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HIV PARTNER NOTIFICATION:

Why Coercion Won't Work

An American Civil Liberties Union Report
March 1998

I. SUMMARY

The term "partner notification" refers to activities aimed at identifying sex and/or needlesharing partners of someone with a disease communicable through sex or shared needles and informing them that they have been exposed to the disease.¹ Little empirical work exists that effectively evaluates the costs and benefits of partner notification. Voluntary partner notification plans, which encourage an infected individual to notify his or her partners and provide training and support, are one component of effective HIV prevention and treatment. However, the available evidence does not justify coercive partner notification. Instead, the scientific research shows that partner notification that is not voluntary or that is linked to HIV surveillance through name reporting will not work.

In the "traditional" context of partner notification for control of STDs, partner notification programs have frequently failed. Partner notification has not been effective in controlling recent STD outbreaks which are the result of high-risk activities similar to those driving the largest number of new cases of HIV infection. The evidence also shows that partner notification does little to change the high risk behavior of those most likely to contract HIV. At the same time, coercive partner notification diverts resources from programs that do work. Resources for treatment and prevention services, which result in more people being treated more effectively and fewer people becoming infected, are already insufficient.

The ACLU recognizes that it is extremely important that individuals who test positive for HIV notify any partners who have been placed at risk. The ACLU therefore supports voluntary partner notification plans. But the ACLU adamantly opposes state-mandated coercive partner notification, including plans that require individuals with HIV to provide the names of their partners to public health authorities and/or require public health authorities to notify partners without the consent of the patient.

II. INTRODUCTION

Partner notification emerged as a public health tool in the United States in the 1930's. The rationale behind partner notification is that it allows identification, treatment, and education of individuals who have been exposed to a communicable disease, preventing the spread of the disease and helping people understand how to avoid future infection.² After the discovery of penicillin as a cure of gonorrhea and syphilis, partner notification became a standard strategy for breaking the chain of transmission of those and other diseases. Partners were contacted by public health officers and immediately treated so that they could not infect others.

Partner notification has not been used systematically with HIV. There are several reasons for this: lack of a drug therapy to cure HIV or prevent transmission, a long incubation period which makes it difficult for patients to name and locate past partners, and serious concerns about confidentiality and social stigma. For these reasons, there has been broad consensus that coercive partner notification is not warranted with HIV.

Recent calls for aggressive and coercive partner notification have been fueled at least in part by the development of drug therapies for treating HIV. These therapies are helping people with HIV live longer and healthier lives. Research suggests that the new drug therapies may be more effective if begun soon after infection. However, the new drug therapies do not offer a cure, and individuals under treatment can still infect others.

Another factor that has changed in recent years is the demographics of HIV. While gay and bisexual men made up the largest at-risk population in the first decade of the AIDS epidemic, in the second decade new cases of HIV are increasingly occurring among people of color and injection drug users.³ Educational outreach to these groups has been more difficult and less effective than it was in gay communities, and partner notification has been suggested by some as an alternative to targeted prevention education.⁴ At the same time, frank, culturally appropriate education and counseling and other prevention measures, such as needle exchange and drug treatment have been largely ignored or rejected on ideological grounds.

III. THE EMERGENCE OF NEW PROPOSALS FOR COERCIVE
HIV PARTNER NOTIFICATION

HIV partner notification policies in effect across the country take many different forms. Some states have formulated programs that heed the Centers for Disease Control and Prevention (CDC) guidelines. These guidelines encourage states to devise partner notification services that are voluntary, confidential, conducted in a collegial and cooperative manner, and are sensitive to potential consequences of notification, such as damage to relationships and potential violence.⁵ Other states, however, have attempted to eliminate the inherently voluntary aspect of notification programs with state-mandated requirements.

Recently, there have been calls for unprecedented coercion in partner notification programs, as well as increased attention to programs which already limit voluntary and anonymous partner notification.

A. Existing policies

Some states impose a legal obligation on people infected with HIV to notify their partners. For example, in Indiana, HIV positive individuals who fail to notify present and past partners may be subject to a penalty of 180 days in jail and/or a fine of $1,000.⁶ In Michigan, health care providers administering HIV tests are required to refer clients testing positive to the local health department if they believe that the individual needs assistance with partner notification. The local health department, in turn, informs individuals that they are legally obligated to notify their partners and the health department is required to notify them as well.⁷

Some states, like Texas, require health care providers to notify partners of all HIV positive patients regardless of whether the patient has done the notification.⁸ Other states authorize, but do not require, physicians and/or public health officials to notify partners of individuals who have tested positive for HIV, even without the consent of the patient.⁹ These laws authorize dramatic departures from the confidentiality that patients expect in their relationship with a health care provider.

Though protecting the welfare of an unknowingly exposed partner may argue in favor of non-consensual disclosure under limited circumstances, existing and proposed legislation in this area is often far too broad.¹⁰

B. Recent proposals for state-mandated partner notification
are extraordinarily coercive

Proposals in Puerto Rico in 1997 and in New York this year mark a move toward coercion that threatens to set back public health efforts to prevent the spread of HIV.

In 1997, the Puerto Rico Health Department promulgated regulations requiring individuals testing positive for HIV to provide the health department with a list of their sex partners, including addresses and phone numbers. Failure to comply would have been punishable by fines of up to $5,000. After public outcry, the Health Department annulled the regulation and announced that it would convert its partner notification proposal into a voluntary program.¹¹

An even harsher proposal presently pending in the New York State Assembly would make it a felony for an individual testing positive for HIV to fail to disclose the names of his or her sex and needle-sharing partners to the health department, or to provide information about such partners known to be false.¹² Other proposed legislation in New York would require that the names of all individuals who test positive for HIV or are diagnosed with AIDS or an HIV-related illness be turned over to local health offices. The local health commissioner would then be required to notify the spouse and known sexual partners of the patient. The proposed legislation places no limits on the local health commissioner's power to investigate in order to identify and notify partners.¹³

These proposals represent a new and misguided move toward coercion as a means of stemming the spread of HIV.

IV. COERCIVE PARTNER NOTIFICATION IS BAD PUBLIC POLICY

Many calls for coercive, state-mandated partner notification policies are based on claims that partner notification is a "traditional" public health tool used to prevent the spread of STDs. Proponents of coercive partner notification for HIV argue that public health efforts to prevent the spread of HIV must use such "proven tools" of prevention. But this argument makes at least two false assumptions: 1) that coercive partner notification measures that are being implemented or proposed in the context of HIV infection are similar to "traditional" public health strategies; and 2) that "traditional" strategies have been effective in controlling other communicable diseases.

