A new Tennessee parental rights law could have unintended consequences in a state that already has seen rising cases of HIV and syphilis, and as the U.S. sees a spike in syphilis cases.

Tennessee’s law is part of a growing conservative movement to give parents more control over their children’s education and health care decisions, especially when it comes to gender and sexuality. Republicans in Congress have introduced similar legislation this year.

As recently as 2021, all states allowed minors of a certain age to consent to HIV and sexually transmitted disease testing without parental approval, according to an analysis published in the American Journal of Public Health.

But the landscape has started to shift. The National Coalition of STD Directors has tracked at least 52 bills introduced in state legislatures this year that would expand parental rights in some capacity, though not all are related to minors seeking health services, said Chris Zivalich, the group’s senior manager of state policy and training.

Along with Tennessee, Idaho implemented its own parental rights law last month. Both laws require parents to consent to their children’s health care decisions and have access to medical records.

Teens and young adults face the highest rate of any age groups of sexually transmitted infections, and research shows a lack of confidentiality is a major barrier to seeking care, according to Lindsey Dawson, associate director of HIV policy and director of LGBTQ health policy at KFF, a nonprofit health policy research, polling and news organization.

“It’s certainly reasonable to assume that decreased access to HIV and STI testing and treatment would lead to adverse outcomes in terms of the trajectory of HIV and STIs among young people,” she said, noting the group accounts for 1 in 5 HIV diagnoses.

Prior to implementation of the Tennessee law earlier this summer, the state allowed teens age 14 or older to seek STD services without parental consent. The new law supersedes that permission.

State Senate Speaker Pro Tempore Ferrell Haile and House Republican Caucus Chairman Jeremy Faison, who sponsored the law, said it “keeps parents in-the-know and ensures they are properly consulted.”

“In non-emergency situations, the law simply requires that a doctor or nurse consult the parents first with a phone call, text or other contact method,” they said in a joint statement.

Dawson said the state consent laws put health care providers “between a rock and a hard place,” just as laws restricting gender-affirming care do in many states. She said providers will have to balance their ethical obligation to do no harm to patients with compliance with the new laws.

“Violating what is now the state law is grounds for losing their license and makes them vulnerable to a civil action,” she said.

Tennessee state Rep. Aftyn Behn said the law is an overreach that could thwart public health efforts underway to de-escalate the HIV epidemic among young people in her state. Under the law, she said, health departments would be unable to test young people for HIV, syphilis or other infections without parental consent. Nashville has already updated its website telling patients under age 18 about the need for consent.

“As legislators committed to the health and well-being of our communities, we are particularly interested in understanding how recent legislative sessions have influenced this public health crisis,” Behn, a Democrat, and 16 other lawmakers wrote in a letter to the Tennessee Department of Health.

The Memphis region ranks second nationally in terms of new HIV infections, and the Shelby County Health Department attributes the biggest increase in new diagnoses to people ages 14 to 35. Since 2018, the county department has documented a 40 percent increase in HIV rates and a 150 percent increase in syphilis rates among those 15 to 19 years old.

Statewide, 861 people were diagnosed with HIV in 2022, an increase of 14 percent compared to 2018, according to a report released in May from the Tennessee Department of Health.

State data also shows that syphilis cases increased 162 percent from 2017 to 2022, or from 950 to 3813 cases. Nationally, syphilis cases increased about 79 percent between 2018 and 2022, accord to the latest Centers for Disease Control and Prevention surveillance data.

The broader public health impact of changing state laws may take time to track. The CDC’s January report on STI surveillance, for example, looked at 2022 data.

Zivalich said states that have already adopted these policies can create carve-outs to protect public health access to testing, but he acknowledged it could be challenging. “One of the things that I think policymakers need to understand is that there can be some level of parental rights, but giving minors access to confidentially test and treat themselves for STIs is not going to usurp all authority of parents,” he said.

A young person getting tested for an STI who is being sexually abused, he said, may be at greater risk if required to first obtain consent from a parent.

“There can just be exemptions within the policy for particular services, but we feel like HIV and STI services would be a great example of that,” he said.

Broader movement

The current debate over parental rights and minors’ medical records is rooted in the larger discussion over health and education issues related to sexuality as well as transgender and other gender-nonconforming individuals.

Republicans, including former President Donald Trump, have elevated the push for parents’ rights as a key campaign issue.

The House passed a parental rights bill focused on public school oversight in 2023, but the legislation most similar to Tennessee’s law hasn’t been acted on after being introduced this year.

The Tennessee law includes language that would guarantee parents the right to “access and review all health and medical records of the child.”

The first documented instance of that phrase stems from a 2022 statewide initiative petition in Nevada, filed by three individuals representing Protect Our Girls PAC. The group primarily seeks to limit abortion access for minors, and the lead petitioner listed is Melissa Clement, who is also the president of Nevada Right to Life.

A Maryland House of Delegates bill from that January includes similar but not identical language.

A broader reference to the concept was used in a Heritage Foundation backgrounder from Jan. 10, 2023, on children and gender. That report called on Congress to allow parents to “access and review all medical records of the child; and to make and consent to all physical and mental health care decisions for the child.”

Similar language split into two separate lines was in legislation that fell short in committee in both chambers of the Mississippi state legislature in 2023 and again in 2024.

The Tennessee law uses the same phrasing as Mississippi, and was first introduced in late January 2023.

Diana Thu-Thao Rhodes, a vice president at Advocates for Youth, a youth sexual health education nonprofit, called the legislative efforts “a political strategy funded by far-right activists at the national level.”

Thu-Thao Rhodes said this was a trend that she has seen broadly using “different language and different mechanisms.”

“The trend has been consistent, both at a federal and national level and at a state and local level,” she said, pointing to ongoing legal challenges related to the federal family planning program known as Title X.

Since 2020, the Health and Human Services Department has been involved in a lawsuit over parental rights and access to birth control at Texas clinics supported by federal Title X funding.

The Biden administration issued a rule in 2021 clarifying that state laws could not supersede federal family planning regulations.

Texas has been requiring parental consent at facilities that receive these federal funds since a 2022 district court ruling. The U.S. Court of Appeals for the 5th Circuit ruled in March that Texas could implement this policy within the state.

Lia DeGroot contributed to this report.