POPS Chapter 3 - HIV/STD Partner Services and Seropositive Notification
Partner services are a broad array of services offered to persons diagnosed with HIV, syphilis, gonorrhea, and chlamydia infection, including their partners and social contacts.
Partner services function as a process through which persons with HIV and sexually transmitted diseases (STD) are interviewed to elicit information about their partners and social contacts to ensure partners and social contacts are confidentially notified of their possible exposure or potential risk.
Partner Services are offered to:
- Persons with HIV/STD*;
- Sex and needle-sharing partners of persons with HIV/STD; and
- Others potentially involved in transmission (social networks who may share risks and partners).
*In Texas, HIV and syphilis are priority infections that receive partner services from a Disease Intervention Specialist (DIS). When resources permit, persons with gonorrhea or chlamydia infections may be offered partner services.
Partner Services helps identify persons at risk (whether through direct exposure or indirect involvement) and a DIS ensures persons are confidentially notified of their possible exposure to HIV/STD. Persons are offered the opportunity to receive testing and treatment, as appropriate, and are linked to a range of medical, prevention and psychosocial services as needed. Partner Services improves the health of individuals and communities.
Confidentiality, accessibility, and client participation are fundamental to the success of a partner services program.
The sensitive and highly personal nature of HIV/STD-related information requires strict confidentiality in the course of activities. Maintaining confidentiality means more than not revealing names. All client and partner information is confidential, whether the client is tested confidentially, anonymously, or declines testing. To maintain confidentiality, no information will be divulged to unauthorized persons that could lead to the identity of the client. Qualified staff conducting partner services are bound by rules regarding confidentiality specified by the employing agency, the laws of the State of Texas and the local jurisdiction in which work is performed.
All information and records relating to reportable diseases are confidential. Providing information to a DIS for the purposes of assisting in disease notification is not a breach of confidentiality.
Proper maintenance and disposition of records is crucial to maintaining the confidentiality of persons involved with partner services. Qualified staff conducting partner services must follow HIV/STD Public Health Follow-Up (PHFU) Confidential Information Security Procedures.
Violation: In accordance with Health and Safety Code HSC §81.103 Confidentiality; Criminal Penalty, breach of confidentiality is a Class A misdemeanor and is punishable by up to one year in jail and fines of up to $5,000. Violation of confidentiality is also a civil offense that may result in liability for damages plus fines.
3.2.2 Accessibility and Client Participation
Programs providing partner services should be accessible and available to all clients with HIV/STD. Persons with HIV/STD should be encouraged to participate in these services at the earliest opportunity. Partner services for persons with HIV/STD should not be a one-time event. Partner services should be offered as soon as persons learn they are infected and should be available throughout their counseling and treatment. Staff conducting these services may work with many providers (public and private) to preserve these elements. Clients that refuse participation with partner services will not be judged, chastised or excluded from other services.
Partner services consist of two integrated components: partner elicitation and partner notification. Partner elicitation is the process by which qualified staff elicits information, from persons with HIV/STD, about sex and needle-sharing partners and others who may be at risk for infection.
Ideally, DIS conduct the partner elicitation portion of the positive result-giving counseling session in accordance with DIS interviewing standards. DIS interviewing standards can be found in Chapter 9 Disease Intervention Specialists Performance Standards.
Partner notification is the process of locating elicited sex and needle-sharing partners and others who may be at risk for infection to inform them of their possible exposure and offer counseling, testing, and referral services. The two approaches to partner notification are health department referral and client referral.
3.3.1 Health Department Referral
Health department referral occurs when a health department DIS confidentially notifies sex and needle-sharing partners of their possible exposure to HIV and/or other STD. No information leading to the identity of the original client is revealed to the partners. DIS may also conduct HIV/STD prevention counseling and venipuncture for confidential testing at the time of the notification. Health department referral relies on the original client providing accurate information regarding partners' names, identifying features, and locating information. Health department referral is the preferred method.