A. Public health policy makers have always emphasized that partner
notification must protect confidentiality and must be voluntary
in order to be effective

Partner notification strategies that abandon anonymity and attempt to coerce participation in notification entail "a rejection of the lessons of four decades of contact tracing, lessons that were rooted in the pragmatics of STD control."¹⁴

When partner notification was first considered as a public health tool to fight the spread of STDs, there was great debate about names based case reporting and coercive partner notification for "traditional" disease prevention. Even though this debate occurred prior to the development of our modern understanding of the importance of privacy as a right, there was strong support for maintaining the anonymity of patients diagnosed with STDs and designing programs that would encourage patients to participate voluntarily in the public health system.¹⁵ The ability of a person infected with an STD to maintain his or her anonymity while receiving treatment and counseling has always been, and remains, an important part of the public health equation for determining appropriate methods of disease prevention.¹⁶

In part, this reflects an obvious reality: no matter what a law says, as a practical matter, no one can be forced to provide information about sexual or needle-sharing partners if he or she is not willing to do so. Thus, while partner notification has always been susceptible to coercive tactics, the necessity of voluntary cooperation of an infected person in notifying his or her partners has not been disputed in traditional public health strategies.¹⁷

A 1962 report produced under the auspices of the former U.S. Department of Health, Education and Welfare, identified the key element of the success or failure of STD control programs as the ability of public health interviewers to gain the confidence of patients so as to elicit information about their sexual contacts.¹⁸

The Department of Health and Human Services 1985 guidelines for STD partner notification programs reiterated the importance of voluntary patient cooperation in the disease intervention process.¹⁹

B. Partner notification frequently has been unsuccessful as a public
health tool in campaigns to eradicate STDs

The effectiveness of partner notification in HIV prevention must be evaluated independently from its effectiveness in other contexts. However, since there is little evidence about its effectiveness with HIV, much support for state-mandated partner notification is based on its supposed effectiveness in preventing the spreads of STDs. But an evaluation of the efficacy of partner notification in controlling STDs tells a different story. Partner notification has clearly not been successful in controlling some STD outbreaks, and even where it has resulted in the successful treatment of some notified partners, there have been serious drawbacks to its use.

In spite of the standard use of partner notification for cases of syphilis and gonorrhea, and the existence of effective treatments for those diseases, the prevalence of syphilis and gonorrhea has increased in recent decades.²⁰ Syphilis is occurring in some parts of the country in epidemic proportions.²¹ A study by the Centers for Disease Control that evaluated this trend in the late 1980's and early 1990's found that "[t]raditional approaches to the control of syphilis that emphasize partner notification have not been effective in halting this epidemic."²² The CDC determined that one reason for this failure was the fact that syphilis outbreaks affect a large number of people who use illegal drugs and who will not or cannot provide sufficient information for public health officials to find and notify exposed partners.²³

The CDC findings echo those of an Oregon study that examined the failure of partner notification to control an outbreak of syphilis in that state.²⁴ Reflecting the national trend, Oregon reported a large number of unlocatable partners, which the study attributed to the long infectious period of the disease and the high incidence of drug use and prostitution among those infected. The Oregon study concluded that the failure of traditional methods to control the syphilis epidemic was of particular concern because many of the risk factors for that epidemic were the same as those for HIV infection.

A 1996 review of the evidence available on the effectiveness of partner notification in controlling STDs points out the basic failings. The study concludes that partner notification is a relatively ineffective means of disease control when sex with anonymous partners is common, when there is considerable delay before contacts can be traced, and when health services are inaccessible or unacceptable to clients.²⁵ Notably, these factors have been among the most prevalent characteristics of the AIDS epidemic. The report also notes that "[s]trikingly absent from the literature are any community-based comparison studies which attempt to evaluate the effectiveness of partner notification in reducing the incidence or prevalence of disease in the community."²⁶ Instead, the success of partner notification has been evaluated in terms of the percentage of named partners that are ultimately notified, which, as the Oregon study notes, is not meaningful when only a small percentage of total exposed partners are likely to be identified in the first place.²⁷

However, the most serious failure of partner notification is not its inability to find people exposed, but its deterrent effect on testing and treatment. It is true of course that STD partner notification programs have led to the testing and treatment of some individuals who might otherwise have gone untreated. But this has come at a significant cost, since partner notification programs have also caused some individuals to avoid being tested for STDs out of fear that they would be asked or required to give information about their sexual contacts.²⁸ These individuals, who would otherwise have received treatment, most likely have instead infected others. And, of course, there has been no partner notification in these cases since there was no STD diagnosis in the first instance.

C. Coerced partner notification would be even less effective
in stemming the spread of HIV

There is a fundamental difference between an STD like syphilis on the one hand and HIV on the other - namely, the existence of a medical treatment that renders an infected individual uninfectious. Such a treatment exists for syphilis, but not for HIV. Therefore, partner notification programs have a far greater chance of breaking the chain of transmission with syphilis than with HIV.

In addition, the various risk factors that have been attributed to the failure of partner notification efforts in controlling recent outbreaks of syphilis -- drug dependency, anonymous sex, needle-sharing partners, and the exchange of sex for drugs or money -- are all present among the fastest growing population at risk for contracting HIV.

Moreover, from the early years of the AIDS epidemic, there has been widespread recognition that absent any therapy which eliminates one individual's ability to infect another, a successful response to the epidemic was unavoidably dependent on the willingness of those at risk for infection to voluntarily comply with public health messages.²⁹ HIV public health policy is largely based on encouraging people at high risk of contracting HIV to voluntarily seek testing and modify risky behavior. Voluntary testing and acceptance of public health messages require that those at risk trust and cooperate with public health. And it has long been recognized that coercive strategies such as involuntary partner notification will erode this trust and cooperation.³⁰

Gaining the trust and cooperation of at risk populations is especially challenging with HIV because of deep-seated fears about stigma and discrimination that is often associated with having HIV. Moreover, the populations most affected by HIV - gay men, injection drug users, and people of color - all have experienced long histories of oppression, social stigma, and government-sponsored discrimination. These groups enter the HIV arena predisposed to distrust government representatives of any sort - including public health officials.³¹

Also, the most prominent means of transmission of HIV are illegal in many parts of the country. Unauthorized injection drug use is a felony in all fifty states. And anal sex is a crime in twenty-one states and Puerto Rico.³² Therefore, forcing individuals to identify those with whom they have had risky contact will often constitute a forced admission of criminal activity.³³

It is not surprising, then, that many people at risk for HIV resist involuntary partner notification. For example, 54% of people who tested positive for HIV at three North Carolina health departments refused to participate in a study that would require them to provide the names and locating information on their sex and needle-sharing partners. They feared discrimination and loss of confidentiality for their partners.³⁴ An evaluation of New Jersey's partner notification program reported that clients' negative attitudes about partner notification were due to fear that their anonymity would be compromised or that contacts might retaliate against them.³⁵

Many of those who are resistant to partner notification struggle with substantial fears of discrimination, debilitating social and economic instability, and violence. Their decisions about whether to reveal deeply personal and sometimes embarrassing information about their lives and contacts are often made in the face of limited emotional and economic resources and a daily struggle for survival. The addition of coercive state intervention can be crushing.

