PARTNER COUNSELING AND REFERRAL SERVICES FOR HIV PREVENTION
>>> USE OF TRADE NAMES OR COMMERCIAL SOURCES IS FOR INFORMATIONAL
PURPOSES ONLY AND DOES NOT CONSTITUTE AN ENDORSEMENT BY THE
UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES, OR THE
PUBLIC HEALTH SERVICE.
VIEWS EXPRESSED BY GUEST PARTICIPANTS AREN'T NECESSARILY THE
VIEWS OF ACCIDENTS FOR DISEASE CONTROL AND PREVENTION.
CDC AND OUR PRESENTERS WISH TO DISCLOSE THEY HAVE NO FINANCIAL
INTERESTS OR OTHER RELATIONSHIPS WITH THE MANUFACTURERS OF
COMMERCIAL PRODUCTS, SUPPLIERS OF COMMERCIAL SERVES OR COMMERCIAL
SUPPORTERS.
PRESENTATIONS WILL NOT INCLUDE ANY DISCUSSION OF THE UNLABELED
USE OF A PRODUCT OR A PRODUCT UNDER INVESTIGATIONAL USE.
>>> HELLO.
I'M JOHN HARBORTH, MANAGER OF THE COMMUNICABLE DISEASE UNIT AT
THE AUSTIN-TRAVIS COUNTY HEALTH AND HUMAN SERVICES DEPARTMENT IN
WELCOME TO "PARTNER COUNSELING AND REFERRAL SERVICES FOR HIV
PREVENTION."
I'LL BE YOUR MODERATOR FOR THIS PROGRAM, WHICH IS COMING TO YOU
FROM THE CENTERS FOR DISEASE CONTROL
AND PREVENTION IN
IN TODAY'S BROADCAST, WE'LL PRESENT INFORMATION ON THE GOALS,
PURPOSE AND CONTEXT OF HIV PARTNER COUNSELING AND REFERRAL
SERVICES, OR PCRS, AS WELL AS THE PROCESS, TECHNIQUES AND SKILLS
FOR DELIVERING PCRS.
WE'LL HEAR FROM COLLEAGUES ACROSS THE COUNTRY AT HEALTH
DEPARTMENTS, COMMUNITY-BASED ORGANIZATIONS AND RESEARCH PROGRAMS.
NEAR THE END OF THE BROADCAST, WE'LL IDENTIFY RESOURCES RELATED
TO PCRS AND TAKE AUDIENCE QUESTIONS.
SO, AS WE CONTINUE, PLEASE JOT DOWN QUESTIONS AND FAX THEM TO US.
WE'LL PROVIDE THAT FAX NUMBER IN A FEW MOMENTS.
IF WE CAN'T RESPOND TO YOUR QUESTION TODAY, WE'LL PROVIDE
TO REACH US LATER.
ALSO, MARK YOUR CALENDARS FOR A SATELLITE BROADCAST AND WEBCAST
ON HIV PREVENTION SCHEDULED FOR
3:00 P.M. EASTERN STANDARD TIME.
THAT PROGRAM WILL FOCUS ON "REVISED RECOMMENDATIONS FOR HIV
SCREENING OF ADULTS, ADOLESCENTS AND PREGNANT WOMEN IN HEALTHCARE
SETTINGS."
MORE INFORMATION WILL BE AVAILABLE AFTER JULY 24th AT THE
SATELLITE BROADCAST WEBSITE.
WE ENCOURAGE YOU TO SET UP VIEWING LOCATIONS AND INVITE
COLLEAGUES NOW TO VIEW THAT SATELLITE BROADCAST AND WEBCAST ON
NOVEMBER 17th.
TODAY'S TOPIC COVERS A
WHILE IT WOULD BE IMPOSSIBLE TO DETAIL ALL THE ISSUES RELATED TO
THIS TOPIC IN TWO HOURS, WE DO EXPECT TO HIGHLIGHT SEVERAL
STRATEGIES AND RESOURCES.
BEFORE WE BEGIN, HERE'S SOME IMPORTANT TELEPHONE NUMBERS WHICH
ARE ALSO ON THE FLYER AND VIEWER HANDOUT AVAILABLE AT YOUR
VIEWING LOCATION OR AT THE BROADCAST WEBSITE.
IF YOU HAVE TECHNICAL DIFFICULTY IN RECEIVING TODAY'S PROGRAM,
OUR TECHNICAL HELP LINE IS 800-728-8232.
FROM OUTSIDE THE UNITED STATES, THE NUMBER IS 404-639-1289.
AND FOR THE HEARING OR SPEECH IMPAIRED, THE TTY NUMBER IS
1-800-815-8152 IN THE
AND 404-639-0182 IN
BECAUSE YOUR PARTICIPATION IS IMPORTANT TO US, PLEASE FAX YOUR
QUESTIONS NOW FOR OUR DISCUSSION SEGMENT.
WE WON'T BE TAKING LIVE CALLS, BUT YOU CAN FAX YOUR QUESTIONS AND
COMMENTS FOR OUR PANEL AT ANY TIME DURING TODAY'S LIVE PROGRAM.
THE FAX NUMBER FOR SUBMITTING QUESTIONS AND COMMENTS TODAY IS
1-800-553-6323.
FOR THE HEARING OR SPEECH IMPAIRED, THE TTY NUMBER IS
1-800-815-8152.
FROM OUTSIDE THE UNITED STATES, THE FAX NUMBER IS 404-639-0181.
AND FOR THE HEARING OR SPEECH IMPAIRED, THE FAX NUMBER FROM
OUTSIDE THE UNITED STATES IS 404-639-0182.
AS MENTIONED, THESE NUMBERS ARE ON THE FLYER AND VIEWER HANDOUT
IF YOU HAVE A COMPUTER WITH INTERNET ACCESS AND REAL PLAYER
SOFTWARE, YOU CAN VIEW THIS PROGRAM ONLINE LIVE OR AFTER AIRDATE.
THE WEBSITE FOR ONLINE VIEWING IS WWW.PHPPO.CDC.GOV/PHTN.
WE HOPE YOU WILL SHARE THIS INFORMATION WITH COLLEAGUES.
TODAY'S PROGRAM HAS A NUMBER OF KEY OBJECTIVES WHICH ARE --
ONE, DEFINE THE GOALS, PURPOSE AND CONTEXT OF HIV PARTNER
COUNSELING AND REFERRAL SERVICES OR PCRS.
TWO, DESCRIBE THE PCRS PROCESS.
THREE, DISCUSS TECHNIQUES FOR DELIVERING PCRS.
FOUR, IDENTIFY THE KNOWLEDGE AND SKILLS REQUIRED FOR PCRS STAFF.
AND FIVE, IDENTIFY RESOURCES RELATED TO PCRS.
>> DR. SAM DOOLEY IS ASSOCIATE DIRECTOR FOR SCIENCE AND PROGRAM
INTEGRATION IN THE DIVISION OF HIV/AIDS PREVENTION AT CDC.
HE PRESENTS AN OVERVIEW OF THE GOALS, PURPOSE AND CONTEXT OF PCRS --
>> THANKS VERY MUCH FOR PARTICIPATING IN THIS SESSION ON HIV
PARTNER COUNSELING AND REFERRAL SERVICES, OR PCRS.
I'D LIKE TO BEGIN MY COMMENTS BY MAKING A VERY CLEAR STATEMENT,
THAT AT CDC, WE VIEW PCRS AS A CRITICAL, BUT VERY UNDERUTILIZED,
STRATEGY FOR STEMMING THE HIV EPIDEMIC, AND HERE'S WHY --
THE NUMBER OF NEW HIV INFECTIONS OCCURRING EACH YEAR IN THE
UNITED STATES PEAKED AT ABOUT 160,000 IN THE MID 1980s.
THANKS TO THE WORK OF MANY DEDICATED GROUPS AND INDIVIDUALS, NEW
INFECTIONS DECLINED SHARPLY UNTIL THE EARLY 1990s, BUT
UNFORTUNATELY, SINCE THEN, THE DECLINE HAS STAGNATED, AND FOR THE
PAST DECADE, NEW INFECTIONS HAVE REMAINED STEADY AT ABOUT 40,000 PER YEAR.
CDC ESTIMATES THAT OVER HALF OF NEW INFECTIONS COME FROM PERSONS
WHO DON'T KNOW THEY'RE INFECTED, AND THERE'S GOOD EVIDENCE THAT
MOST PERSONS WHO LEARN THEY'RE INFECTED GREATLY REDUCE THEIR RISK BEHAVIOR.
SO HELPING THEM LEARN THEIR HIV STATUS IS ONE OF THE MOST
EFFECTIVE STRATEGIES FOR REDUCING TRANSMISSION.
BUT CDC ALSO ESTIMATES THAT ABOUT ONE QUARTER OF THE NEARLY 1
MILLION PERSONS WITH HIV IN THE UNITED STATES DO NOT KNOW THEY'RE
INFECTED, AND OF THOSE WHO DO KNOW, OVER A THIRD LEARN OF THEIR
INFECTION WITHIN THE YEAR BEFORE BEING DIAGNOSED WITH AIDS.
THIS SUGGESTS THAT MANY ARE DIAGNOSED LATE IN THEIR INFECTION,
MEANING THEY HAVEN'T BENEFITED FROM EARLY MEDICAL CARE AND HAVE
NOT BEEN AWARE THAT THEY MAY BE TRANSMITTING HIV TO OTHERS.
REACHING THE 25% OF INFECTED PERSONS WHO DON'T KNOW THEY'RE
INFECTED, AND DOING SO EARLY IN THEIR INFECTION, BEFORE THEY'VE
TRANSMITTED HIV TO OTHERS, IS CRITICAL TO HIV PREVENTION.
IT'S ALSO CRITICAL TO REACH PERSONS WHO KNOW THEY'RE INFECTED BUT
CONTINUE RISKY BEHAVIOR, PERSONS WHO ARE HIV-NEGATIVE AND AT VERY
HIGH RISK, BUT NOT AWARE OF THAT RISK, AND PERSONS WHO ARE
HIV-NEGATIVE AND AWARE OF THEIR RISK, BUT HAVING DIFFICULTY
REDUCING THEIR RISKY BEHAVIORS.
STEMMING THE EPIDEMIC DEPENDS ON REACHING THESE FOUR GROUPS.
AND PCRS OFFERS AN EFFICIENT MEANS OF REACHING ALL FOUR GROUPS.
RESEARCH AND PROGRAM EXPERIENCE INDICATE THAT PCRS CAN REACH
PERSONS AT HIGHEST RISK.
IN STUDIES OF PCRS, FROM 8% TO 39% OF PARTNERS TESTED WERE FOUND
TO HAVE PREVIOUSLY UNDIAGNOSED HIV.
THIS PREVALENCE IS SUBSTANTIALLY HIGHER THAN IN OTHER SETTINGS,
WHERE HIV TESTING IS COMMONLY DONE.
PCRS HAS ALSO BEEN FOUND TO BE COST-EFFECTIVE, AND ACCEPTABILITY
OF PCRS HAS BEEN DEMONSTRATED IN SURVEYS OF PERSONS SEEKING HIV
TESTING, HIV-INFECTED PERSONS AND NOTIFIED PARTNERS.
IN EACH CASE, THE MAJORITY OF RESPONDENTS SUPPORTED PARTNER
NOTIFICATION.
THE POTENTIAL OF PCRS FOR REACHING HIGH-RISK PERSONS HAS BEEN
WELL-DEMONSTRATED.
BUT A SURVEY OF HEALTH DEPARTMENTS IN AREAS WITH HIGH RATES OF
HIV, PUBLISHED IN 2003, FOUND THAT IN AREAS WITH HIV REPORTING,
HEALTH DEPARTMENTS WERE INTERVIEWING ONLY 52% OF INFECTED PERSONS FOR PCRS.
HEALTH DEPARTMENT DATA SUBMITTED TO CDC ALSO INDICATES THAT PCRS
IS HIGHLY UNDERUTILIZED AND NEEDS SUBSTANTIAL IMPROVEMENT AT THE
PROGRAM LEVEL.
THIS IS UNFORTUNATE, BECAUSE PCRS IS A VALUABLE SERVICE FOR
PERSONS LIVING WITH HIV AND THEIR PARTNERS, NOT AN INTRUSION INTO
THEIR PRIVACY, AS IS SOMETIMES BELIEVED.
MOST PERSONS WHO LEARN THEY'RE INFECTED WANT THEIR PARTNERS TO BE
AWARE OF THEIR RISK, BUT ARE OFTEN UNCERTAIN HOW TO INFORM THEM.
PCRS OFFERS HIV-INFECTED PERSONS A
FOR INFORMING PARTNERS OF THEIR EXPOSURE TO HIV.
IT ALSO OFFERS HIV-INFECTED PERSONS ACCESS TO COUNSELING AND
SUPPORT FOR REDUCING RISK BEHAVIORS, AS WELL AS REFERRALS TO
SOCIAL AND MEDICAL SERVICES.
FOR PARTNERS OF INFECTED PERSONS, THE MAIN BENEFIT OF PCRS IS
LEARNING THEIR RISK AND GAINING ACCESS TO COUNSELING AND TESTING.
THOSE WHO ARE NOT INFECTED CAN RECEIVE ASSISTANCE IN CHANGING
RISK BEHAVIORS.
THOSE WHO ARE INFECTED CAN ALSO BENEFIT FROM EARLIER DIAGNOSIS
AND ACCESS TO MEDICAL EVALUATION AND TREATMENT, AND IT'S
IMPORTANT TO EMPHASIZE THAT PCRS IS VOLUNTARY FOR INFECTED
PERSONS AND PARTNERS, AND IS CONFIDENTIAL.
TO ADDRESS THE CONTINUING HIGH RATE OF HIV TRANSMISSION IN THE
UNITED STATES, AND TO PROMOTE DEVELOPMENT OF NEW PREVENTION
STRATEGIES, CDC IMPLEMENTED AN INITIATIVE CALLED "ADVANCING HIV
PREVENTION: NEW STRATEGIES FOR A CHANGING EPIDEMIC," OR AHP.
ONE OF THE INITIATIVE'S KEY STRATEGIES IS WORKING WITH INFECTED
PERSONS TO HELP THEM REDUCE THEIR RISK FOR TRANSMITTING HIV.
AN IMPORTANT PART OF THIS STRATEGY IS TO PLACE INCREASED EMPHASIS
ON PARTNER NOTIFICATION AND SUPPORT NEW APPROACHES TO PARTNER
NOTIFICATION, LIKE OFFERING RAPID HIV TESTING TO PARTNERS AND
USING PEERS TO CONDUCT PARTNER NOTIFICATION, COUNSELING AND REFERRAL.
CDC ROUTINELY FUNDS HEALTH DEPARTMENTS TO CONDUCT PCRS.
AS PART OF AHP, CDC IS ALSO CONDUCTING DEMONSTRATION PROJECTS
WITH SIX HEALTH DEPARTMENTS TO EXAMINE THE ROLE OF RAPID HIV
TESTING FOR PCRS.
THREE DIFFERENT MODELS ARE BEING USED IN THESE PROJECTS.
THE FIRST MODEL INCORPORATES RAPID HIV TESTING INTO TRADITIONAL
PCRS ACTIVITIES AT HEALTH DEPARTMENTS.
THE SECOND BUILDS ON TRADITIONAL PCRS BY OFFERING THESE SERVICES
IN COMMUNITY-BASED ORGANIZATIONS, OR CBOS.
AND THE THIRD MODEL RELIES ON HIV-POSITIVE PERSONS TO NOTIFY
THEIR PARTNERS OF THEIR EXPOSURE AND MAKES RAPID TESTING EASILY
AVAILABLE TO THE PARTNERS ONCE NOTIFIED.
CDC IS ALSO CONDUCTING DEMONSTRATION PROJECTS WITH NINE CBOS
WORKING WITH HIV-INFECTED PERSONS TO USE THEIR SOCIAL NETWORKS AS
A MEANS OF REACHING AND PROVIDING COUNSELING AND TESTING TO
PERSONS AT VERY HIGH RISK FOR HIV.
AND THROUGH ITS DIRECTLY FUNDED CBO PROGRAM, CDC IS FUNDING
SEVERAL CBOS TO COLLABORATE WITH HEALTH DEPARTMENTS TO PROVIDE PCRS.
THROUGH ALL THESE ACTIVITIES, WE HOPE TO EXPAND PUBLIC HEALTH
OPTIONS FOR PROVIDING PCRS.
PCRS IS A PROMISING TOOL FOR HIV PREVENTION, BUT ITS SUCCESS
DEPENDS ON THE UNDERSTANDING AND SUPPORT OF HIV-INFECTED PERSONS,
HEALTH CARE PROVIDERS, PUBLIC HEALTH PRACTITIONERS AND THE
COMMUNITY.
IT'S UP TO ALL OF US TO MAXIMIZE THIS IMPORTANT TOOL.
WE HOPE THIS SATELLITE BROADCAST WILL HELP MOVE US IN THAT
DIRECTION.
THANKS AGAIN FOR PARTICIPATING IN THIS SESSION.
>> WE VISITED STATE HEALTH DEPARTMENTS IN COLORADO, NORTH
CAROLINA AND FLORIDA TO LEARN ABOUT THEIR PROCESS AND TECHNIQUES
FOR DELIVERING PCRS.
HERE'S WHAT THEY HAD TO SAY.
>> THE PARTNER COUNSELING AND REFERRING SERVICE AT THE COLORADO
DEPARTMENT OF HEALTH IS INITIATED BY US.
WE WERE TALKING TO AN ORANGE CLIENT WHO WAS INFECTED WITH HIV.
OUR GOAL IS TO CONTACT AND NOTIFY AS MANY PARTNERS AS POSSIBLE
WHO COULD BE INFECTED WITH THE DISEASE.
WE HAVE THREE DIFFERENT APPROACHES FOR THAT.
FIRST APPROACH IS THE ORIGINAL CLIENT DOING A NOTIFICATION
THEMSELVES.
WE COACH THEM THROUGH THAT.
SECOND ONE IS, IF A CLIENT FEELS THAT THEY CAN SEE -- FEEL THE
PERSON SHOULD BE NOTIFIED BUT IS UNCOMFORTABLE IN HOW TO EXPLAIN
IT, WE'LL SIT THROUGH THEM IN THAT NOTIFICATION.
THIRD ONE IS WHERE WE DO THE NOTIFICATION AND WE KEEP IT
CONFIDENTIAL.
PERSON'S IDENTITY IS ALWAYS KEPT CONFIDENTIAL.
>> HOW I LOCATE AND NOTIFY PARTNERS CAN SOMETIMES BE A CHALLENGE,
DEPENDING ON WHAT TYPE OF INFORMATION WE RECEIVE FROM THE
ORIGINAL PATIENT, IT CAN BE VERY LIMITED.
AT THAT POINT WE DO AS MUCH AS WE DO.
WE DO DEPARTMENT OF MOTOR VEHICLE SEARCHES.
WE DO HOSPITAL SEARCHES.
LOCAL COUNTY HEALTH DEPARTMENTS.
COMMUNITY HEALTH CENTERS, AS WELL AS OUR HOMELESS SHELTER.
IF AT THAT TIME WE'RE ABLE TO NOTIFY AND FIND THIS PERSON, I THEN
MAKE AN INITIAL PHONE CALL AND I LET THE PERSON KNOW WHAT I DO,
WHO I AM, AND HOW I'D LIKE TO COME OVER AND DISCUSS WITH THEM A
MEDICAL MATTER.
AT THAT POINT WE SET UP AN APPOINTMENT AND A PLACE TO MEET.
