2.1 Making Services Available to All HIV-infected Persons

People can learn that they are HIV-infected through a variety of sources, including confidential and anonymous testing sites, private care physicians, or home collection kits. However, regardless of where and how persons have been tested, PCRS must be made easily accessible to all HIV-infected persons. For example, an HIV-infected person who has been tested by a private provider might seek services from a CDC-funded provider.

Although verified evidence of HIV infection should always be presented to the PCRS provider before partners are contacted, PCRS must be made available to the HIV-infected person.

The client who has just been informed of being HIV-infected will, of course, need to have PCRS offered at the earliest appropriate time, but the PCRS provider will encounter many others to whom services should be offered. For example, those persons could include a previously identified HIV-infected -

• client who in the past was not offered PCRS;
• sex or needle-sharing partner who the PCRS provider learns is continuing to have unprotected sex and who has partners other than the original HIV-infected client;
• client who now has new sex or needle-sharing partners;
• client who is now seeking additional STD or family planning services or substance abuse treatment; or
• client who in the past refused or only partially participated in PCRS but has now decided to participate fully.

Health department HIV prevention program staff should ensure that health care and prevention providers in the community and HIV-infected persons in the area are aware that PCRS is available at publicly funded sites and are aware of how to access those services. Furthermore, health departments can expand access to PCRS by developing agreements with private providers. These agreements could specify that the private providers will deliver PCRS to their HIV-infected clients. In such situations, these providers should be given relevant information, training, and support to successfully deliver the services.

2.1.1 Services for Those Persons Tested Anonymously

Opportunities to access PCRS must be provided to HIV-infected clients who have been tested anonymously and choose to remain anonymous. Program experience has indicated that PCRS can be conducted in an anonymous setting (Hoffman, et al., 1995). CDC requires that, unless prohibited by state law or regulation, grantees must provide reasonable opportunities for anonymous testing. Clients who test HIV-positive in anonymous settings must be counseled on how to enter a confidential system and be strongly encouraged to do so. This will assist them in receiving medical care and other services, including PCRS.

Recent reports show that persons who enter anonymous HIV testing programs do so earlier in their HIV infection and are more likely to begin medical care while still comparatively well (Bindman et al., 1998; Nakashima et al., 1998). CDC currently recommends that persons initially testing positive for HIV in an anonymous setting be counseled and informed about how to enter a confidential medical care system.

2.1.2 Inability To Pay

CDC-funded PCRS programs must provide access to PCRS regardless of clients' or partners' ability to pay (CDC, 1993).

2.2 Accommodating Requests from Other Health Jurisdictions

PCRS providers might sometimes be asked to contact the partner of an HIV-infected person residing in another health jurisdiction. Such contacts with other jurisdictions is the role of the state health department. For example, a PCRS provider might request that the staff in a neighboring state health department assist in locating and informing a previous partner or former spouse of an HIV-infected client. A reasonable effort must be made to accommodate that request if it complies with state and local regulations and policies, and confidentiality is maintained.

Go to Section 3.0