Exposure to HIV partner counseling and referral services and notification of sexual partners among persons recently diagnosed with HIV

ARTICLES Exposure to HIV Partner Counseling and Referral Services and Notification of Sexual Partners among Persons Recently Diagnosed with HIV Duncan A. MacKellar, MA, MPH,* Sn-I Hon, DRPH,7‘ Stephanie Behel, MPH,* Brian Boyett, MS,* David Miller, BA,* Ekow Sey, PHD,.3Iq Nina Harawa, PHD,§ Nik Prachand, MPH,|| Trista Bingham, PHD,i and Carol Ciesielski, MD||fl Objective: Among HIV-infected persons. we evaluated use of client partner notification (CPN) and health-department partner notification strategies to infonn sex partners of possible HIV exposure. and prior exposure to partner counseling and referral services. Methods: We conducted a cross-sectional. observational study of 590 persons diagnosed with HIV in the prior 6 months at 5| HIV test. medical. and research providers in Chicago and Los Angeles in 2003 and 2004. Logistic regression was used to identify independent corre- lates of using CPN to notify all locatahle partners. Results: Participants reported a total of 5091 sex partners in the 6 months preceding HIV diagnosis: I253 (24.6%) partners were locatable and not known to be HIV-positive. Of 439 panicipants with 2| locatable partners. 332 (75.6%) reported notifying 696 (55.5%) part- ners by CPN (585. 8-Ll‘/r). health-department partner notification (94. l3.5%). or other means ( I7. 2.4%): 208 (47.4%) used CPN to notify all locatahle partners. Independent correlates of CPN included having fewer locatable partners and discussing the need to notify partners with an HIV medical-care provider (black and Hispanic participants only). Many participants reported that their HIV test or medical-care provider did not discuss the need to notify partners (48.8%. 33.7%. respectively) and did not offer health-department partner-notification services (60.8%. 52.8%). Conclusion: Many locatahle sex partners who might beneiit from being notified of potential HIV exposure are not notified. In accordance with national policies. HIV test and medical-care providers should routinely provide partner counseling and referral services to HIV- infected clients so that all locatable partners are notified and provided *Division of HIV/AIDS Prevention—Surveillance and Epidemiology. National Center for HIV. STD. and TB Prevention. Centers for Disease Control and Prevention. Atlanta. CA: the I'College of Public Health. University of Georgia. Athens. GA: the :£Los An- geles County Department of Public Health; the §Charles R Drew University of Medicine and Science. Los Angeles. CA; the ||Chi- cago Department of Public Health. Chicago. IL: and the ‘IDivision of STD Prevention. National Center for HIV. STD. and TB Pre- vention. Centers for Disease Control and Prevention. Atlanta. GA Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention or the US Department of Health and Human Services. Correspondence: Duncan A. MacKellar. MA. MPH. Centers for Dis- ease Control and Prevention. 1600 Clifton Road NE. MS E-46. Atlanta. GA 30333. E—mail: dym4@cdc.gov. Received for publication March 17. 2008. and accepted October 2. 2008. D01: I0. I097/0LQ.0b0 I 3e3 l 8 I 8d6500 Copyright © 2009 American Sexually Transmitted Diseases Association All rights reserved. an opportunity to learn their HIV status. H iv partner counseling and referral services (PCRS) include the broad array of prevention counseling. testing, and referral services provided to HIV-infected persons and their sexual and needle-sharing partners.‘ In accordance with na- tional PCRS policies. HIV test and medical-care providers should discuss with their HIV-infected clients the need to notify partners of their possible exposure to HIV and help plan how partners might be notified.'-3 Two frequently used partner-notification strategies in- clude client partner notification (CPN). where HIV-infected clients personally notify their partners. and health-department partner notification (HDPN). where clients give sufficient in- formation to health department staff who are then responsible for notifying identified partners.'-4 Provision of PCRS and use of CPN and HDPN are important prevention strategies in the United States because many partners of HIV-infected persons are unaware of their HIV infection. and because most persons who become aware of their infection take steps to prevent transmission to others.-q5 Most research on PCRS. conducted before the dissemi- nation of national policies and the availability of highly active antiretroviral therapy. has focused on the effectiveness of HDPN in identifying and testing I-IIV-infected. unaware part- nets.‘-4 Provision of PCRS by HIV test and medical-care pro- viders since the dissemination of national polices and the relative use of CPN and HDPN to notify partners have not been reported and are unknown. Use of CPN to notify all locatahle partners by client socio-demographic characteristics. time since diagnosis. number and types of partners. and exposure to PCRS is also unknown. Infomiation on these and other potential correlates of CPN might be useful for improving PCRS by identifying potential partner-notification barriers and helping clients choose successful strategies to notify partners. To evaluate implementation of national PCRS policies and to help meet these infomtation needs. we analyzed data from the client‘s perspective on exposure to PCRS from HIV test and medical-care providers. use of CPN and HDPN, and correlates of CPN among persons recently diagnosed with HIV in Chicago and Los Angeles. METHODS Survey Design, Recruitment, and Interview We conducted a cross-sectional. observational study of persons recently diagnosed with HIV referred from a nonprob- ability sample of 51 HIV test. medical. and research providers in Chicago and Los Angeles in 2003 and 2004. Providers 170 Sexually Transmitted Diseases 0 Volume 36, Number 3, March 2009