>> HOW I APPROACH INTERVIEWING A NEW CLIENT WITH THE PARTNER
COUNSELING AND REFERRAL SERVICE PROGRAM IS BY FIRST LETTING THEM
KNOW THAT THEIR CONFIDENTIALITY AND THEIR PRIVACY WILL ALWAYS BE
PROTECTED.
ONCE THEY REALIZE THAT THAT'S A TRUE AND POSSIBLE THING FOR ME TO
DO, THEY ARE MORE APT TO TALK WITH ME.
WE DISCUSS THE PARTNER NOTIFICATION AND WHY IT'S IMPORTANT THEM
AND THEIR LOVED ONES TO KNOW THEY MAY BE INFECTED WITH THIS
DISEASE AND HOW IMPORTANT IT IS TO FIND OUT THAT JUST YOU MAY BE
INFECTED WITH HIV AND HOW YOU CAN OVERCOME ANY OBSTACLES YOU MAY
HAVE REGARDING THAT, AS WELL AS GETTING THE CARE THAT YOU NEED AS
SOON AS POSSIBLE.
>> IN MY OFFICE, ALL HIV RECORDS ARE LOCKED AT ALL TIMES.
WE DO HAVE A SECURITY SYSTEM TO GET INTO OUR BUILDING.
I AM THE ONLY ONE WITH ACCESS TO MY OFFICE ITSELF.
AND WHEN IT COMES TO PARTNER NOTIFICATION, WE MAKE SURE THAT THE
PARTNER HAS NO IDEA WHO GAVE US THE NAME, HOW WE WERE NOTIFIED --
HOW WE RECEIVED THE INFORMATION ON THEM.
WE DO THAT BY SAYING TO SOMEONE THAT I UNDERSTAND YOUR PRIMARY
CONCERN IS WHO GAVE US YOUR NAME.
WE ARE HERE TO TELL YOU THAT THE MOST IMPORTANT THING IS THAT
WE'RE HERE AND THAT YOU NEED TO BE TESTED AND THE REASONS FOR THAT.
THE PERSON WHO GAVE US YOUR NAME IS NOT IMPORTANT.
IT WAS JUST SOMEONE WHO CARES ABOUT YOU.
>> I'M USING RAPT TESTING IN MY PROGRAM BECAUSE IT GIVES THE
BENEFIT TO THAT CLIENT TO KNOW THEIR TEST RESULTS WITHIN 20 MINUTES.
THEN WE CAN DISCUSS CARE, IF NEED, REFERRALS THEY MAY NEED,
NOTIFYING OTHER PARTNERS, ANYTHING THAT MIGHT BE IN THEIR BEST INTEREST.
THE ONLY DRAWBACK TO DOING RAPID TESTING IS IT MUST BE IN A
CONTROLLED ENVIRONMENT.
LIVING IN
SUMMERTIME.
YOU CANNOT CARRY AROUND THE CONTROLS AND TESTS WITH YOU IN YOUR CAP.
>> HOW WE STAY UP TO DATE WITH PCRS IS BY INITIALLY WE ATTEND A
THREE TO FOUR-DAY TRAINING WHICH TEACHES US HOW TO APPROACH A
CLIENT REGARDING PARTNER COUNSELING AND REFERRAL SERVICE, HOW TO
GET THEM ON BOARD FOR THAT, AND ALSO ASSURE THEM THAT THEIR
CONFIDENTIALITY WILL BE KEPT AT ALL TIMES.
ALSO, WE ATTEND A QUARTERLY MEETING IN
WITH A CLINICAL CONSULTANT REGARDING DIFFICULT CASES WE MAY BE
HAVING AT THAT TIME, HOW TO APPROACH UNAPPROACHABLE CLIENTS OR PARTNERS.
THAT'S VERY HELPFUL TO US INDIVIDUALLY.
WE ALSO ATTEND TRAININGS THAT ARE PUT ON BY THE
DEPARTMENT OF PUBLIC HEALTH THROUGH OUR TECHNICAL ASSISTANCE PROGRAM.
>> HERE IN
OF PCRS ONCE WE RECEIVE A POSITIVE LAB FOR HIV, WE GO OUT AND
TALK TO THE ORIGINAL CLIENT AND INTERVIEW THE CLIENT.
WE SOLICIT THE CLIENT FOR THEIR SEX AND IMMEDIATE SHARING PARTNERS.
IN SOME CASES THE ORIGINAL CLIENT IS A LITTLE NERVOUS ABOUT US
GOING OUT TALKING TO THE PARTNER BECAUSE OF CONFIDENTIALITY.
SO WHAT WE DO IS, WE DO A ROLE PLAY AND SHOW THEM WHAT WE'RE
ACTUALLY GOING TO SAY TO THE PARTNER ONCE WE NOTIFY THEM.
THE STAFF MEMBER GETS ALL THE INFORMATION THEY NEED, SUCH AS --
LOCATING INFORMATION, SUCH AS PHONE NUMBER AND ADDRESS.
THEY GO TO THE PARTNER'S HOUSE AND THEY LET THE PARTNER KNOW THAT
THEY HAVE BEEN EXPOSED TO HIV AND THEY GET THEM IN TO GET THEM
TESTED AND COUNSELED FOR HIV.
>> IN
INTERVIEWING THE ORIGINAL CLIENT IS THE STANDARD APPROACH.
THIS MEANS WE FOCUS ON THE CLIENT'S NEEDS FIRST, THAT'S OUR
PRIMARY GOAL.
ONCE WE DO THAT WE TRY TO PROVIDE SUPPORT FOR THE CLIENT.
CONSIDERING THIS IS A HIGHLY SENSITIVE TOPIC.
WHILE PROVIDING SUPPORT, WE WANT TO BE EMPATHETIC.
WE ALSO TRY TO BE ASSERTIVE WHEN WE NEED TO BE.
WHEN ELICITING PARTNERS FROM THE CLIENT, SOMETIMES CLIENTS ARE
RELUCTANT TO GIVE US LOCATING AND IDENTIFYING INFORMATION.
SO WE WANT TO BE REASSURING THAT THEIR CONFIDENTIALITY, ALONG
WITH THE CONFIDENTIALITY OF THEIR PARTNER, IS GOING TO BE
PROTECTED.
CONFIDENTIALITY IS A MAJOR CONCERN FOR OUR OFFICE.
SOME OF THE THINGS THAT WE DO TO ASSURE CONFIDENTIALITY WITHIN
THE OFFICE ARE TO KEEP ALL DATA LOCKED AWAY IN SECURE FILES.
OUR COMPUTERS ARE ALSO IN SECURED OFFICES AND WE HAVE CONTROLLED
ACCESS TO ALL OF THOSE OFFICES.
WE ALSO USE CODES TO DESCRIBE VARIOUS DISEASES.
SOME OF THE THINGS THAT WE DO WITHIN THE FIELD TO ASSURE
CONFIDENTIALITY IS THAT WE NEVER ALLOW LOCATING OR IDENTIFYING
INFORMATION FOR CLIENTS TO LEAVE OUR VEHICLES.
WE ALSO ASSURE THAT WE'RE SPEAKING WITH THE RIGHT CLIENT WHEN WE
APPROACH A CLIENT BY ASKING FOR THEIR SOCIAL SECURITY NUMBER OR
THEIR DATE OF BIRTH.
WE THEN ALLOW THE CLIENT TO FIND A SECURE CONFIDENTIAL LOCATION
FOR US TO DISCUSS THE INFORMATION.
SOME OF THE PROBLEMS WE EXPERIENCE LOCATING AND IDENTIFYING
PARTNERS ARE DEALING WITH TRANSIENT POPULATIONS, PEOPLE THAT MOVE
FROM
SO, HAVING ACCURATE LOCATING INFORMATION ON BOTH INDIVIDUALS IS
VERY DIFFICULT.
ALSO, WITH THE INCREASING NUMBER OF PEOPLE WHO HAVE ANONYMOUS SEX
PARTNERS, LOCATING PEOPLE THROUGH SCREEN NAMES FROM THE INTERNET,
OR NICKNAMES IS VERY DIFFICULT.
ALSO, WITH MINORS, WE FIND THAT IT'S EASIER TO GO THROUGH THE
SCHOOL SYSTEM TO LOCATE THOSE CLIENTS, AS OPPOSED TO TRYING TO
LOCATE THEM AT THEIR HOMES.
SOME OF THE RESPONSES WE GENERALLY GET FROM PEOPLE ARE
OVERWHELMING.
PEOPLE ARE VERY GRATEFUL ONCE WE COME OUT AND NOTIFY THEM,
BECAUSE OTHERWISE, A LOT OF THOSE INDIVIDUALS WOULD HAVE NEVER
TESTED AND FOUND OUT THEIR STATUS.
>> WHEN WE RECEIVE A POSITIVE LAB FROM A MEDICAL PROVIDER OR A
PRIVATE PROVIDER, WE CONTACT THAT OFFICE.
AND OF COURSE, THE DOCTOR WOULD LIKE TO ALWAYS LET THE CLIENT
KNOW FIRST OF THEIR STATUS.
WHAT THEY DON'T NORMALLY CONTACT THE PARTNERS AND WE LET THEM
KNOW THAT WE WILL BE CONTACTING THE SEX AND SHARING PARTNERS.
IF THEY'RE A NEW PROVIDER IN THE AREA, WE MAY PROVIDE A CALL OR
VISIT AND TAKE FORMS OUT TO THEM AND JUST LET THEM KNOW WHAT WE
WILL BE DOING.
AND ACTUALLY, FROM WHAT I'VE SEEN, THE RESPONSE HAS BEEN REALLY
GREAT IN THIS AREA.
ALL OUR STAFF ARE INTERNALLY TRAINED.
WE HAVE A TWO-WEEKS COURSE, WHICH IS FUNDAMENTALS OF DISEASE
INTERVENTION.
AND THIS CONSISTS THEM ROLE PLAYING, WHICH I MENTIONED EARLIER,
HOW TO GO OUT, TALK TO CLIENT, INTERVIEW THE CLIENT, AND ALSO DO
PARTNER NOTIFICATION.
THEY ALSO HAVE A THREE-DAY COURSE ON COUNSELING, TESTING AND
REFERRAL IN HIV.
AND THAT ALSO HAS THEM ROLE PLAYING AND PARTNER NOTIFICATION.
ONCE THEY FINISH THAT, THEY COME BACK TO THE OFFICE.
THEY ARE MENTORED IN A FIELD ANYWHERE FROM FOUR TO SIX MONTHS.
ONCE WE FIELD THAT THEY ARE READY TO GO IN THE FIELD BY
THEMSELVES, WE LET THEM GO OUT AND WE ALSO MONITOR THEM BY DOING
FIELD AUDITS.
THE SUPERVISOR IN THE FIELD GOES OUT WITH THEM.
IF THEY'VE BEEN HERE A WHILE, THEY STILL MONITOR THEM IN THE
FIELD TO MAKE SURE THE CLIENT AND -- ARE RECEIVING THE BEST CARE POSSIBLE.
OUR STAFF IS STAFFED IN RAPID TESTING.
WE GO OUT, WE DO OUTREACHES, HEALTH FAIRS, AND SCREENINGS.
WE ALSO PROVIDE THE RAPID TESTING KITS TO OUR COMMUNITY-BASED
ORGANIZATIONS.
HOWEVER, ALL OUR STAFF ARE IN PHLEBOTOMY AS WELL.
THE REASON WE DO THAT, WE WANT TO GET TWO TESTS, NOT JUST THE HIV
TESTS, BUT WE ALSO WANT TO TEST FOR SYPHILIS.
WE TEST IN YOUR HOMES.
WE MIGHT DRAW BLOOD IN THE CAR.
AND THE REASON THAT WE DO THIS IS, SOMETIMES THE CLIENT IS
RELUCTANT ABOUT GOING INTO THE HEALTH DEPARTMENT BECAUSE THEY
MIGHT HAVE A FAMILY MEMBER THERE.
AND WE FIND THAT THIS REALLY HELPS US IN THE FIELD.
>> IN
WITH PCRS, ONE OF WHICH IS MAINTAINING CONFIDENTIALITY OF THAT CLIENT.
ONCE WE GET THE CLIENT IN, WE THEN ASK THE CLIENT FOR SOME TYPE
OF IDENTIFICATION TO ENSURE THAT THIS IS THE PERSON THAT ACTUALLY
TOOK THAT ORIGINAL TEST.
ONCE WE GET THAT INFORMATION, WE THEN NOTIFY THE PERSON OF THEIR
TEST RESULTS AND MAKE SURE THAT THEY GET A CLEAR UNDERSTANDING OF
THOSE TEST RESULTS AND WHAT IT MEANS TO THEM.
WE WANT OUR CLIENTS TO TAKE OWNERSHIP OF THIS RESULT.
WE THEN WILL REFER THAT PERSON ON TO GET THE TYPE OF ADDITIONAL
CARE THERAPY AND/OR TREATMENT.
WE FOLLOW UP WITH THAT PERSON AS WELL AS DOING INFORMATION,
GETTING INFORMATION, ON THEIR PARTNERS AND/OR NEEDLE SHARING
PARTNERS AND ENSURING THAT THESE INDIVIDUALS ARE REFERRED IN FOR
TESTING AS WELL AND/OR TREATMENT.
WHEN YOU -- ONE THING WE DO --
WE GO THROUGH A FULL RISK REDUCTION PROCESS WHERE WE GO THROUGH
BEHAVIOR MODIFICATION WITH THEM.
INTERESTING ENOUGH, IN THE STATE OF
CALL A MAMA BEAR PROGRAM WHERE WE WORK WITH PREGNANT FEMALES
SPECIFICALLY.
WHAT WE DO IN THIS PROGRAM IS WE MAKE SURE THAT THESE FEMALES ARE
SEEN IMMEDIATELY FOR CARE AND/OR TREATMENT TO ENSURE THAT THEY'RE
HAVING LESS LIKELY A CHANCE TO TRANSMIT THE VIRUS ON TO THEIR CHILDREN.
OUR FIELD GOES THROUGH TRAINING.
THE FIRST IS EDUCATION WHERE THEY LEARN ABOUT THE STDs.
THE INTERVIEWING TRAINING SHOWS THEM TO TALK TO PATIENTS AND
CLIENTS IN A CONFIDENTIAL MANNER.
THE THIRD PROCESS WILL BE 500 AND 501 TRAINING WITH OUR HIV/AIDS
DEPARTMENT WHERE YOU LEARN HOW TO TALK AND UNDERSTAND THE
INFORMATION OF HIV AND AIDS.
OF COURSE, THE FOURTH STEP WOULD BE ON-THE-JOB TRAINING WHERE
THEY MEET THE SUPERVISORS, MANAGERS AND FELLOW STAFF WHO HAVE
BEEN EXPERIENCED IN THIS POSITION AND UNDERSTAND THE DAY-TO-DAY
RUNNING OF THE INFORMATION AND THIS JOB.
FOLLOW UP THE WHOLE THING WITH DOING AUDITS AS A SUPERVISOR AND
MONITORING THEIR WORK FOR A PERIOD OF ONE TO THREE YEARS.
>> THIS GIVES US THE CHANCE TO GET TOGETHER EACH MORNING TO
DISCUSS INTERVIEWS THAT WERE DONE THE PREVIOUS DAY, WHETHER IT BE
IN THE CLINIC OR IN THE FIELD.
THE FACILITATOR GOES AROUND THE ROOM AND ASKS EACH SPECIALIST
ABOUT THEIR INTERVIEWS ON THE PREVIOUS DAYS.
THE DIS THEN GIVES DEMOGRAPHIC INFORMATION ABOUT THE CASE, GETS
INPUT FROM THE CO-WORKERS REGARDING DIFFERENT TECHNIQUES, TOOLS
AND PERSPECTIVES, AND DIFFERENT IDEAS ABOUT HOW TO APPROACH THE CASE.
WE GIVE OUR PLAN OF ACTION, WHERE WE'RE GOING TO GO WITH THE
CASE, WHAT THE NEXT STEP SHOULD BE, AND WE RECEIVE INPUT FROM OUR
CO-WORKERS AS TO WHAT THEY THINK SHOULD BE THE NEXT STEP IN OUR CASE.
THIS SOMETIMES GIVES US AN
NOT HAVE BEEN POSSIBLE HAD WE NOT SHARED ALL THIS INFORMATION.
MOST MEDICAL PROVIDERS ARE NOT EDUCATED ON PCRS.
THEY ARE TRAINED IN COUNSELING AND TREATMENT.
BUT IT IS OUR GOAL AT THE HEALTH DEPARTMENT TO MAKE THEM AWARE OF
WHAT PCRS IS AND WHAT THE BENEFITS ARE OF PCRS TO THE PATIENTS
AND THEIR PARTNERS.
ONCE WE EDUCATE THEM, MOST OF THE MEDICAL PROVIDERS REACT
FAVORABLY.
THEY ARE MORE THAN WILLING TO COOPERATE AND PROVIDE US WITH
WHATEVER INFORMATION THEY CAN.
WE VISIT THE PROVIDERS, WE PROVIDE THEM UPDATES AS THEY BECOME
AVAILABLE TO US, ESTABLISH A PARTNERSHIP WITH A MEDICAL PROVIDERS
TO LET THEM KNOW THAT WE'RE -- WHAT WE'RE TRYING TO DO WILL
BENEFIT THEM, THE PATIENTS AND THEIR PARTNERS.
IT'S A WIN-WIN SITUATION FOR EVERYBODY.
WE LET THEM KNOW THAT WE CAN DO PCRS AT THE OFFICE IF THAT MAKES
THEM AND THE CLIENT MORE COMFORTABLE.
WE FIND OUT ONCE THEY GET ALL THE INFORMATION, WE ESTABLISH A
PARTNERSHIP, ALL THE PIECES FIT TOGETHER.
THEY REACT FAVORABLY AND EVERYBODY WINS.
>> CONFIDENTIALITY IS VERY IMPORTANT.
IT BEGINS THE MOMENT YOU WALK IN THE DOOR.
YOU CAN ONLY ACCESS ENTRY TO THE CLINIC BY KNOWING SPECIFIC CODES
THAT ARE GIVEN TO PEOPLE THAT WORK IN THE CLINIC.
ONCE INSIDE, YOU'RE IN A PRIVATE ROOM WHERE WE CAN HAVE A
ONE-ON-ONE INTERVIEW.
IN THE COMMUNITY, I DO NOT WEAR MY BADGE SO THAT YOU CAN IDENTIFY WHO I AM.
I DO NOT DRIVE A STATE-MARKED VEHICLE THAT MAY LET NEIGHBORS KNOW
WHO IS THAT, WHERE IS SHE FROM, WHAT'S SHE DONE?
WE DON'T WANT TO GIVE ANYONE ANY IDEA WHY WE'RE THERE.
THAT WAY, I USE MY OWN CAR.
IF YOU FEEL MORE COMFORTABLE COMING TO MY CAR, YOU CAN COME IN MY CAR.
I WELCOME ANYTHING THAT WILL MAKE YOU MORE COMFORTABLE AND MAKE
IT EASIER FOR YOU TO TALK TO ME.
AND THAT WAY, MY CLIENTS TEND TO BE MORE OPEN BECAUSE I'M ON A
ONE-TO-ONE BASIS WITH THEM, AND I'M ALSO CULTURALLY SYMPATHETIC
TO WHATEVER AREA I'M IN AND IT TENDS TO WORK VERY WELL.
>> OUR TRANSIENT POPULATION IS A BIG CHALLENGE.
THE WAY I HANDLE THAT, I GO OUT INTO THE COMMUNITY, INTO THAT
TRANSIENT POPULATION.
