The Other Pill: Expanding Access to Pre-Exposure Prophylaxis to Prevent HIV Transmission among Minors in New York

By Neishlos, Aaron; D'Ambrosio, Michael | Fordham Urban Law Journal, July 2017 | Go to article overview

The Other Pill: Expanding Access to Pre-Exposure Prophylaxis to Prevent HIV Transmission among Minors in New York


Neishlos, Aaron, D'Ambrosio, Michael, Fordham Urban Law Journal


Introduction                                                      726 I. Background: HIV/AIDS, Treatment, and Prevention                728      A. What Is HIV?                                              728      B. The Demographics of HIV                                   730      C. HIV Treatment                                             731      D. PrEP                                                      734 II. Assessing the Current Legal Landscape                         740      A. Informed Consent                                          740      B. Minors' Rights to Consent and the Confidentiality of         Medical Treatment in New York                             742        1. Minors' Capacity to Consent to Medical Treatment        742        2. Confidentiality of HIV Testing and Treatment            746           a. Testing and Confidentiality: Article 27-f            747           b. Treating HIV As an STI So Minors May              Consent Without Parental Involvement                 750           c. Governor Andrew Cuomo's 2016 Proposal                751 III. Birth Control                                                752      A. Background: Minors' Reproductive Rights                   754      B. Outcomes of Permitting Teen Access to Birth Control       757 IV. Creating a PrEP Exception in New York State Law               759      A. PrEP Functionally Resemble Birth Control                  760      B. Minors Have a Right to Privacy That Covers Access to         PrEP                                                      761      C. Why the Arguments Against Expanding Access to         PrEP Are Wrong                                            763 Conclusion                                                        766 

INTRODUCTION

Reproductive rights should inform the next phase in HIV prevention. Since the 1980s, medicine has made enormous strides in preventing and treating HIV infections. Today, the Food and Drug Administration ("FDA") has approved forty different drugs to treat HIV. (1) In the last decade, AIDS-related deaths have fallen by more than thirty percent. (2) Still, new HIV infections predominately impact young people. (3) In particular, thirteen to twenty-four year olds accounted for twenty-two percent of all new HIV-infections in 2014 -- a number that has not significantly declined in the last decade. (4) To address these disparities among young people, the law should afford minors the right to access HIV-prophylactic medication.

In 2012, the FDA approved Truvada--otherwise known as Pre-Exposure Prophylaxis ("PrEP")--to prevent HIV infections. (5) PrEP is a once daily pill composed of two antiretroviral drugs that reduce one's risk of HIV infection by ninety-two to ninety-nine percent. (6) The World Health Organization ("WHO"), Centers for Disease Control and Prevention ("CDC"), and United States Public Health Service have all endorsed PrEP as an effective means to reduce the risk of HIV infection. (7) Expanding access to PrEP among thirteen to twenty-four year olds could significantly reduce the persistent infection rate in this demographic--the demographic most at risk of HIV infection. (8)

In New York State, however, a minor (a person under eighteen years old) may consent to medical treatment only in unique circumstances or for specified conditions, such as mental healthcare, substance abuse treatment, or reproductive healthcare. (9) Minors generally do not have the capacity to consent to HIV treatment. (10) PrEP, however, is a prophylactic medication. It functionally resembles birth control in its daily regimen and ability to prevent the long-term health effects of sexual activity: pregnancy for birth control and HIV for PrEP. (11)

Under New York law, a minor may pursue reproductive healthcare without parental consent. (12) Reproductive healthcare includes accessing prophylactic medication, such as the birth control pill. (13) New York should treat PrEP as another prophylactic medication vital to reproductive health. …

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