Assessing the Influence of State-Level Confidentiality-Relevant HIV Laws on U.S. Adolescents' HIV Testing Practices

PROJECT SUMMARY/ABSTRACT The purpose of this Ruth L. Kirschstein Predoctoral Individual National Research Service Award (F31) is to provide essential research and training opportunities to lay the foundation for a successful career as an independent investigator who conducts community-engaged, policy-relevant HIV prevention research among youth. Compared to all other age groups, U.S. adolescents are the least likely to be aware of their HIV infection and linked to care in a timely manner. Increasing HIV testing is essential to improving adolescents? health outcomes at every step of the HIV care continuum. For young key populations at disproportionate risk for HIV, including young men who have sex with men (YMSM), transgender youth (TGY), and young people who inject drugs (YPWID), regular HIV testing is especially critical. Prior research has largely focused on individual-level factors associated with HIV testing among adolescents, leaving a gap in the knowledge base about structural- level factors which may affect their access to and uptake of HIV testing. Confidentiality concerns are a major barrier to health care for adolescents, suggesting that laws related to confidentiality may have an influence on their testing practices. Confidentiality-relevant HIV laws vary on the state-level, with wide variation in legislation that allows minors to consent to HIV testing, requires minors to be a specific age to waive parental/guardian consent, allows providers to notify parents/guardians of minors? HIV testing, protects the confidentiality of minors insured as dependents, and requires individuals who test positive for HIV to inform their sexual and/or needle- sharing partners. To achieve widespread access to testing and linkage to care ? a key area of focus of the National HIV/AIDS Strategy ? it is important to identify structural-level factors (e.g., state laws) that can be modified to mitigate HIV risk for adolescents on a population level. However, there is a paucity of research on the relationship between confidentiality-relevant HIV laws and adolescents? HIV testing practices. The goal of the proposed research is to address this gap by examining the influence of state legal climate ? confidentiality- relevant HIV laws in the aggregate ? on U.S. adolescents? HIV testing practices. This goal will be achieved through the following aims: (1) examine the influence of state legal climate on HIV testing for U.S. adolescents using state-level data from the 2019 Youth Risk Behavior Surveillance System, (2) evaluate whether state legal climate has a differential impact on HIV testing practices for YMSM, TGY, and YPWID, and (3) obtain rich qualitative data exploring adolescent perceptions of how confidentiality-relevant HIV laws affect their HIV testing practices. Through a combination of intensive mentorship, coursework, experiential learning through the proposed research, and professional development activities, this F31 will provide rigorous training in (1) advanced quantitative approaches to analyze and interpret population-based data, (2) the collection and analysis of qualitative data, and (3) empirical writing and academic communication skills and will facilitate transition to research independence.