NEW YORK, NY December 14, 2004 —Testing positive for HIV is traumatic, and one of the next steps – informing your partner, or partners – is also very difficult. Before 2000, New York didn't require care-givers to ask about people's partners. But as WNYC's Fred Mogul reports, for the last four years, the state has taken a different approach – with mixed results.

FM: Social Worker Holly Dando occasionally helps new HIV patients break the news to their partners. A few years ago, one woman found out she was HIV positive, while donating blood. She didn’t know what to tell her husband, so she brought him into Dando’s office…

HD: ...but she was unable to get the words out. She was just looking at him with her mouth opening and closing. The nurse and I finally took over for her and break this horrible news to him...We were in a room with asphalt walls, and he punched the wall and lit a cigarette…They were both crying hysterically and clinging to each other. We were there with all the health-, insurance-related questions that he would have right then in terms of getting himself tested, getting care, if he needed that, what he could expect in terms of his wife's health.

FM: Her husband tested HIV negative. State and city health officials want healthcare providers like Dando to play an active role in reaching the partners of people who test HIV positive. In 2000, a new state law was imposed requiring them to do just that – sort of. Providers must question patients about their partners, but the patients don’t have to answer – and most do not. Last year, only about 25 percent of those who tested positive officially shared the names of their partners with health officials. At New York Hospital for Special Studies, most of Dando's patients tell her they do inform their partners -- on their own -- and she trusts them.

HD: We do have to take it on faith, and generally...that faith is warranted. You can see it. You can see that they’re relaxed, that their relationship is better integrated now that they’ve been able to talk about this.

FM: Dando introduced me to Isabelle Caraballo, who lives in the South Bronx and has been living with HIV for 16 years. She was married for most of that time to a man who also had the virus. He died about a year-and-a-half ago. For the last six months, she has had a new relationship with an old friend she hopes to marry. They have always talked openly about her HIV status.

IC: I used to be scared to tell anyone I had the virus, thinking I would be rejected. But today, I'm really open with it. Because, if they’re going to love me, they have to love me for my person, not for what I have.

FM: It's difficult to know how typical Caraballo is in her willingness to speak about HIV with her partner. The only figures are for those who actually share their partners' names with officials – not for those who say they’re handling it themselves. The city has set up a network to help people, called the Contact Notification Assistance program, but it is not used much. Dr. Susan Blank, the city’s Assistant Health Commissioner for STD Prevention And Control, says the city could do a better job at clearing up misconceptions people have about partner notification.

SB: People really need to know having the health department involved in partner notification protects the identity of the original case, that it’s entirely voluntary, that there are a variety of different options available and that we’ll work with each individual to come up with options that are appropriate for each partner.

FM: The state of North Carolina, however, has had better results. Todd Van Hoy at the state health department estimates that about 75 percent of those who test positive for HIV enlist the help of healthcare providers in informing their partners. Van Hoy is the Field Services manager for HIV and Sexually Transmitted Diseases Prevention. He says his "disease intervention specialists" convey to people that the best way to protect their anonymity -- if that’s what they want -- is to let the health department handle partner notification.

TVH: It's the way we explain it to them...We tell them how to do it, and they see it's a big procedure to handle the right way. Or we say, 'We can handle it for you. You stay in the picture and meet your obligation, and …there's no way anyone will pass information that you have a disease, because word on the street travels fast.'

FM: Van Hoy last year co-authored an article with impressive findings in a journal published by the Centers for Disease Control. Of those partners whose names were given by the primary HIV patient to a health department worker, 85 percent were located and interviewed, 66 percent were tested and 21 percent were found to be HIV positive. That translates to identifying 108 people who didn't know they had the virus. In addition to health department workers' interview techniques, Van Hoy says the whole system is designed to be un-intimidating.

TVH: We don't do any HIV interviews or anything like that over the phone. We do face-to-face. We drive our own cars in NC, so that's a confidentiality protection in itself. We don’t dress, we don’t wear ID’s in the field, and it allows us to build a better rapport with our clients.

FM: Back up here, Dr. Rona Vail at the Callen Lorde Community Health Center isn’t sure what it would take to make sure partners really are notified.

RV: People are very very afraid of disclosure. They're afraid of rejection from their partners, friends and family. I think our role is pushing people along in the process, getting them comfortable with themselves and also helping them find ways to either broach the subject themselves or find ways to do it.

FM: Notifying people they may have been exposed to a communicable disease is a crucial challenge to the public health system -- whether it's tracing those who ate food prepared by Typhoid Mary or those who slept with someone who has tested HIV positive. But simply informing them isn’t enough – authorities need to persuade them to get their own tests, and, if necessary, use condoms to stop the spread of the disease.

LINKS:

» City Health Department -- HIV-AIDS Prevention

» City Health Department -- Report on Partner Notification (download the .pdf)

» Callen Lorde Community Health Center

» New York Center for Special Studies