Adolescent Perceptions of HIV Testing Access and Utilization Across Two States with Varying Laws Regulating Minors' Access to Confidential Sexual Health Services: A Qualitative Study in Connecticut and New Jersey.

Abstract

Confidentiality concerns have been identified as a significant barrier to sexual health service utilization for adolescents. This qualitative study compares perceptions of HIV testing access and utilization among sexually active adolescents in two U.S. states with varying laws regulating minors' access to confidential sexual health services. Between November 2022 and June 2023, we conducted semi-structured interviews with a purposive sample of 60 sexually active adolescents aged 16-17 in Connecticut (i.e., where confidentiality for HIV testing is mandated; n = 30) and New Jersey (i.e., where confidentiality for HIV testing is not mandated; n = 30). Guided by Andersen's behavioral model of health services use, we used Dedoose software to identify key themes and explore areas of thematic convergence and divergence across states. Overall, we identified few thematic differences between states. Despite stressing the importance of confidentiality, most participants reported a lack of awareness of state laws regulating minors' access to confidential sexual health services. Confidential care-i.e., having time alone with a healthcare provider during visits, the ability to self-consent to services, and the privacy of health information maintained-was identified as a key theme underlying perceptions of HIV testing access and utilization. Participants connected receipt of confidential care to increased comfort engaging in discussion of sexual health issues, disclosing sensitive sexual health information, and testing for HIV. Findings suggest that confidentiality concerns may be a key mechanism that can be acted upon to increase adolescent HIV testing uptake.