These 2008 recommendations consolidate and replace the 1998 HIV Partner Counseling and Referral Services Guidance and the 2001 Program Operations Guidelines for STD Prevention, ostensibly to eliminate inconsistencies in how state programs manage partner notification services. As defined by the CDC, partner services include partner notification, prevention counseling, HIV and STD testing, and referral to medical care and other services for people who test positive for HIV or STDs and their sexual and needle-sharing partners. Geared towards health department managers, the recommendations stress linkage to care and prevention for those who test positive, and focus more on the types of activities health departments should engage in, as opposed to how things should be done.
Included in the recommendations are specific discussions related to confidentiality, the “duty and privilege to warn,” and criminal HIV exposure. During the comment period, many advocates submitted comments related to these sections, concerned that the CDC’s new recommendations would increase the risk of breaches of patient confidentiality and needless prosecution of HIV-positive individuals, which would undermine the initiative and its goals.
Ultimately, advocates’ comments and concerns largely were ignored. Although the recommendations do stress the importance of protecting the confidentiality of index patients, they also allow for a number of exceptions. The recommendations also assert the existence of duty or privilege to warn laws, and the breach of confidentiality that goes along with them, without a nuanced discussion of the applicable legal standards or their applicability to risks of HIV exposure. Likewise, the recommendations acknowledge the possibility of criminal prosecution for HIV exposure without any discussion of why such prosecutions are antithetical to sound public health policy or how they further stigmatize an already marginalized population.
The recommendations place a heavy emphasis on the relationship between disease surveillance systems and case identification, encouraging states to use their disease surveillance data to identify candidates for partner services. In a telebriefing prior to the release of the recommendations, CDC acknowledged that using disease surveillance data in this way may pose a challenge, especially for those states that agreed not to use HIV surveillance data for anything other than surveillance when they moved from code-based to name-based HIV reporting systems. Despite the potential challenge, and the obvious confidentiality concerns, CDC is urging states to use the data as a means of identifying index patients.
CDC also acknowledged in the telebriefing that a lack of resources may present a barrier to states trying to implement the recommendations, but that states should move ahead with implementation anyway. During the telebriefing, CDC also indicated that although they are encouraging all states to develop systems that are consistent with the recommendations, the recommendations are not a mandate.