Partner notification

Partner notification, sometimes referred to as contact tracing, is often used in relation to other sexually transmitted infections, but is less used in HIV. Its aim is to identify the sexual partners of someone with an infection ('the index case'), inform the partners of their potential exposure, and encourage them to seek testing or treatment.

Partner notification may be relatively informal (a clinician encouraging a patient to ask any sexual partners to attend a clinic), or may be more structured, involving counselling and an interview with the patient to elicit the name of partners. Index patients may contact partners themselves, or contact may be made by healthcare workers (usually without revealing the identity of the index patient).

There is a tension in partner notification between the benefit to public health and the privacy of the index patient. These tensions were particularly marked in the early years of the HIV epidemic, when many felt that the risk of stigmatising people with HIV was too great, in comparison with the limited benefit of advising people that they had an untreatable infection.¹

In recent years, prosecutions for the transmission of HIV have created a new obstacle to partner notification. Nonetheless, improving treatments and changing social attitudes may mean that partner notification for HIV is more acceptable now than it was in the 1980s.

A 2006 evaluation of partner notification among people with newly diagnosed HIV in Brighton found that they needed to interview six newly diagnosed people to identify one HIV-infected partner. The programme was more successful at contacting and testing regular partners than casual partners. A third of the people with primary infection had contacts with primary infection, too, and so partner notification helped identify people who were extremely infectious.²

Between 2004 and 2008, 481 newly diagnosed people in San Francisco attended a partner-notification interview. Over half did not name any partners, but the interviews identified 200 people who were contactable and prepared to be tested. Of these, 44 people tested HIV-positive. In this programme, it was necessary to interview eleven people to identify one HIV-infected partner.³

In 2008, the US Centers for Disease Control and Prevention (CDC) issued new guidance for the use of partner notification, urging that more effort should be put into partner notification for index cases with HIV and syphilis, than for other sexually transmitted infections.⁴