Page 84 - HIVMED_v21_i1.indb

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 5 Original Research

Be legally wise: When is parental consent

required for adolescents’ access to

pre-exposure prophylaxis (PrEP)?

Authors: Background: South African adolescents (12–17 years) need an array of prevention tools to
Ann Strode address their risk of acquiring the life-long, stigmatized condition that is HIV. Prevention tools
1,2
Catherine M. Slack 2
Zaynab Essack include pre-exposure prophylaxis (PrEP). However, service providers may not be clear on the
1,3
Jacintha D. Toohey 1 instances where self-consent is permissible or when parental consent should be secured.
Linda-Gail Bekker 4
Aim: To consider the legal norms for minor consent to PrEP using the rules of statutory
Affiliations: interpretation.
1 School of Law, College and
Law and Management Setting: Legal and policy framework.
Sciences, University of
KwaZulu-Natal, Results: We find that PrEP should be interpreted as a form of ‘medical treatment’; understood
Pietermaritzburg, broadly so that it falls within the ambit of one of consent norms in the Children’s Act. When
South Africa
PrEP is interpreted as ‘medical treatment’, then self-consent to PrEP is permissible for persons
2 HIV/AIDS Vaccines Ethics over 12 years, if they have the mental capacity and maturity to understand the benefits, risks,
Group, School of Applied social and other implications of the proposed treatment. Currently, PrEP is only lisensed for
Human Sciences, College of persons over 35 kg. Reaching the age of 12 years is a necessary but not sufficient criteria
Humanities, University of
KwaZulu-Natal, for self-consent and service-providers must ensure capacity requirements are met before
Pietermaritzburg, implementing a self-consent approach. Decisional support and adherence support are critical.
South Africa
Conclusions: We recommend that service-providers should take steps to ensure that those
3 Center for Community-Based persons who meet an age requirement for self-consent, also meet the capacity requirement,
Research, Human and Social and that best practices in this regard be shared. We also recommend that policy makers should
Capabilities Division, Human
Sciences Research Council, ensure that PrEP guidelines are updated to reflect the adolescent consent approach articulated
Pietermaritzburg, above. It is envisaged that these efforts will enable at-risk adolescents to access much needed
South Africa interventions to reduce their HIV risk.

4 The Desmond Tutu HIV Keywords: parental consent; self-consent; HIV; prevention; minors’ capacity.
Centre, University of Cape
Town, Cape Town,
South Africa Adolescent human immunodeficiency virus risk and

Corresponding author: pre-exposure prophylaxis
Ann Strode,
[email protected] Globally young people are especially vulnerable to human immunodeficiency virus (HIV). 1,2,3,4
Human immunodeficiency virus prevalence amongst adolescents and young adults in
Dates:
Received: 13 July 2020 South Africa remains skewed. In 2017, the HIV prevalence amongst females was higher than
Accepted: 20 Aug. 2020 their male counterparts (5.8% vs. 4.7% amongst 15–19 year olds and 15.6% vs. 4.8% amongst
Published: 10 Nov. 2020
20–24 year olds). In the same year, 66 000 new HIV infections occurred amongst adolescent
5
5
girls and young women in South Africa. Likewise, young men having sex with men (MSM) in
South Africa are highly vulnerable to HIV infection. 5
There is now good evidence that oral pre-exposure prophylaxis (PrEP) taken daily, as part of a
combination prevention package, can protect HIV-negative adults against HIV acquisition. 6,7,8,9
The US Federal Drug Administration has, based on safety data, licensed oral combination of
Tenofovir (TDF)/Emtricitabine (FTC) for HIV prevention for at-risk adolescents with body
weights above 35 kg (Bekker, personal communication, 9 Jun 2020). The South African Health
R
ead online:
Read online: Products Regulatory Authority (SAHPRA) has similarly approved a fixed-dose combination of
Sc an this QR tenofovir disoproxyl fumarate and emtricitabine for PrEP (for adults and adolescents > 35 kg). 7
Scan this QR
c
our
code with your
ode with y
smart phone or
smart phone or
mobile de vice How to cite this article: Strode A, Slack CM, Essack Z, et al. Be legally wise: When is parental consent required for adolescents’ access to
mobile device
pre-exposure prophylaxis (PrEP)?. S Afr J HIV Med. 2020;21(1), a1129. https://doi.org/10.4102/sajhivmed.v21i1.1129
ead online.
o r
t to read online.
Copyright: © 2020. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.
http://www.sajhivmed.org.za 76 Open Access