By PREM MISIR, Ph.D.

This paper was published: Misir, P., 1999. AIDS PATIENT CARE and STDs, 13(6), pp.327-334.The Bureau of STD Control provides partner notification services via its Contact Notification Assistance Programme (CNAP) and, as aforementioned, has had a fair measure of success. However, CNAP may find it useful to review the results at the Gothenberg Clinic. This Swedish Clinic was effective in partner notification processes where the counselors were clinically active providers and not Department of Health pseudo-counselors. In this way, the names of clients and partners do not leave the clinic.

“A key factor in evaluation could be whether the person with HIV/AIDS needs to make needed adjustments to the existing socialisation process, or whether there is a need to engage in resocialisation.”

The current literature on partner notification shows the efficacy of clinic-based partner notification programmes. Partner notification in slum-based antenatal clinics in a poor Haitian community was a considerable success.22 Partner notification also has widespread acceptance in clinical practice, specifically in genitourinary medicine clinics.23 In Colorado and North Carolina, a high success rate was found at confidential test sites compared to anonymous sites.24,25 Recommendations from these latter studies suggested that local health departments should have responsibility for evaluating and improving partner notification services. The confidential clinic test sites seem to have greater efficacy than anonymous test sites (these are run by local health departments and are less clinic-based) for partner notification programmes.
From the literature and established partner notification programmes, one can draw positive suggestions to improve existing notification programs or design new ones (Table 1).

Table 1. Suggestions to Improve
Partner Notification
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The following suggestions are extracted from the literature on partner notification:
• Use a social system perspective
• Protection of the ethical issues by legislation
•targeting people who exchange sex for drugs or money
•Hiring staff from minority ethnic groups and those with inner city experiences
•Using outreach clinics for difficult-to-reach risk groups
• Flexible usage of patient referral and third party referral
•Tracing of contacts not to exceed a period of more than 2 years
• CDC guidelines on partner notification for programs in receipt of federal funding need to be appraised periodically
•Evaluating partner notification by these criteria: numbers educated, counselled, and tested per staff person
• Risk-reduction education as a component in partner notification programs should incorporate a culture of restraint and responsibility, embracing the norms of each cultural group
• Some persons with AIDS to be recruited and placed in appropriate partner notification programs
• Conditional contracting where health professionals present the patient with an option to have special
sexual partners referred by health workers or effect self-referral over a specific period.
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SOCIAL SYSTEM PERSPECTIVE
There is a consensus that contact tracing is an integral public health measure used to retard the spread of HIV. Unlike tracing programmes for syphilis, the notification procedures associated with HIV may be more effective if developed as systems. Counseling protocols could be enhanced in this way with partner notification/contact tracing programs incorporating a social system perspective26 utilising four functions: adaptation, goal attainment, integration, and latency (pattern maintenance).
Partner notification programs, if effecting the adaptation function, will include the client’s external situational exigencies that present themselves to both the client and partner. These measures may have to be responsive to the in-fected individual’s environment, including their needs. The client/partner is expected to adapt to the environment as well, but this adaptation may be ineffective when resources are deficient.
Partner notification procedures will have as their foci the client/partner-determined short-term, medium-term, and long-term goals, geared toward facilitating the virally infected individual to have a socially supportive interface with a humane public health system. The person’s drives, derived from the social context, help to shape his/her goals. Partner notification protocols could be built from three kinds of client/partner drives: seeking social approval, complying with cultural standards, and having role expectations. Providers would require an understanding of the client/partner social context in order to utilize these three drives. The implication is that counsellors attached to partner notification programmes must have practical knowledge of the client/partner social context.
Knowing this social context would yield data on the client/partner status and role in their social system. Social system is used to mean the patterns of social relationships between the client and his partners, and also to institutions of society. The client/partner status and role may assist them in integrating their personal drives and the societal value patterns. In effect, it is crucial to understand whether the individual stricken with HIV infection is able to relate to society.
A key factor in evaluation could be whether the person with HIV/AIDS needs to make needed adjustments to the existing socialisation process, or whether there is a need to engage in resocialization. The patterns of his/her relationship in a social context would determine whether socialisation or resocialisation is needed to achieve integration with society. Counselors would be drawn into developing a sense as to how the client/partner’s social system relates to other pertinent systems; and whether the client/partner’s system receives support from other systems, meets the needs of the client/partner, allows meaningful participation for the client/partner, can cope with an incurable disease such as AIDS, and has symbols that provide meaning to client/partner interaction in order to persist. Counselors should understand the client/partner’s beliefs, values, and norms, in a word, the individual’s “culture.” The person’s culture is incorporated in the adaptation, goal attainment, integration, and latency functions within the partner notification protocol. Failure to acknowledge the individual’s culture would eventually affect the functioning of the protocol.

REFERENCES
22. Desormeaux J, Behets FM, Adrien M. Introduction of partner referral and treatment for control of sexually transmitted diseases in a poor Haitian community. Int J STD AIDS 1996;7:502-506.
23. Fenton KA, Copas A, Johnson AM. HTV partner notification policy and practice within GUM clinics in England: where are we now? Genitourin Med 1997;73:49-53.334
24. Hoffman RE, Spencer NE, Miller LA. Comparison of partner notification at anonymous and confidential HIV test sites in Colorado. J AIDS Hum Retrovirol 1995;8:406-10.
25. Kassler WJ, et al. Eliminating access to anonymous HIV antibody testing in North Carolina: effects on HIV testing and partner notification. J AIDS Hum Retrovirol 1997;14:281-289.
26. Ritzer G. Modern Sociological Theory, 4th ed. New York: McGraw-Hill, 1996;99-108.