Confidentiality-promoting state laws and sex differences in HIV testing among sexually experienced U.S. high school students

Confidentiality concerns are a well-established barrier to sexual health services for adolescents. Given that gender is one of the most salient factors associated with adolescent HIV testing, we examined whether associations between <i>confidentiality-promoting</i> state laws (i.e., states that <i>explicitly allowed</i> minors to consent to HIV testing, <i>did not</i> have an age clause which set a minimum age to consent to sexual health services<i>, did not</i> permit parental notification, had <i>confidentiality protections</i> for insured dependents) and lifetime HIV testing varied between sexually experienced male and female high school students in the 2019 state-level Youth Risk Behavior Surveillance System (<i>N </i>= 46,444). In most cases, females were more likely than males to test for HIV - regardless of whether laws were confidentiality-promoting. Males were significantly more likely to report HIV testing in states that explicitly allowed minors to consent to HIV testing, did not permit parental notification, or had confidentiality protections for insured dependents. Females were significantly less likely to report HIV testing in states that had confidentiality protections for insured dependents. Findings suggest that the potential impact of confidentiality-promoting state laws on adolescent HIV testing may vary substantially by sex, and that certain laws may facilitate HIV testing for male adolescents in particular.