Dear Colleague: Minor Consent to HIV and HPV Prevention and

December 19, 2017

Dear Health Care Provider:

This letter is to inform you of recent changes to Part 23 of New York Codes, Rules and

Regulations (NYCRR) regarding the right of minors to consent for sexually transmitted disease

(STD) and HIV prevention and treatment services. Section 23.1 of Title 10 NYCRR has been

amended to include HIV in the existing list of STDs. Section 23.4 of Title 10 NYCRR now allows

health care providers to “…render medical care related to other sexually transmitted diseases

without consent or knowledge of the parent or guardian.”

This regulatory change permits health care providers to prescribe antiretroviral

medication for treatment and prevention of HIV infection to minors without parental/guardian

consent. Approximately 20 percent of young people diagnosed with HIV infection are not in

care. Of young people engaged in care, viral suppression rates fall below the state average.

This regulatory change provides young people with the opportunity to consent to HIV treatment,

which can remove barriers that prevent or delay access to care. In addition, young people will

be able to consent to HIV-related preventive services, such as pre-exposure prophylaxis (PrEP)

and post-exposure prophylaxis (PEP). These preventive services ensure better health

outcomes for young people and can reduce viral transmission to others.

Under this regulatory change, health care providers are also permitted to provide human

papillomavirus (HPV) vaccination to sexually active minors without parental/guardian consent.

HPV is the most common sexually transmitted virus in the United States, accounting for an

estimated 79 million infections and 14 million new infections per year. Up to 70 percent of

sexually active people will get genital HPV infection at some point in their lives.

While the New York State Department of Health encourages parents and guardians to

talk with their adolescents about sexual health, including HPV vaccination, these discussions

can be difficult, and may not happen in a timely fashion. In addition, some adolescents may not

have a safe, healthy family environment in which these conversations can take place.

Removing the requirement of parental consent allows New York’s adolescents to receive high

quality, recommended prevention.

Nine-valent HPV vaccination prevents 73 percent of cervical cancers, other anogenital

and oropharyngeal cancers, and over 95 percent of non-cancerous anogenital warts caused by

HPV infection

. While data are not yet available on nine-valent efficacy, quadrivalent vaccine-

https://www.cdc.gov/mmwr/volumes/65/wr/mm6526a1.htm

type HPV prevalence has decreased 64 percent among a nationally representative sample of

teenagers age 14-19 in the vaccine era (2009-2012), compared with the pre-vaccine era

The Centers for Disease Control and Prevention (CDC) recommend that HPV

vaccination be provided to females and males at age 11 or 12, with catch-up for females age 13

through 26 and for males age 13 through 21. Vaccination for males who identify as gay,

bisexual or other men who have sex with men (MSM), as well as HIV-infected males and males

with immune deficiencies, is recommended through age 26. Other males who do not meet

these criteria may be vaccinated through age 26. The vaccination schedule varies by age.

Young people who start the series before their 15

birthday require only 2 doses of the vaccine,

with 6-12 months between doses

. Older patients still require the 3-dose series.

Public and private insurers regulated by New York State are required to cover the costs

of all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP).

This requirement includes HPV vaccination

. The federal Vaccines for Children Program can

help pay for the vaccine for patients under the age of 18 who are uninsured, underinsured,

Medicaid eligible, or an American Indian or Alaska native. Merck, the vaccine manufacturer,

offers patient assistance programs for those individuals age 19 – 26 years who cannot afford

the vaccination.

While efforts are made to protect the confidentiality of minors, please note that the NYS

Immunization Information System (NYSIIS) allows parents and guardians access to their child’s

vaccine information, including HPV vaccination. There is no exemption or exception to reporting

HPV vaccination to NYSIIS. Minors who independently consent to the HPV vaccine should be

advised of NYSIIS and the availability of information from this system to a parent/guardian.

Visit http://www.health.ny.gov for additional guidance and resources on HPV. Questions

related to HPV vaccination can be sent to immuniz[email protected]. New York City providers

can contact the NYC Department of Health and Mental Hygiene by calling 311.

Sincerely,

http://pediatrics.aappublications.org/content/early/2016/02/19/peds.2015-1968

https://www.cdc.gov/hpv/parents/questions-answers.html

http://www.cdc.gov/vaccines/hcp/acip-recs/recs-by-date.html