I HAVE BEEN GIVEN SPECIFIC DEMOGRAPHICS WHERE I CAN LOCATE THAT
PERSON, WHAT TIME OF DAY THEY'RE THERE.
THEY HAVE A NICKNAME.
THEY ARE V THESE KINDS OF CLOTHES ON.
THEY DO CRACK.
I TAKE ALL OF THIS AND COMPILE IT.
I GO OUT.
I VISIT THAT SITE.
THAT PERSON MAY NOT BE THERE.
SOMEONE MAY SAY HE'S AT JOE'S STORE TWO BLOCKS AWAY.
YOU GO THERE.
IF THEY SAY, WELL THAT PATIENT WAS HERE, BUT THEY WENT TWO BLOCKS
OVER, OVER TO MARK'S STORE, THAT'S WHERE I GO.
I KEEP GOING AND GOING.
AND WHEN YOU HAVE A GOOD PHYSICAL DESCRIPTION, YOU KNOW THAT THAT
PATIENT HANGS OUT THERE, YOU HAVE THAT INFORMATION NOW.
YOU HAVE SOMETHING TO GO ON.
YOU HAVE TO PERSEVERE AND SOONER OR LATER YOU WILL CATCH THAT CLIENT.
YOU WILL CATCH UP WITH THEM AND HOPEFULLY, YOU WILL GET THEM TO
COME INTO THE CLINIC, WITH OR WITHOUT ID, BECAUSE I HAVE TAKEN
OWNERSHIP OF THAT PATIENT.
I HAVE IDENTIFIED THIS PATIENT.
BECAUSE HE DOES NOT HAVE AN IDENTIFICATION, DOES NOT MEAN HE'S
NOT GOING TO GET WHAT HE NEEDS TO GET IN THAT CLINIC.
AND I'M GOING TO FOLLOW IT THROUGH FROM THE BEGINNING TO THE END.
I USE THE DIRECT APPROACH IN INTERVIEWING MY CLIENTS.
I EXPLAIN WHY THEY'RE THERE.
THE STD.
I LIKE THE CLIENT TO UNDERSTAND THE DIAGNOSIS, THE OUTLOOK, THE
TREATMENT.
I WANT THE CLIENT TO FEEL COMFORTABLE WITH ME.
I WANT TO ELICIT AS MUCH INFORMATION FROM THAT PARTNER ABOUT
THEIR PARTNERS, AND TO GIVE THE CLIENT A POSITIVE OUTLOOK ON LIFE
AND KNOW THAT OF COURSE YOU HAVE AN STD.
IS NOT THE END OF THE WORLD.
THE MORE THAT YOU EDUCATE THEM, THEY WILL EDUCATE THE NEXT
PERSON, AND WE'LL BEGIN TO MAKE A DIFFERENCE IN STOPPING THE
SPREAD AND PREVENTING STDs.
>> JOINING ME NOW IN THE STUDIO ARE TWO COLLEAGUES FROM STATE
HEALTH DEPARTMENTS.
STD/HIV SECTION OF THE COLORADO DEPARTMENT OF PUBLIC HEALTH AND
ENVIRONMENT.
SHE HAS ALSO BEEN A DISEASE INTERVENTION SPECIALIST, OFFERING
PCRS TO STD AND HIV-INFECTED INDIVIDUALS SINCE 1987.
SHE'S PARTICIPATED IN THE EVOLUTION OF
INTERVENTION TO PREVENT THE TRANSMISSION OF HIV.
STAN PHILLIP IS THE PUBLIC HEALTH REGIONAL SUPERVISOR FOR THE
STD/HIV PREVENTION AND CARE BRANCH FOR
HE MANAGES A 12 COUNTY REGION AND SUPERVISES 11 DISEASE
INTERVENTION SPECIALISTS, ENSURING THAT THEY ARE TRAINED AND
READY TO CONDUCT PCRS.
HE ALSO WORKS WITH PROVIDERS AND HEALTH DEPARTMENTS TO ENSURE
MAXIMUM USE OF PCRS.
THANK YOU BOTH FOR BEING WITH US TODAY.
ASK YOU FOR ANY ADDITIONAL COMMENTS ABOUT THE PROCESS AND
TECHNIQUES THAT WE JUST SAW FROM
LET'S START WITH
>> THANK YOU, JOHN.
I THOUGHT THE VIDEO REALLY CAPTURED THE ESSENCE OF PCRS.
TWO COMMENTS THAT I WOULD LIKE TO MAKE ARE THAT NOT ONLY DO WE
TRY TO IDENTIFY PAST AND CURRENT PARTNERS, WE TRY TO HAVE
DISCUSSION ABOUT DISCLOSING TO FUTURE PARTNERS.
AND TO DETERMINE WHAT BARRIERS MAY EXIST FOR THE CLIENT IN
DISCLOSING TO POTENTIAL FUTURE PARTNERS AND TRY TO BREAK DOWN
THOSE BARRIERS.
ALSO, I'D LIKE TO SAY THAT PCRS IDENTIFIES PEOPLE WHO NOT ONLY
MAY NOT KNOW THEIR STATUS, BUT THEY MAY HAVE TESTED POSITIVE FOR
HIV IN THE PAST AND MAY NOT BE GETTING APPROPRIATE MEDICAL CARE
AN MAY NEED SOME MORE COUNSELING AND SUPPORT SERVICES TO HELP
THEM ALONG.
DAN?
>> THANKS.
>> STAN?
WHAT WOULD YOU LIKE TO ADD?
>> WELL, JOHN, STATE OF
THE INCIDENCE OF HIV AND WE HAVE EMBRACED PCRS AS NOT ONLY A
PUBLIC HEALTH TOOL, BUT ALSO AN
MUCH NEEDED SUPPORT AND SERVICES FOR HIV POSITIVE RESIDENTS, AS
WELL AS THEIR SEX AND NEEDLE SHARING PARTNERS.
WITH RESPECT TO THAT COMMITMENT, WE PLACE A HIGH PRIORITY ON
TRAINING OF OUR DISEASE INTERVENTION SPECIALIST STAFF WHO IS --
THEIR ROLE IS CRITICAL IN THIS ENDEAVOR.
THE DIS GOES THROUGH A MULTIFACETED TRAINING WITH A STRONG
EMPHASIS ON PCRS.
OUR GOAL IS TO DEVELOP PUBLIC HEALTH PROFESSIONALS THAT ARE NOT
ONLY CAPABLE OF CARRYING OUT PCRS BUT ARE ALSO WILLING AND ABLE
TO CONVEY THE BENEFITS OF PCRS TO NOT ONLY THEIR CLIENTS OR
PRIVATE PROVIDERS, BUT ANYONE WITHIN THE PUBLIC HEALTH COMMUNITY.
>> THANKS, STAN, FOR YOUR INSIGHT.
CLIENT CENTERED COUNSELING FOR PCRS IS SO IMPORTANT.
HERE TO DEMONSTRATE COUNSELING TECHNIQUES FOR PCRS ARE
DUBOSE AND LISA KIMBROUGH FROM CDC'S DIVISION OF HIV/AIDS
PREVENTION.
>> HELLO.
MY NAME IS HOPE.
>> HI, HOPE.
>> I'M AN HIV PREVENTION COUNSEL HERE AT THE SOUTH COUNTY HEALTH
DEPARTMENT.
TODAY I'LL TALK WITH YOU ABOUT THE SERVICES YOU RECEIVED.
BEFORE I BEGIN, I'D LIKE TO JUST CHECK IN.
HOW ARE YOU DOING?
>> AS WELL AS CAN BE EXPECTED.
>> HOW DO YOU FEEL ABOUT THE SERVICES YOU RECEIVED THUS FAR?
>> THEY'VE BEEN FINE SO FAR.
>> AS YOUR HIV PREVENTION COUNSELOR I'LL WORK WITH YOU TO ANSWER
ANY QUESTIONS YOU MIGHT HAVE.
FURTHER, EXPLAIN YOUR HIV TEST RESULTS, DISCUSS APPROPRIATE
REFERRALS, AUK TO YOU ABOUT HOW BEST TO REFER YOUR PARTNERS FOR
HIV TESTING AND PLANS FOR FOLLOW-UP.
HOW DOES THAT SOUND TO YOU?
>> THAT SOUNDS GREAT.
THAT WAS EXACTLY WHAT I WAS HOPING WE'D TALK ABOUT TODAY.
>> NOW, I KNOW THAT YOU RECEIVED A LOT OF OVERWHELMING
INFORMATION TODAY.
BUT I WOULD LIKE FOR YOU TO TRY TO RELAX AND UNDERSTAND THAT
EVERYTHING WE TALK ABOUT REMAINS CONFIDENTIAL.
>> OKAY.
>> BEFORE WE GO ANY FURTHER, WHAT QUESTIONS OR CONCERNS DO HAVE
YOU RIGHT NOW?
>> WELL, I REALLY WANT YOU TO EXPLAIN TO ME WHAT MY TEST RESULTS
REALLY MEAN.
THEY TOLD ME THAT I WAS HIV POSITIVE, BUT WHAT DOES THAT REALLY MEAN?
>> LAST YEAR IN MARCH WHEN YOU CAME TO OUR FACILITY YOU RECEIVED
AN HIV TEST RESULT THAT WAS NEGATIVE.
HOWEVER, THE TEST RESULTS RECEIVED TODAY CONFIRM THAT YOU'RE HIV POSITIVE.
NOW WHAT THAT MEANS IS THAT THE TEST YOU RECEIVED TODAY DETECTED
HIV ANTIBODIES IN YOUR BODY AND THAT TELLS US THAT YOU'RE
INFECTED WITH HIV.
>> WELL, I FEEL FINE.
AND I KNOW I DON'T LOOK LIKE I HAVE HIV.
WHAT AM I GOING TO DO?
WHAT AM I GOING TO TELL MY FAMILY AND MY FRIENDS AND MY
BOYFRIEND?
WHAT ARE THEY GOING TO THINK OF ME NOW?
ARE THERE ANY MEDICATIONS THAT I CAN TAKE SO THAT I WON'T GET SICK?
THIS IS JUST TOO MUCH TO HANDLE RIGHT NOW.
I'M JUST FEELING TOO OVERWHELMED.
>> NAOMI, I WOULD LIKE FOR YOU JUST TO CALM DOWN, TAKE A DEEP BREATH.
AND LET'S JUST DISCUSS ONE THING AT A TIME.
>> OKAY.
>> NOW TO BEGIN ANSWERING YOUR QUESTION ABOUT MEDICATIONS
AVAILABLE TO YOU.
WE HAVE A CASE MANAGER HERE ON SITE THAT CAN HELP YOU SET UP A
DOCTOR'S APPOINTMENT AND ANY OTHER SUPPORT SERVICES THAT YOU
MIGHT NEED.
IF YOU LIKE, AFTER WE GET THROUGH WITH THIS SESSION, I CAN WALK
YOU OVER TO MEET HER AND TO SET UP AN APPOINTMENT AS SOON AS POSSIBLE.
>> THAT WILL BE GREAT.
>> THE OTHER THING YOU SAID YOU WERE CONCERNED ABOUT IS HOW TO
TELL YOUR FAMILY, YOUR FRIENDS, AND YOUR BOYFRIEND.
NOW I CAN ASSIST YOU WITH FINDING THE
AND FOR OTHERS THAT YOU WOULD LIKE TO TELL, I CAN REFER YOU TO
THE
>> WHAT'S THE
>> IT'S A NON-PROFIT ORGANIZATION THAT HAS A PROGRAM THAT
SPECIALIZES IN WORKING WITH CLIENTS TO HELP THEM DISCLOSE THEIR
HIV STATUS TO THEIR PARTNERS AND TO THEIR LOVED ONES.
THE PROGRAM IS CALLED HEALTHY RELATIONSHIPS.
IT'S REALLY A GOOD PROGRAM AND I HIGHLY RECOMMEND IT.
SO HOW DOES THAT SOUND TO YOU?
>> OH, THAT SOUNDS GREAT.
BUT YOU KNOW WHAT MY MAIN CONCERN IS?
I'M REALLY CONCERNED ABOUT HOW TO TELL MY BOYFRIEND.
WE'VE BEEN TOGETHER FOR THE PAST TWO YEARS, AND I KNOW HE'S GOING
TO THINK I'VE BEEN CHEATING ON HIM.
>> HAS HE ACCUSED YOU OF CHEATING ON HIM BEFORE?
>> YES, HE'S ACCUSED ME OF CHEATING SEVERAL TIMES, BUT HE'S THE
ONLY ONE I'VE BEEN WITH FOR THE PAST TWO YEARS.
>> HOW DO YOU THINK HE'LL REACT WHEN HE FINDS OUT YOU'RE HIV POSITIVE?
>> HE'S GOING TO BE REALLY UPSET AND USUALLY WHEN HE'S UPSET, HE
THREATENS TO HIT ME.
HE HASN'T HIT ME BEFORE, BUT HE ALWAYS THREATENS TO HIT ME WHEN
HE GETS UPSET.
>> NAOMI, LET ME GIVE YOU THIS REFERRAL CARD TO THE WOMEN'S CENTER.
THEN IN THE EVENT THAT HE BECOMES VIOLENT, PLEASE CONTACT THEM
IMMEDIATELY.
>> OKAY.
THANK YOU.
>> WITH THIS IN MIND, LET ME TELL YOU ABOUT THE DIFFERENT WAYS
THAT HE OR OTHER PARTNERS CAN BE REFERRED FOR TESTING, AND YOU
CAN CHOOSE THE ONE THAT IS BEST FOR YOU.
>> I TOLD YOU, I ONLY HAVE ONE PARTNER.
>> OKAY.
I JUST WANT TO MAKE SURE THAT EVERYONE HAS AN
ALSO, I WANT TO ASSURE YOU THAT THIS PROCESS IS VOLUNTARY AND
EVERYTHING WE TALK ABOUT TODAY REMAINS CONFIDENTIAL.
SHALL WE CONTINUE?
>> YES.
WE CAN GO AHEAD.
>> NOW, BEFORE I CAN PROVIDE ANY SERVICES TO YOUR BOYFRIEND, I
NEED TO GET SOME INFORMATION.
>> OKAY.
>> SO THAT I WON'T FORGET ANYTHING, I WOULD LIKE TO TAKE A FEW NOTES.
IS THAT OKAY WITH YOU?
>> SURE, THAT'S FINE.
>> WHAT IS HIS FIRST AND LAST NAME?
>> JAMES
>> GIVE ME A DESCRIPTION OF JAMES SO THAT WHEN HE COMES INTO THE
CLINIC I'LL KNOW EXACTLY WHO HE IS.
>> WELL, HE'S TALL, SLIM, DARK SKIN.
>> WHAT IS HIS RACE?
>> HE'S BLACK.
>> AND ABOUT HOW TALL IS JAMES?
>> HE'S ABOUT 6'3".
>> WHAT IS IT ABOUT JAMES THAT MAKES HIM UNIQUE?
>> WELL, HE'S BALD-HEADED.
BUT HE ALWAYS WEAR THIS BLACK HAT THAT HAS BOB MARLEY ON IT.
HE LOVES REGGAE MUSIC AND BOB MARLEY SO YOU ALWAYS SEE HIM WITH
THAT BLACK HAT ON.
>> OKAY, GREAT.
WHERE DOES JAMES STAY?
>> HE STAYS WITH ME.
>> NOW WHEN HE'S NOT STAYING WITH YOU, WHERE ELSE DOES HE LIVE?
>> WITH HIS MOM OVER
I THINK THE ADDRESS IS
>> NOW IF I NEEDED TO CONTACT JAMES BY PHONE, WHAT IS THE PHONE
NUMBER OR CELL NUMBER?
>> HIS PHONE NUMBER IS THE SAME AS MINE.
BUT HIS CELL NUMBER IS 555-9816.
>> WHERE DOES JAMES WORK IT >> HE WORK AT THE SAM'S CLUB OVER ON
PENINSULA PARKWAY.
>> WHAT ELSE CAN YOU TELL ME ABOUT JAMES?
>> WELL, HE SOMETIMES GOES TO THE
I THINK THE NAME OF IT IS VISIONS NIGHTCLUB.
>> GREAT!
THANKS FOR THE IMPORTANT INFORMATION THAT YOU GAVE ME ABOUT JAMES.
I THINK IN THE EVENT THAT I NEED TO CONTACT HIM, I WILL HAVE
ENOUGH INFORMATION.
>> OKAY.
>> NOW THAT I KNOW MORE ABOUT JAMES, LET ME TELL YOU ABOUT THE
THREE WAYS THAT HE CAN BE REFERRED FOR TESTING.
ONE WAY IS FOR YOU TO TAKE FULL RESPONSIBILITY OF TELLING JAMES
THAT HE MAY HAVE BEEN EXPOSED TO HIV AND REFER HIM FOR COUNSELING
AND TESTING SERVICES.
A SECOND WAY IS FOR YOU TO GIVE ME, OR OTHER HEALTH DEPARTMENT
STAFF, PERMISSION TO INFORM JAMES AND REFER HIM FOR COUNSELING
AND TESTING SERVICES AND OTHER SUPPORT SERVICES.
THE
FIRST, BY A SET DATE WOULD YOU TAKE FULL RESPONSIBILITY FOR
MAKING SURE JAMES COMES IN FOR COUNSELING AND TESTING SERVICES.
HOWEVER, IF JAMES DOES NOT COME IN BY THAT DATE, I, OR OTHER
HEALTH DEPARTMENT STAFF, WILL CONTACT HIM, OR WE CAN INFORM HIM TOGETHER.
HOW WOULD YOU LIKE TO NOTIFY JAMES?
>> I THINK THE THIRD OPTION IS THE BEST FOR ME RIGHT NOW.
I THINK I'LL FEEL MORE COMFORTABLE WITH A TAG TEAM APPROACH.
BEFORE ANYONE ELSE GETS INVOLVED I NEED TO TELL JAMES MYSELF.
I'M JUST AFRAID OF HOW HE'S GOING TO REACT TO THE NEWS.
ANYWAY, LET ME TALK WITH HIM FIRST AND I'LL GET HIM TO COME IN BY FRIDAY.
IF THAT DOESN'T WORK, I'LL GIVE YOU PERMISSION TO FOLLOW UP.
>> OKAY.
GREAT CHOICE.
NOW, LET'S SPEND A LITTLE TIME ROLE PLAYING ABOUT HOW YOU'RE
GOING TO TELL JAMES AND REFER HIM FOR TESTING.
I'LL BE JAMES, AND YOU TELL ME HOW ARE YOU GOING TO TELL HIM
ABOUT YOUR HIV STATUS AND GETTING HIM TESTED?
>> OKAY.
JAMES, I NEED TO TALK WITH YOU ABOUT SOMETHING VERY IMPORTANT.
WHAT DO YOU MEAN YOU NEED TO TALK WITH ME ABOUT SOMETHING VERY
IMPORTANT?
>> WELL, I WENT TO THE HEALTH DEPARTMENT ABOUT TWO WEEKS AGO AND
HAD A PREGNANCY TEST.
>> WHAT?
YOU'RE PREGNANT!
>> NO, I'M NOTE PREGNANT.
BUT WHILE I WAS THERE THEY DID OFFER ME AN HIV TEST AND I ACCEPTED.
AND, WELL, MY RESULTS CAME BACK POSITIVE.
>> WHAT DO YOU MEAN?
YOU MEAN TO TELL ME THAT YOU'RE HIV POSITIVE?
>> YEAH.
>> YOU MEAN YOU TELLING ME THAT YOU'VE BEEN MESSING AROUND AND
CAUGHT SOMETHING?
