-A 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. Counselling protocols could be enhanced in this way with partner notification/contact tracing programmes incorporating a social system perspective (Ritzer, 1996) utilizing four functions: adaptation, goal attainment, integration, and latency (pattern maintenance).
Partner notification programmes, 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 infected 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 inter- face with a humane public health system. The person’s drives, derived from the social con- text, 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 utilise these three drives. The implication is that counsellors attached to partner notification programmes must have practical knowledge of the client/partner social context.

TABLE 1: SUGGESTIONS TO IMPROVE PARTNER NOTIFICATION

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 two years
•    CDC guidelines on partner notification for programmes 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 programmes 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 programmes
•    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.

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 socialization process, or whether there is a need to engage in resocialization. The patterns of his/her relationship in a social context would determine whether socialization or resocialization is needed to achieve integration with society. Counsellors 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. Counsellors 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.
(This paper was published in AIDS PATIENT CARE AND STDs, Vol. 13, No. 6, June 1999 (USA)