In a recent study, 45% of health care providers serving HIV positive women reported that they had patients who feared partner notification because they were afraid of domestic violence.³⁶ One quarter of the providers had patients who were in fact assaulted by their partners upon notification.³⁷ Coercive partner notification can be physically dangerous.

Other populations also deeply fear involuntary partner notification. Among clients of a methadone detoxification program, one study found that 59% of the HIV positive clients said they would not enter treatment if HIV testing and partner notification were required.³⁸ Another analysis of drug users' views about partner notification found that at least 50% of those surveyed identified their distrust of government agencies as a barrier to their participation in partner notification.³⁹ High levels of resistance to partner notification have also been documented among gay and bisexual men.⁴⁰

Resistance to coercive partner notification is founded in part on suspicion of the means by which involuntary notification occurs. And there is reason to believe that this suspicion has some basis in reality. Though mandatory partner notification schemes typically purport to shield the identities of both patient and partners, breaches of confidentiality by health officials involved in partner notification are not difficult to find. In one incident, public health officers posted a notice on an individual's door indicating that she had been exposed to HIV.⁴¹ On another occasion, public health officials found a partner at a bowling alley, identified themselves to the partner's bowling team members as public health authorities, and then proceeded to tell the partner that he had been exposed to HIV.⁴² The ACLU has documented other examples of violation of the privacy rights of people with HIV by public health officials and law enforcement officers.⁴³

Fear of coercive partner notification is often fed by commentators who link partner notification with names-based HIV case reporting. Many advocates of aggressive partner notification programs call for names based case reporting as a means of implementing partner notification.⁴⁴ Name reporting is feared by many people at risk for HIV and is opposed by most AIDS advocacy and civil liberties organizations because of its documented deterrent effect on HIV testing.⁴⁵

Name reporting actually is not necessary for partner notification, whether voluntary or involuntary. Partner notification protocols generally prohibit disclosure of the identity of the person with HIV to the partner. Moreover, the available evidence indicates that anonymous testing provides the best means of conducting effective, voluntary partner notification. People who test anonymously are far more likely to return for their test results than those who test confidentially and provide their name.⁴⁶ If people do not return for their test results, they cannot be counseled on the importance of notifying their partners if they test positive. In addition, partners identified by anonymous testers are more likely to be located and more likely to be HIV positive than partners identified by confidential testers.⁴⁷

Analyzing partner notification from the perspective of individuals with HIV rather than from that of their perhaps unknowing partners has been the subject of much criticism. But partners cannot be identified if HIV-infected individuals do not trust the health system enough to seek testing in the first place. The evidence of resistance of high-risk groups to coercive notification efforts demonstrates that if these programs are implemented, people at high risk for HIV infection will be discouraged from voluntarily seeking testing and from cooperating with prevention efforts.

D. The available evidence shows that coercive HIV partner
notification programs have not worked

As with partner notification for the control of STDs, the effectiveness of partner notification in controlling HIV infection has not been measured in terms of actual reduction in the incidence or prevalence of HIV in any given community.⁴⁸ Instead, success in partner notification has largely been defined by the percentage of named contacts that were notified, tested, and found to be HIV positive. But this measure of success ignores substantial evidence that the positive impact of partner notification is limited to a few, specific contexts, and that broad, mandatory implementation is counterproductive from a public health standpoint.

In the first place, mandatory partner notification, whether through requirements aimed at people with HIV or at health care providers, is not enforceable. Many people who participate in partner notification programs simply will not identify partners or will not provide accurate information.⁴⁹ For example, a study conducted in North Carolina, where failure of people with HIV to contact their partners is a misdemeanor punishable by a fine, a prison term, or both, found that only 7% of HIV positive people taking part in the study succeeded in notifying their partners.⁵⁰ Even after the remaining study participants were given assistance in notifying partners, 66% of identified partners could not be found.⁵¹ In a partner notification program that succeeded in contacting a greater number of named partners, 21% of HIV positive participants still refused to name any partners at all.⁵²

In addition, the available evidence does not support the assumption that partners who are notified and tested reduce high-risk behavior or receive effective treatment, thus reducing transmission of HIV. There is growing evidence that perceived risk of exposure to HIV is unrelated to the likelihood that one will take any given preventative action.⁵³ Instead, it increasingly appears that much more extensive and long-term efforts specifically tailored to the individual needs of those infected with HIV are necessary to change high-risk behavior. In fact, studies that have evaluated behavior change associated with the HIV testing and limited counseling that currently accompanies most partner notification efforts have shown that, unless accompanied by preventive services and intensive counseling, they have little or no effect on changing risk behavior in many high-risk populations.⁵⁴

There are several reasons for the negligible impact of partner notification on rates of HIV infection. One limitation on the effectiveness of partner notification is the fact that there is no medical treatment that renders a person with HIV uninfectious. And what treatments exist are often not available until years after the individual is infected. A recent review of HIV-positive individuals' access to newer and more effective drug therapies demonstrates that a significant number of HIV-positive individuals do not qualify for state AIDS drug assistance programs or Medicaid early in the course of their disease.⁵⁵ One medical center in a high-incidence urban area found that the majority of HIV-infected patients tested in the hospital did not even receive adequate referrals for post-discharge care.⁵⁶ The sad reality is that many people infected with HIV, especially poor people, are not able to access appropriate medical care.⁵⁷ Thus, even if partners are successfully notified, they may not receive the benefit of new drug therapies, or any other treatment for that matter.

Even those with access to treatment face daunting obstacles. Maintaining the rigorous schedule that new drug therapies require can be extraordinarily difficult and successfully reducing risk behavior is a never-ending battle for many. Many new cases of HIV are occurring among people who struggle with homelessness, drug dependency, domestic violence, mental illness, and/or severe poverty. Measures to stabilize peoples' lives so that treatment is successful and to promote lasting behavior change require a commitment of resources far beyond merely notifying someone of their possible exposure to HIV.⁵⁸ Services that include readily available treatment for drug dependency and mental illness, housing and job assistance, needle exchange and sustained counseling for risk reduction are necessary to truly diminish the spread of HIV infection.

