n July, St. Louis Children's Hospital will begin offering free, confidential HIV testing to all adolescents age 15 and older when they are admitted to its emergency room. The hospital will leave it to patients to decide whether to accept the rapid test, and results will be delivered before they leave the ER.

The youths will be encouraged to tell their parents the results. However, Missouri law ultimately gives minors the right to confidential care for HIV and STDs. At least 25 states have similar minor consent laws.

"When it comes to medical care, the parent should have absolute authority over whether a child is tested and should be the first notified of the results," said Peter Sprigg, vice president for policy for the Family Research Council. "There are states where you can't get your ears pierced or go to a tanning salon without parental permission, yet you're going to tell people they have HIV without getting the parents involved?"

"A lot of teenagers involved in high-risk behaviors won't participate in the testing if the testing is not confidential," said Children's pediatrician Ericka Hayes. "We really want to remove that from the equation and let the adolescent decide on testing for HIV. Otherwise teenagers engaging in high-risk behaviors often will not get tested."

Approximately once a month, Hayes' clinic enrolls another new patient with sexually acquired HIV. In 1997, there were 21 new behavior-related pediatric HIV cases in St. Louis, according to Hayes. But there were 54 new diagnoses in 2006, and there are likely many more youths who have not yet been diagnosed, she said.

Children's Hospital patients whose HIV-positive results have been confirmed will be referred to its Pediatric HIV clinic for counseling and education on how to disclose their serostatus to relatives, Hayes said. Their parents or guardians will most likely have to be informed eventually, since they are usually responsible for the bill, Hayes said.