Provider Referral Partner Notification

Provider referral interventions prevent the transmission of HIV from people with HIV to sexual and needle-sharing partners. In provider referral interventions, people with HIV voluntarily disclose information about partners. Providers or other public health professionals notify partners that they were potentially exposed to HIV.

This notification can help prompt these individuals to get tested for HIV, learn more about prevention, and begin seeking treatment if they test positive during screening. It may also bring them into care sooner, before they are symptomatic, which can prevent the spread of the virus. Partner counseling and referral services are generally provided by health departments rather than private organizations.

This model is recommended by the Guide to Community Preventive Services as an effective intervention both to increase rates of HIV testing and to identify new HIV-positive cases.

Examples of Programs Identifying HIV-Positive People through Provider Referral Partner Notification:

The Idaho Department of Health and Welfare provides funding to help supplement Partner Services staffing and activities in all seven of the state's local public health districts. Disease Intervention Specialists work with people who test positive to collect contact information for partners and then locate and inform the partner of his/her potential exposure. Specialists then provide counseling to partners on reducing HIV risk behaviors and refer the partner to an appropriate location for testing.
New York State Department of Health Partner Services program serves urban and rural areas of New York. Healthcare providers who identify new cases of HIV and other sexually transmitted infections connect people with Partner Services. Partner Services will then help make a notification plan for each partner and will assist with notification if the person prefers to remain anonymous. The Partner Services Specialist can then assist partners in accessing HIV testing and counseling.

Considerations for Implementation

Partner notification services require special attention and sensitivity to maintain the trust and privacy of people who choose to disclose information about sexual and needle-sharing partners. Though identifying partners is voluntary, people may fear stigma and personal repercussions associated with providing this information. Providers and health departments with strong connections to the community may be most successful at implementing this model, since patients who feel safe may be more likely to provide this information.

Integrating couples counseling to facilitate disclosure of testing results is encouraged by both the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC). When partners learn their HIV status together, they can work together to make decisions about mutual disclosure to any third parties together. Testing Together (TT) is a public health service that facilitates communication and disclosure of HIV status. During a TT session, two or more persons who are in or planning to be in a sexual relationship receive HIV testing services together, including their HIV test results. Providers may also use a TT session to link partners to HIV medical care, pre-exposure prophylaxis (PrEP), and other appropriate services. CDC TRAIN offers eLearning modules for providers who are interested in TT training.

In addition, the Guide to Community Preventive Services notes that a major challenge for implementing partner notification services in some locations relates to the presence of laws criminalizing people living with HIV who fail to disclose their status to partners. The Centers for Disease Control and Prevention (CDC) outlines HIV laws in each state that are important to consider. In particular, 21 states legally require HIV-positive individuals to disclose this information to all sexual partners and 12 states require sharing this information with needle-sharing partners.

An additional consideration, which varies by state, is whom a provider is legally allowed to notify of HIV exposure. For example, in Illinois, providers who identify an HIV-positive person can only disclose this information to an individual's married spouse or legal partner through civil union. Before providers can notify a spouse, they are also required to first allow and encourage the person to self-disclose to their partner.

Since confidentiality risks are an important concern in partner notification services, providers need to also consider the personal consequences that people may experience because of disclosure.

Resources to Learn More

How Can Partner Services Programs Help Me and My Patients?
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Describes free services offered by local and state health department staff to people infected with HIV and other sexually transmitted diseases (STDs) by helping them locate their partners and inform them of their risk for HIV and STDs. Offers testing, counseling, referrals, and access to treatment for partners at risk of who test positive.
Organization(s): National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC)

Find the Laws in Your State
Website
A database organized by state to show HIV criminal laws and policies. Includes guidelines for HIV testing, healthcare workers with HIV, and minors' access to testing and treatment for sexually transmitted infections (STIs) and HIV. Includes a searchable HIV Policy Resource Bank providing reports, research, court decisions, and guides on topics of interest to people with HIV and to their advocates.
Organization(s): The Center for HIV Law and Policy