Partner notification as a prevention strategy: a social system perspective

Provider referral and contact referral are two established means to provide notification of contagious, but treatable diseases, as has been done for tuberculosis and sexually transmitted diseases (e.g., syphilis). Because AIDS is at this time an incurable disease, programs of notification have proved highly controversial. The author examines recent adjustments to the New York State public health law regarding HIV/AIDS notification mechanisms. A literature review supports further discussion of ethical and partner notification issues as they bear on the perception and objections of various constituencies, stigmatization, and principles of confidentiality. Both U.S. and Swedish strategies to partner notification are outlined as well as why these schemes may not be interchangeable based on culture differences; points for general improvement are drawn from this comparison. A social system perspective based on the social functions of adaptation, goal attainment, integration, and latency (pattern maintenance) is introduced as a means to address the barriers inherent in HIV/AIDS notification programs and to enhance counseling programs--the objective being that knowledge and understanding of the patient's culture and social context can give providers additional tools with which to stop the spread of HIV/AIDS and bring people to treatment earlier.