Partner notification for HIV prevention: Effects on partnerships and behaviors
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Description
The purpose of this prospective cohort study was to assess the effects of partner notification for human immunodeficiency virus (HIV) infection on partnerships and behaviors, and to compare these changes to the effects of partner notification for syphilis. Persons who received partner notification for HIV or syphilis in the New Orleans metropolitan area were eligible to participate. Participants were enrolled in the study at the time of partner notification, and follow-up data were collected at three and six months after partner notification. A behavioral questionnaire was administered in a face-to-face interview at each visit. The main outcomes of interest included the status of partnerships at follow-up (dissolution/continuation) and changes in high-risk behaviors including abstinence, frequency of unprotected vaginal or anal intercourse, condom use at last sexual act, and consistent condom use. The formation of new partnerships after partner notification was also described. Descriptive analyses were stratified by the infection status of the participant and the concordance status of the partnership, and generalized estimating equations were used in the modeling A total of 112 individuals with 159 partnerships were included in the analysis. The study sample was predominantly African-American, heterosexual, and of low socioeconomic class. At the end of the 6-month follow-up period, 73% of HIV concordant, 56% of HIV discordant, and 75% of syphilis partnerships had dissolved. After adjusting for confounding, HIV concordant partnerships were 2.6 times (95% CI = 0.7--9.7) more likely to dissolve than syphilis partnerships, and there was no difference in the likelihood of dissolution between HIV discordant and syphilis partnerships (OR = 0.9, 95% CI = 0.33.8). Both HIV concordant and discordant partnerships that did not dissolve were more likely than syphilis partnerships to reduce the frequency of unprotected sexual acts and to increase condom use. HIV index cases formed 8 new partnerships during the follow-up period, and 7 of these new partnerships were discordant. The rate of new partner acquisition among HIV index cases in the follow-up period was 4.4 per 100 person-months, which was comparable to the baseline rate of 3.5 per 100 person-months (p > 0.90) The results of this study suggest that positive changes occur after partner notification for HIV. The reduction in the number of sexual partners and the decreases in high-risk behaviors are likely to result in lower rates of HIV transmission. Despite these beneficial effects, the greater likelihood of dissolution among HIV concordant partnerships and the formation of new discordant partnerships by HIV index cases after partner notification may promote the spread of HIV in the community. Though these negative effects may not be directly attributable to partner notification, their occurrence could diminish the positive effect that partner notification has on reducing the spread of HIV Partner notification remains an important public health intervention for counseling at-risk individuals, providing HIV testing to people who do not know their serostatus, and identifying infected persons who can be referred for treatment. The benefits of HIV partner notification most likely outweigh the potentially negative consequences, though such outcomes are not negligible and should be addressed during the partner notification process and in future research studies