E. Partner notification is not the best use for limited resources

Many seem willing to conclude that coercive partner notification provides a benefit greater than its costs, even if relatively few people are notified of their exposure to HIV and those notified are often no better off after notification.⁵⁹ Though actual costs vary from program to program, the experiences of three test sites, two in Florida and one in New Jersey, are instructive. At those test sites, it cost $281,964 to locate 1,035 partner (of 8,633 that had been named). 122 of the notified partners tested positive for HIV.⁶⁰ Though notification was doubtless personally valuable to some of those notified, the public health benefit gained from the program must be measured by considering how money spent for partner notification might otherwise have been spent and the extent to which partner notification will lead to effective treatment of those partners infected and reduce new HIV transmission.

For example, $281,964 spent targeting high-risk populations with frank and culturally appropriate prevention education, or other services, might well have a much broader impact on risk behaviors and disease transmission than identifying 122 people who have HIV but have access to little in the way of follow-up services. Investing these funds in other HIV programs would also avoid the deterrent effect of coercive partner notification. Individuals who decide not to be HIV tested because of coercive partner notification will not learn their HIV status, will not seek medical treatment, and may unwittingly infect others, all of which carries high costs.

V. THE ACLU SUPPORTS AND ENCOURAGES VOLUNTARY PARTNER
NOTIFICATION

The ACLU recognizes that it is important that people with HIV notify any partners who may have been put at risk. The ACLU therefore supports public health programs that, where necessary, help people with HIV notify their partners. Partner notification services should be part of the standard of care and should be provided to all persons who test positive for HIV. These services must be voluntary, non-coercive and confidential. Services should include counseling the client who tests positive for HIV about the importance of partner notification and helping the client develop strategies to notify partners. Different strategies will be appropriate for different circumstances. For example, the client who is in a relationship marked by domestic violence will have fears different from those of the client in a stable relationship or the client who needs to notify casual sexual partners.

Health providers who work with clients being tested for HIV should be trained in the various methods of partner notification. These include client notification of partners, counselor notification, and combinations of these approaches. All providers in the public and private sector should be educated about the availability of public partner notification services and encouraged to use those services.

The confidentiality of the client must be protected. Counselors or providers who assist a client by doing voluntary partner notification should not disclose any identifying information about the client.

In fact, partner notification programs that follow some or all of these guidelines are already in place. For example, the City Clinic of the San Francisco Department of Public Health trains HIV counselors in partner notification strategies.⁶¹ Counselors provide partner notification services to people who test positive for HIV at city testing facilities, as well as to individuals referred from other testing sites. Partner notification services are always voluntary, client-centered and non coercive, with partner notification strategies devised by the client in consultation with an HIV counselor. Clients are offered information about the range of issues involved in partner notification, including the possible responses they may expect from partners that they notify. Counselors also help clients decide how to carry out partner notification and are available to assist with the notification, or to carry out the notification if the client wishes. The confidentiality of the client is protected.

VI. CONCLUSION

Recent proposals to adopt coercive HIV partner notification reject the lessons of decades of public health experience. Public health policy has long emphasized the importance of winning the voluntary cooperation of individuals at risk for exposure to communicable diseases. Moreover, even those partner notification approaches, invoked with increasing frequency in the debate over HIV partner notification, have often failed to stem the spread of sexually transmitted diseases. The reasons for this failure - the inability to locate partners due to the long incubation period of some STDs, the connection between infection and the use of illegal drugs, and the frequency of contact with anonymous partners - are well known features of the HIV epidemic. It is therefore not surprising that the available evidence indicates that coercive partner notification plans have met with little success in campaigns to stem the spread of HIV.

Moreover, coercive partner notification threatens the privacy and civil liberties of people with HIV. Few programs could be more invasive of an individual's right to privacy than programs that require the individual to identify his or her sexual or needle-sharing partners to government agents. Such forced disclosure is made even more troubling by the fact that illegal injection drug use is a felony in all fifty states, and anal sex is a crime in twenty-one states.

Because partner notification violates privacy for no real gain in stemming the AIDS epidemic, the ACLU opposes the adoption of coercive partner notification plans. It is important that people with HIV notify their partners if they may have been exposed to HIV, and the ACLU believes that partner notification services should be part of the standard of care to which every person with HIV is entitled. But partner notification services must be provided on a voluntary, non-coercive, and confidential basis. And, emphasis on partner notification must not become an excuse to divert attention or resources from culturally appropriate, frank education, needle exchange, and other prevention programs that have a proven track record of success.

Michael Adams
American Civil Liberties Union - AIDS Project

Barabara Saavedra
American Civil Liberties Union of Northern California

March 1998

APPENDIX OF STATE LAWS ON HIV PARTNER NOTIFICATION

Alabama Code
§22-11A-38(d) -- physicians or the state health official may notify a third party where there is a "foreseeable, real or probable risk of transmission of the disease."
§22-11A-38(f) -- extends immunity from liability to physicians, health department employees, and hospitals and other health care facilities, for notifying or failing to notify partners exposed to infected person.
§22-11A-53 -- notification of positive HIV test result shall include an explanation of the benefits of locating, testing and counseling partners and a full description of the public health services for locating and counseling partners.

Arizona Revised Statutes
§32-1457(A)/§32-1860(A) -- a physician may report the name of the spouse or sex/needlesharing partner of a patient that has tested positive for HIV to the department of health services if: the physician knows that the patient has not or will not notify these people; and the physician has asked the patient to release this information voluntarily.
§32-1457(C)/§32-1860(C) -- extends immunity from liability to physicians for notifying or failing to notify partners exposed to infected person.
§36-664(K) -- any person who knows that an individual is HIV positive, and who reasonably believes that an identifiable third party is at risk of HIV infection from that individual, may report that risk to the Health Department. Upon receipt of such report the department shall notify the person at risk.
§36-665 -- an order for disclosure of or a search warrant for confidential communicable disease-related information may be issued on a showing of a clear and imminent danger to a person whose life or health may unknowingly be at significant risk as a result of contact with the person to whom the information pertains.
§36-666(C) -- extends immunity from civil or criminal liability to a health care facility or health care provider for failing to notify the contact of a person with a communicable disease.

California Health & Safety Code
§121015 -- a physician may notify a person reasonably believed to be the spouse or sex/needle-sharing partner of a patient testing positive for HIV of their exposure to HIV if the physician has: discussed the test results with the patient and offered appropriate educational and psychological counseling; and notified the patient of the intent to notify patient's partners prior to notification. A physician has no duty to notify and may not be held criminally or civilly liable for notifying partners. A physician may also report risk of exposure to third parties to the health department, which may then alert those persons to their risk.

