Most minors may consent to STD services in all fifty U.S. states and the District of Columbia. Thirty-one of the fifty states explicitly include HIV testing and treatment including HIV RNA test, as part of the STD services available to minors. In eighteen states physicians are allowed to inform a minor’s parents that their child is seeking or receiving STD services, specifically in cases when the physician deems such a disclosure to be in the best interest of the minor.
There is no state, however, that requires physicians to notify parents about their STD-related health care, and only in one state is a physician obligated to notify a minor’s parents when the minor tests positive for HIV.
On the federal level, a key ruling took effect in 2002 that was designed to protect the privacy of individuals with regard to their personal health information and medical records. Based on provisions found in the Health Insurance Portability and Accountability Act (HIPAA) of 1996, this federal ruling is known as the Privacy Rule.
The Privacy Rule represents important confidentiality protections for minors, while also deferring to state and federal laws as well as the judgment of health care providers. This allows for compromise between differing ideologies where the privacy rights of minors are concerned so that minors can receive access to needed STD services and parents can access their children’s health information when necessary.
According to the HIPAA Privacy Rule, adolescents (ages 18 and older) and emancipated minors can exercise their right to access their protected health information, including their online STD testing records, and prohibit others from doing the same.
However, the Privacy Rule does not allow unemancipated minors to restrict their parents’ access to their protected health information, particularly if the parents already have the right to make health care decisions on their children’s behalf. There are three specific circumstances in which a minor can exercise the rights afforded them under the Privacy Rule:
1. When the minor has the right to consent to health care and has consented
2. When the minor is given court approval to receive health care without parental consent
3. When a parent has allowed an agreement of confidentiality between the health care provider and the minor to take place
Moreover, the Privacy Law dictates that if a state or local law explicitly requires that protected medical information be disclosed to a parent, the health care provider is obliged to comply with that law and inform the parents. On the other hand, if these laws explicitly permits, but does not require, the disclosure of medical information to a parent, then it is up to the discretion of the health care provider to disclose the information.
The health care provider is also allowed to exercise discretion in cases where the laws are silent on the question of parental access. In addition, a provider is not allowed to disclose a minor’s medical information or records without his or her consent to the minor’s parents if state or local laws prohibit it.
There are a number of valid justifications for why the Privacy Rule should exist to protect the private medical information of minors. For one, some minors would not seek required STD testing if they couldn’t receive it confidentiality. Forgoing access to private STD testing doesn’t necessarily mean that minors will stop being sexual active – in fact, they may instead elect to use less effective contraceptive methods or not use contraception at all.
Another reason why minors may want to keep their medical information confidential is that their parents or guardians may not be suited to act in their best interests. For instance, the parent or guardian in question may be a substance abuser, may be physically or verbally abusive to their children, or may have mental or emotional issues that don’t allow them to make rational decisions.
Finally, there may be other cases when allowing parental access to a minor’s medical records may lead to harm for the minor, especially if they are prohibited from accessing medical care that could prove beneficial for them.
Jessica Malleby is a senior writer and blogger at STDCheck.com