Notification guidelines finally being published
CDC hopes guidance will bring uniformity
The Centers for Disease Control and Prevention has completed a draft document on HIV partner notification, but it may be coming too late. The document comes four years after the CDC's first guidelines, and after states have begun passing varying versions of partner notification laws.
The guidelines are geared to help service providers craft partner notification services that will be more comprehensive and user-friendly.
As part of the Ryan White reauthorization law passed last year, states are required to make a good-faith effort to implement partner notification programs. Because it is voluntary and controversial, partner notification varies from state to state and provider to provider. Most programs are limited to client-referral services, primarily because of lack of resources and not because health departments don't want to offer more, says Gary West, a public health advisor in the CDC's Division of HIV Prevention. Lack of CDC guidance has not helped, he adds.
The CDC developed partner notification guidelines four years ago, but the practice had become so controversial that it delayed publishing them. One result of that vacuum has been a haphazard approach by many states.
"A few states give high priority to partner notification, but most don't," he says. "There is very little from CDC out there, and yet we're seeing bills from Congress and state legislatures with positions not even close to ours."
New York passes notification law
Most recently, the New York Assembly passed an HIV names reporting bill that included the provision that public health officials ask for the names of HIV-positive partners so they could notify them about the patient's HIV status. The law, passed in June, will not penalize patients who refuse to name their sexual partners; however, the bill allows health officials to contact the spouse or known partner of an infected person without their consent.
The process for developing the guidelines began in October 1996 with expert consultation. In July, the CDC plans to mail a draft for comment to state and local health departments who are funded under its HIV prevention cooperative agreement. It hopes to publish the guidelines by October.
The guidelines are based on principles that expand the scope of traditional partner notification. In fact, the term "partner notification" has been replaced by "partner counseling" and "referral services" to better reflect the range of HIV prevention services that the programs will be expected to offer to both sex and needle-sharing partners, West says. Moreover, the guidelines probably will be combined later with guidelines for partner services related to other STDs, as the programs target many of the same populations and provide the same service, he adds.
Because HIV infection is a lifelong condition and HIV-infected people need periodic partner counseling and referral services, the guidelines are geared toward developing and maintaining a service as an ongoing activity rather than as a one-time event. Thus, a comprehensive program also should offer client-centered counseling (many do not at this time), increased support for clients who choose to notify their own partners, and assistance in accessing medical evaluation and treatment.
"We don't want to just notify people and then walk away from them," West explains. "We want to be able to give them specific counseling that links them to services. When you look across the country, a lot of what goes on now is just notification."
For many groups, HIV notification is fraught with dangers of government intrusion and confidentiality breaches - the same sorts of fears that have made HIV name reporting so controversial. (See related article on HIV name reporting, p. 93.) The New York partner notification law came after years of bitter fighting, including the recent HIV transmission cluster in Chautauqua County in which a young man willfully infected more than two dozen partners. Both the American Civil Liberties Union and the Gay Men's Health Crisis opposed the New York law.
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