Protocol for HIV partner notification

[NurseLoveJoy88, ASN, RN]

At work a very interesting discussion came up. There are two patients at our facility who are homosexuals and have become partners. One of the patients is HIV +. They do engage in sexual activity. My question is : What role do health care providers play in this ? My original thought was there will be NO notification to the unaffected partner due to HIPAA. At the same time if the partner do infect someone, that person should be made aware but the identity of the partner that passes it remains unknown. The only thing we can do I suppose if encourage safe sex to both partners, and anyone else gay or straight.

Thoughts ??

[happy2learn]

Its the responsibility of the HIV+ person to inform the partner before they engage in sexual activity.

[EowynRN]

It's their responsibility - otherwise it's HIPPA. If you saw a ex-HIV patient on the street with a partner, would you walk up and say something? Nope, because it's a HIPPA violation.

At least you know that if that patient is on treatment and using protection, the risk of transmission is very low.

[NurseLoveJoy88, ASN, RN]

It's their responsibility - otherwise it's HIPPA. If you saw a ex-HIV patient on the street with a partner, would you walk up and say something? Nope, because it's a HIPPA violation.

At least you know that if that patient is on treatment and using protection, the risk of transmission is very low.

Yeah this was my exact thinking too. HIPAA would not allow this info. to be disclosed. I guess it was a silly question.

[Jolie, BSN]

Not a silly question at all.

We dinosaurs are able to recall the days when individuals diagnosed with sexually transmitted diseases were obligated/compelled to report their contacts who were then notified by public health authorities of the need for testing/treatment.

All of that changed during the early days of HIV/AIDS when those who were (+) were frequently discriminated against (kept out of school, denied jobs, etc.) due to fear of transmission. No one understood how the disease was transmitted yet, and discrimination/disability laws didn't exist to the extent they do now. So mandatory reporting of STDs went by the wayside.

It's a dual edged sword. The patient's privacy is protected, but those who have potentially been exposed are no longer notified, unless the patient himself/herself has the integrity to do so.

We (as a society) have essentially exchanged the individual right to privacy for the collective right of contacts to know of potential exposure.

[NurseLoveJoy88, ASN, RN]

I have another question. Has nothing to do with my OP. A doctor wanted to order a HIV test without the patients' consent. Where can I find info. about this. I plan on doing a google search.

[Jolie, BSN]

There may be some exceptions in which a patient can be legally required to submit to an HIV test against his/her will (someone who is incarcerated, perhaps?), but generally speaking informed consent is required.

If the physician wants to do a test without the patient's knowledge, I can only assume it is because s/he believes that the patient won't consent.

By doing a "secret" test, s/he is taking away the patient's right to refuse.

I wouldn't touch this with a 10 foot pole.

[NurseLoveJoy88, ASN, RN]

There may be some exceptions in which a patient can be legally required to submit to an HIV test against his/her will (someone who is incarcerated, perhaps?), but generally speaking informed consent is required.

If the physician wants to do a test without the patient's knowledge, I can only assume it is because s/he believes that the patient won't consent.

By doing a "secret" test, s/he is taking away the patient's right to refuse.

I wouldn't touch this with a 10 foot pole.

You are so Right Jolie ! I didn't touch it at all !

[MunoRN, RN]

The rules vary by state, by in my state the Physician or lab is required to notify the State Department of Health. If the Physician knows the identity of a sexual partner(s) they can either notify the Department of Health who will notify the partner and provide counseling, or they can notify the partner directly. They do not need the permission of the patient but they do need to notify the patient first that they will be informing the partner(s). If the patient is concerned the patient will react violently, precautions will be taken and the partner notified when it is safe to do so.

[JSlovex2]

Not a silly question at all.

We dinosaurs are able to recall the days when individuals diagnosed with sexually transmitted diseases were obligated/compelled to report their contacts who were then notified by public health authorities of the need for testing/treatment.

All of that changed during the early days of HIV/AIDS when those who were (+) were frequently discriminated against (kept out of school, denied jobs, etc.) due to fear of transmission. No one understood how the disease was transmitted yet, and discrimination/disability laws didn't exist to the extent they do now. So mandatory reporting of STDs went by the wayside.

It's a dual edged sword. The patient's privacy is protected, but those who have potentially been exposed are no longer notified, unless the patient himself/herself has the integrity to do so.

We (as a society) have essentially exchanged the individual right to privacy for the collective right of contacts to know of potential exposure.

well, i don't know how prehistoric we're talking, but i was notified by telephone by a public health worker when someone i had sexual contact with tested positive for 2 STD's and this was 9-10 years ago. luckily, i didn't contract anything (and it wasn't AIDS). i remember it clearly bc he called me at work on a friday afternoon and had a sad tone when he said i should come in first thing monday morning for a test. i said, "oh god, what is it? just tell me." he said he wasn't allowed to tell me over the phone and i was like "GD'it! just tell me! i can't go all weekend wondering if i could have aids!" luckily, he told me. he wouldn't tell me WHO it was, but i had a pretty good idea since i hadn't had many partners. anyway, just saying - it wasn't that long ago that those who were exposed were notified. at least it was way after the early days of hiv/aids.

[Motivated grandma]

Regarding testing - you might check the fine print of your hospital's admission papers - where I was doing clinicals patients give consent to testing whether or not they know it. It's in the "fine print."

[lrobinson5]

I think you can actually be in trouble with the law if you have sex with someone and not tell them you are HIV positive. I don't think it would be out of the question to mention that to your HIV + patient, it might encourage them to be upfront about the whole thing.