Pre-exposure prophylaxis (PrEP) is a highly effective method of HIV prevention. Data from the Centers for Disease Control and Prevention show that PrEP use among gay, bisexual, and other men who have sex with men (MSM) increased 500% from 2014 to 2017, although uptake among other groups remains lower and disparities among MSM continue to exist. Further efforts are needed to support PrEP uptake among adolescents and young adults, including reform of consent and confidentiality laws that hinder PrEP access.
Adolescents and young adults bear a disproportionate HIV burden. In 2017, youth aged 13 to 24 made up 21% of all new HIV diagnoses. The vast majority of these new diagnoses (83%) occurred among young gay and bisexual men, with Black and Latinx gay and bisexual men most affected. Young Black gay and bisexual men account for half of new HIV diagnoses among young gay and bisexual men, while young Latinx gay and bisexual men, who experienced a 17% increase in HIV diagnoses between 2010-2016, account for a quarter of new HIV diagnoses among young gay and bisexual men.
Ensuring that adolescents and young adults at risk for HIV can access PrEP is a key step toward reducing new HIV infections among this population. A number of states have recently taken steps to update laws to permit minors (i.e., young people who have not reached the age of majority, which varies from state to state but is 18 years old in most states) to consent to PrEP without parental consent. Eliminating parental consent requirements removes a major barrier to PrEP access for young people at risk for HIV, who may not have disclosed their sexual orientation or risk behaviors to their parents and may fear the repercussions of disclosure.
Earlier this year, I wrote an issue brief for amfAR that discussed statutory and regulatory reforms that permitted minors to consent on their own to PrEP in Colorado and New York. This month, Connecticut Governor Ned Lamont signed into law HB 6540, which allows Connecticut health providers to prescribe PrEP without parental consent to minors who disclose that they are at risk of HIV exposure and request PrEP for protection. In May, the Illinois General Assembly passed HB 2665, a bill that aligns state with federal guidance on a minor’s ability to access preventive health care services, like PrEP, without parental consent. The bill is currently awaiting Governor J.B. Pritzker’s signature.
More states must consider options for improving PrEP access and supporting effective HIV prevention for adolescents and young adults. This must include addressing issues of consent and confidentiality that can be significant barriers to obtaining care. There is no time to waste.