>> NO, YOU'RE THE ONLY PERSON I'VE BEEN WITH.
I HAVEN'T BEEN WITH ANYONE ELSE.
AND I DON'T WANT TO BE WITH ANYONE ELSE.
>> WELL, HOW DID YOU GET IT?
BECAUSE I SURE DON'T HAVE IT?
>> HOW DO YOU KNOW.
THE ONLY WAY I FOUND OUT WAS BECAUSE I GOT TESTED.
AND YOU NEED TO GET TESTED TO.
LADY AT THE CLINIC WAS VERY NICE AND SHE SAID THAT YOU CAN CALL
HER AT ANY TIME.
SHE'LL ARRANGE FOR YOU TO GET TESTED AND, FOR FREE.
>> WHAT?
YOU TOLD THEM ABOUT ME?
>> WELL, YES.
I TOLD THEM THAT YOU WERE THE ONLY ONE I'VE BEEN HAVING SEX WITH.
THE COUNSELOR WANTED TO MAKE SURE ANYONE THAT I WAS HAVING SEX
WITH IS TESTED TO MAKE SURE THAT THEY WERE OKAY.
SHE HELPED ME OUT A
>> I CAN'T BELIEVE THIS!
WELL, I GUESS I NEED TO GET A TEST.
WHAT'S HER NUMBER?
I WANT TO GET ONE TODAY.
>> YOU WANT ME TO GO WITH YOU?
>> YES.
LET'S GO TOGETHER.
>> I'LL CALL HER RIGHT NOW.
>> THAT WAS EXCELLENT.
I HOPE THAT IT GOES THAT SMOOTHLY WITH JAMES.
HOWEVER, IN THE EVENT THAT HE BECOMES VIOLENT, REMEMBER TO CALL
THE WOMEN'S CENTER.
>> OKAY.
THANKS.
>> NOW, AS I MENTIONED EARLIER, I'LL WALK YOU OVER TO THE CASE
MANAGER TO SET UP AN APPOINTMENT FOR MEDICAL CARE AT ANY OF THE
-- AT ANY OTHER SUPPORT SERVICES THAT YOU MIGHT NEED.
ALSO, IF EVERYTHING GOES WELL, I HOPE TO SEE YOU, OR JAMES, BY FRIDAY.
>> OKAY.
THANKS FOR ALL YOUR HELP.
>> OUR DISCUSSION SEGMENT IS COMING UP IN A FEW MOMENTS AFTER OUR BREAK.
WE WON'T BE TAKING LIVE CALLS, BUT RATHER, INVITE YOU TO FAX
QUESTIONS FOR OUR PANEL AT ANY TIME.
FROM THE UNITED STATES, THE FAX NUMBER IS 1-800-553-6323.
FOR THE HEARING OR SPEECH IMPAIRED, THE TTY NUMBER IS
1-800-815-8152.
FROM OUTSIDE THE UNITED STATES, THE FAX NUMBER IS 404-639-0181.
AND FOR THE HEARING OR SPEECH IMPAIRED, THE FAX NUMBER FROM
OUTSIDE THE
JOINING ME NOW ARE TWO COLLEAGUES WHO HIRE AND TRAIN COUNSELORS
WHO DELIVER PCRS.
DENISE TAFOYA IS PROGRAM COORDINATOR AND TRAINER WITH THE PARTNER
AND PROGRAM SERVICES SECTION IN
FOR SEVEN YEARS SHE HAS DELIVERED HIV PCRS TRAINING THERE THROUGH
A CDC FUNDED PROGRAM.
HER EXPERIENCE ALSO INCLUDES CONDUCTING HIV TESTING AND
COUNSELING IN TRADITIONAL STD CLINIC SETTINGS, IN HEALTH
DEPARTMENTS AND FOR SEVERAL YEARS SERVED AS A DISEASE
INTERVENTION SPECIALIST CONDUCTING PARTNER NOTIFICATION IN RURAL
AND URBAN SETTINGS.
SHE ALSO WORKED AS AN STD PROGRAM MANAGER AND TRAINER FOR CDC FOR
EIGHT YEARS.
CINDY GETTY IS TEAM LEADER FOR TRAINING AND DEVELOPMENT IN THE
CAPACITY BUILDING BRANCH IN THE DIVISION OF HIV/AIDS PREVENTION AT CDC.
FOR MANY YEARS, SHE HAS CONDUCTED PCRS, SUPERVISED PCRS STAFF,
TRAINED PUBLIC AND PRIVATE PROVIDERS ON HOW TO PROVIDE PCRS,
PROVIDED TECHNICAL ASSISTANCE ON PCRS, AND TRAINED TRAINERS ON PCRS.
THANK YOU BOTH FOR JOINING US TODAY.
DENISE AND CINDY, YOU'VE BEEN INVOLVED FOR MANY YEARS IN TRAINING
HIV COUNSELORS.
WHAT ADDITIONAL INFORMATION WOULD YOU LIKE TO SHARE ABOUT PCRS
COUNSELING OR THE ROLE PLAY SESSION THAT WE JUST SAW?
LET'S BEGIN WITH DENISE.
>> THANK YOU, JOHN.
FIRST LET ME SAY THAT I THOUGHT THAT THIS PCRS SESSION HAD A REAL
RHYTHM TO IT.
IT HAD DIRECTION, FOCUS, AND MAINTAINED A CLIENT-CENTERED APPROACH.
THESE ARE ALL THINGS WE WANT TO ACHIEVE IN OUR SESSIONS.
ONE OF THE BIGGEST CONCERNS PEOPLE HAVE AROUND PARTICIPATING IN
PCRS IS THE ISSUE OF CONFIDENTIALITY.
AT THE BEGINNING OF THE SESSION, THIS WAS DISCUSSED AND THEN
AGAIN BEFORE INQUIRING ABOUT INFORMATION AROUND THE BOYFRIEND THE
COUNSELOR ALSO BROUGHT THE SUBJECT UP.
SOMETHING THAT'S IMPORTANT TO REMEMBER IS THAT WHEN YOUR CLIENT
PRESENTS WITH A LIST OF CONCERNS, AS THIS CLIENT DID, BE MINDFUL
OF NOT BECOMING OVERWHELMS YOURSELF AS THE PROVIDER.
AND I RECOGNIZE THAT SOMETIMES THIS MAY BE VERY DIFFICULT TO DO.
BUT IT IS OUR ROLE TO BE THE GROUNDING FORCE IN THAT ROOM AND TO
TAKE ONE OPTION OR -- PARDON ME, ONE CONCERN AT A TIME, AS THIS
PARTICULAR COUNSELOR DID.
ONE OF THE BEST PARTS ABOUT THIS SESSION WAS THE COUNSELOR'S
CHECKING IN WITH THE CLIENT ABOUT DOMESTIC VIOLENCE OR INTIMATE
PARTNER VIOLENCE.
AND THEY'RE NOT MAKING A JUDGMENT ABOUT THAT, BUT ARE OFFERING
THE CLIENT A REFERRAL TO A WOMEN'S SHELTER IN THE EVENT THAT SHE
NEEDED IT IN THE FUTURE.
THE LAST COMMENT I WANT TO MAKE IS THAT NOTIFICATION OF EXPOSURE
TO HIV IS NOT RECOMMENDED WHEN THE CLIENT WILL BE IN PHYSICAL
DANGER OR FEEL THEIR LIFE WILL BE IN JEOPARDY AS A RESULT OF
NOTIFYING THE PARTNER.
JOHN?
>> THANK YOU, DENISE.
CINDY, WHAT WOULD YOU LIKE TO ADD ABOUT PCRS COUNSELING AND ALSO
ABOUT THE KNOWLEDGE AND SKILLS REQUIRED OF PCRS STAFF?
>> THANKS, JOHN.
LET'S TALK A LITTLE BIT ABOUT THE KNOWLEDGE AND SKILLS.
BECAUSE THERE ARE A NUMBER OF ACTIVITIES INVOLVED IN CONDUCTING
PCRS, THERE IS
PCRS USUALLY CONSISTS OF THREE ACTIVITIES OR THREE PARTS, IF YOU WILL.
THE FIRST PART IS WORKING WITH THE HIV INFECTED CLIENT.
THIS ACTIVITY IS OFTEN CALLED ELICITATION.
THERE ARE DISEASE INTERVENTION SPECIALISTS, HIV COUNSELORS, CASE
MANAGERS AND OTHER HEALTH CARE PROFESSIONALS.
THE OTHER PART IS LOCATING PARTNERS.
THIS IS OFTEN DONE BY TRAINED PUBLIC HEALTH PROFESSIONALS LIKE
DISEASE INTERVENTION SPECIALISTS.
THEN THE THIRD PART IS NOTIFYING THE PARTNERS, WHICH CAN BE DONE
BY CLIENT WITH OR WITHOUT ASSISTANCE, OR BY OTHER HEALTH
PROFESSIONALS LIKE DISEASE INTERVENTION SPECIALISTS OR CASE MANAGERS.
WITH THAT, THE KNOWLEDGE REQUIRED FOR PCRS INCLUDES AN OVERALL
UNDERSTANDING OF HOW PCRS WORKS, BECAUSE EVEN IF A PROVIDER ISN'T
RESPONSIBLE FOR ALL THE PHASES OF IT, HE OR SHE MUST UNDERSTAND
HOW THE PROCESS WORKS SO THAT IT CAN BE EXPLAINED TO THE CLIENT.
CLIENTS OFTEN HAVE QUESTIONS ABOUT THE PROCESS THAT MUST BE
ANSWERED BEFORE THEY WILL AGREE TO PARTICIPATE IN PCRS.
PROVIDERS MUST ALSO HAVE AN OVERALL UNDERSTANDING OF THE BENEFITS
OF PCRS FOR THE CLIENT, AND HIS OR HER PARTNERS, AS WELL AS AN
UNDERSTANDING OF THE CONCERNS THAT MANY CLIENTS AND/OR PARTNERS
MIGHT HAVE.
AGAIN, THESE MUST OFTEN BE ADDRESSED BEFORE CLIENTS WILL AGREE TO
PARTICIPATE.
PROVIDERS MUST ALSO UNDERSTAND THE LOCAL LAWS, POLICIES AND
PROTOCOLS ASSOCIATED WITH PCRS AND MUST BE ABLE TO EXPLAIN THEM
TO CLIENTS.
AN UNDERSTANDING OF HOW TO GATHER INFORMATION REQUIRED FOR PCRS
ALSO IMPORTANT, AS IS AN UNDERSTANDING OF HIV PREVENTION
COUNSELING, HOW TO FACILITATE HIV TESTING FOR THOSE PARTNERS WHO
ARE NOTIFIED, AND PROTOCOLS FOR HIV PREVENTION COUNSELING AND
FACILITATING TESTS WILL VARY ABOUT -- BY THE LOCAL AREA.
FINALLY, PROVIDERS MUST KNOW ABOUT COMMUNITY RESOURCES FOR
LOCATING PARTNERS, ESPECIALLY IF THEY'RE INVOLVED IN THAT PHASE
OF PCRS OR THAT ACTIVITY, AND THEY MUST KNOW ABOUT COMMUNITY
RESOURCES FOR REFERRALS SINCE ONE OF THE GOALS OF PCRS IS TO
CONNECT CLIENTS WITH APPROPRIATE RESOURCES TO HELP THEM REDUCE
THEIR RISK OF ACQUIRING OR TRANSMITTING HIV.
NOW THE SKILLS REQUIRED TO CONDUCT ALL OF THE ACTIVITIES IN PCRS
INCLUDE THE ABILITY TO MAINTAIN CONFIDENTIALITY FOR BOTH THE
ORIGINAL CLIENT AND THE PARTNERS TO BE NOTIFIED, EXCELLENT
LISTENING SKILLS AND MEMORY SKILLS SINCE CLIENTS OFTEN DON'T
PROVIDE INFORMATION IN A SYSTEMATIC WAY, EXCELLENT COMMUNICATION
SKILLS, WHICH INCLUDES THE ABILITY TO ASK QUESTIONS, GET
INFORMATION FROM CLIENTS, AND EXPLAIN UNFAMILIAR CONCEPTS SIMPLY
AND EASILY.
COUNSELING SKILLS ARE ALSO VERY IMPORTANT AND IT INVOLVES HELPING
PEOPLE CHANGE BEHAVIOR IN ORDER TO REDUCE THEIR RISK OF HIV.
RESEARCH AND INVESTIGATIVE SKILLS ARE IMPORTANT FOR PROVIDERS WHO
ARE INVOLVED IN LOCATING AND/OR NOTIFYING PARTNERS.
AND IN ADDITION, THOSE PROVIDERS NOTIFYING AND LOCATING PARTNERS
NEED TO HAVE SKILLS IN CONDUCTING FIELD WORK ACCORDING TO LOCAL
POLICY AND PROTOCOLS.
NOW THE QUALITIES OF THOSE KIND OF INTANGIBLE THINGS THAT MAKE
PEOPLE WELL-SUITED FOR THEIR JOBS THAT WE OFTEN SEE IN PEOPLE WHO
CONDUCT PCRS INCLUDE COMPASSION, PERSISTENCE, A DESIRE TO BE
HELPFUL OR CONTRIBUTE TO THE GREATER GOOD, AND A NON-JUDGMENTAL NATURE.
TRAINING IS REALLY CRITICAL FOR ANYONE WHO WILL BE PROVIDING
PCRS, ANY OF THE ACTIVITIES INVOLVED IN PCRS, IN FACT.
ONGOING SUPERVISORY SUPPORT AND PROFESSIONAL DEVELOPMENT ARE ALSO
VERY IMPORTANT.
TOPICS COVERED IN TRAINING AND ONGOING PROFESSIONAL DEVELOPMENT
SHOULD INCLUDE INTERVIEWING CLIENTS, HIV PREVENTION COUNSELING,
HOW TO CONDUCT THE HIV TEST, CONFIDENTIALITY, DOCUMENTATION,
FIELD SAFETY, AND ANY OTHER TOPIC THE LOCAL AREA THINKS IS
IMPORTANT TO PROVIDING RELEVANT SERVICES TO CLIENTS.
JOHN?
>> THANKS, CINDY.
>> DENISE, YOU SERVE AS THE PROGRAM AND TRAINING COORDINATOR AT
THE
CAN YOU PLEASE TELL US A LITTLE ABOUT THE PREVENTION TRAINING
CENTER PROGRAM IN THE UNITED STATES?
>> THANK YOU, JOHN.
THE NATIONAL NETWORK OF STD AND
IS FUNDED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION AND
IS DEDICATED TO INCREASING AND MAINTAINING THE SKILLS AND
KNOWLEDGE OF HEALTH PROFESSIONALS IN THE AREAS OF SEXUAL AND
REPRODUCTIVE HEALTH.
THE NETWORK WAS INITIALLY FUNDED IN 1979 FOR CLINICAL TRAINING,
AND THEN ABOUT TEN YEARS AGO ADDED TWO OTHER TRAINING COMPONENTS.
BEHAVIORAL AND PARTNER SERVICES TRAINING, WHICH OFFER
COMPREHENSIVE PROVIDER TRAINING FOR THE MANAGEMENT OF STD AND HIV
PATIENTS OR CLIENTS.
THERE ARE CURRENTLY TEN TRAINING CENTERS, FOUR BEHAVIORAL AND
AND PROGRAM SUPPORT TRAINING CENTERS.
YOU CAN SEE THAT THE NETWORK OPERATES UNDER NATIONAL QUADRANT
SYSTEMS WITH EACH QUADRANT HOUSING AND OFFERING ALL THESE
CATEGORIES OF TRAINING PROGRAMS.
THERE IS ONE CLINICAL
WHERE TRAINING IS TARGETED AT PUBLIC AND PRIVATE HEALTH CARE
PRACTITIONERS.
THE BEHAVIORAL AND SOCIAL INTERVENTION TRAINING CENTER ARE
AVAILABLE TO PROVIDE STD AND HIV PREVENTION SPECIALISTS WITH
INDIVIDUAL, GROUP AND COMMUNITY-LEVEL INTERVENTION TRAINING.
THE FOUR PARTNER SERVICES AND
BRINGING PARTNER NOTIFICATION AND DISEASE INVESTIGATION TRAINING
TO PUBLIC HEALTH WORKERS.
WITH SPECIAL EXPERTISE IN TRAINING OF NEW DISEASE INTERVENTION
SPECIALISTS.
THESE CENTERS ARE READILY AVAILABLE TO PROVIDE HIV PARTNER
COUNSELING AND REFERRAL SERVICES TRAINING WITH MOST TRAINERS
HAVING BEEN, OR PRESENTLY ARE, CERTIFIED HIV TEST COUNSELORS, AS
WELL AS FORMER DISEASE INTERVENTION SPECIALISTS.
IN ADDITION TO OFFERING THE COURSE SERIES OF TRAINING PROGRAMS
LIKE PCRS, THE NATIONAL NETWORK OF PREVENTION TRAINING CENTERS
ALSO PROVIDES SUPPORT AND TECHNICAL ASSISTANCE TO AREAS OF
SPECIAL INTEREST, LIKE SYPHILIS EXAMINATION, INFERTILITY
PREVENTION AND THE INITIATIVE FOR ADVANCING HIV PREVENTION.
THE NATIONAL NETWORK DOES PROVIDE ON-SITE TRAINING, AS WELL AS
WEB-BASED TRAINING AND CAN SERVE AS A REAL LINK TO OTHER
RESOURCES, GUIDELINE DOCUMENTS AND OTHER STD AND HIV PREVENTION
TRAINING PRODUCTS.
FOR ANYONE INTERESTED IN PCRS TRAINING, OR COURSE OFFERINGS IN
THE AREAS I'VE DISCUSSED, OR JUST FOR MORE GENERAL INFORMATION
ABOUT THE NETWORK, PLEASE VISIT OUR WEBSITE AND REGISTER FOR
TRAINING AT WWW.STDHIV PREVENTIONTRAINING.ORG.
JOHN?
>> THANKS, DENISE.
WE'LL TAKE A 10 MINUTE BREAK NOW WITH A COUNT DOWN CLOCK ON SCREEN.
PLEASE CONTINUE FAXING YOUR QUESTIONS DURING THIS INTERMISSION,
AND WE'LL SEE IN 10 MINUTES.
>> WELCOME BACK TO CDC'S SATELLITE BROADCAST, "PARTNER COUNSELING
AND REFERRAL SERVICES FOR HIV PREVENTION."
AND WELCOME BACK TO
FROM
AND TO DENISE TAFOYA FROM THE
PREVENTION.
IN A FEW MOMENTS, OUR FOUR PANELISTS WILL TAKE QUESTIONS THAT OUR
VIEWERS ARE FAXING IN.
BUT FIRST, LET'S DISCUSS THE SOCIAL NETWORKS DEMONSTRATION
PROJECT AND ITS IMPLICATIONS FOR PCRS.
CDC FUNDED NINE PROJECTS FOR A TWO-YEAR PERIOD TO DEMONSTRATE THE
FEASIBILITY OF USING SOCIAL NETWORK STRATEGIES TO REACH AND
PROVIDE HIV COUNSELING, TESTING AND REFERRAL SERVICES TO PERSONS
AT HIGH RISK FOR HIV INFECTION IN COMMUNITIES OF COLOR.
THE GOAL OF THE PROJECT IS TO ENLIST HIV POSITIVE PERSONS TO
IDENTIFY AND RECRUIT HIGH RISK PERSONS FROM THEIR SEXUAL,
DRUG-USING AND SOCIAL NETWORKS AND REFER THEM FOR HIV COUNSELING,
TESTING AND REFERRAL SERVICES.
