.