Missouri: Adolescents, not parents, to decide on HIV testing

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June 26, 2008

Anonymous The Joplin Globe Thu Jun 26, 2008, 10:14 PM CDT

The Associated Press

ST. LOUIS — Pediatrician Ericka Hayes rarely sees new cases of young people infected with HIV at birth. But hardly a month passes when her clinic at St. Louis Children’s Hospital doesn’t take on a patient that has acquired the disease through unprotected sex.

Children’s next month will become by its account the nation’s first pediatric hospital offering free and immediate HIV testing to patients ages 15 and older. Results will be available within minutes.

But one aspect of the program is raising some eyebrows: The patient, not the parents or guardians, will decide whether to be tested. Likewise, it will be the young patient who gets the results.

“A lot of teenagers involved in high-risk behaviors won’t participate in the testing if the testing is not confidential,” Hayes said. “We really want to remove that from the equation and let the adolescent decide on testing for HIV. Otherwise teenagers engaging in high-risk behaviors often will not get tested.”

Peter Sprigg, vice president for policy for the Family Research Council, said the parents — not the kids — should be calling the shots.

“When it comes to medical care, the parent should have absolute authority over whether a child is tested and should be the first notified of the results,” Sprigg said. “There are states where you can’t get your ears pierced or go to a tanning salon without parental permission, yet you’re going to tell people they have HIV without getting the parents involved? To me, that’s outrageous.”

The Centers for Disease Control and Prevention in 2006 recommended routine HIV screening for people 13-64, and some hospitals have begun universal screening. But Hayes said the program at Children’s will be unique among pediatric hospitals. Also unique is the fact that the testing decision is left to the adolescent.

A 10-year analysis by Hayes showed a staggering increase in new behavior-related cases of HIV involving people ages 13-24. In 1997, there were 21 new cases diagnosed in St. Louis; in 2006, there were 54. And Hayes said there are likely many more teens and young adults with HIV who don’t know it.

Starting in July, adolescents who come to the Children’s emergency room — regardless of their injury or illness — will receive written information explaining the HIV testing. The patient will be asked privately if he or she wants the test.

If so, a swab of the patient’s gums will be conducted. Results should be back within 20 minutes. If the test is negative, the patient will be informed. If positive, a blood test will be given to verify the results. That preliminary blood test also takes about 20 minutes.

Good or bad, the patient will know the results of the test before leaving the ER, Hayes said. It will be up to the patient to decide if the news is shared with the parents, though he or she will be encouraged to do so.

“To go from your parents don’t even know you’re having sex to learning you have HIV in 20 minutes is a big jump,” Hayes said. “We’re going to help walk the family through it.”

The first step after a positive diagnosis is a no-cost visit to the hospital’s Pediatric HIV clinic. Hayes said counseling, education and help on how to disclose the diagnosis to relatives occurs at that visit.

Hayes acknowledges that in the case of a positive diagnosis the parents or guardians will eventually have to be informed because they are, in most cases, responsible for the bill.

A Missouri statute allows minors to decide for themselves on testing and treatment for HIV and other sexually transmitted diseases and to learn the results in confidence. At least 25 other states have similar minor consent laws.

“There are going to be people, I fully accept, who are not going to like it,” Hayes said. “But when you think of the good of the teenagers and the good of the community, it’s a good thing to do.”

Sprigg disagreed.

“I don’t think its ever for the community’s good for an institution like a hospital to come between a parent and a child,” he said. “This is almost like the hospital conspiring with the minor against the parents.”

Nineteen-year-old Arthur Kinnard of St. Louis learned two years ago he was HIV-positive. Kinnard said he began having unprotected sex with men when he was 16.

As devastating as the diagnosis was, Kinnard said it has allowed him to get the medical care he needs and begin moving forward again with his life. He supports testing of adolescents and feels they should be able to decide if their parents know the results.

“Gay black males are often not accepted in the black community,” Kinnard said. “Say you told my father first, things would be really, really bad. The parent is not the one dealing with it. I am.”

A grant from the CDC helps pay for the initiative. Hayes said a specific start date has not been decided.

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Missouri: Adolescents, not parents, to decide on HIV testing

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