Only a qualified DIS, employed by a federal, state, region, or local health department, may conduct HIV/STD partner notification. A qualified DIS is a professional who has a combination of training and experience in conducting partner notification activities for HIV and other STD and can handle problematic notifications skillfully and effectively.
3.3.2 Client Notification
Client notification relies on persons with HIV/STD to assume initial responsibility for locating and referring a partner to the health department DIS. DIS are responsible for ensuring notification of all elicited partners. At a minimum, DIS is responsible for coaching persons with HIV/STD on how to notify and refer their partners to testing and for developing contracts with persons diagnosed with HIV/STD for follow-up to ensure partners are notified.
In many cases, combinations of the two methods for notification are acceptable. For example, a client may decide to inform steady partners and choose health department referral for others, especially partners who live out of town.
3.4.1 Spousal Elicitation and Notification Requirements
The federal Ryan White Care Act requires all states to make a good faith effort to notify a spouse of a known HIV-infected client that they may have been exposed to HIV and should seek HIV counseling and testing. In accordance with Title 42 of the U.S. Code 42 USC 300ff-27a Spousal Notification, a spouse is defined as any person who is the marriage partner of an HIV-infected patient, or who has been the marriage partner of that client at any time within the 10-year period prior to the diagnosis of HIV infection. If two persons consider themselves married and so represent themselves to the outside world, they are considered married, whether by common law or marriage license. Therefore, when discussing partners in a counseling session, every HIV-infected client will be asked questions in order to obtain information about any present or past spouses.
Programs that fail to fulfill this requirement will put their program and the State of Texas in jeopardy of losing Ryan White CARE Act grant funds. At minimum, spousal elicitation efforts will be documented in case notes.
If a prevention program has sufficient locating information to contact the spouse of a person with HIV infection, the program will notify the local or regional HIV/STD program. The local or regional HIV/STD program will then notify the spouse regardless of patient consent.
Private physicians or their designee, may notify spouses or partners of their possible exposure to HIV or may seek assistance from the local or regional HIV/STD program. Physicians asking HIV/STD programs to contact a spouse will provide written confirmation that the client tested HIV-positive.
3.4.2 Referral of HIV/STD Clients to the Local or Regional Health Department
All prevention contractors are required to have a partner services work plan in place with the local or regional health department that outlines how an HIV/STD-positive client will be referred for partner services. All public and private providers have a seven day period to inform their infected clients of results. Providers are required to notify the regional health department when they have been unable to inform their clients about their infection.
DIS will ensure the results are given to the client, referrals to medical care are made and partner services are offered.
In accordance with Health and Safety Code HSC §81.051 Partner Notification Programs; HIV Infection, health care providers shall notify their local or regional partner notification program when the provider knows the HIV/STD-positive status of a client and has actual knowledge of possible exposure to a third party. “Actual knowledge of possible exposure” means the health care provider has received the information directly from the infected client or from a self-named partner (sex and needle-sharing) who discloses to the doctor that they have been exposed to a client with HIV/STD.
Providers will be required to provide proof of the original client’s HIV status in order for HIV/STD programs to accept the exposure information and provide notification services to the partners. Feedback regarding the success or failure of the notification attempts may be relayed to the referring health care provider in a manner deemed appropriate by HIV/STD program managers and consistent with state and local policies. Other special partner notification situations should be managed in consultation with the local or regional health department.
Information regarding HIV/STD Public Health Follow-Up (PHFU) Confidential Information Security Procedures: dshs.texas.gov/hivstd/policy/procedures/2016-01
Centers for Disease Control and Prevention: cdc.gov
Texas Constitution and Statutes: statutes.legis.state.tx.us
Health and Safety Code: statutes.legis.state.tx.us/?link=HS
Texas Family Code: statutes.legis.state.tx.us/?link=FA
U.S. Code: law.cornell.edu/uscode/text