Interventions to Identify HIV-Positive People through Provider Referral Partner Notification
These 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.
The Community Preventive Services Task Force (CPSTF) recommends partner notification by provider referral as an effective intervention for increasing HIV testing rates and identifying 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 the patient with Partner Services. Partner Services will then help the patient make a notification plan for each partner and will assist with notification if the patient 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 and their client-base may be most successful at implementing this model, since patients who feel safe may be more likely to provide this information.
In addition, the Community Guide 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 his/her 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. Domestic violence is a serious concern and some people may fear a violent reaction from their partner.
Resources to Learn More
State HIV Laws
A searchable database organized by state to show HIV laws and policies. Also provides other online resources including a national advocacy agenda for people interested in understanding and helping people living with and impacted by HIV.
Organization(s): The Center for HIV Law and Policy