HIV/STI partner notification by providers

There is strong evidence that partner notification by provider referral increases testing for HIV among partners of newly diagnosed patients (CG-HIV/AIDS and pregnancy, Hogben 2016) and increases identification of HIV in undiagnosed individuals (CG-HIV/AIDS and pregnancy, Hogben 2016, Cochrane-Ferreira 2013).

Based on effectiveness among HIV patients, the Centers for Disease Control and Prevention (CDC) also recommends patient notification by provider referral for syphilis and, in high priority cases, gonorrhea and chlamydia (CDC MMWR-Partner services 2008). When resources do not allow provider referral, CDC recommends that patients infected with chlamydia and gonorrhea be counseled to inform their partners independently (CDC MMWR-Partner services 2008). Additional research is needed to confirm the most effective type of referral for STIs other than HIV (Cochrane-Ferreira 2013).

Barriers to successful partner notification include anonymous partners, individuals not feeling comfortable sharing partner contact information, insufficient contact information when partners primarily communicate through apps, declining partner notification services, and staffing issues among partner notification programs (Magaziner 2018).

Experts suggest that the current partner notification system is outdated, as it primarily relies on mail and phone contact in a world where digital communication such as in smart phone apps or text messaging is increasingly the norm (Golden 2022). Electronic communication methods may be especially helpful to contact partners that met through dating apps and social media platforms (Pellowski 2016). Use of electronic notification options such as text messaging, email, social networking, and other websites and apps appear to be acceptable, particularly when partners might not have been notified (Pellowski 2016) or been unreachable without electronic notification (Hochberg 2015), such as those met through dating apps (Contesse 2019).

Experts suggest partner notification expansion into routine care should be considered instead of only being offered upon a new diagnosis (Oehler 2021); being offered partner notification options in various settings may improve participation (Gore 2018).

It is unclear what impact HIV/STI partner notification by providers may have on disparities in HIV and STI incidence, especially among vulnerable populations including people of color, young people, and LGBTQ populations.

Inequalities by sexuality, gender, race, geographical location, and economic status persist in HIV diagnosis and care (Taggart 2021). In 2021, 70% of new HIV infections where among men who have sex with men (MSM) (CDC-HIV incidence) and in 2019, 29% of new HIV infections were among Hispanic individuals (CDC-Hispanic/Latino HIV Incidence), most of them among MSM (CDC-Hispanic/Latino MSM HIV incidence), and 41% were in Black individuals (CDC-African American HIV Incidence). New HIV infections disproportionately affect Black MSM (who account for 26% of new HIV cases) (CDC-African American MSM HIV Incidence), Black heterosexual women, and Black transgender women (CDC-HIV and black discrimination). Chlamydia, gonorrhea, and syphilis also disproportionally affect racial and sexual minority groups. In 2021, almost a third of new infections were in Black individuals, MSM were diagnosed with around a third of gonorrhea cases and almost half of syphilis infections, and among women STI rates were highest for Black, American Indian/Alaskan Native, and Native Hawaiian/Pacific Islander individuals (CDC-STI Surveillance).

Traditionally, partner notification is to be provided to those with a new diagnosis, but a Chicago-based study of young Black MSM suggests not all individuals are being offered this service (Gore 2018).

Sexually transmitted infections (STIs) have carried stigma for centuries, shaped by negative views of poverty, women, and sex (McGough 2005). STIs are associated with promiscuity and deviant behavior for women, while STIs in men are treated merely as a medical condition (East 2012). Stigma has continued to shape how STIs are studied, diagnosed, and treated. The racist and unethical Tuskegee Syphilis Study, administered by the federal government, intentionally withheld syphilis treatment from Black men for decades without their knowledge, to study the natural course of the disease, ultimately sowing widespread mistrust of health systems and medical research (Tobin 2022).

When the AIDS epidemic began, federal response was slow to acknowledge and respond to it, in part because it primarily affected gay men in a time when many states still criminalized homosexuality. While the first case of HIV/AIDS in the U.S. was reported in 1981 (HIV.gov, Bennington-Castro 2020), major federal funding wasn’t allocated until 1985 (Bennington-Castro 2020). HIV criminalization laws were passed in many states criminalizing behavior such as non-disclosure, exposure, and/or transmission of HIV, or increasing sentence length for crimes based on someone’s HIV status (CDC HIV-Exposure), long before pharmaceuticals were available to treat or prevent transmission (CDC HIV-Criminalization). Today, HIV criminalization unjustly applies criminal law to nonmalicious behavior by people living with HIV and the laws are disproportionately applied to people from groups who have been marginalized (Bernard 2022), While 13 states have repealed or modernized their HIV criminalization laws, 34 states still have HIV/STI/communicable disease criminalization laws in place in 2023. Such laws can carry penalties up to life in prison (CDC HIV-Exposure).

Partner notification has been a public health tool since the 18th century, when Danish priests participated in contract tracing efforts to notify sexual partners of individuals with syphilis. In 2016, the WHO recommended partner notification services be a part of the standard care provided to an individual with HIV (Golden 2017). Today, in an effort to keep up with modern technology, electronic notification options are being considered in order to notify partners via email, text messaging, social networking, and apps (Pellowski 2016, Contesse 2019). State and federal funding are important to address the rising incidence of STIs, however, historical trends show that funding has stagnated (NCSD-STD Funding).

• What clinics or organizations in your community provide partner notification? What method(s) do they use?
• Who is offered partner notification services? Are notification services provided to everyone? How can services be expanded to ensure all individuals with a positive diagnosis are offered partner notification services?
• How does stigma, and other barriers, prevent people from accessing sexual health care and HIV/STI testing services in your community? What additional strategies can be implemented to overcome those barriers?

Partner notification services appear to be used widely; in 2016, most surveyed STI testing sites reported providing some form of partner notification services (Desir 2016). Partner services offer free services to newly diagnosed individuals and their partners; services include HIV and STI testing, referrals to support services, counseling, and connecting individuals to the necessary care they need. Partner services vary by state, based on state-level policies (CDC-States' partner services policies and laws).

CDC-Partner notification services - Centers for Disease Control and Prevention (CDC). How can partner notification services help me and my patients?

CDC-Partner services - Centers for Disease Control and Prevention (CDC). Partner services.

CDC-Partner services for HIV and STDs - Centers for Disease Control and Prevention (CDC). Partner services for HIV and STDs. 2021.

* Journal subscription may be required for access.

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Cochrane-Ferreira 2013* - Ferreira A, Young T, Mathews C, Zunza M, Low N. Strategies for partner notification for sexually transmitted infections, including HIV. Cochrane Database of Systematic Reviews. 2013;(10):CD002843.

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Oehler 2021* - Oehler C, Rajagopal A, Songster T, et al. Partner notification services for patients with established and new HIV infection leads to diagnosis and linkage of HIV-positive partners. AIDS and Behavior. 2021;25:809-813.

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