The Relationship Between State-Level Confidentiality Mandates and HIV/Sexually Transmitted Infection Testing Among High School Students in the United States

Document Type

Journal Article

Publication Date

9-22-2025

Journal

The Journal of adolescent health : official publication of the Society for Adolescent Medicine

DOI

10.1016/j.jadohealth.2025.07.013

Keywords

HIV; Infectious disease; Policy; Public health; STI; Youth

Abstract

PURPOSE: As of 2019, only 14 states mandate confidentiality for HIV testing and 13 states have enacted similar regulations for sexually transmitted infections (STIs), respectively. Nevertheless, the impact of these protections remains inconclusive and underexplored. This study aimed to understand the relationship between these privacy statutes and self-reported HIV/STI testing history among 9th-12th graders in the US and assessed whether sex served as an effect modifier of these associations. METHODS: We conducted a secondary, cross-sectional analysis with responses from the Youth Risk Behavior Survey 2019. Particularly, we coded exposure information after confirming documentation of confidentiality mandates and dichotomized the outcome of self-reported HIV/STI testing history (e.g., yes/no). Next, we calculated the prevalence odds ratio (POR) by comparing the proportion of self-reported HIV/STI testing history across these groups; we also computed adjusted PORs to control for known confounders like age, race/ethnicity, sexual orientation, and smoking status with multivariable logistic regression modeling techniques. RESULTS: Importantly, living in states with confidentiality mandates was associated with small, yet significant, increases in self-reported HIV (adjusted POR: 1.16; 95% confidence interval: 1.07-1.26) and STI (adjusted POR: 1.17; 95% confidence interval: 1.03-1.34) testing history after accounting for age, race/ethnicity, sexual orientation, and smoking status. Sex was not an effect modifier or confounder. These relationships were stronger among participants with previous voluntary sexual contact. DISCUSSION: These findings are novel and supplement our understanding of policy changes to improve the frequency and acceptance of HIV/STI testing; confidentiality obligations diminish these age-related barriers and may thus alleviate HIV/STI morbidity.

Department

Epidemiology

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