Do partner notification services cause harm to people with HIV?
18 January 2024
Partner notification services are viewed with caution by some in civil society. So do they cause harm or not?
A new evidence review suggests that HIV partner notification services are a safe and effective way to find people with undiagnosed HIV, but with some important exceptions – such as those with violent partners.
What is the research about?
HIV partner notification services are when the sexual partners (and/or children and drug injecting partners) of someone diagnosed with HIV are offered an HIV test. Partner notification can take different forms. It can be led by the person with HIV (sometimes known as ‘passive’) or by the health worker (sometimes known as ‘assisted’ or ‘active’). It should always be done with the consent of the person with HIV.
Researchers reviewed 16 studies done between 2015 and 2021 involving 44,000 people. Most involved the general population, but some focused on marginalised groups most at-risk of HIV, women with violent partners and women in antenatal settings. All but one of the studies were in Africa (Kenya, Cameroon, Malawi, Tanzania, Mozambique, Uganda and Zambia, plus Viet Nam).
Why is this research important?
The World Health Organization (WHO) endorses partner notification services and provides guidelines on four different methods. But some in civil society say these services are putting people with HIV at risk of harm. This needs to be better understood to design effective testing services.
What did they find out?
Overall, incidents of harm were reported by 0% to 6% of participants. Those most at risk of harm were women with abusive partners.
Although harm did happen it was rare. Most studies (69%) reported that fewer than 1% of participants experienced harm due to partner notification services. This was the case for passive and assisted approaches.
The most common type of harm was relationship break-up, followed by violence and loss of financial support.
What does this mean for HIV services?
Passive or assisted HIV partner notification services are generally a safe and effective way to find people with HIV and link them to care.
But the service must be delivered correctly to ensure the person with HIV is put at as little risk as possible. People should be fully informed about their risk so they can weigh up the benefits of sharing their diagnosis against the harm it could cause. WHO guidelines state that all partner notification services must follow ‘5Cs’: consent, confidentiality, counselling, correct test results, and connection to HIV prevention, care and treatment. The guidelines state that screening for partner abuse is also essential.
The findings in this review that women with violent partners were most at risk of harm shows the importance of such screening. Some partner notification services in this review excluded people with violent partners, while others included them then provided additional monitoring, counselling and safety plans to protect them during the process.
It is also important to consider the risks that people from marginalised and criminalised groups face, such as blackmail or violence with fewer opportunities to access justice. Given the power dynamics, the specific risks of adolescent girls and young women must also be taken into account.
It is essential that people with HIV are given a choice over how to share their diagnosis with their partners. And they must be able to say no to a notification service if they feel the risk of harm is too great. If people are afraid that they will be forced to share information about their sexual partners, it may stop many people getting tested in the first place.
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