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Perspectives in Sexual and Reproductive Health

Sexual and Gender Minority Adolescents’ Views On HIV Research Participation and Parental Permission: A Mixed‐Methods Study
CONTEXT Sexual and gender minority adolescents are underrepresented in HIV research, partly because institutional review boards (IRBs) are reluctant to waive parental permission requirements for these studies. Understanding teenagers’ perspectives on parental permission and the risks and benefits of participating in HIV research is critical to informing evidence‐based IRB decisions. METHODS Data from 74 sexual and gender minority adolescents aged 14–17 who participated in an online focus group in 2015 were used to examine perspectives on the risks and benefits of participation in a hypothetical HIV surveillance study and the need for parental permission and adequate protections. Data were analyzed thematically; mixed methods analyses examined whether concerns about parental permission differed by whether teenagers were out to their parents. RESULTS Most adolescents, especially those who were not out to their parents, would be unwilling to participate in an HIV study if parental permission were required. Perceived benefits of participation included overcoming barriers to HIV testing and contributing to the health of sexual and gender minority youth. Few risks of participation were identified. Adolescents suggested steps that researchers could take to facilitate informed decision making about research participation and ensure minors’ safety in the absence of parental permission; these included incorporating multimedia presentations into the consent process and explaining researchers’ motivations for conducting the study. CONCLUSIONS Respondents believed that the benefits of HIV surveillance research outweighed the risks. Requiring parental permission may exclude many sexual and gender minority teenagers from taking part in HIV research, especially if they are not out.

The Role of Publicly Funded Family Planning Sites In Health Insurance Enrollment
CONTEXT Publicly funded family planning providers are well positioned to help uninsured individuals learn about health insurance coverage options and effectively navigate the enrollment process. Understanding how these providers are engaged in enrollment assistance and the challenges they face in providing assistance is important for maximizing their role in health insurance outreach and enrollment. METHODS In 2014, some 684 sites participating in California's family planning program were surveyed about their involvement in helping clients enroll in health insurance. Weighted univariate and bivariate analyses were conducted to examine enrollment activities and perceived barriers to facilitating enrollment by site characteristics. RESULTS Most family planning program sites provided eligibility screening (68%), enrollment education (77%), on‐site enrollment assistance (55%) and referrals for off‐site enrollment support (91%). The proportion of sites offering each type of assistance was highest among community clinics (83–96%), primary care and multispecialty sites (65–95%), Title X–funded sites (72–98%), sites with contracts to provide primary care services (64–93%) and sites using only electronic health records (66–94%). Commonly identified barriers to providing assistance were lack of staff time (reported by 52% of sites), lack of funding (47%), lack of physical space (34%) and lack of staff knowledge (33%); only 20% of sites received funding to support enrollment activities. CONCLUSIONS Although there were significant variations among them, publicly funded family planning providers in California are actively engaged in health insurance enrollment. Supporting their vital role in enrollment could help in the achievement of universal health insurance coverage.

Guttmacher Policy Report

Medicaid Continues to Account for Three-Quarters of U.S. Publicly Funded Family Planning Expenditures

Public expenditures for family planning services totaled $2.1 billion in fiscal year 2015, and Medicaid accounted for three-quarters of those expenditures, according to a new Guttmacher Institute report.

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<April 2017>