IN
CONGRESO DE LATINOS UNIDOS, ONE OF THE NINE ORGANIZATIONS FUNDED
TO CONDUCT THE SOCIAL NETWORKS DEMONSTRATION PROJECT.
IN THE FOLLOWING VIDEOTAPED SEGMENT ABOUT CONGRESO, YOU'LL HEAR
THE TERMS RECRUITER AND NETWORK ASSOCIATE.
IN THIS DEMONSTRATION PROJECT, A RECRUITER IS A PERSON WHO IS HIV
POSITIVE OR HIV NEGATIVE BUT AT HIGH RISK FOR HIV, WHO AGREES TO
IDENTIFY OR RECRUIT PERSONS FROM THEIR SOCIAL, SEXUAL OR
DRUG-USING NETWORK WHO MAY BE INFECTED WITH HIV BUT NOT AWARE OF
THEIR INFECTION.
THE GOAL IS TO ENCOURAGE AND ASSIST MEMBERS IN THEIR NETWORK (SEX
PARTNERS, NEEDLE-SHARING PARTNERS, CLOSE ACQUAINTANCES, ETC )
CALLED NETWORK ASSOCIATES, TO ACCESS HIV COUNSELING, TESTING AND
REFERRAL SERVICES.
HERE'S WHAT CONGRESO HAD TO SAY.
>> THE SOCIAL NETWORK PROJECT HERE IS A PROJECT THAT'S UTILIZED
TO REDUCE THE INCIDENCE OF HIV AND AIDS, SPECIFICALLY IN THE
LATINO COMMUNITY IN THE
THE PROJECT IS DONE BY RECRUITING INDIVIDUALS WHO ARE HIV
POSITIVE, OR ARE AT HIGH RISK OF BEING HIV POSITIVE, TO MOTIVATE
THEM TO BRING UP A DISCUSSION WITH THEIR FELLOW PEERS, THEIR
INTRAVENOUS DRUG USE PARTNERS, SEXUAL PARTNERS OR FRIENDS AND
FAMILY THAT THEY KNOW ARE AT RISK OF BEING HIV INFECTED.
OUR TARGET POPULATION FOR THIS PROJECT ARE LATINO
AFRICAN-AMERICAN MEN WHO HAVE SEX WITH MEN, LATINO AND
AFRICAN-AMERICAN HETEROSEXUALS, AND LATINO AND AFRICAN-AMERICAN
INTRAVENOUS DRUG USERS.
AND THIS PROJECT IS USED BETWEEN THE AGE GROUP OF 18 TO 40.
IT'S JUST USED TO GET THEM AT A MORE COMFORTABLE LEVEL TO DISCUSS
AND REFER THEM TO COME IN FOR HIV TESTING.
>> THE PROJECT FIRST STARTED I HAD HESITATIONS AND DOUBTS ABOUT
IT DUE TO THE FACT THAT WE HAD MANY BARRIERS WITH OUR REGULAR
COUNSELING AND TESTING PROGRAM IN INITIATING NEWLY IDENTIFIED
INDIVIDUALS TO REVEAL THEIR SEXUAL CONTACTS.
NOW, WITH THE RESULTS OF THE PROJECT, WE WERE ABLE TO APPROACH
494 INDIVIDUALS FROM THOSE 494 INDIVIDUALS, 344 WERE SUCCESSFULLY TESTED.
AND FROM THOSE 344, WE WERE ABLE TO IDENTIFY 14 HIV POSITIVE
INDIVIDUALS, NEWLY IDENTIFIED.
IN ADDITION TO THAT, FROM THOSE 14, 12 WERE SUCCESSFULLY LINKED
TO MEDICAL CARE.
SO I FEEL THE PROJECT IS A GREAT PROJECT.
>> RESPONSE TO THE PROJECT HAS BEEN BOTH NEGATIVE AND POSITIVE.
NEGATIVE, WHICH WHEN WE TRY TO RECRUIT FROM INDIVIDUALS WHO ARE
HIV POSITIVE OR AT HIGH RISK OF BEING HIV POSITIVE, THEY HAVE
FEAR OF DISCLOSURE AND DISCRIMINATION.
ALSO, IT'S IMPORTANT TO CONTINUE A RAPPORT WITH POSSIBLE
RECRUITERS.
FOR EXAMPLE, WE HAD A RECRUITER WE HAD A RAPPORT WITH FOR TWO OR
THREE MONTHS.
THIS INDIVIDUAL FINALLY BECAME A RECRUITER.
AND IN ADDITION TO THAT, WHEN HE BECAME A RECRUITER, IN OUR
COACHING SESSIONS WE WERE ABLE TO ROLE PLAY MANY OF THE
SITUATIONS THAT THEY MAY ENCOUNTER WHEN APPROACHING THEIR NETWORK
ASSOCIATES.
WE HAD THE SAME RECRUITER HAVE A NEGATIVE RESPONSE IN THE
COMMUNITY WHEN HE WENT OUT TO A NETWORK ASSOCIATE.
BUT BASED ON WHAT HE LEARNED AND THE SKILLS HE DEVELOPED IN OUR
COACHING SESSIONS, HE WAS ABLE TO INTEGRATE A POSITIVE RESPONSE
WITH A NEGATIVE RESPONSE FROM THEIR NETWORK ASSOCIATE.
AND HE CAME BACK TO THE AGENCY AND SAID HOW THAT COACHING SESSION
REALLY HELPED HIM OUT.
>> RELATIVE TO PCRS, THIS COMMUNITY-BASED APPROACH EXPANDS THE
FIELD OF CONTACTS OF AN HIV POSITIVE PERSON BEYOND SEXUAL
PARTNERS TO INCLUDE OTHER CLOSE PERSONS IN THE NETWORK WHO ARE
HIGH RISK FOR HIV INFECTION.
THE USE OF SOCIAL NETWORKS TO IDENTIFY UNDIAGNOSED HIV INFECTION
AND THOSE PERSONS AT HIGH RISK PERSONS FOR HIV INFECTION PROVIDES
TREMENDOUS POTENTIAL FOR HIV PREVENTION.
BEFORE WE GO TO OUR PANEL DISCUSSION OF YOUR QUESTIONS ABOUT
PCRS, PLEASE REMEMBER TO MARK YOUR CALENDAR FOR OUR UPCOMING
SATELLITE BROADCAST AND WEB CAST ON
TO
THAT PROGRAM WILL BE ON "REVISED RECOMMENDATIONS FOR HIV
SCREENING OF ADULTS, ADOLESCENTS, AND PREGNANT WOMEN IN HEALTH
CARE SETTINGS."
MORE INFORMATION ABOUT THAT PROGRAM WILL BE AVAILABLE AFTER JULY
24 AT THE SATELLITE BROADCAST WEBSITE.
IN ADDITION TO THE INFORMATION THAT DENISE TAFOYA PROVIDED ABOUT
THE HIV/STD PREVENTION TRAINING CENTERS ACROSS THE UNITED STATES,
WE'VE PROVIDED A HANDOUT OF RESOURCES RELATED TO PCRS.
THAT HANDOUT IS AVAILABLE AT YOUR VIEWING LOCATION OR AT THE
SATELLITE BROADCAST WEBSITE.
THE HANDOUT IS A RESOURCE DIRECTORY OF WEBSITES, GUIDANCE
DOCUMENTS AND RECOMMENDED
NOW, LET'S MOVE TO OUR DISCUSSION SEGMENT AND ASK OUR PANEL TO
RESPOND TO YOUR QUESTIONS AND COMMENTS.
JUST A REMINDER, OUR PANEL WILL ONLY BE ABLE TO DISCUSS QUESTIONS
ON PCRS THE FIRST QUESTION IS FROM TODAY.
-- FOR CINDY.
CINDY, HOW DO YOU COUNSEL A POSITIVE RAPID TEST WITHOUT A
POSITIVE WESTERN BLOT?
DO YOU SEE THIS AS A DRAWBACK?
>> WELL, ONE OF THE THINGS THAT WE WANT TO DO WHEN WE GIVE A TEST
RESULT FOR A POSITIVE RAPID TEST RESULT IS ALWAYS TO SAY TO THE
CLIENT, YOUR PRELIMINARY TEST RESULT IS POSITIVE, BUT WE WON'T
KNOW FOR SURE UNTIL IT'S BEEN CONFIRMED.
THE ADVANTAGE OF THIS IS IT GIVES US A GREAT
CONTINUE DEVELOPING RAPPORT WITH THE CLIENT AND TO BEGIN THE WORK
OF ADDRESSING ISSUES RELATED TO PARTNERS AND LINKAGES TO CARE.
IT ALSO GIVES US A GREAT
AND FACILITATING A CONFIRMATORY TEST AND HAVE THEM COME BACK TO
TALK WITH THEM.
IS THIS SEEN AS A DRAWBACK?
I THINK THERE ARE ADVANTAGES AND DISADVANTAGES TO EVERYTHING.
ONE OF THE BEST ADVANTAGES IS THAT IT ALLOWS US TO CONTINUE
BUILDING RAPPORT WITH THE CLIENT.
IT ALLOWS US TO BEGIN THE DISCUSSION OF PCRS, AND IN MANY CASES,
TO CONTINUE THE DISCUSSION OF PCRS.
IF A CLIENT PROVIDES US WITH INFORMATION AT THAT INITIAL VISIT,
IT LETS US CHECK BACK IN AT A CONFIRMATORY TEST RESULT, IT LETS
US FOLLOW UP WITH THE CLIENT.
THE DISADVANTAGE CAN BE THAT YOU DON'T HAVE A CONFIRMED TEST, IN
WHICH CASE WE DEFINITELY ALWAYS RECOMMEND THAT WE WAIT UNTIL
THERE IS A CONFIRMED TEST BEFORE TAKING ANY ACTION.
BUT IT'S AN EXCELLENT
AND ADDRESSING THESE ISSUES AND PLANNING WITH THEM ABOUT HOW
WE'RE GOING TO MOVE FORWARD TOGETHER.
JOHN?
>> THANKS, CINDY.
OUR NEXT QUESTION IS FOR STAN.
STAN, HOW CAN WE MAINTAIN CONFIDENTIALITY WITH INCARCERATED
PARTNER CONTACTS?
>> WELL, JOHN, THAT POSES A MAJOR CHALLENGE FOR PARTNER
NOTIFICATION IN INCARCERATED FACILITIES.
ONE ISSUE YOU MUST FACE, PRIMARILY, JUST NAVIGATING THE SAFETY
PROCEDURES AND POLICIES WITHIN THOSE FACILITIES.
THIS REQUIRES THAT YOU ESTABLISH A GOOD RELATIONSHIP AND RAPPORT
WITH THOSE FACILITIES THAT ENSURE THAT AT ANY TIME THAT A PARTNER
NOTIFICATION NEEDS TO
YOU CAN CONDUCT YOUR ACTIVITY.
AND IN SOME FACILITIES, THERE MAY BE ROOMS IN THE HEALTH SECTIONS
THAT THEY PROVIDE.
AND YOU ALSO ARE CONCERNED ABOUT PERCEPTION.
YOU DON'T WANT A SITUATION WHERE THAT YOU GO IN AND OTHER INMATES
MAY VIEW YOU AS AN INDIVIDUAL WHO IS DEALING WITH HIV.
NO.
OFTEN WE USE FACILITIES THAT THE ATTORNEYS USE SO THERE IS NO
DISTINCTION BETWEEN THE TWO.
IN ADDITION TO THAT, YOU HAVE GOOD RELATIONSHIPS WITH THE HEALTH
PROVIDERS AND THEY ENSURE CONFIDENTIALITY BY MAINTAINING RECORD SAFETY.
>> THANKS, STAN.
OUR NEXT QUESTION IS FOR
ACTIVITIES?
>> WELL, I THINK THE BENEFITS ARE TWO-FOLD.
THINK THAT WITH THE COMPLEXITY OF THE ISSUES THAT THE CLIENTS
THAT WE WORK WITH, THE PSYCHO-SOCIAL ISSUES THAT CLIENTS WE WORK
WITH HAVE, THAT WE REALLY NEED TO COLLABORATE.
TOO T NEEDS TO BE A COLLABORATIVE EFFORT TO PREVENT HIV
TRANSMISSION.
AND TO ENSURE THAT PEOPLE ARE LINKED TO THE PROPER SERVICES AND
CARE THAT THEY NEED.
THE COMMUNITY-BASED ORGANIZATIONS OFTENTIMES MAY WORK WITH
CLIENTS ON AN ONGOING BASIS SO THAT THEY MAY HAVE A BETTER
RAPPORT, KNOW THE CLIENT BETTER.
THE CLIENT MAY FEEL MORE COMFORTABLE DISCUSSING THEIR SEXUAL
BEHAVIORS AND PEOPLE THAT MAY BE AT RISK FOR HIV.
IN THAT SITUATION, THE COMMUNITY-BASED ORGANIZATION CAN CERTAINLY
LET THEM KNOW THAT THE STATE HEALTH DEPARTMENT CAN HELP THEM
COUNSEL THEIR PARTNERS AND ENSURE THAT THEIR PARTNERS GET TESTED
FOR HIV, OR THE COMMUNITY-BASED ORGANIZATION CAN TAKE THE PARTNER
INFORMATION DOWN AND LET THE HEALTH DEPARTMENT KNOW THIS
INFORMATION SO THAT SOMEONE FROM THE HEALTH DEPARTMENT CAN GO
NOTIFY THOSE PARTNERS.
>> THANKS.
OUR NEXT QUESTION IS FOR DENISE.
DENISE, ARE DIS TRAINED TO PROVIDE HIV, PCRS ACTIVITIES ONLY?
OR DO THEY PERFORM OTHER STD NOTIFICATIONS?
>> MOST DIS ARE TRAINED TO CONDUCT BOTH STD AND HIV PARTNER
NOTIFICATION.
AND THAT WILL DEPEND UPON THE AREA THAT PARTICULAR PERSON IS
WORKING IN.
BUT THE USUAL COURSE OF TRAINING WOULD BE FOR SOMEONE WHO WAS
DOING BOTH PARTNER NOTIFICATION WOULD BE TO FIRST GO THROUGH A
SERIES OF STD MODULES.
THAT WOULD BE FOLLOWED BY A TWO-WEEK COURSE CALLED THE
INTRODUCTION TO STD INTERVENTION.
ONCE A PERSON HAS COMPLETED THAT COURSE, THEY WOULD COME BACK AND
MOST LIKELY HAVE ADDITIONAL INFORMATION ABOUT HIV AND HOW THE
INFECTION DISEASE WORKS.
THAT TYPE OF TRAINING WOULD BE OFFERED TO THEM.
THEY'D LIKELY ATTEND A TRAINING COURSE FOLLOW BY HIV-PCRS
TRAINING PROGRAM.
I HAVE TO SAY THAT ALL OF THAT TRAINING REALLY DOES NEED TO BE
SUPPORTED BY SOMEONE WHO CAN MENTOR THAT PERSON, WHO CAN MODEL
FOR THAT PERSON WHEN THEY GET BACK TO THEIR HOME SITE.
>> THANKS, DENISE.
OUR NEXT QUESTION IS FOR CINDY.
DURING PCRS, WHY WOULD THE COUNSELOR ASK PERMISSION FROM THE
CLIENT TO TAKE NOTES?
>> WELL, FIRST OF ALL, PCRS IS VERY INFORMATION-INTENSIVE.
THERE IS A LOT OF DISCUSSION THAT HAS TO
TALKING TO CLIENTS ABOUT HOW PCRS SHOULD PROCEED, WHAT THE PLAN
WILL BE, AND ESPECIALLY IF WE'RE TAKING INFORMATION ABOUT THE
FOLKS THAT ARE TO BE NOTIFIED.
SO TAKING NOTES FOR THE COUNSELOR IS REALLY IMPORTANT, AND AT THE
SAME TIME, WE ALSO WANT TO BE OPEN WITH OUR CLIENTS AND TELL THEM
WHAT WE'RE DOING AND WHY WE'RE DOING IT, BECAUSE OFTENTIMES
PEOPLE DON'T WANT TO GIVE INFORMATION OR TALK TO YOU ABOUT THINGS
UNLESS THEY UNDERSTAND THE RATIONAL BEHIND IT.
IT CAN BE VERY INTIMIDATING FOR A CLIENT TO ALL OF A SUDDEN BE
TALKING IS TO A PROVIDER AND HAVE THAT PROVIDER START WRITING
THINGS DOWN WHEN THEY DON'T KNOW EXACTLY WHAT THEY'RE WRITING OR
HOW THE INFORMATION IS GOING TO BE USED.
SO WHAT I ALWAYS RECOMMEND THAT PROVIDERS DO IS EXPLAIN THAT THEY
WOULD LIKE TO TAKE SOME NOTES, AND TO ASK THE CLIENT HOW THEY
FEEL ABOUT THAT.
THAT WAY THEY HAVE AN
SURE, OR HOW ARE YOU GOING TO USE THE NOTES, WHAT'S GOING TO
HAPPEN TO THIS INFORMATION AFTER YOU'RE DONE WITH IT?
AND THE PROVIDER CAN EXPLAIN ALL OF THAT.
IT HELPS THE PROCESS MOVE FORWARD MUCH MORE SMOOTHLY AND MAKES
FOR OPEN COMMUNICATION BETWEEN THE PROVIDER AND THE CLIENT.
>> THANKS, CINDY.
OUR NEXT QUESTION IS FOR STAN.
STAN, WHAT UNIQUE CHALLENGES DO DISEASE INTERVENTION SPECIALISTS
FACE WHEN WORKING WITH THE INJECTION DRUG USING COMMUNITY?
AND, WHAT TECHNIQUES CAN YOU RECOMMEND TO ADDRESS THESE
CHALLENGES?
>> WELL, THAT POPULATION POSES A VERY DIFFICULT TASK.
ONE, IT TENDS TO BE A TRANSIENT POPULATION.
AND ESTABLISH A RAPPORT IS OFTEN DIFFICULT BECAUSE YOU GOT TO
FIND INDIVIDUALS WHERE THEY EXIST AND OFTEN IN THOSE EXISTENCE,
THEY MAY BE UNDER THE INFLUENCE OF DRUGS, WHICH POSES A
COMMUNICATION PROBLEM.
NOW, THE DIS IS VERY SKILLED AT DEVELOPING RAPPORT REGARDLESS --
IRRESPECTIVE OF THOSE CHALLENGES AND IN THE PROCESS, YOU CAN GAIN
A LOT OF INFORMATION, NOT ONLY FROM JUST INTERACTION, BUT A VERY
GENERAL CONVERSATION WITH THOSE INDIVIDUALS.
AND ONCE THAT INFORMATION IS COLLECTED, THERE IS ALSO CLUSTERING
WHERE ADDITIONAL INFORMATION CAN BE GATHERED, NOT FROM THE
INDIVIDUALS BUT INDIVIDUALS WHO MOVE THAT N THAT SOCIAL CIRCLE.
ONCE YOU PROCESS ALL THIS INFORMATION, WE HAVE ONGOING
INVESTIGATIONS SO YOU CAN ALSO ACCESS ADDITIONAL CASES, PREVIOUS
CASES, WITH WHERE CASES OCCURRED IN THAT AREA AND USE ALL THAT
INFORMATION TO DEAL WITH THAT CLIENT.
AND ALSO THE SEX AND NEEDLE-SHARING PARTNERS.
>> THANK YOU, STAN.
OUR NEXT QUESTION IS FOR
RE GHEE, WHY IS PCRS VOLUNTARY AND NOT MANDATORY?
