Reviewing Independent Access to HIV Testing, Counselling and Treatment for Adolescents in HIV-Specific Laws in Sub-Saharan Africa: Implications for the HIV Response

October 2017 - Combination Prevention

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Eba, P.M., and Lim, H. Journal of the International AIDS Society (August 2017), 20: 21456, doi: 10.7448/IAS.21.1.21456.

This literature review examined 28 HIV-specific laws for adolescents in sub-Saharan Africa to understand how legislation affects their access to HIV services. Three out of 28 laws did not address pediatric testing, counseling, or treatment; one law provided minimal information. Twenty-four laws included at least one aspect of World Health Organization (WHO) guidance for adolescents, but none addressed all four WHO recommendations. Eleven countries identified an age of consent (between 11 and 18 years); seven of these allowed adolescents under age 18 to independently access HIV testing. In 13 countries, only adults can independently access HIV testing; eight of these countries allow various exceptions including for pregnancy, high HIV risk, and legal emancipation. Madagascar is the only country that does not require parental consent for HIV treatment. Only five countries have protections against disclosing minors' test results. Laws for adolescents on testing, care, and treatment generally have not incorporated WHO guidance and are not based on human rights principles. Existing laws also largely address only testing, and neglect consent for treatment. The authors stressed the need to reform laws to maximize service access, remove legal barriers (including age of consent laws), and support implementation of these laws by developing guidelines, including through guideline development, training providers, and sensitizing youth and parents/caregivers.

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