Among the most difficult barriers to preventing the spread of HIV are those that hamper the notification of sexual and needle-sharing partners that they have been exposed to the infection. In a new study, Yale researchers investigate the factors that prevent such partner notification, both directly by men who have sex with men and by the health department, and suggest ways to overcome those barriers in order to better treat the disease and prevent its spread. Their study appears in the journal AIDS and Behavior.
According to the Centers for Disease Control, around 50,000 people in the United States are newly infected with HIV each year, and nearly two-thirds of those infections occur in men who have sex with men. In Connecticut, public health officials say 18% of those infected with HIV are unaware of it.
To identify the barriers to partner notification by HIV-positive men and health officials, and find ways to ease them, the Yale research team worked in partnership with AIDS Project New Haven and the Connecticut Department of Public Health. They interviewed case managers, disease intervention specialists (public health authorities who facilitate partner notification), and men who have sex with men to try to understand their different perspectives regarding partner notification. They found differences in perspectives regarding factors that impact engagement in risky sexual behavior, HIV disclosure, and barriers to building trusting relationships between the men and healthcare providers.
Some of the men who have sex with men reported that they distrust the healthcare system. Many perceive a stigma associated with HIV and homosexuality, and believe that this leads men to engage in high-risk behaviors such as unprotected sex. Some expressed fear about talking openly about their sexual orientation and HIV status, even to their sexual partners, and some reported that being honest with others about his HIV status led to feelings of rejection and subsequent drug use.
In contrast, some healthcare providers blamed the Internet for increasing sexual promiscuity, and some perceived that sexual promiscuity and lack of HIV status disclosure are simply characteristics of men. Some providers described other barriers, including the way physicians misinterpret confidentiality laws.
The researchers write that facilitating honest, trusting discussion may lead to better partner notification and, therefore, earlier HIV diagnosis and treatment. “Partner notification services offered through the state health department are key for promoting timely diagnosis of HIV infection, but we need to find ways to educate providers about these services and optimize their utilization and implementation,” said first author Jennifer Edelman, assistant professor of internal medicine at Yale School of Medicine.
Other authors are Christopher Cole and Nicholas Boshnack of AIDS Project New Haven, Wanda Richardson and Heidi Jenkins of the Connecticut Department of Public Health, and Marjorie Rosenthal of Yale.
This study was supported by the Yale School of Medicine, the Yale Center for Clinical Investigation, the Robert Wood Johnson Clinical Scholars Program, and the United States Department of Veteran Affairs.