Colorado Revised Statutes
§25-4-1405.5(2)(a)(II) -- the state board of health shall adopt rules specifying the performance standards for anonymous and confidential counseling and testing, including standards for partner notification.
§25-4-1406 -- as a last resort, the executive director of the state department of public health, or the director of the local department of health may issue an order to direct a person with HIV infection to cease and desist from specified conduct which endangers the health of others.
§25-4-1407 -- if the procedures of the previous section fail, the state executive director or local director may bring an action in district court to enjoin a person from engaging in specific conduct which endangers the public health. The district court may issue an order to take the person into custody for a period not to exceed seventy-two hours.

General Statutes of Connecticut
§19a-584(a) -- a public health officer may notify the partner of a person infected with HIV if:
1) she reasonably believes a significant risk of transmission exists, 2) she reasonably believes that the index patient will not himself warn the contact, and 3) she has informed the patient of her intent to warn the third party. The physician or public health officer has no obligation to warn, inform, identify or locate any partner.
§19a-584(b) -- a physician may notify a known partner of a patient who tests positive for HIV, if that partner is also a patient of the physician. A physician must follow the same procedures as public health officers before notifying a partner.
§19a-582(b) -- anyone taking a test for HIV must be told before the test that if they test positive, public health counselors or a physician may notify their known partners of a risk of infection whether or not they have consent to do so.

Delaware Code
§16-1203(a)(10) -- allowing disclosure of HIV test results to a third party on court order based on "compelling need."
§16-1205(c) -- extends immunity from civil or criminal liability for disclosure of an HIV test result under §1203.

District of Columbia Code
§6-117 -- a court may order disclosure of HIV status to a third person if it finds, upon clear and convincing evidence, that it is essential to safeguard the physical health of others. The person whose status is to be disclosed shall have an opportunity to contest the disclosure.

Florida Statutes
§381.004(3)(e) -- no HIV test result shall be revealed to the test subject without telling the subject the benefits of locating and counseling any individual that may have been exposed to HIV by the subject and of the availability of public health services to help locate and counsel partners.
§381.004(3)(f)(9) -- a court may order HIV test results disclosed to a third party on a showing of compelling need, and after weighing the privacy interest of the test subject and the public interest which may be disserved by disclosure which deters HIV testing or which may lead to discrimination.
§381.004(4)(c) -- each county health department shall provide counseling and testing on an anonymous basis, including informing clients of the availability of partner notification services and the benefits of such services.
§384.26 -- permitting the health department to interview all HIV positive individuals for information regarding the identification and notification of partners.
§455.674 -- a health practitioner shall not be civilly or criminally liable for disclosing confidential HIV information to a sex or needle-sharing partner of a patient testing positive for HIV if the practitioner first recommends that the patient notify the partner or refrain from risk activities, and the practitioner has told the patient of her intent to inform the partner. A practitioner is not liable for failing to disclose such information.

Official Code of Georgia
§24-9-47(g) -- a physician may notify a spouse, sexual partner or child of a patient infected with HIV that the physician reasonably believes to be at risk of exposure. The physician must attempt to notify the patient that disclosure will be made.
§24-9-47(h)(3)(B) -- the Department of Human Resources may contact any person reasonably believed to be at risk of being infected with HIV to disclose their possible exposure to HIV.
§24-9-47(h)(3)(C) -- the Department of Human Resources must contact and inform the spouse of an HIV infected person of their exposure if they are reasonably likely to have engaged in risk activities with the infected person.
§24-9-47(j) -- extends immunity from civil or criminal liability for authorized disclosure to third parties. Releases persons authorized to make disclosures from duty to disclose or liability for failing to disclose exposure to HIV to third parties.

Hawaii Code
§325-101(a)(4) -- physicians and public health officers may notify sex or needle-sharing partners of an HIV positive patient where: 1) there is reason to believe that the contact is at risk of HIV transmission; and 2) the patient has been counseled and is unwilling to inform the contact directly or consent to disclosure by a third person. Physicians and public health officers have no obligation to identify or locate any contact and are immune from civil or criminal liability.

Idaho Code
§39-610(2) -- state or local health authorities may contact and advise people who authorities believe to have been exposed to HIV.
§39-610(5) -- extends immunity for civil or criminal liability for authorized disclosure or for nondisclosure.

Illinois Compiled Statutes
§410-305-9 -- a physician may notify the spouse of a patient who tests positive for HIV if the physician has tried to persuade the patient to notify the spouse or if, after a patient has agreed to make the notification the physician has reason to believe that the patient has not provided the notification. This section does not create a duty or obligation for a physician to notify the spouse, and no civil or criminal liability may be imposed on the physician for disclosing or failing to disclose HIV test results to a spouse.
§410-325-5.5 -- when the department of public health determines that a person infected with HIV may be exposing others to HIV, the department shall investigate the person with HIV and her contacts and notify the contacts if it appears that the person with HIV will not carry out notification.

Indiana Statutes
§16-41-7-1 -- a person who is infected with HIV has a duty to warn or cause to be warned by a third party people with whom they are engaged in activities that carry a high risk of transmission of HIV.
§16-41-7-3(a) -- a physician must inform patients with HIV of their duty to notify partners.
§16-41-7-3(b)(1) -- a physician may notify a health officer of patients with HIV that pose a serious and present danger to the health of others, patients suspected of being at risk, or any other person reasonably believed to be at risk of contracting HIV.
§16-41-7-3(b)(2) -- a physician may also notify persons at risk directly if she has reason to believe that they have been exposed to HIV, that they will not be informed by any other person, and she has made reasonable efforts to inform the patient of her intent to notify the person at risk.
§16-41-7-3(d) -- a physician who provides notification in good faith is immune from civil or criminal liability.
§16-41-7-4 -- a health officer or the state department shall notify persons reported to be at risk unless they determine that intervention is not necessary.

Code of Iowa
§141.6(3)(a) -- department of public health shall provide for a person who tests positive for HIV to receive counseling and be encouraged to refer partners for notification.
§141.6(3)(d)(2) -- when a physician believes that a patient infected with HIV will not warn a third party at risk, and will not participate in the voluntary partner notification program, she may reveal the identity of the patient to the extent necessary to protect the party at risk. The physician shall attempt to notify the infected patient of her intent to notify, the person to be notified, and the anticipated date of disclosure.

Kansas Statutes
§65-6004 -- a physician who has reason to believe that the spouse or partner of a person who has tested positive for HIV has been exposed to HIV and is unaware of their exposure, may inform them of their risk of exposure. Such disclosure is immune from civil or criminal liability, and no duty to warn is created.

