This guidance is intended to assist state and local health department HIV
prevention cooperative agreement grantees and HIV prevention community
planning groups in planning, implementing, and evaluating the services provided
to persons living with HIV and their sex and needle-sharing partners. External
consultants and CDC staff collaborated in the development of this guidance, which
is intended to supplement current CDC cooperative agreement guidance for HIV
prevention programs. The development process included input based on reviews of
the relevant scientific literature, actual program experience, and expert recommendations
from within and outside CDC.
This guidance uses new terminology to label the process of reaching and
serving sex and needle-sharing partners. As opposed to contact tracing and partner
notification, the term partner counseling and referral services (PCRS) is used in this
document because it better reflects the type and range of public health services that
are recommended for sex and needle-sharing partners. These services are vital to
any community's HIV prevention efforts. This guidance should assist in developing
programs, planning services, or prioritizing resource allocation for PCRS, and
state and local programs supported with CDC funds should adapt it to meet their
local policies, needs, and circumstances.
The principles listed on the following pages constitute the basis for PCRS
and are applied to issues discussed throughout this document. Principles 1-8 apply
to partner counseling and referral services associated with partner services for all
sexually transmitted diseases, including HIV. Principles 9-13 apply to partner
counseling and referral services associated with HIV in particular.
Principles Associated with Providing PCRS for All Sexually Transmitted Diseases, Including HIV
- Voluntary. PCRS
is voluntary on the part of the infected person and his or her partners.
- Confidential. Every part of PCRS is confidential.
- Science-Based. PCRS activities are science-based
and require knowledge, skill, and training.
- Culturally Appropriate. PCRS is to be delivered
in a nonjudgmental, culturally appropriate, and sensitive manner.
- A Component of a Comprehensive Prevention System. PCRS
is one of a number of public health strategies to control and prevent the spread of HIV
and STDs. Other strategies include access to clinical services, outreach to and targeted
screenings of at-risk populations, behavioral interventions, and educational programs.
- Diverse
Referral Approaches. PCRS may be delivered through two basic approaches: provider
referral, whereby the PCRS provider locates and informs sex or needle-sharing partners of
their exposure, and client referral, whereby the infected person takes responsibility for
informing his or her partners. Sometimes a combination of these approaches is used.
- Support Services and Referral. PCRS is delivered in a
continuum of care that includes the capacity to refer sex and needle-sharing partners to
HIV counseling, testing, and treatment, as well as other services, e.g., STD treatment,
family planning, violence prevention, drug treatment, social support, housing.
- Analysis and Use of PCRS Data. PCRS program
managers should collect data on services provided and use the data for evaluating and
improving program efficiency, effectiveness, and quality.
- Counseling and Support for Those Who Choose To Notify Their Own
Partners. Counseling and support for those who choose to notify their own partners is
an essential element of PCRS. Such efforts can assist in ultimately reaching more partners
and minimizing unintended consequences of notification. Assistance to clients in deciding
if, how, to whom, where, and when to disclose their infection can help them avoid
stigmatization, discrimination, and other potential negative effects. Working with a
client to think through what it means to notify a partner and creating a specific plan to
ensure he or she successfully accomplishes the notification is a
vital role of the
provider.
- Client-Centered Counseling. Providing
client-centered counseling for HIV-infected individuals and
their partners can reduce behavioral risks for acquiring or transmitting HIV
infection. In addition, client-centered counseling will help the provider
understand the readiness of the client to notify partners. This will allow the
provider to offer services to assist the client in successfully notifying
partners without adverse consequence.
- Increased Importance as New Technologies Emerge. As
new technologies emerge, such as rapid diagnostic tests, vaccines, behavioral
interventions, and even more effective therapies, PCRS will become an increasingly
important prevention tool.
Principles Associated with Providing PCRS, Particularly for HIV
- Ongoing Access to PCRS for HIV-Infected Individuals and Partners.
PCRS should not be a one-time
service. It should be offered as soon as an HIV-infected individual learns his or her
serostatus and made available throughout that person's counseling and treatment. If
new partners are exposed in the future, PCRS should be made available again.
HIV-infected individuals should have the ability to access PCRS whenever needed.
- Assistance in Accessing Medical
Evaluation and Treatment To Prolong Life. Sex and needle-sharing partners might
already be HIV-infected but be unaware of or deny their risks. They can be assisted
through PCRS in learning their status, and in obtaining earlier medical evaluation and
treatment for HIV disease and opportunistic infections. PCRS provides an opportunity for
HIV primary prevention interventions for those partners not infected with HIV and an
opportunity for secondary prevention for those partners living with HIV.
How To Use This Document
The standards and guidance in this document describe the core elements
that are essential for successful PCRS programs at publicly funded sites. Even
though HIV and STD programs share many common goals, policies, and
activities, PCRS is designed specifically for HIV prevention programs. It is
not intended to replace or modify CDC guidance for partner notification for
other STDs.
The two levels of recommendations in this document are Standards and
Guidance:
Standards. Specific standards are provided in several sections and are
intended to be applied consistently. Standards must be followed by CDC grantees
in virtually all cases where CDC funds are used to support services. To
assist the reader, each standard is set apart from the other text in
| reverse type on a black background. |
In addition, Appendix A is a concise listing of all the PCRS standards in
the order discussed in the main part of the document.
Guidance. The main text of this document provides overall guidance for
PCRS programs. This guidance should be followed in most cases, but can be
tailored to fit the individuals and affected communities being served as
well as the program needs. Providers are urged to follow this guidance but
have flexibility to modify or adapt based on state or local needs, policies,
or circumstances.
Other organizations providing PCRS or other HIV prevention service
providers might also find this document a useful guide. CDC recommends that
the guidance be shared with providers and consumers of services in local areas.
Managers of PCRS programs are urged to work closely with STD prevention,
violence prevention, drug treatment, reproductive health, and other state agencies
in planning, implementing, and evaluating their program and services. |
