A new study found that adolescents who were aware of their state’s minor consent laws were more likely to seek and receive testing for HIV and other sexually transmitted infections, suggesting that teens’ accurate knowledge of their legal capacity to consent to healthcare services may be more important than the laws providing this right.
Confidentiality concerns and limitations are significant reasons why adolescents do not seek sexual healthcare. Adolescents who can consent independently to testing, treatment, and prevention services for sexually transmitted infections (STI) and HIV are more likely to receive these services, according to a new study led by a researcher at Boston University School of Public Health (BUSPH).
Furthermore, adolescents who are aware of their legal capacity to consent to STI and HIV services without permission from guardians are even more likely to receive them. The findings were published in the journal Pediatrics .
At the time of the study, which occurred from December 2022-April 2024, all US states and Washington, DC had laws that allowed minors to consent independently to testing and treatment for HIV and certain STIs, depending on age. These laws were implemented to increase access to these services for minors who were hesitant or unwilling to involve their parents or guardians. However, the study found that more than 60 percent of adolescents in the study did not know about their ability to independently consent to these services.
The study is the largest to examine minor consent laws and included at least 50 adolescents in every US state, plus Washington, DC. The findings suggest that adolescents’ accurate knowledge of their state’s minor consent laws may be even more influential in their STI/HIV testing than the laws themselves. Access to this testing is especially important for this age group, as US youth ages 13-24 have disproportionately higher rates of STIs and HIV , compared to older adults, and currently, adolescent STI/HIV testing rates are lower than the goal rates set in Healthy People 2030, the federal government’s 10-year plan for public health.
“These findings indicate that having these laws on the books is not enough—teens need to know about them for the laws to be helpful,” says study lead and corresponding author Dr. Kimberly Nelson , associate professor of community health sciences at BUPSH, and who also recorded a video abstract that is included at the top of the study. Pediatrics also published an invited commentary about the findings.
For the study, Dr. Nelson and colleagues collected survey data on minor consent laws and STI/HIV services, with input from nearly 6,000 adolescents ages 13-17 across the country. The team assessed participants’ knowledge about their ability to consent to receive testing and treatment for STIs and HIV, HIV preventative treatment, and the HPV vaccine. Participants’ legal capacity to consent was determined using a comprehensive dataset the study team created, available at LawAtlas.org , which captures more than 170 years of minor consent laws in each state.
Participants who could independently consent to STI and HIV services were more likely to have received STI and HIV testing within the past year. Among the adolescents who said they knew whether they could or could not independently consent, almost half reported guessing. But those who had accurate knowledge of their ability to independently consent were even more likely to have been tested for STIs and HIV within the past year.
The study also found that teens who learned about minor consent laws from reputable sources such as healthcare providers or at school—as opposed to family and friends or an online source—were also more likely to have received an STI or HIV test within the past year.
“Increasing the amount of healthcare providers or schools who inform teens about their ability to independently consent to these services could increase testing rates among teens,” Dr. Nelson says.
However, she says, it is also important for clinicians to recognize that the state/s in which they practice could potentially revoke minor consent laws, and advocate for these laws accordingly. For example, between 2023 and 2024, Montana, Indiana, and Tennessee passed laws that significantly reduced minors’ capacity to consent independently to healthcare. In 2023, Montana repealed a provision that had allowed minors to consent independently to nonemergency care “for conditions that will endanger the health or life of the minor if services would be delayed” by parental consent. The state narrowed the law's language , stating that minors in Montana can only consent independently to general healthcare when they need “immediate healthcare” and the doctor believes “that the giving of aid is the only alternative to probable death or irreparable physical damage"—which effectively eliminates minors' access to most care. In 2024, Tennessee enacted a law that allows minors to consent only for emergency treatment, and Idaho passed a similar law specifying that, with the exception of a life-threatening emergency or “imminent, irreparable physical injury,” minors cannot seek or receive healthcare services without prior consent from a parent “except as otherwise provided by court order."
“As this is the first time in US history that the ability for minors to independently consent to care is being revoked, it is critical that researchers assess the effect of these reversions on clinical practice, access to care, and health outcomes among minors,” says Dr. Nelson.
Future research should explore whether disseminating information about minor consent laws in various environments affects adolescents’ knowledge of these laws and their decision to obtain STI/HIV services, the research team says.
“For minor consent laws for HIV and STI services to be effective for their intended purpose—to make HIV and STI services more accessible to minors—the law must be known by minors, known and trusted by clinicians, implemented by individuals and organizations, and attentive to barriers like cost and confidentiality protections,” Dr. Nelson says. “Additional research assessing every step in the operationalization and implementation of these laws is critical for understanding how these laws are being used, or are not being used, in practice and what the continued barriers are to successful implementation.”
Contact:
Jillian McKoy, jpmckoy@bu.edu
Michael Saunders, msaunder@bu.edu
About Boston University School of Public Health
Founded in 1976, Boston University School of Public Health is one of the top ten ranked schools of public health in the world. It offers master's- and doctoral-level education in public health. The faculty in six departments conduct policy-changing public health research around the world, with the mission of improving the health of populations—especially the disadvantaged, underserved, and vulnerable—locally and globally.
PEDIATRICS
Survey
People
Presence and Knowledge of Minor Consent Laws and STI Testing in US Adolescents
18-May-2026