Department of Prevention and Community Health, George Washington University, Washington, DC, USA.
Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.
J Int AIDS Soc. 2019 Jul;22(7):e25363. doi: 10.1002/jia2.25363.
Youth under the age of 25 are at high risk for HIV infection. While pre-exposure prophylaxis (PrEP) has the potential to curb new infections within this population, it is unclear how country-specific laws and policies that govern youth access to sexual and reproductive health (SRH) services impact access to PrEP. The purpose of this review was to analyse laws and policies concerning PrEP implementation and SRH services available to youth in countries with a high HIV incidence. To the best of our knowledge this is the first systematic assessment of country-level policies that impact the availability of PrEP to adolescent populations.
We conducted a review of national policies published on or before 12 June 2018 that could impact adolescents' access to PrEP, SRH services and ability to consent to medical intervention. Countries were included if: (1) there was a high incidence of HIV; (2) they had active PrEP trials or PrEP was available for distribution; (3) information regarding PrEP guidelines were publicly available. We also included a selected number of countries with lower adolescent HIV incidence. Internet and legal database searches were used to identify policies relevant to adolescent PrEP (e.g. age of consent to HIV testing).
Fifteen countries were selected for inclusion in this review. Countries varied considerably in their respective laws and policies governing adolescents' access to PrEP, HIV testing and SRH services. Six countries had specific polices around the provision of PrEP to youth under the age of 18. Five countries required people to be 18 years or older to access HIV testing, and six countries had specific laws addressing adolescent consent for- and access to- contraceptives.
Adolescents' access to PrEP without parental consent remains limited or uncertain in many countries where this biomedical intervention is needed. Observational and qualitative studies are needed to determine if and how adolescent consent laws are followed in relation to adolescent PrEP provisions. Intensified efforts to amend laws that limit adolescent access to PrEP and restrict the establishment of national guidelines supporting adolescent PrEP are also needed to address the epidemic in this group.
年龄在 25 岁以下的年轻人感染艾滋病毒的风险很高。虽然暴露前预防（PrEP）有可能遏制这一人群中的新感染，但尚不清楚管理青年获得性和生殖健康（SRH）服务的国家特定法律和政策如何影响 PrEP 的可及性。本研究的目的是分析高艾滋病毒发病率国家中与 PrEP 实施和青年获得 SRH 服务相关的法律和政策。据我们所知，这是首次对影响青少年人群获得 PrEP 的国家政策进行系统评估。
我们对截至 2018 年 6 月 12 日发布的可能影响青少年获得 PrEP、SRH 服务和同意医疗干预能力的国家政策进行了审查。如果满足以下条件，则纳入国家：（1）艾滋病毒发病率高；（2）有正在进行的 PrEP 试验或 PrEP 可供分发；（3）PrEP 指南信息公开。我们还纳入了一些艾滋病毒青少年发病率较低的选定国家。使用互联网和法律数据库搜索来确定与青少年 PrEP 相关的政策（例如，艾滋病毒检测的同意年龄）。
选择了 15 个国家纳入本研究。各国在管理青少年获得 PrEP、艾滋病毒检测和 SRH 服务的法律和政策方面存在较大差异。6 个国家有关于向 18 岁以下青年提供 PrEP 的具体政策。5 个国家要求 18 岁或以上才能接受艾滋病毒检测，6 个国家有关于青少年同意获取和使用避孕药具的具体法律。
在许多需要这种生物医学干预的国家，青少年在没有父母同意的情况下获得 PrEP 的机会仍然有限或不确定。需要进行观察性和定性研究，以确定在提供青少年 PrEP 方面是否以及如何遵守青少年同意法。还需要加强努力，修改限制青少年获得 PrEP 和限制制定支持青少年 PrEP 的国家指南的法律，以解决该群体中的艾滋病流行问题。