Louisiana Statutes
§1300.14(E) -- a physician may notify contacts of a patient infected with HIV if: she reasonably believes there is a significant risk of transmission to the contact; if the patient has been counseled and the physician reasonably believes that the patient will not inform the contact; and the physician has informed the patient of her intent to notify the contact. The physician has no obligation to identify or locate any contact.
§1300.15 -- a court may grant an order for disclosure of HIV test results to a third person upon a showing of a "clear and imminent danger to an individual whose life or health may unknowingly be at significant risk" as a result of contact with an individual whose HIV status is sought. "The court shall weigh the need for disclosure against the privacy interest of the protected individual and against the public interest that may not be served by disclosure which deters future testing or treatment or which may lead to discrimination."

Maine Revised Statutes
§19203-D(A) -- HIV infection status may be released only if the person to whom the information pertains has specifically authorized a separate release of that information. A general release form is insufficient.
§801 -- a person who fails or refuses to cooperate with a health department contact notification program, or who engages in behavior that creates a significant risk of transmission of a communicable disease is considered a "public health threat."
§808 -- a public health department investigative team shall have access to medical and laboratory records relevant to the investigation of a public health threat
§810 -- upon a showing of clear and convincing evidence that a person requires immediate custody in order to avoid a clear and immediate public health threat, a judge of the district court may grant temporary custody of the person and may order specific emergency care, treatment or evaluation.

Maryland Health-General Code
§18-336(b)(2) -- counseling before HIV testing must include informing the test subject of the physician's duty to warn third parties who may be at risk of contracting HIV from the subject.
§18-337(b) -- if an individual tests positive for HIV and refuses to notify her sex/needlesharing partners, the individual's physician may inform the local health officer and/or the individual's partners directly, of the identity of the HIV-positive patient and the circumstances giving rise to the notification. A physician may not be held liable for disclosure or nondisclosure if acting in good faith.

Michigan Statutes Annotated
§14.15(5131)(5)(b) -- creates an affirmative duty for a physician or local health officer to notify known partners of individuals infected with HIV or diagnosed as having AIDS, if the physical or health officer determines that notification is necessary to prevent a reasonably foreseeable risk of transmission of HIV.
§14.15(5131)(6) -- a person who releases information in the course of partner notification is immune from civil or criminal liability.
§14.15(5131)(7) -- a person who notifies a partner of an HIV infected individual shall not include information that identifies the infected individual unless the identifying information is determined by the person making the disclosure to be reasonably necessary to prevent a foreseeable risk of transmission of HIV.
§14.15(5114a)(1) -- a person or government entity that administers a test for HIV shall refer individuals testing positive for assistance with partner notification if they determine that the individual needs assistance with partner notification
§14.15(5114a)(3) -- a local health department that assists individuals with partner notification must inform the individual that he has a legal obligation to inform each of his sexual partners of his infection before engaging in sexual relations with that partner, and that he may be subject to criminal sanctions for failure to so inform his partners.
§14.15(5114a)(5) -- if a local health department receives a report that indicates that a resident of the state is HIV infected, the health department shall make it a priority to attempt to interview the individual and offer to contact the individual's sex/needle-sharing partners, and within 35 days of interview to contact each individual identified as a partner.

Revised Statutes of Missouri
§191.656(2)(1)(d) -- unless a person acts in bad faith or with conscious disregard, no person will be liable for violating any duty or right of confidentiality for disclosing the results of an individual's HIV testing to the spouse of the subject of the test.
§191.656(2)(2) -- paragraph (d) does not impose any duty to disclose HIV testing results.
§191.656(6) -- a person who negligently violates this section is liable for actual damages, injunctive relief, court costs and reasonable attorney's fees, and a person who willfully or intentionally or recklessly violates this section is liable for the same damages and for exemplary damages.
§191.686(4) -- all anonymous test sites are required to initiate partner notification when submitting test results to individuals who test positive for HIV.

Montana Code Annotated
§50-16-1009(3) -- a health care provider shall encourage a subject testing positive for HIV to notify potential contacts. If the subject is unable or unwilling to notify contacts, the health care provider may ask the subject to disclose voluntarily the identities of the contacts and to authorize notification of the contacts by a health care provider.
§50-16-529(9) -- a health care provider may disclose health care information about a patient, without the patient's authorization, to any contact if the health care provider reasonably believes that disclosure will avoid or minimize an imminent danger to the health or safety of the contact or any other individual.
§50-16-1004 -- expressing the intent of the legislature to treat AIDS and HIV infection in the same manner as other communicable diseases, including sexually transmitted diseases, by adopting the most currently accepted public health practices with regard to, among other things, partner notification.
§50-18-106 -- if a physician or other person knows or has reason to suspect that a person who has a sexually transmitted disease is conducting himself in a way which might expose another to infection, he shall immediately notify the local health officer of the name and address of the diseased person and the essential facts in the case.

Revised Statutes of Nebraska
§71-501.02(6) -- to the extent funds are available, the Department of Health and Human Services may offer partner notification services that are culturally and language specific upon request to persons testing positive for HIV.

Nevada Revised Statutes Annotated
§441A.220(5) -- confidential information about a communicable disease may be disclosed to any person who has a medical need to know the information for his own protection or for the well-being of a patient or dependent person.

New Jersey Statutes
§26:5C-9(a) -- the record of a person who has or is suspected of having AIDS or HIV infection may be disclosed by an order of a court upon a showing of good cause. At a good cause hearing the court shall weigh the public interest and need for disclosure against injury to the person who is the subject of the record, to the physician-patient relationship, and to the services offered by the program.

New Mexico Statutes Annotated
§24-1-8 -- if a physician knows or has good reason to suspect that a person with an STD may conduct himself so as to expose other persons to infection, he shall notify the district health officer of the name and address of the diseased person and the facts of the case.
§24-2B-4 -- a person who tests positive for HIV must be informed of the benefits of locating and counseling any partners that may have been exposed to HIV.

New York Consolidated Law Services - Public Health
§2782(4)(a) -- a physician may disclose confidential HIV-related information to a contact or to a public health officer for disclosure to a contact if: the physician reasonably believes there is a significant risk of infection to the contact; the physician has counseled the patient infected with HIV of the need to notify the contact; the physician reasonably believes the patient will not inform the contact; and the physician has informed the patient of her intent to notify the contact.
§2782(4)(c) -- a physician or public health officer has no obligation to identify or locate any contact.
§2785(2)(b) -- a court may grant an order for disclosure of confidential HIV-related information upon a showing of clear and imminent danger to an individual whose life or health may unknowingly be at significant risk as a result of contact with the individual to whom the information pertains.
§2785(5) -- in assessing compelling need and clear and imminent danger, the court shall weigh the need for disclosure against the privacy interest of the protected individual and the public interest which may be disserved by disclosure which deters future testing or treatment or which may lead to discrimination.

General Statutes of North Carolina
§130A-143(4) -- information relating to the HIV status of an individual may be released if necessary to protect the public health and is made as provided by the Commission in its rules regarding control measures for communicable diseases.