>> WELL, BY THE VERY NATURE OF PARTNER COUNSELING AND REFERRAL
SERVICES, IT REALLY NEEDS TO BE VOLUNTARY BECAUSE THE INFORMATION
THAT WE WANT TO GET FROM PEOPLE ABOUT THEIR PARTNERS IS INSIDE
THEIR HEAD AND IT'S A PRIVATE ACTIVITY THAT'S OCCURRED IN A VERY
PRIVATE SETTING.
IT HAS TO BE VOLUNTARY IN ORDER FOR PEOPLE TO FEEL COMFORTABLE
TALKING ABOUT THEIR PARTNERS, TALKING ABOUT THEIR BEHAVIORS,
GIVING
IF IT WERE MANDATORY, PEOPLE MAY NOT WANT IT, SEEK TESTING, MAY
NOT WANT TO GET TESTED FOR HIV FOR FEAR THAT THEY'RE GOING TO
HAVE TO PARTICIPATE IN THIS PROGRAM THAT WOULD BE MANDATORY.
>> THANKS.
OUR NEXT QUESTION IS FOR DENISE.
DENISE, HOW DO STAFF -- OR HEALTH DEPARTMENTS IN THE UNITED
STATES, WITHOUT A PTC, ACCESS PCRS TRAINING?
AND A FOLLOW-UP QUESTION TO THAT IS, HOW MUCH DOES IT COST?
>> THE WAY TO EASILY ACCESS PREVENTION TRAINING CENTER, EVEN
THOUGH IT MIGHT NOT BE HOUSED IN YOUR STATE, WOULD BE TO GO TO
THE WEBSITE THAT I MENTIONED EARLIER.
AGAIN, THAT'S WWW.STDHIV PREVENTIONTRAINING.ORG.
AND WHAT IT WILL DO IS IT WILL ASK YOU TO INPUT YOUR STATE AND
THEN IT WILL CONNECT THE QUADRANT THAT WOULD BE ABLE TO PROVIDE
THAT TYPE OF TRAINING TO YOU.
SO LET'S SAY YOU ARE IN
YOU WANT TO ATTEND PCRS TRAINING.
YOU CAN THEN -- YOU WILL THEN BE ROUTED TO THE
YOUR WAY THROUGH PARTNER MANAGEMENT OR PARTNER SERVICES TRAINING.
WE WOULD BE ABLE TO PROVIDE TRAINING ON-SITE AND TYPICALLY WE ARE
ASKING THAT YOU DO HAVE A CLUSTER OF PEOPLE WHO NEED TRAINING
WITH A GROUP SIZE OF ABOUT EIGHT TO TEN INDIVIDUALS.
AND THEN WE CAN COME ON-SITE AND DELIVER IT.
AND THE COST IS FREE.
>> GREAT.
THANKS.
NEXT QUESTION IS FOR CINDY.
ARE THERE ANY SPECIAL TRAININGS FOR DISEASE INTERVENTION
SPECIALISTS WORKING WITH THE MSM COMMUNITY?
>> THERE IS NO REQUIRED TRAINING FOR DIS WHO WORK WITH THE MSM
COMMUNITY, BUT THERE ARE MANY ORGANIZATIONS IN THIS COUNTRY THAT
ARE FUNDED BY CDC TO PROVIDE CAPACITY BUILDING ASSISTANCE THAT
CAN HELP JURISDICTIONS, STATES AND LOCAL AREAS, IN WORKING WITH
MSM COMMUNITIES.
AND IF YOU FIND THAT TO BE A NEED IN YOUR AREA, WE RECOMMEND THAT
YOU CONTACT YOUR PROJECT OFFICER WHO WILL BE HAPPY TO TELL YOU
MORE ABOUT IT.
>> WONDERFUL.
THANK YOU.
OUR NEXT QUESTION IS FOR STAN.
STAN, WHAT UNIQUE CHALLENGES DO DIS FACE WHEN WORK -- OOPS.
SORRY.
>>> IF THE HEALTH DEPARTMENT IS INVOLVED IN NOTIFYING PARTNERS,
WHAT INFORMATION ARE THEY GIVEN ABOUT THE INFECTED PERSON AND HOW
DO THEY -- WHY DO THEY NEED THAT INFORMATION?
>> WELL, I BELIEVE THE FIRST FOCUS SHOULD BE THE FACT THAT WITH
PCRS, EVERYTHING IS CLIENT-CENTERED.
AND IF YOU START FROM A CLIENT-CENTERED POSITION, THEREFORE, YOU
HAVE TO LOOK AT ALL SERVICES THAT ARE AVAILABLE TO THESE
INDIVIDUALS, INCLUSIVE OF THE HEALTH DEPARTMENT AND OTHER
REFERRAL AGENCIES.
SO THE HEALTH DEPARTMENT NEEDS INFORMATION THAT, WHEN THAT
INDIVIDUAL VISITS THE HEALTH DEPARTMENT, THE HEALTH DEPARTMENT
HAS AN IDEA OF WHAT SERVICES THAT PERSON NEEDS.
AND IT CAN INCLUDE INFORMATION ON PARTNERS, IT CAN INCLUDE
INFORMATION ON THE PATIENT'S
ALSO, ANY PARTICULAR SERVICES THAT WE FEEL THAT INDIVIDUAL MAY
NEED SO THAT THEY CAN START DEALING WITH THEIR STATUS, WHICH ALSO
BRINGS TO MIND THAT YOU HAVE TO HAVE A GOOD WORKING RELATIONSHIP
WITH YOUR HEALTH DEPARTMENT.
THEY HAVE TO UNDERSTAND THAT ONCE CLIENTS ARE REFERRED, CLIENTS
ARE SEEKING SERVICES.
THIS MAY BE YOUR ONE AND ONLY CHANCE TO DEAL WITH THAT CLIENT.
SO THEREFORE, ONCE THEY WALK IN THE DOOR, YOU WANT TO BE PREPARED
TO OFFER WHATEVER SERVICES THAT THAT CLIENT NEEDS.
SO THEREFORE, GOOD LOCATING INFORMATION, PATIENT INFORMATION THAT
SPECIAL CIRCUMSTANCES THAT MAY BE NEEDED TO DEAL WITH THEIR
SITUATION IS ALSO SHARED WITH THE HEALTH DEPARTMENT.
>> THANK YOU.
>> WELL, ESSENTIALLY PARTNERS ARE TOLD THAT THEY HAVE COME IN
CONTACT WITH SOMEONE THAT TESTED POSITIVE FOR HIV.
WE ALSO DO A RISK ASSESSMENT TO DETERMINE WHEN -- IF SOMEONE HAS
BEEN TESTED IN THE PAST, WHAT DATE THAT TEST WAS CONDUCTED, HOW
DO THEY PERCEIVE THEIR RISK TO BE FOR HIV.
WE MAKE APPROPRIATE REFERRALS, AS NEEDED.
BUT WE DO NOT TELL THE PARTNER WHO NAMED THEM, THE SEX OF THE
PERSON THAT NAMED THEM, WHETHER THEY THE EXPOSURE WAS A SEXUAL
EXPOSURE OR A NEEDLE-USING EXPOSURE, SO THAT THEY CAN'T --
OR WHEN THAT EXPOSURE TOOK PLACE SO THAT THEY CAN'T TRY TO FIGURE
OUT WHO THE PERSON WAS THAT NAMED THEM.
ALL OF THAT INFORMATION NEEDS TO BE CONFIDENTIAL.
WE ALSO LET THEM KNOW THAT THE PERSON THAT NAMED THEM REALLY DID
CARE ENOUGH ABOUT THEM TO WANT THEM TO GET TESTED, AND IF THEY
NEED MEDICAL CARE, TO GET MEDICAL CARE.
>> THANK YOU.
OUR NEXT QUESTION IS FOR DENISE.
DENISE, SHOULD PCRS ONLY BE CONDUCTED BY HEALTH DEPARTMENT
PERSONNEL?
>> PCRS DOESN'T HAVE TO BE CONDUCTED BY HEALTH DEPARTMENT
PERSONNEL.
IT CAN BE DONE BY OTHER HEALTH PROVIDERS.
I WOULD SAY THAT IF YOU ARE SOMEONE WHO WOULD LIKE TO ENGAGE IN
THIS TYPE OF A SERVICE AND BE ABLE TO OFFER THAT TO YOUR CLIENTS,
THAT IT WOULD BE WISE TO GO THROUGH HIV PCRS TRAINING AND TO ALSO
GET A SENSE OF HOW A NOTIFICATION WOULD ACTUALLY HAPPEN.
SO IF YOU WERE ABLE TO LINK WITH SOMEONE WHO CAN QUITE A BIT OF
EXPERIENCE AND BE ABLE TO SHADOW THEM FOR A WHILE, AND AS WELL
PERFORM SOME OF THE NOTIFICATIONS IN THE PRESENCE OF SOMEONE WHO
HAS EXPERIENCE, THEN I THINK THAT THAT WOULD BE SUFFICIENT ALONG
WITH WHATEVER OTHER POLICIES THAT YOUR LOCAL AGENCY THAT YOU WORK
FOR IS ASKING YOU TO FOLLOW.
I THINK THAT ALL OF THAT COMBINED MODELED TOGETHER WOULD BE
SUFFICIENT TO GO AHEAD AND GO FORTH AND OFFER PCRS.
>> GOOD.
OUR NEXT QUESTION IS FOR CINDY.
HOW CAN RAPID TESTING SUPPORT PCRS IN THE FIELD?
>> THAT'S AN EXCELLENT QUESTION.
ONE OF THE VERY IMPORTANT THINGS THAT WE WANT TO DO AS A PART OF
PCRS IS OFFER THE PARTNERS WHO ARE NOTIFIED THE
TESTED, AND RAPID TESTING ALLOWS US THE
A REALLY RELEVANT,
MANY PEOPLE FIND THEIR EXPERIENCE WITH PCRS IS THAT THE MOMENT
THAT PARTNERS ARE NOTIFIED, THEY WANT TO BE TESTED RIGHT THEN AND THERE.
SOME PARTNERS WANT AN
BIT, BUT MANY PARTNERS ARE ALL ABOUT RIGHT AWAY, WHERE CAN I BE TESTED?
WHAT CAN I DO?
AND IF THE PCRS PROVIDER CAN SAY "I CAN TEST YOU RIGHT HERE,
RIGHT NOW, AND WE CAN RESOLVE THE ISSUE OF YOUR HIV STATUS BY THE
END OF MY VISIT TODAY," THAT CAN BE SO HELPFUL TO THE FOLKS THAT
ARE NOTIFIED AND IT CAN BE HELPFUL TO THE PCRS PROVIDER, BECAUSE
THEN THEY KNOW HOW TO PROCEED FROM THERE ON, DO THEY NEED TO
SCHEDULE A CONFIRMATORY TEST OR DO THEY NEED TO FOLLOW UP IN SOME
OTHER WAY?
SHOULD THEY MAKE REFERRALS FOR OTHER PREVENTION SERVICES?
ET CETERA, ET CETERA.
SO WE FIND IT CAN BE A REALLY SUPPORTIVE AND INNOVATIVE WAY TO
MOVE A PCRS PROGRAM.
>> THANKS.
PERHAPS YOU'D LIKE TO ADD.
>> YOU KNOW, ACTUALLY I AGREE WITH CINDY.
I THINK THAT RAPID TESTING REALLY HAS DONE WONDERS FOR PCRS.
IT'S REALLY SHORTENED THE LENGTH OF TIME THAT IS NECESSARY AS FAR
AS CONTACTING THE CLIENT, FINDING THEM, TESTING THEM, AND THEN
TRYING TO RELOCATE THEM TO -- TEN DAYS TO TWO WEEKS DOWN THE
ROAD, PARTICULARLY WITH THE NEGATIVE RESULT.
PEOPLE REALLY DO WANT TO KNOW RIGHT AWAY WHAT THEIR TEST RESULT
IS AND IT REALLY REDUCES A LOT OF CLIENT ANXIETY SURROUNDING HIV TESTING.
>> CERTAINLY A WONDERFUL TECHNOLOGY.
OUR NEXT QUESTION IS FOR STAN.
WHAT KIND OF TECHNIQUES HAVE WORKED IN YOUR COMMUNITY WHEN
WORKING WITH NON-COMPLIANT NOTIFIED PARTNERS?
>> NON-COMPLIANT PARTNERS?
WELL, WHAT WE DO IN OUR COMMUNITY, ONE SOMEBODY IS THAT WE TRY TO
SELL THE BENEFIT OF NOTIFICATION FIRST AND FOREMOST.
AND FROM A CLIENT'S STANDPOINT, WE HAVE UNDERSTOOD THAT THERE ARE
A MYRIAD OF ISSUES THAT OUR CLIENTS FACE, AND WHICH MIGHT BE THE
UNDERLYING ISSUE OF WHY THEY'RE NON-COMPLIANT.
IT'S NOT ENOUGH TO SAY THEY ARE NOT COMPLIANT.
WHAT WE DO IS THROUGH A PROCESS OF ONGOING CONVERSATION, WE TRY
TO ASCERTAIN WHAT IS IT, A SOCIAL FACTOR?
A DRUG PROBLEM?
WHAT IS IT THAT IS GIVING THIS PATIENT DIFFICULTY IN DEALING WITH
THE SITUATION?
AND WE USE A NUMBER OF APPROACHES WHERE THE DIS MEET ONE ON ONE
WITH THAT INDIVIDUAL.
WE TRY TO MEET THEM ON THEIR TERMS, THEIR TURF, IF YOU MAY, TO
ENSURE THAT THEY FEEL COMFORTABLE WITH THE PROCESS.
NOW IF ONE DIS GOES IN AND SPEAKS WITH AN INDIVIDUAL AND WE STILL
HAVE THOSE ISSUES, WE MAY ENTERTAIN SENDING A DIFFERENT DIS,
DIFFERENT GENDER, DIFFERENT SEX, RACE, WHAT HAVE YOU, BECAUSE OUR
ONE GOAL IS TO ENSURE THAT WE REACH THAT CLIENT AND GIVE THAT
CLIENT TO BUY INTO THIS PROCESS AND LET THEM KNOW THAT THERE IS
BENEFIT TO THIS WHOLE PROCESS.
WE'RE NOT JUST THERE TO ELICIT PARTNERS, BUT WE WANT TO HELP YOU
TO BEGIN WITH YOUR STATUS AND ALSO TO HELP THEIR PARTNER AS WELL.
>> THANK YOU.
OUR NEXT QUESTION IS FOR
RELATED TOPIC.
HOW MUCH TIME SHOULD BE GIVEN FOR A CLIENT TO NOTIFY THEIR PARTNERS?
AND, HOW DO YOU FOLLOW UP TO ENSURE THAT THE CLIENT ACTUALLY DID
NOTIFY THEIR PARTNERS?
>> OKAY.
WELL, THERE IS REALLY NO SET TIME FRAME TO GIVE TO A CLIENT TO
NOTIFY THEIR PARTNERS.
BUT PROBABLY TEN DAYS WOULD BE THE MAXIMUM AMOUNT OF TIME.
IF PEOPLE CAN'T FIGURE OUT A WAY OR GET THEMSELVES IN A
CONVERSATION SITUATION TO BE ABLE TO NOTIFY THEIR PARTNERS IN
THAT TIME PERIOD, THEN MAYBE THEY COULD PUT IT OFF FOR A MUCH
LONGER TIME PERIOD AND ULTIMATELY END UP NOT BEING SUCCESSFUL AT
DOING THAT NOTIFICATION THEMSELVES.
IN
THERE IS A SITUATION OF DOMESTIC VIOLENCE OR WE HAVE CONCERN
ABOUT THE CLIENT BEING IN AN UNSAFE SITUATION.
HOW WE FOLLOW UP TO ENSURE THAT THE PARTNERS HAVE BEEN NOTIFIED
IS WE GO AHEAD AND GET THAT INFORMATION ABOUT THE PARTNER FROM
THE ORIGINAL CLIENT AS FAR AS THEIR NAME AND THEIR ADDRESS AND
THEIR PHONE NUMBER, OR WE WORK OUT A SYSTEM WITH THE ORIGINAL
CLIENT WHEREBY THEY CAN HAVE THAT PARTNER CALL US UP TO LET THEM
KNOW THAT THEY HAVE IN FACT BEEN TALKED TO AND THEY DO KNOW THAT
THEY HAVE BEEN EXPOSED TO HIV.
>> THANKS.
CINDY?
WOULD YOU LIKE TO ADD?
>> YEAH.
I WANT TO ADD THAT I -- IT IS VERY COMMON FOR JURISDICTIONS OR
OTHER AREAS TO HAVE STANDARDS FOR NOTIFYING PEOPLE OF THEIR
EXPOSURE TO HIV AND OTHER STDs, AND SO IT REALLY DOES DEPEND ON
THE LOCAL AREA.
DIFFERENT AREAS MAY HAVE DIFFERENT POLICIES ON THAT, AND YOU
SHOULD ALWAYS CHECK WITH YOUR LOCAL AREA IF THIS IS A CONCERN FOR YOU.
>> THANK YOU.
OUR NEXT QUESTION IS FOR DENISE.
HOW IS CONFIDENTIALITY OF THE INFECT PERSON MAINTAINED?
>> JOHN, FIRST OF ALL, WE WANT TO MAKE SURE THAT ANY DOCUMENT
THAT CONTAINS INFORMATION ABOUT AN INFECTED CLIENT IS HELD
NIGHTLY, DAILY, IN A LOCKED FILE CABINET AND IN AN OFFICE THAT IS SECURED.
YOU ALSO WANT TO MAKE SURE THAT YOU'RE NOT HAVING ANY KIND OF A
CONVERSATION ABOUT THIS CLIENT TO OTHER PEOPLE WHO ARE NOT ON THE
TEAM OF CARE.
AND I ALSO HAVE TO SAY THAT WHEN THE PARTNERS OF INFECTED PERSONS
ARE CONTACTED, AND THEY ARE SO -- NEVER AT ANY TIME IS THAT
PARTNER GIVEN INFORMATION ABOUT THIS ORIGINAL CLIENT.
SO WE'RE NOT GOING TO GIVE THEM THE NAME OF THE PERSON.
WE WILL NOT DESCRIBE THE FIRST PERSON FOR THE PARTNER, NOR WILL
WE TALK ABOUT WHEN, WHERE AND HOW THE EXPOSURE TOOK PLACE.
>> THANK YOU.
OUR NEXT QUESTION IS FOR
HOW DO YOU PROVIDE PCRS AMONG THE YOUTH COMMUNITY?
>> WELL, REALLY, IT'S REALLY CONDUCTED IN ABOUT THE SAME MANNER.
SOMETIMES, BECAUSE OF CONFIDENTIALITY, WE MAY NOT WANT OTHER
PEOPLE IN THE FAMILY TO KNOW, SUCH AS PARENTS, SIBLINGS, FRIENDS,
SO WE MAY GO THROUGH THE SCHOOL SYSTEM TO TRY TO NOTIFY YOU --
NOTIFY YOUTH WHO HAVE COME IN CONTACT WITH HIV OR GO THROUGH THE
SCHOOL SYSTEM TO TRY TO NOTIFY -- TO TRY TO FIND THEM SO WE CAN
DISCUSS THEIR HIV STATUS WITH THEM AND MAKE SURE THAT THEY HAVE
ALL OF THE SUPPORTS AND REFERRALS AND SERVICES THAT THEY NEED.
