Posted by: lesleyhamming | May 8, 2013

NC Senate Bill 675: Hindering Teen Access to Health Services

Senators Daniel, Randleman, and Newton are sponsoring N.C. Senate Bill 675, which seeks to prohibit physicians from providing health services to minors for the prevention, diagnosis, and treatment of venereal and communicable diseases including HIV without written parental consent.  On April 3, 2013, the bill passed a first reading and was referred to the Health Care Committee.  The bill was approved by the Health Care Committee yesterday (May 7). [Update – late Wednesday the bill was pulled before reaching the House floor and sent to the Judiciary Committee.)

Should the General Assembly enact this bill,  North Carolina will become the only state to completely prohibit minors from consenting to STD services.  Eleven states require minors to reach a certain age, typically 12 or 14, and eighteen states allow, but do not require, physicians to notify parents that the minor is seeking these services. The NC Bill is unique in requiring written parental consent before a minor of any age can receive these medical services.

NC Senate Bill 675 will undermine efforts to create an “AIDS free generation.”  Currently, the southern states, including NC, have the highest rates of new HIV infections among youths aged 13-24 over any other region in the U.S.[1]  At-risk adolescents will be less likely to get tested and treated for HIV if they have to get parental consent.  A survey of adolescents at two pediatrics practices in North Carolina found that while 92% would undergo STD testing if their parents “definitely would not” find out about the test, only 35% would undergo STD testing if their parents “definitely would” find out about the test.[2]  Moreover, the Connecticut Department of Public Health saw an increase in HIV testing of 151% for males and 90% for females the month after Connecticut removed a parental consent requirement for STD testing.[3]

The reduced rates of testing that will occur if NC Senate Bill 675 passes will lead to increased HIV transmissions.  The longer a person delays diagnosis and treatment for HIV, the higher the risk he/she will transmit the disease to others.  A landmark study from UNC at Chapel Hill demonstrated that HIV-infected people who started antiretroviral drug treatment early in the course of their disease were 96% less likely to infect their partners than those HIV-infected people who delayed drug treatment until they experienced a decline in CD4 count or the onset of HIV-1-related symptoms.[4]

These increased HIV transmissions will increase public health costs.  About 25% of HIV-positive individuals in NC receive Medicaid[5] and the average lifetime medical costs to treat each person ranges from $567,000-618,900 with higher costs resulting when HIV is diagnosed late in the disease progression.[6]

Supporters of Senate Bill 675 may believe the parental consent requirement will strengthen parent-teen communication.  Parent-teen communication is important, but passing this bill in an effort to force any teenager to discuss sex with his parents will not succeed.    Faced with such a threat, a teen is much more likely to continue his risky behavior and forgo testing.  A survey found that not only would 59% of sexually active girls stop seeking sexual healthcare services if they had to get parental consent, but also only 1% said they would stop having sexual intercourse.[7]

A better course of action is to support parents in communicating with their sons and daughters about sexual decisions while at the same time giving them access to confidential health care.  Physicians know that offering confidential services is key to adolescent willingness to seek treatment.  Indeed, the American Academy of Pediatrics recommends that “Pediatricians should be prepared to offer confidential, nonjudgmental education and risk-reduction counseling around issues of sexuality for adolescent patients, including teens with chronic illnesses and/or disabilities.”[8]

Should the NC General Assembly pass Senate Bill 675, many adolescents will forgo testing and medical treatment leading to greater STD transmission to their peers and greater economic costs to society.

For more information, see Rose Hoban’s report, Teen Medical Restrictions Bill Passes House Committee, in North Carolina Health News


[1] CDC, Vital Signs: HIV Infection, Testing, and Risk Behaviors Among Youths – United States, 61 Morbidity & Mortality Weekly Rep. 971 (2012), http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6147a5.htm.

[2] Carol Ford & Dana Best, Confidentiality and Adolescents’ Willingness to Consent to Sexually Transmitted Disease Testing, 155 Arch. Ped. & Adolescent Med. 1072 (2001).

[3] Thera Neehan et al., The Impact of Parental Consent on the HIV Testing of Minors, 87 Am. J. Pub. Health 1338, 1339 (1997).

[4] Cohen et al., Prevention of HIV-1 infection with Early Antiretroviral Therapy, 365 N. Eng. J. Med. 493, available at www.nejm.org/doi/full/10.1056/NEJMoa1105243#t=articleTop.

[5] Medicaid Enrollment and spending on HIV, FY2009 Kaiser Family Foundation, http://www.statehealthfacts.org/comparereport.jsp?rep=133&cat=11.

[6] Schackman, et al., The Lifetime Cost of Current Human Immunodeficiency Virus Care in the United States, 44 Med. Care 990 (2006).

[7] Diane Reddy et al., Effect of Mandatory Parental Notification on Adolescent Girls’ Use of Sexual Health Care Services, 288 JAMA 710 (2002).

[8] Contraception and Adolescents, 120 Pediatrics 1135 (2007), http://pediatrics.aappublications.org/content/120/5/1135.full (emphasis added).


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