North Dakota Century Code
§23-07.4-01(2)(c) -- when a state health officer knows, or has reason to believe that a person has HIV and is a danger to the public health, and the infected person has been ordered to report for counseling and information on how to avoid infecting others, that official may issue an order to direct that person to cease and desist from specified conduct that endangers the health of others.
§23-07.4-01(4) -- If a court affirms the order, and the person subject to the order is infected with HIV, the court shall require the person to disclose the names and addresses of sex/needle-sharing partners. Failure to comply with court-ordered disclosure constitutes contempt of court.
§23-07.4-02 -- if the procedures of the previous section have been exhausted, and a person believed to be infected with HIV continues to engage in behavior that presents an imminent danger to the public health, a court may issue other orders, including an order to take the person into custody, for a period not to exceed 90 days and place the person in a facility designated or approved by the state health officer.

Ohio Revised Code Annotated
§3701.241(A) -- the director of public health shall develop and administer both confidential and anonymous tests for HIV and a confidential partner notification system.
§3701-241(B) -- the director shall prepare a list of sites where an individual may obtain an anonymous HIV test, and make available a copy of the list to anyone who requests it.
§3701.243(C)(1)(b) -- a court may issue an order granting access to or authority to disclose HIV test results only if the court finds by clear and convincing evidence that there is a compelling need for disclosure. The court shall weigh the need for disclosure against the privacy right of the individual tested and against any disservice to the public interest that might result from the disclosure, such as discrimination against the individual or the deterrence of others from being tested.
§3701.243(F) -- an individual who knows that he is HIV positive shall disclose this information to any other person with whom he intends to have sex or share a hypodermic needle.

Oklahoma Statutes
§1-502.2 -- confidential information about a person with a communicable disease may be released if necessary to protect the health and well-being of the general public.

Oregon Revised Statutes
§433.008 -- if the local public health administrator determines that a person with a contagious disease is violating the rules of the division pertaining to control of that disease, it may disclose that person's name and address to a third person if clear and convincing evidence requires disclosure to avoid a clear and immediate danger to other individuals or to the public generally. A decision not to disclose information, if made in good faith, shall not subject the person withholding the information to liability.

Pennsylvania Statutes
§7609(A) -- a physician may disclose confidential HIV-related information to a known contact of a patient infected with HIV if: the physician reasonably believes disclosure is medically appropriate and there is a significant risk of future infection to the contact; the physician has counseled the patient about the need to notify the contact and the physician reasonably believes the patient will not inform the contact or abstain from activities which pose a significant risk of infection to the contact.
§7609(B) -- a physician shall have no duty to identify, locate or notify any contact and no cause of action shall arise for nondisclosure or for disclosure.
§7608 -- a court may issue an order to allow access to confidential HIV related information upon a showing of compelling need.

General Laws of Rhode Island
§23-6-17(2)(v) -- a physician may disclose the HIV-positive status of a patient to a third party who has contact with that patient if there is a clear and present danger of HIV transmission to the third party, and if, despite the physician's strong encouragement, the patient has not and will not warn the third party.

South Carolina Annotated
§44-29-146 -- a physician or state agency identifying and notifying a spouse or known contact of a person having HIV is not liable for damages resulting from the disclosure.
§44-29-90 -- the Department of Health and Environmental Control must, to the extent resources are available, notify known sex/needle-sharing contacts of a person who has HIV.

South Dakota Codified Laws
§34-22-9(3) -- the department of health shall establish procedures for communicable disease contact notification, referral and management.
§34-22-12.1 -- confidential information about a communicable disease may be disclosed to the extent necessary to protect the health or life of a named person.

Tennessee Code Annotated
§68-5-101 -- whenever any case of communicable disease exists or is suspected to exist in any household, it is the duty of the head of the household, or any other person in the household possessing knowledge of the facts, to notify the municipal or county health authorities.
§68-10-115 -- a person who has a reasonable belief that a person has knowingly exposed another to HIV may inform the potential victim without incurring any liability.

Texas Health & Safety Code
§81-051(g)(1) -- a partner notification program shall notify the partner of a person with HIV infection with or without the consent of the person with HIV.
§81-051(g)(2) -- a health care professional shall notify the partner notification program when the health care professional knows the HIV status of a patient and has actual knowledge of possible transmission of HIV to a third party.
§81-051-(h) -- a health care professional who fails to make the notification required by section (g) is immune from civil or criminal liability.

Utah Code Annotated
§26-63.5 -- the department of health shall utilize contact tracing and other methods for partner identification and notification.

Virginia Code Annotated
§32.1-36.1 -- the results of a test for HIV may be released to the spouse of the person tested.
§32.1-37.2 -- every person who tests for HIV shall be informed of the need to notify any partners who may have been exposed to the virus.

Revised Code of Washington
§70.24.105(f) -- a court may order disclosure of an HIV test to a third party on a showing of good cause and weighing the public interest and the need for disclosure against the injury to the patient, to the physician patient relationship, and to the treatment services.
§70.24.105(h) -- if a health officer determines that a person has been placed at risk of contracting HIV, and that the exposed person is unaware of the risk, then the identity of the person with HIV that they are in contact with may be disclosed.

West Virginia Code
§16-3C-3(d) -- sex or needle-sharing partners of a person with HIV may be notified of their exposure to HIV without revealing the identity of the person with HIV, and no cause of action may arise from such notification.
§16-3C-3(e) -- a physician or health care provider has no duty to notify the spouse or other sex or needle-sharing partner of a person infected with HIV, and no cause of action may arise from the failure to notify.

Wisconsin Statutes
§252.12 -- the public health department shall contact individuals who test positive for HIV and encourage them to refer any sex or needle-sharing partners for counseling and testing.

Wyoming Statutes
§35-4-133 -- a health officer shall make every reasonable effort to notify any sex or needlesharing partners of a person with a sexually transmitted disease (including HIV) of their possible exposure to infection.

NOTES

1 "Contact tracing" has sometimes been used to describe those partner notification efforts mandated by the state and carried out by public health officials. Because there have been such a variety of partner notification policies enacted in recent years, government involvement in partner notification has become complex and varied. Inconsistent use of terminology in conjunction with the proliferation of different practices makes it difficult to know which terminology refers to which specific practices. For these reasons, this report will use the broad descriptor "partner notification" and will describe distinct policies where necessary to delineate between practices.

2 Allan M. Brandt, NO MAGIC BULLET: A SOCIAL HISTORY OF VENEREAL DISEASE IN THE UNITED STATES SINCE 1880 (1985).

3 Lawrence O. Gostin, Prevention of HIV/AIDS Among Injection Drug Users: The Theory and Science of Public Health and Criminal Justice Approaches to Disease Prevention, 46 EMORY L.J. 587 (1997).