THERE ARE CERTAINLY ORGANIZATIONS THAT FOCUS ON YOUTH AND THAT
PROVIDE PREVENTION AND OTHER HEALTH SERVICES TO YOUTH, SO WE
WOULD MAKE APPROPRIATE REFERRALS SO THAT THOSE PEOPLE CAN GET
WHAT THEY NEED IN A SETTING THAT'S REALLY CONDUCIVE FOR THEM.
JOHN?
>> THANK YOU.
OUR NEXT QUESTION IS FOR STAN.
WHAT SAFETY PRECAUTIONS AND TECHNIQUES ARE DIS TRAINED TO PRACTICE?
>> WELL, DIS ARE TRAINED VERY EARLY ON THAT, FIR AND FOREMOST, IS
THEIR SAFETY.
WE APPROACH EVERYTHING FROM A CLIENT-CENTERED STANDPOINT, AND
OFTEN THAT REQUIRES THAT YOU MEET CLIENTS ON THEIR TERMS OR THEIR TURF.
AND THAT CAN BE ANY AREA IN YOUR COMMUNITY.
NOW DIs NEED TO BE PERFECTLY AWARE OF THE CIRCUMSTANCES THAT
THEY'RE WALKING INTO, THEY NEED TO BE AWARE OF THEIR SURROUNDINGS
AS THEY APPROACH DIFFERENT HOUSEHOLDS.
IF SOMEONE OR A PARTICULAR ACTIVITY IN THAT AREA THAT THEY FEEL
UNCOMFORTABLE WITH, THEY'RE TRAINED TO ASSESS THAT SITUATION
IMMEDIATELY, MAKE A DECISION, A SAFETY DECISION FIRST, AND THEN
IF THEY FEEL THERE IS A DANGER, RETREAT FROM THAT AREA.
DIS IN THE STATE OF
IF THERE IS A SITUATION WHERE YOU'RE AFRAID OR SUSPECT THERE
MIGHT BE SOMETHING UNSAVORY ABOUT APPROACHING A HOME, YOU CAN
MAKE A PHONE CALL FIRST AND FIND OUT IF SOMEONE IS THERE AND ASK
THEM FO COME TO THE CAR AND EVEN MOVE TO AN AREA THAT THEY FEEL
OR THEY DEEM THAT IS SAFE.
AGAIN, PUBLIC HEALTH MATTERS IS PRIMARY.
BUT THE SAFETY OF A DIS IS
AND THEY'RE TRAINED THAT I GUESS YOU COULD CALL THAT A SIXTH
SENSE, TO ALWAYS BE AWARE OF THEIR SURROUNDINGS, BECAUSE WE WANT
DISEASE INTERVENTION, BUT WE WANT OUR DIs TO RETURN SAFE.
>> THANK YOU.
IMPORTANT TOPIC, SAFETY.
NEXT QUESTION IS FOR CINDY.
IF CBOs ARE INVOLVED IN THE PCRS PROCESS, WHAT COLLABORATION
SHOULD BE
>> THAT'S AN IMPORTANT QUESTION, BECAUSE CBOs CAN PLAY AN
IMPORTANT ROLE IN PCRS.
HOWEVER, AT THE SAME TIME, HEALTH DEPARTMENTS USUALLY HAVE A
REGULATORY AND A STATUTORY RESPONSIBILITY FOR CONDUCTING PARTNER
NOTIFICATION AND DISEASE INTERVENTION ACTIVITIES IN THEIR STATES.
SO THERE SHOULD ALWAYS BE A COLLABORATION WITH THE HEALTH
DEPARTMENTS AMONG ANY ENTITY THAT IS DOING PARTNER NOTIFICATION
OR PCRS ACTIVITIES.
IT'S VERY, VERY IMPORTANT.
AND PART OF THE REASON IS BECAUSE THERE ARE SO MANY LOCAL LAWS,
POLICIES AND PROTOCOLS TO BE HANDLED, AND ALSO BECAUSE HEALTH
DEPARTMENTS OFTENTIMES HAVE ACCOUNTABILITY STATUTES THAT THEY
HAVE TO FOLLOW THROUGH WITH.
SO COLLABORATION IS REALLY KEY.
>> THANK YOU.
WE HAVE A QUESTION FOR DENISE, AND THEN
WHY SHOULD A CLIENT PARTICIPATE IN PCRS?
WHAT ARE THE BENEFITS TO INVOLVING THE HEALTH DEPARTMENT?
>> PCRS CAN RELIEVE I THINK A CLIENT FROM THE BURDEN OR THE
CHALLENGE OF HAVING TO GO BACK AND HAVE A VERY DIFFICULT
CONVERSATION WITH PARTNERS.
AND KNOWING THAT THAT SERVICE AND THAT PERSON IS AVAILABLE TO
ASSIST THEM AT THAT TIME I THINK IS A WONDERFUL SERVICE TO HAVE
AVAILABLE.
I ESPECIALLY -- WHEN A CLIENT IS JUST RECENTLY BEEN TOLD THAT
THEY HAVE HIV AND ALREADY OVERWHELMED, THIS COULD BE AN
ADDITIONAL BURDEN THAT THEY DON'T REALLY NEED TO CARRY AT THIS TIME.
I WOULD ALSO SAY THAT SOMETHING THAT'S IMPORTANT TO NOTE IS THAT
PCRS IS A -- AS A SERVICE DOES HAVE ANOTHER BENEFIT TO THE CLIENT
AND THEIR PARTNERS, AND THAT'S THE ABILITY TO LINK TO OTHER
SERVICES THAT MIGHT BE NEEDED AND OTHER RESOURCES THAT THEY MAY
HAVE NO IDEA ABOUT UNLESS THEY WERE TO PARTICIPATE IN A PCRS PROGRAM.
I THINK THAT ONE OF THE BENEFITS -- OR SOME OF THE BENEFITS OF
UTILIZING HEALTH DEPARTMENT STAFF TO PROVIDE THIS SERVICE WOULD
BE THAT YOU CAN UTILIZE TRAINED STAFF.
THIS IS STAFF WHO HAS AN ABUNDANCE OF EXPERIENCE AROUND
NOTIFICATIONS.
THEY ALSO ARE VERY USED TO CONDUCTING FIELD NOTIFICATION, WORKING
WITH COMMUNITIES.
THEY KNOW HOW TO PROTECT AND GUARD CONFIDENTIALITY FOR THE
PATIENT AND -- FOR CLIENT AND FOR THEIR PARTNERS.
AND MANY OF THE TIME -- MOST OF THE TIME, I SHOULD SAY, STAFF OF
HEALTH DEPARTMENTS ARE ALSO AVAILABLE TO PROVIDE TESTING AND
COUNSELING ON-SITE.
>> THANKS.
>> WELL, THE ONLY THING THAT I WOULD LIKE TO ADD TO THAT IS THAT
PCRS STAFF CAN ALSO HELP THE CLIENT IN ROLE PLAYING AND FEELING
REALLY COMFORTABLE IN NOTIFYING THEIR OWN PARTNERS.
NOT ONLY THE CURRENT PARTNERS OR PAST PARTNERS THAT THEY MAY HAVE
BUT THE POTENTIAL FUTURE PARTNERS AS WELL.
AND THEIR CONFIDENTIALITY IS MAINTAINED WHEN THE HEALTH
DEPARTMENT IS INVOLVED IN THE NOTIFICATION.
THE ORIGINAL CLIENT DOESN'T --
THE PARTNERS DON'T KNOW WHO THAT PERSON IS THAT'S POSITIVE.
>> THANK YOU.
OUR NEXT QUESTION IS FOR STAN.
STAN, WHY DO SOME PHYSICIANS RESIST PARTICIPATING IN PCRS AND
WHAT CAN THE HEALTH DEPARTMENT DO TO WORK WITH THESE PROVIDERS?
>> WELL, JOHN, I BELIEVE THAT IS ROOTED IN A HISTORY WHERE
INITIALLY FOR PARTNER NOTIFICATION, IT WAS VIEWED AS A COLD,
INTRUSIVE PROCESS THAT THEIR CLIENTS OR PATIENTS WENT THROUGH.
AND PHYSICIANS SHARED THOSE SAME SENTIMENTS.
I BELIEVE WHAT THE HEALTH DEPARTMENT NEEDS TO DO IS TO CONTINUE
TO ESTABLISH RAPPORT WITH PROVIDERS, GET THEM TO BUY INTO THE
CONCEPT THAT THEY'RE PART OF THIS CONTINUUM OF CARE THAT THEIR
CLIENTS NEED, AND THAT THERE ARE OFTEN A
PHYSICIANS MAY NOT BE ABLE TO PROVIDE TO THEIR CLIENTS BUT IS
NECESSARY FOR THEIR CLIENTS' SUPPORT.
AND THAT REQUIRES THE HEALTH DEPARTMENT TO CONTINUOUSLY REACH OUT
TO PROVIDERS, ESTABLISHING THOSE RELATIONSHIPS.
TELL THEM THE BENEFITS OF PCRS AND ALSO THE BENEFIT OF THIS
CONTINUUM OF CARE THAT EXTENDS BEYOND THE PHYSICIAN'S ABILITY.
>> THANK YOU.
OUR NEXT QUESTION IS FOR CINDY.
CINDY, HOW IS PARTNER NOTIFICATION FOR PARTNERS WHO LIVE IN A
JURISDICTION DIFFERENT FROM THE ORIGINAL CLIENT?
HOW IS PARTNER -- LET ME TRY THIS ONE AGAIN.
HOW WOULD YOU DO PARTNER NOTIFICATION FOR PARTNERS WHO LIVE IN A
JURISDICTION DIFFERENT FROM THE ORIGINAL CLIENT?
>> OKAY.
THERE IS A NATIONAL SYSTEM FOR NOTIFYING PARTNERS WHO DON'T LIVE
IN THE SAME AREA THAT THE ORIGINAL CLIENT LIVES IN.
THAT SYSTEM IS RUN THROUGH STATE HEALTH DEPARTMENTS.
AND WHAT HAPPENS IS THE PCRS PROVIDER COLLECTS AS MUCH
INFORMATION ABOUT THE PARTNER AS THEY POSSIBLY CAN FROM THE CLIENT.
THEY PROVIDE THAT INFORMATION TO THE STATE HEALTH DEPARTMENT, WHO
THEN PROVIDES THAT INFORMATION TO THE STATE HEALTH DEPARTMENT
WHERE THE PARTNER LIVES.
INDIVIDUALS FROM THE AREA WHERE THE PARTNER LIVES AND THEN GO OUT
AND MAKE THE NOTIFICATION.
ONE THING THAT'S REALLY IMPORTANT ABOUT THIS SYSTEM IS THAT IT'S
A CONFIDENTIAL SYSTEM, CONFIDENTIALITY IS MAINTAINED BOTH FOR THE
ORIGINAL CLIENT WHO NAMES THE PARTNER AND FOR THE PARTNER WHO IS NOTIFIED.
SO, FOR EXAMPLE, IF WE NOTIFY SOMEONE IN ANOTHER STATE FROM WHERE
THE ORIGINAL CLIENT IS, THE PROVIDER WHO GOES OUT AND
NOTIFICATION DOES NOT SAY, "BY THE WAY, SOMEONE IN X, Y, Z STATE
SENT THIS TO US IN ORDER FOR US TO NOTIFY YOU."
SO EVERYBODY IS PROTECTED.
THEY ALSO DON'T PROVIDE ANY INFORMATION BACK ABOUT THE PARTNER.
>> THANK YOU.
OUR NEXT QUESTION IS FOR DENISE.
DENISE, SHOULD PRIVATE PROVIDERS ATTEMPT TO DO PARTNER
NOTIFICATION?
>> YES.
I THINK THAT THEY CAN.
BUT JUST MAKE SURE THAT IF YOU ARE WANTING TO DO THAT, THAT
YOU'VE HAD THE
AND I THINK THAT A PRIVATE PROVIDER SHOULD CONDUCT THIS TYPE OF
SERVICE WHEN IT IS REQUESTED BY THE CLIENT.
I WOULD JUST -- KEEP IN MIND THAT IT IS A BIT TIME CONSUMING, CAN
BE TIME CONSUMING, AND JUST MAKE SURE THAT YOU WOULD BE ABLE TO
BE RESPONSIVE TO THE SERVICE, TO PARTNER, AND TO YOUR CLIENT.
>> THANKS.
PHYSICIANS NEED TO FACILITATE THE PCRS PROCESS?
>> WELL, PRIVATE PHYSICIANS WOULD NEED TO GET FROM THE ORIGINAL
CLIENT THE PERSON REQUESTING THAT THEY CONDUCT PCRS.
THEY WOULD NEED TO GET THE PARTNER'S NAME, PARTNER'S ADDRESS,
PHONE NUMBER, CELL PHONE NUMBER, ANY INFORMATION THAT WOULD HELP
THE PCRS PROVIDER LOCATE AND NOTIFY THAT PARTNER, EVEN
IDENTIFYING MARKS, HEIGHT AND WEIGHT, A PHYSICAL DESCRIPTION OF
THE CLIENT, AND ALSO A LITTLE -- THEY NEED TO KNOW A LITTLE
INFORMATION ABOUT PARTNER COUNSELING AN REFERRAL SERVICES SO THEY
CAN ALLEVIATE ANY CONCERNS THAT THEIR CLIENTS MAY HAVE ABOUT THIS
BEING CONDUCTED.
>> THANK YOU.
OUR NEXT QUESTION IS FOR STAN.
AND THEN CINDY.
HOW DO COUNSELORS WORK WITH CLIENTS WHO INITIALLY RESIST NAMING
THEIR PARTNERS?
>> WELL, AGAIN, IT'S A PROCESS OF ESTABLISHING RAPPORT.
AND, AGAIN, APPROACHING IT FROM A CLIENT'S STANDPOINT, YOU HAVE
TO FIND OUT WHAT'S BEHIND THAT RESISTANCE.
OFTEN IT'S NOT JUST THE CLIENT SAYING, I DON'T WANT TO BE PART OF
THIS PROCESS.
THERE ARE SOME UNDERLYING FACTORS, SOCIAL, ECONOMICAL.
THEY MIGHT BE IN FEAR OF RETRIBUTION FROM A PARTNER, AND
THEREFORE, THOSE ISSUES HAVE TO BE FERRETED OUT BEFORE YOU CAN
MOVE FORWARD.
AND IF YOU APPROACH THIS FROM A CLIENT-CENTERED STANDPOINT, YOU
WOULD LEARN THESE ISSUES THAT THE CLIENTS ARE DEALING WITH AND
YOU WOULD FIND A WAY TO DEAL WITH THOSE AND SOMEHOW ESTABLISH
THAT RAPPORT AND, THEREFORE, YOU NOW HAVE TURNED A CLIENT THAT'S
RESISTANT TO A CLIENT THAT IS COOPERATIVE IN THE PROCESS.
>> CINDY, WOULD YOU LIKE TO ADD?
>> I AGREE WITH EVERYTHING THAT STAN HAS SAID.
AND I THINK IT'S AN EXCELLENT
ANYONE TALKING ABOUT PCRS, TO USE PROBLEM-SOLVING SKILLS AND ALL
OF THOSE COMMUNICATION AND LISTENING SKILLS THAT WE TALKED ABOUT
EARLIER, BECAUSE IT IS TRUE THAT OFTEN CLIENTS HAVE VERY REAL
CONCERNS ABOUT PCRS, AND SO LISTENING TO THOSE CONCERNS AND THEN
PROBLEM SOLVING AROUND TO MOTIVATE FOLKS TO PARTICIPATE IS REALLY
IMPORTANT.
IT'S ALSO ONE OF THE THINGS THAT WE OFTEN COVER IN ONGOING
TRAINING WITH PCRS PROVIDERS.
>> THANK YOU.
WE HAVE SEVERAL QUESTIONS HERE THAT ARE VERY SIMILAR.
PERHAPS WE COULD EACH TAKE A SHOT AT IT.
TALK ABOUT IN PARTICULAR, HOW HAS RAPID TESTING AFFECTED PCRS IN
YOUR AREA?
LET'S START WITH
>> OKAY.
WELL, I THINK THAT PCRS HAS HAD A POSITIVE IMPACT -- OR RAPID
TESTING HAS HAD A POSITIVE IMPACT ON PCRS IN OUR AREA.
PEOPLE REALLY DO LIKE THE IDEA OF KNOWING THEIR STATUS WITHIN 20 MINUTES.
RAPID TESTING HAS BEEN CONDUCTED IN THE FIELD SETTING, IN
CLIENTS' HOMES, IN THE BACK OF CARS OR PICKUP TRUCKS.
SO WE CAN REALLY PROVIDE RAPID TESTING IN ANY SETTING.
THE PERSON IS ABLE TO KNOW THEIR RESULTS WITHIN 20 MINUTES.
AND WE CAN DO RISK REDUCTION COUNSELING, ASK QUESTIONS ABOUT
ISSUES THAT MAY BE AFFECTING THE CLIENT'S ABILITY TO MAKE OR
SUSTAIN SAFER BEHAVIORS.
AND THE ORIGINAL CLIENT, ONCE WE EXPLAIN TO THEM THAT WHEN THEY
NAME US THEIR PARTNERS, THAT WE ARE ABLE TO DO A TEST WITHIN 20 MINUTES.
IT SEEMS TO PUT THE ORIGINAL CLIENT AT EASE OF BEING ABLE TO GIVE
THE PARTNER THAT INFORMATION, AND IT SEEMS TO BE A MORE VALUED SERVICE.
CLIENTS ARE MORE APT TO BRING THEIR PARTNERS IN FOR TESTING WITH
US, EVEN WITHOUT GIVING US THAT PARTNER'S NAME.
THAT'S A DOABLE SITUATION.
SO I REALLY HAVE VIEWED RAPID TESTING TO BE VALUABLE IN THE PCRS
ACTIVITIES.
>> IT'S REALLY HARD TO ADD TO THAT, BUT I WOULD LIKE TO SAY FROM
MY LOCAL PERSPECTIVE, THERE IN TRAVIS COUNTY IN
RAPID TESTING REALLY HAS BROUGHT US TO BE VIEWED AS A HEALTH CARE
PROVIDER BY THE CLIENT, AND FROM THE PUBLIC HEALTH PERSPECTIVE,
HAS BEEN VERY PRODUCTIVE.
WE'VE SEEN A MUCH MORE PRODUCTIVE INTERVIEW WITH MORE PARTNERS TO
FOLLOW UP ON WITH THE HEALTH DEPARTMENT'S HELP.
>> LET'S MOVE ON TO A QUESTION HERE FOR DENISE.
DENISE, HOW WOULD YOU -- HOW WOULD NOTIFICATION BE HANDLED IF
INFECTED PERSONS AND PARTNERS ARE MINORS?
>> THAT'S REALLY GOING TO DEPEND ON WHAT THE STATE STATUTES OR
LOCAL STATUTES ARE SAYING ABOUT THIS PARTICULAR SITUATION.
I'D HAVE TO SAY THAT IN THE STATE OF
IS 12 YEARS OF AGE AND OLDER DOES HAVE THE RIGHT TO SEEK STD
MEDICAL SERVICES WITHOUT THE CONSENT OF THEIR PARENT.
AND MANY TIMES I HAVE HAD TO GO OUT AND GET IN TOUCH WITH SOMEONE
WHO WAS ANYWHERE FROM 12 -- I HAVE TALKED TO SOMEONE WHO WAS 12,
AND I'VE ALSO SPOKEN TO KIDS UP TO THE AGES OF 18, WHERE THEY ARE MINORS.
AND WHEN THAT IS THE CASE, IT IS CHALLENGING AS A PROVIDER.
