Partner Notification and Counseling

Notifying partners about HIV infection is important because it can help reduce the spread of HIV. Risk-reduction counseling can, when given to HIV-infected partners, help decrease the likelihood that they will transmit the infection to others, and when given to uninfected partners can help them reduce their chances of becoming infected. Partner notification allows for partners to be tested if they desire and if HIV testing is available; if they are infected with HIV, they may undergo medical evaluation and receive treatment if available.

When referring to persons who are infected with HIV, the term “partner” includes not only sex partners but also injection drug users who share needles, syringes, or other injection equipment.

Who should be notified?

If possible, all sex and drug-sharing partners (as appropriate) of an infected client should be notified of their exposure to the infection and encouraged to visit a health care facility. If the partners have other partners, they should also be contacted.

Importance of voluntary consent and confidentiality

Partner notification should be a voluntary process, done with the full consent of the client. All possible efforts must be made to protect the confidentiality of the client and his or her partner(s).

In addition, partner notification must be conducted with great sensitivity, taking into account social and cultural factors, such as the possibility of violent reactions on the part of partners.

Providers should be aware of the impact HIV can have on a client’s life. When a client tells a partner about the infection, the partner’s reaction can cause problems. Providers need to minimize these kinds of problems by ensuring confidentiality and by ensuring that clients agree to help with partner referral voluntarily.

Strategies for partner notification

Notification can be done by the client, the provider, or public health authorities.

• Client notification. The client accepts full responsibility for informing partners of their exposure and for referring them to appropriate services. This is the preferred method of partner notification.
• In some cases, clients may choose to notify partners in the presence of a provider to lend support and answer questions and address concerns.
• Provider/public health authority notification. With the consent of the infected client, the provider or another health care worker takes responsibility for confidentially notifying partners of the possibility of exposure.

Often, more than one strategy may be used to notify different partners of the same infected client, depending on the client and partner circumstances. For example, a client may feel that he or she is in a better position to notify a main partner, but would prefer that the provider notify other partners. The decision about the type of notification to use should also be based on program priorities and program staffing levels.

In some countries, mandatory contact tracing is required for HIV. In such cases, public health workers actually track down and inform the contacts of the client and make referrals to appropriate services.

It is important to note that research indicates that a fear of violence can discourage some women who receive voluntary counseling and testing (VCT) from telling partners about their test results. Based on a study in Tanzania that explored the links between HIV infection, disclosure of HIV status, and partner violence among women attending a VCT clinic, researchers have recommended the following actions to address women’s fear of violence:

• Train counselors to engage in a dialogue with clients about potential partner violence and to develop “safe disclosure plans” with clients.
• Develop community-based interventions to raise awareness and change norms about violence.
• Enact and enforce laws against domestic violence that punish abusive partners and help women leave violent relationships.

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