|
|
Partner Counseling
and Referral Services
|
Since its inception in 1988, HIV Partner
Counseling and Referral Services (PCRS), formerly known as Partner Notification, has been
an important prevention strategy. It offers HIV-infected persons an opportunity to meet
with a public health professional to obtain counseling, assistance with the notification
of sexual and needle-sharing partners, and referral for medical care, case management, and
support and other related services.
The process of PCRS
State or local health department PCRS staff attempt to contact and
counsel each individual with HIV infection or AIDS who is reported to
the Wisconsin AIDS/HIV Program. Cases are assigned to the PCRS staff
person (counselor) in the health department that has jurisdiction in
the community where the HIV-infected individual resides. PCRS staff
have 90 days to initiate, interview, counsel, notify and test
partners, assess TB status, and close newly assigned cases.
During a typical counseling session, the
counselor and client discuss four main topics: medical information, support services, risk
reduction, and partner notification and referral. The counselor helps the seropositive
person identify potentially exposed sexual and needle-sharing partners, assists with
prioritizing which partners need to be notified and offered testing, and assists with
establishing optimal strategies for informing each partner.
Ideally, PCRS staff encourage HIV-infected
individuals to notify current partners themselves. However, if notification of a current
or past partner is perceived as too personally difficult, a threat to loss of
confidentiality, or dangerous for an HIV-infected person, PCRS staff are available to
notify partners without revealing the identity of the source person.
During a partner notification meeting, the
PCRS counselor informs the partner he/she has had contact with an individual who is HIV
antibody positive. The counselor provides the partner with information on HIV/AIDS and
risk reduction and strongly encourages and offers immediate ("field-based") HIV
antibody testing.
A person who receives a positive HIV test
at an anonymous CTS or out-of-state can also utilize PCRS. The AIDS/HIV Program believes
that everyone with HIV infection should be given several chances to use the partner
notification program. Therefore, persons who refuse PCRS or who were initially unlocatable
are offered services again in six months. In addition, a person with HIV infection who is
named as a recent partner by someone with a newly reported sexually transmitted disease or
HIV infection is also offered or reassigned PCRS.
PCRS are most successful at identifying
new infection when recently infected individuals participate in the program. This is
because individuals are more likely to accurately recall the names and locating
information of recent partners.
All services through the Partner Referral
Program are voluntary, free and confidential. No identifying information about the
original or source individual with HIV infection is given to the notified
partner(s).
Maintaining the confidentiality and anonymity of HIV-infected persons who participate in
PCRS is critical to its success.
The primary goals of PCRS
are to:
- Inform past and current partners of HIV-infected (seropositive) individuals regarding their personal risk for HIV infection, and the
availability and advantages of obtaining HIV counseling and testing services.
- Identify previously unidentified infection by notifying and
providing testing (or referring for counseling and testing) to all named and locatable
partners of HIV-infected persons.
- Interrupt the transmission of HIV by providing
individualized risk reduction information to seropositive persons and to partners of
HIV-infected persons.
- Provide seropositive persons with referrals for medical
evaluation, early intervention, case management and other support services.
- Provide seropositive persons who are assessed to be
exposing others with referral for evaluation and behavior intervention services.
Summary of past and future
program directions
Since 1988, PCRS has evolved from a program provided by three state staff to a service
available locally through the health department in virtually every county. Specially
trained and highly skilled public health professionals are available to provide persons
with HIV infection with immediate access to PCRS. Local health department staff are
knowledgeable regarding Wisconsin confidentiality laws and the personal and privacy
concerns of persons with HIV infection. Staff working in a local health department know
local resources available to persons testing positive for HIV in their community.
Additionally, health department staff can provide HIV-infected persons access to TB and
STD testing directly or through referral. They also provide partners of HIV-infected
persons with immediate access to HIV counseling and testing services.
A long term goal of the PCRS Program is to offer recently notified partners immediate access to an HIV test. By April 2000, 100% of
health departments should be able to offer immediate testing.
Section 8 of federal Public Law 104-146,
the Ryan White CARE Act Amendments of 1996, requires states to certify that marital
partners of persons with known HIV infection are notified of HIV risk and referred for
testing. The Wisconsin Division of Public Health requires all local agencies providing HIV
partner counseling and referral services to routinely and sensitively address the issue of
spousal notification when interviewing persons with AIDS and/or HIV infection. It is a
general policy of the Wisconsin AIDS/HIV Program to notify and refer all partners of
HIV-infected persons (including current or past marital partners), over a period of at
least the previous ten years.
1997 Wisconsin Act 54 was enacted in
December 1997 and created statutory language [Wisconsin statute s. 252.15 (7m)] which
permits physicians to report to the state epidemiologist the names of persons known by the
physician to be significantly exposed to a person testing positive for HIV. The sharing of
partner names enables the AIDS/HIV Program to assist in the notification and testing of
partners who might not otherwise be informed. The physician may report these names to the
state only after the physician has:
- counseled the test subject who tests
positive for HIV to inform any person they may have significantly exposed to HIV
and
- notified the test subject that the name of
any person known to the physician to have been significantly exposed to the test subject
will be reported to the state epidemiologist.
Because persons with HIV are at increased
risk for TB, local health departments assess the TB test status of all newly reported
persons for whom they provided partner notification. Persons not recently tested for TB
are either referred to their provider for PPD testing or the PCRS worker offers to place
and read the PPD. As a result of this initiative, the AIDS/HIV and TB Programs anticipate
having PPD results on over 90% of persons newly reported with HIV in Wisconsin. These
efforts are directed at ensuring that all HIV-infected persons identified with TB
infection receive preventive therapy.
The AIDS/HIV Program will continue
evaluating PCRS to assess efficacy and cost effectiveness. Evaluation findings will be
used to identify strategies for more effectively providing PCRS to persons with HIV
infection. The AIDS/HIV Program will examine linkages between CTS and PCRS to ensure that
individuals who test positive at an anonymous CTS understand what PCRS is and are provided
ready access to it. The Program will also review linkages between PCRS and early
intervention, case management, prevention case management, and other support/prevention
services.
For additional information regarding the
PCRS Program, contact Dhana Shrestha at 608-267-5288.
Listing of Wisconsin
Health Departments Providing HIV Partner Counseling and Referral Services
(PDF, 110 KB)
Last Revised: September 20, 2007 |
