1347Measuring potential impacts of parental consent laws on adolescent HIV testing globally: multinational insights from 51 population-based surveys


Co-auteurs

J.G. Rosen * (1), E.M. Stone (2), M.T. Mbizvo (3) (1) Johns Hopkins Bloomberg School of Public Health, International Health, Baltimore, United States, (2) Johns Hopkins Bloomberg School of Public Health, Health Policy and Management, Baltimore, United States, (3) Population Council, Lusaka, Zambia


Abstract

BACKGROUND: HIV testing remains imperative to close gaps in both the prevention and treatment cascades, but pervasive social and structural barriers'including national policies'inhibit HIV testing uptake among priority populations, including adolescents. We assessed the relationship between age-of-consent laws for HIV testing and adolescent HIV testing prevalence in 51 low- and middle-income countries.
METHODS: We pooled 51 nationally representative household surveys (Demographic and Health Surveys, AIDS Indicator Surveys, and Population-Based HIV Impact Assessments) from 2010 to 2020. We estimated the weighted country-level prevalence of lifetime HIV testing separately for adolescent girls and boys (ages 15-19). We then abstracted age-of-consent laws for HIV testing across countries. Using multivariable linear regression, we estimated the average difference in national HIV testing coverage estimates for adolescent girls and boys by age-of-consent restrictions for HIV testing.
RESULTS: National HIV testing coverage estimates were substantially heterogeneous, ranging from 0.7% to 72.5% among girls and 0% to 73.2% among boys in Pakistan and Lesotho, respectively. Median national HIV testing prevalence estimates were 18.0% among girls and 7.5% among boys. Adjusting for region, World Bank income classification, and per-capita health expenditure, HIV testing coverage in countries requiring parental consent for HIV testing in individuals younger than 18 years was, on average, 7.8% lower (95%CI: '14.6% to '1.0%) among girls and 8.2% lower (95%CI: '14.6% to '1.9%) among boys. Comparing countries with more restrictive (age-of-consent: 18 years) to less restrictive (age-of-consent: 14 years or younger) HIV testing laws, HIV testing prevalence was significantly lower among girls (β = '7.7%, 95%CI: '15.1% to '0.3%) and boys (β = '8.3%, 95%CI: '15.2% to '1.3%) in countries with more restrictive parental consent policies.
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CONCLUSIONS: Age-of-consent laws are persistent obstacles to adolescent HIV testing. Revoking parental consent requirements for HIV testing is needed to expand coverage and ensure equity.