USUALLY WE WILL GO TO THE SCHOOL SCHOOL SITE AND ASK TO SPEAK
WITH THE SCHOOL NURSE.
NEVER MENTIONING TO THE SCHOOL NURSE WHAT THE SITUATION IS ABOUT,
ONLY THAT I NEED TO SPEAK WITH THAT PERSON.
AND WHEN I AM IN FRONT OF THE MINOR, THEN I MAKE AN APPOINTMENT
TO SPEAK WITH THEM IN MY OFFICE IN A PRIVATE SETTING SO THAT WAY
I CAN DELIVER THE INFORMATION THAT I NEED TO DELIVER.
>> THANK YOU.
HERE IS A FOLLOW-UP QUESTION FOR
HOW DO YOU IN
THE FIELD WITH THE RAPID TESTING TECHNOLOGY?
>> OKAY.
WE'VE DONE A LOT OF RESEARCH AND PLAYING AROUND WITH THE CONTROLS.
WHAT WE DID WAS WE TAKE A COOLER AND WE PUT FREEZER PACKS IN IT.
WE PUT THE CONTROLS IN THERE AND PUT THEM IN OUR CAR AND WENT OUT
AND DID THE TEMPERATURE EVERY FEW HOURS TO DETERMINE THE BEST ICE
PACKS IN THE COOLER, HOW LONG IT WOULD STAY AND MAINTAIN AT THAT
RIGHT TEMPERATURE.
ALSO, IN THE FIELD, YOU JUST NEED TO HAVE A STABLE, FLAT SURFACE
WITH A CHUB'S PACK OVER IT.
IT'S DEFINITELY DOABLE IN THE FIELD.
YOU DO NEED TO RUN CONTROLS ANYTIME YOU CONDUCT A TEST IN A
DIFFERENT SETTING.
AND SO FAR WE'VE NEVER HAD A CONTROL THAT WAS INVALID AND THE
TESTS HAVE ALL BEEN VALID TESTS.
>> THANK YOU.
WHAT TECHNOLOGY DO YOU USE?
WHICH RAPID TESTING TECHNOLOGY?
>> WE USE THE ORA-QUICKS.
>> BECAUSE EACH HAS ITS OWN SET OF STANDARDS THAT YOU MUST MAINTAIN.
NEXT QUESTION FOR STAN.
HOW DO YOU HANDLE A POSITIVE DIAGNOSIS IF THE PATIENT CANNOT BE
EASILY LOCATED?
>> WELL, THAT'S PROBABLY A MAJOR PART OF WHAT THE DIS DOES ON A
DAILY BASIS.
BECAUSE OFTEN, THROUGH THE PROCESS, YOU GET VERY LIMITED LOCATING
INFORMATION.
AND THROUGH A PROCESS AGAIN OF CLUSTERING, NOT ONLY THE ORIGINAL
PATIENT, BUT PATIENTS THAT TRAVEL IN THE SAME
GET A
MAY HANG OUT, AND CERTAIN DISTINGUISHING MARKS WHETHER IT'S A
TATTOO, PARTICULAR ARTICLE OF CLOTHING THAT THEY WEAR ON OCCASION.
AND GATHERING ALL THIS INFORMATION, THE DIS ARE ABLE TO LOCATE
PATIENTS IN AREAS THAT ARE PARTICULARLY TROUBLING AND IT'S --
AGAIN, IT'S PART OF A DAILY PROCESS THAT THEY DO.
DIS IS VERY SKILLED AT COLLECTING INFORMATION, NOT ONLY AT THE
INDEX PATIENT, BUT FROM ALL SOURCES AND YOU COMPILE ALL THAT
INFORMATION AND YOU GO OUT AND THEY'RE VERY SUCCESSFUL AT
LOCATING DIFFICULT PARTNERS.
>> THANK YOU.
SPEAKING OF CHALLENGES, CINDY, HERE IS A QUESTION FOR YOU.
HOW WOULD YOU ADDRESS A SITUATION WHEN A PARTNER NEEDS TO BE
TESTED, HOWEVER, DOMESTIC VIOLENCE IS A MAJOR CONCERN?
>> THAT'S AN IMPORTANT THING TO CONSIDER, BECAUSE DOMESTIC
VIOLENCE, OR EVEN A PERCEIVED THREAT OF DOMESTIC VIOLENCE, IS A
MAJOR CONCERN FOR SOME CLIENTS.
I WANT TO FIRST START BY SAYING THAT MANY AGENCIES HAVE THEIR OWN
LOCAL PROTOCOLS THAT RELATE TO HOW YOU HANDLE SITUATIONS WHERE
DOMESTIC OR PARTNER VIOLENCE IS AN ISSUE.
SO YOU WOULD ALWAYS WANT TO CONSULT YOUR LOCAL POLICY OR PROTOCOL FIRST.
BUT I ALSO WOULD ENCOURAGE ANYONE INVOLVED IN THIS SITUATION TO
REALLY STRATEGIZE AND PROBLEM SOLVE WITH THE CLIENT ABOUT HOW
THEY THINK THAT THEY COULD GET THAT NEED MET.
MANY TIMES -- WELL, ALWAYS, CLIENTS KNOW THEIR OWN SITUATIONS
BETTER THAN WE DO AS PROVIDERS AND CAN OFFER US THE BEST SOLUTION
TO THOSE SITUATIONS IF WE JUST ASK THEM, LISTEN TO THEM, AND THEN
STRATEGIZE ABOUT HOW TO MAKE WHAT IT IS THAT THEY NEED HAPPEN.
FOR EXAMPLE, I'VE HAD CLIENTS MEET ME IN OTHER AREAS AWAY FROM THE HOME.
I'VE HAD CLIENTS ENGAGE IN DIFFERENT KINDS OF TESTS.
SAY, FOR EXAMPLE, AN ORAL TEST WHERE THEY WOULDN'T HAVE TO GO
HOME WITH A BAND-AID WHERE THEY HAD BLOOD DRAWN, ET CETERA, ET CETERA.
SO THERE ARE MANY, MANY DIFFERENT WAYS TO STRATEGIZE AND I REALLY
THINK THAT OFTENTIMES CLIENTS HAVE ALL THE ANSWERS.
WE JUST NEED TO HELP THEM GET THERE.
>> THANK YOU.
OUR NEXT QUESTION IS FOR DENISE.
WHAT'S THE DIFFERENCE BETWEEN PCRS AND PARTNER ELICITATION AND
NOTIFICATION FOR OTHER STDs?
>> WHEN I THINK ABOUT THE TWO, I WOULD SAY THAT THEY'RE -- THERE
ARE MORE SIMILARITIES THAN THERE ARE DIFFERENCES.
WHEN YOU ARE APPROACHING EITHER AN STD, GENERAL STD CLIENT, OR A
PERSON WHO HAS HIV, AND YOU WANT TO DISCUSS PARTNERS WITH THEM,
BOTH TYPES OF CLIENTS NEED TO BE APPROACHED WITH THE SAME LEVEL
OF RESPECT AND COMMITMENT TO CONFIDENTIALITY.
I WOULD ALSO SAY THAT THE TYPE OF INFORMATION THAT YOU'RE GOING
TO COLLECT AROUND THE PARTNERS, FOR EITHER TYPE OF CLIENT, IS
GOING TO BE THE SAME.
YOU STILL NEED TO KNOW THE NAME OF THE PARTNER, YOU NEED
DESCRIPTIVE INFORMATION.
YOU STILL WANT TO KNOW WHAT THE
TO CONTACT THAT PERSON WOULD BE.
AND YOU'RE STILL GOING TO INQUIRE A LITTLE BIT ABOUT THE
RELATIONSHIP, SO EXPOSURE INFORMATION.
I WOULD ALSO SAY THAT WHEN YOU'RE ACTUALLY CONTACTING AND HAVING
A CONVERSATION WITH THE PARTNERS, THEY ARE BOTH TREATED THE SAME WAY.
NEVER, EVER ARE WE GIVING THE NAME OR INFORMATION ABOUT STD OR
HIV-INFECTED ORIGINAL CLIENT.
AND WE ARE PROVIDING THEM WITH SERVICES AND OPTIONS JUST LIKE WE
WOULD ANYONE ELSE WHO NEEDS TO BE NOTIFIED OR MANAGED.
>> THANK YOU.
WE HAVE A QUESTION HERE FOR
WHAT HAPPENS WHEN A CLIENT TESTS POSITIVE?
DO THEY GET HELP WITH OTHER ISSUES SUCH AS SHELTER?
>> OH, DEFINITELY.
WHEN A CLIENT TESTS POSITIVE, WE DO REALLY A COMPREHENSIVE
ASSESSMENT TO DETERMINE WHAT SERVICES WOULD DEFENDANT SUIT THIS
PARTICULAR CLIENT.
AND SOME OF THE ISSUES THAT MAY COME UP MIGHT BE SUBSTANCE USE,
MISUSE, MENTAL HEALTH ISSUES, DOMESTIC VIOLENCE, LACK OF
FINANCES, LACK OF INSURANCE.
SO WE LET THE CLIENTS KNOW EXACTLY WHERE THEY CAN GO BASED ON
WHAT THEY NEED AND WHAT THEIR INDIVIDUAL CIRCUMSTANCES ARE.
FOR EXAMPLE, IF A CLIENT DOES NOT HAVE HEALTH INSURANCE AND THEY
ARE CONCERNED ABOUT RECEIVING THE MEDICAL TESTS AND MEDICAL CARE
THAT THEY NEED FOR THEIR HIV, WE CAN REFER THEM TO APPROPRIATE
PLACES IN
THEY MAY RECEIVE CARE BASED UPON THEIR FINANCIAL SITUATION.
ALSO, WHEN A PERSON TESTS POSITIVE, THAT REALLY IS THE TIME THAT
WE WANT TO HELP THEM NOTIFY THEIR PARTNERS.
IF WE BELIEVE SOMEONE IS GOING TO HAVE A HARD TIME EITHER
ACCESSING THE APPROPRIATE CARE THAT THEY NEED, LETTING THEIR
PARTNERS KNOW, ARE GOING TO HAVE A HARD TIME HAVING SAFER SEX IN
THE FUTURE, THEN WE CAN REFER THEM TO MORE INTENSIVE INTERVENTION
SUCH AS PREVENTION CASE MANAGEMENT SERVICES, OR MENTAL HEALTH
SERVICES, SO THAT THEY CAN GET THE CARE THAT THEY NEED IN ORDER
TO BE THE HEALTHIEST INDIVIDUAL THAT THEY CAN BE.
>> THANK YOU.
LET'S END WITH MORE OF A TECHNICAL QUESTION ON HOW PARTNER
NOTIFICATION IS ACCOMPLISHED.
AND LET'S START WITH STAN AND DENISE.
WHAT ABOUT PARTNER NOTIFICATION BY TELEPHONE?
>> WELL, PARTNER NOTIFICATION BY TELEPHONE IN
PROHIBITED.
AND THERE ARE A NUMBER OF ISSUES THAT SURROUND PARTNER
NOTIFICATION BY TELEPHONE.
ONE, WE CANNOT ENSURE THAT THE PERSON AT THE OTHER END OF THAT
LINE IS THE INDIVIDUAL THAT WE INTEND TO NOTIFY.
WE CAN HAVE THE MOST DESCRIPTIVE INFORMATION, AND THAT PERSON CAN
RESPOND POSITIVELY THAT, YES, THIS IS THE PERSON THAT YOU'RE
TRYING TO REACH.
BUT I HAVE A
SPOUSES.
FRIENDS, ET CETERA, THAT I CAN GIVE TO SOMEONE ON THE TELEPHONE
AND ENSURE THAT I'M THE PERSON THAT THEY'RE MAKING CONTACT TO.
SO WE AVOID PARTNER NOTIFICATION BY TELEPHONE.
WHAT WE DO UTILIZE THE TELEPHONE TO DO IS TO FACILITATE MEETING
THAT INDIVIDUAL AT THEIR FACILITY, ON THEIR TERMS, AND, AGAIN,
USING THE TELEPHONE, IT'S A TIME SAVER.
BUT AGAIN, WE'RE CONCERNED ABOUT PARTNER IDENTIFYING THE WRONG
INDIVIDUAL.
>> THANK YOU.
>> AND I THINK THAT THE BEAUTY OF MAKING THAT FACE-TO-FACE
MEETING, AND THEN WHEN YOU GO OUT TO MEET THAT PERSON IS THAT YOU
ARE ABLE TO USE THE DESCRIPTIVE INFORMATION THAT YOU HAVE, AND
THEN COMPARE IT TO PERSON THAT YOU NEED TO SPEAK WITH.
AND THAT'S AN EXCELLENT WAY OF CONFIRMING THE IDENTITY OF THE
PERSON THAT YOU WANT TO TALK TO.
AND I AGREE WITH WHAT STAN SAID HERE, THAT MOST AREAS DO AVOID
THIS TYPE OF NOTIFICATION, OVER THE PHONE, FOR THE VARIOUS
REASONS THAT STAN'S JUST TALKED ABOUT.
>> THANK YOU.
CINDY?
>> WELL, I THINK IT IS IMPORTANT TO HAVE SPECIFIC POLICIES AND
PROTOCOLS AROUND USE OF A PHONE, SUCH AS THEY HAVE IN NORTH
I KNOW THAT THERE ARE SOME AREAS AROUND THE COUNTRY WHERE
ACTUALLY USING THE PHONE WOULD BE REALLY BENEFICIAL.
AND I THINK IF YOU ARE GOING TO DO THAT, IT IS IMPORTANT TO
STRATEGIZE ABOUT HOW YOU WILL HANDLE IDENTIFYING PARTNERS TO MAKE
SURE THAT YOU HAVE THE RIGHT PERSON ON THE PHONE, HOW YOU WILL
HANDLE THE POTENTIAL FOR BREACH OF CONFIDENTIALITY, IF IT DOES
INDEED HAPPEN, AND TO SET ALL OF THAT DOWN IN POLICY AND PROTOCOL
FOR YOUR STAFF.
>> THANK YOU.
OUR LAST PANEL LIST ACTUALLY DOES ACCOMPLISH PARTNER NOTIFICATION
OVER THE TELEPHONE, PERHAPS YOU COULD TELL US ABOUT THAT.
>> YES.
IN
TELEPHONE.
WHAT WE'VE EXPERIENCED IN THE PAST IS THAT SOMETIMES THE CLIENT'S
ANXIETY LEVEL INCREASES WHEN WE LET THEM KNOW THAT WE HAVE
MEDICAL INFORMATION TO DISCUSS WITH THEM, BUT WE DON'T GIVE THEM
SPECIFICALLY WHAT INFORMATION THAT IS.
WE DO HAVE
THE CORRECT PERSON, AND THERE HAS NEVER BEEN A BREACH OF
CONFIDENTIALITY WHEN CONDUCTING PARTNER NOTIFICATION OVER THE
PHONE IN
THE BENEFITS TO THIS ARE THAT THE CLIENT GETS TO KNOW INFORMATION
RIGHT AWAY.
THEY HAVE THE OPTION WHETHER THEY WANT TO GET TESTED OR NOT.
THEY DON'T NEED TO MEET WITH US AND THEN DETERMINE WHETHER THEY
WANT TO GET TESTED FOR HIV.
THEY HAVE THAT OPTION.
WE CAN DO RISK REDUCTION COUNSELING OVER THE PHONE IF THE PERSON
CHOOSES AT THAT TIME THAT THEY DON'T WANT TO GET TESTED.
AND, ALSO, IN
SPEND FOUR OR FIVE HOURS DRIVING TO A CLIENT'S HOME TO GIVE THEM
THE INFORMATION, AND THEN THEY'RE NOT THERE.
THEY'VE MISSED THE APPOINTMENT, WE HAVE TO DRIVE BACK TO THE OFFICE.
SO TO MAKE SURE THAT THE CLIENT IS GETTING ALL OF THE INFORMATION
THAT THEY NEED, IN
SUCCESSFUL AND NOTIFYING PARTNERS OVER THE PHONE.
>> THANK YOU,
>> THAT'S ALL THE TIME WE HAVE FOR OUR DISCUSSION SEGMENT.
THANK YOU TO OUR AUDIENCE FOR YOUR QUESTIONS.
AND THANK YOU TO OUR PANELISTS FOR YOUR PARTICIPATION TODAY.
IN JUST A FEW MINUTES, WE'LL HAVE SOME IMPORTANT INFORMATION
ABOUT HOW TO ORDER A VIDEOTAPE OR VIDEO CD-ROM OF TODAY'S PROGRAM
AND A REMINDER ABOUT OUR UPCOMING BROADCAST IN NOVEMBER.
SO PLEASE STAY WITH US A FEW MORE MINUTES.
VIEWERS AND SITE FACILITATORS, IF YOU HAVE FEEDBACK RELATED TO
TODAY'S BROADCAST OR QUESTIONS THAT WE DIDN'T GET TO, PLEASE SEND
US AN EMAIL
PLEASE PUT "ATTENTION SATELLITE BROADCAST" IN THE SUBJECT LINE.
YOU CAN ORDER A VIDEOTAPE OR VIDEO CD-ROM OF TODAY'S PROGRAM BY
CALLING 866- 366-7502.
FOR UPDATES ON PCRS, WE RECOMMEND THAT YOU PERIODICALLY VISIT
CDC'S WEBSITE FOR THE DIVISION OF HIV/AIDS PREVENTION WHICH CAN
BE REACHED THROUGH WWW.CDC.GOV.
THEN JUST CLICK ON "HIV/AIDS PREVENTION."
AND PLEASE MARK YOUR CALENDARS FOR AN IMPORTANT SATELLITE
BROADCAST AND WEBCAST ON
EASTERN STANDARD TIME.
THAT BROADCAST WILL BE ON "REVISED RECOMMENDATIONS FOR HIV
SCREENING OF ADULTS, ADOLESCENTS, AND PREGNANT WOMEN IN HEALTH
CARE SETTINGS."
FOR MORE INFORMATION ABOUT THAT PROGRAM, PLEASE VISIT CDC'S HIV
BROADCAST WEBSITE AT WWW.CDCNPIN.ORG AFTER JULY 24.
OR YOU CAN RECEIVE INFORMATION FROM THE CDC FAX INFORMATION
SYSTEM AT 1-888- CDC-FAXX.
WHEN PROMPTED, ENTER DOCUMENT NUMBER 130042 AND YOUR RETURN FAX NUMBER.
OR, YOU CAN CALL 866-366-7502 AND PLEASE MARK YOUR CALENDARS FOR
BEING HELD AT THE HYATT REGENCY ATLANTA HOTEL.
THIS CONFERENCE BRINGS TOGETHER PREVENTION PROGRAMS AND SCIENCE
INCLUDING LOCAL, REGIONAL AND NATIONAL DECISION MAKERS,
RESEARCHERS, POLICY MAKERS, COMMUNITY LEADERS AND PRACTITIONERS.
FOR MORE INFORMATION, VISIT WWW.2005HIVPREVCONF.ORG OR CALL
1-866-277-6313.
THAT BRINGS US TO THE END OF THIS UPDATE ON PARTNER COUNSELING
AND REFERRAL SERVICES FOR HIV PREVENTION.
WE SINCERELY HOPE THAT TODAY'S INFORMATION WILL ASSIST
ORGANIZATIONS WITH INCORPORATING THIS VALUABLE INTERVENTION INTO
YOUR HIV PREVENTION EFFORTS.
ON BEHALF OF THE CENTERS FOR DISEASE CONTROL AND PREVENTION, AND
THE PUBLIC HEALTH TRAINING NETWORK, WE WISH YOU WELL IN YOUR HIV
PREVENTION WORK.