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Abstract

A troubling state legislative trend is emerging, marked by regressive restrictions on minors’ sexual health care autonomy, which increases their risk of HIV infection. This trend aligns with the current political hostility towards access to reproductive health care, including minors’ access to contraceptives. Access to HIV preventive care may become collateral damage as politicized parental control legislation aims to roll back established norms that recognized the public health imperative of allowing minorsto independently consent to sexual health care, including HIV testing and treatment, thereby encouraging their uptake. This backsliding is occurring as rates of HIV infection among youth are unacceptably high, and HIV prevention methods like longacting injectable PrEP have become more youth-friendly. Even where minors’ consent to HIV care is allowed, too many states omit HIV preventive care and only cover testing and treatment once infected. Many minors, especially LGBTQ+ youth, will avoid sexual health care if they fear their parents will be informed. Beyond the chilling effect of parental consent or notice requirements, confidentiality gaps are prevalent—especially in insurance billing and electronic medical records access—further deterring minors from seeking HIV preventive care. Given the energized movement to protect access to reproductive health care in response to abortion bans and contraceptive access restrictions, there is an opportunity for youth health advocates to capitalize on that momentum by proposing new protective state statutory measures and reforms of existing inadequate statutes to expand and protect youths’ access to necessary HIV preventive care. I propose several routes to achieve that protection and reform and offer model state statutory provisions to address existing inadequacies and much needed modernization.

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