4 Andrew Pavia, Partner Notification for Control of HIV: Results After 2 Years of a Statewide Program in Utah, 83 AM.J.PUB.HEALTH 10:1418 (1993) (noting that targeted education in the context of partner notification may be more effective than non-targeted education).

5: AIDS Alert, CDC Defines Good Partner Notification, Vol.12, No.1 (Jan. 1, 1997) (citing unpublished CDC handout).

6: IND.CODE ANN. §35-50-3-3 (1994).

7 MICH.STAT.ANN. §14.15 (5114a) (1997).

8: TEX.HEALTH & SAFETY CODE §81.051 (1997).

9: See, e.g., CAL.HEALTH & SAFETY CODE §121015 (1995) (public health officers and physicians may notify any persons reasonably believed to be a spouse, sexual partner, or needle partner of an individual who has tested positive for HIV); CONN.GEN.STAT. §19a-584 (1997) (physicians and public health officers may inform known partners of individuals testing positive for HIV); NY PUBLIC HEALTH LAW §2782(4) (1993) (physicians may notify partner at risk of infection upon reasonable belief that person who tests HIV positive will not do so).

10: Although not the subject of this paper, it is worth noting that at least half of the states have enacted special criminal penalties making it a felony offense to knowingly expose someone to HIV. (AR, CA, CO, DE, FL, GA, ID, IL, IN, KY, LA, MI, MN, MS, MO, NV, OH, OK, PA, SC, TN, TX, UT, VA, and WA). In at least four states it is a misdemeanor (AL, KA, MD, MT), and in North Dakota it is an infraction. See HIV/AIDS Facts to Consider, National Conference of State Legislatures (1996). The ACLU opposes such laws, which single out HIV-related behavior for harsher criminal treatment than other types of behavior that pose similar risks.

11: AIDS Policy and Law, Notification Scrapped, Vol. 12, No. 11 (June 13, 1997).

12: 1997 NY A.B. 9146.

13: 997 NY A.B. 6629.

14: Ronald Bayer and Kathleen E. Toomey, HIV Prevention and the Two Faces of Partner Notification, 82 AM.J.PUB.HEALTH 8 (1992).

15: Nels A. Nelson and Gladys L. Crain, SYPHILIS, GONORRHEA AND THE PUBLIC HEALTH (1938) 233.

16 Bayer and Toomey, supra note 14; Brandt, supra note 2 at 151 (concluding that the maintenance of individual privacy has been a "fundamental dilemma" in the control of venereal disease).

17: Bayer and Toomey, supra note 14; see also, Karen H. Rothenberg, et al., The Risk of Domestic Violence and Women with HIV Infection: Implications for Partner Notification, Public Policy, and the Law, 85 AM.J.PUB.HEALTH 11:1569 (1995) ("Commentators and public health officials have long recognized that the success of partner notification efforts depends heavily on the voluntary cooperation of the infected patient.").

18 Robert R. Swank, Role of the Interviewer in Syphilis Control, in U.S. Department of Health, Education and Welfare, PROCEEDINGS OF THE WORLD FORUM ON SYPHILIS AND OTHER TREPONEMATOSES (1962) 105.

19 Department of Health and Human Services, GUIDELINES FOR STD CONTROL PROGRAM OPERATIONS (1985).

20 U.S. Department of Health and Human Services, Sexually Transmitted Diseases: 1980 Status Report, 20 Publication No. 81-2213 ("The incidence of [STDs] has increased dramatically in the past 15 to 20 years.").

21 U.S. Awakes to Epidemic of Sexual Diseases and Finds No Safety Net, New York Times, March 9, 1998 at A-1; Centers for Disease Control, Alternative Case-Finding Methods in a Crack-Related Syphilis Epidemic Philadelphia, 40 MMWR 5:77 (1991).

22: Centers for Disease Control, Alternative Case-Finding Methods, supra note 21.

23: Id.

24: Jon K. Andrus, et al., Partner Notification: Can It Control Epidemic Syphilis? 112 ANN.INT.MED. 7:539 (1990).

25: Frances M. Cowan, et al., The Role and Effectiveness of Partner Notification in STD Control: A Review, 25 72 GENITOURIN.MED. 247 (1996).

26: Id.

27: Andrus, supra note 24.

28: Brandt, supra note 2; Arthur H. Rosenberg, Compulsory Disclosure Statutes, 280 N.ENG.J.MED. 1287 (1969).

29: See, e.g., Lawrence O. Gostin and William J. Curran, The Limits of Compulsion in Controlling AIDS, 29 Hastings Center Report, December 1986.

30: Id.

31: See, e.g., Woodrow Jones, An Overview Of Health Care Issues In Black America, in Jones & Rice, BLACK HEALTH CARE (1987).

32 Sodomy laws, which frequently ban both anal and oral sex, exist in Alabama, Arkansas, Arizona, Florida, Georgia, Idaho, Kansas, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, North Carolina, Oklahoma, Puerto Rico, Rhode Island, South Carolina, Texas, Utah, and Virginia. Six states - Arkansas, Kansas, Maryland, Missouri, Oklahoma, and Texas - criminalize only same sex sodomy.

33: The Fifth Amendment to the U.S. Constitution prohibits the government from forcing an individual to confess to criminal activity, unless immunity from prosecution is provided.

34: Suzanne E. Landis, et al., Results of a Randomized Trial of Partner Notification in Cases of HIV Infection in North Carolina, 326 N.ENGL.J.MED. 101 (1992).

35: Stephen Crystal, AIDS Contact Notification: Initial Program Results in New Jersey, 2 AIDS ED.& PREV. 4:284 (1990).

36: Karen H. Rothberg, et al., Domestic Violence and Partner Notification: Implications for Treatment and Counseling of Women with HIV, 50 JAMWA 3:87 (1995).

37 Id.

38 Susan M. Rubin, Partner Notification May Deter HIV Positive Drug Users From Treatment, VII International Conference on AIDS, Abstract #W.D.P.1 (1991).

39 Susan Rogers, Partner Notification with HIV-infected Drug Users: Results of Formative Research, Abstract #Th.C.4629, XI International Conference on AIDS (1996).

40 Landis, supra note 34.

41 AIDS Alert, Partner Notification Practices Found 'Appalling' in Some Clinics, Vol. 9, No. 2 (Feb. 1, 1994).

42 Conversation with Jeff Reynolds, Director, Policy and Public Relations, Long Island Association for AIDSCare.

43 HIV Surveillance and Name Reporting, ACLU Briefing Paper, October 1997.

44 See, e.g., AMA, DIGEST OF HIV/AIDS POLICY (Jan. 1993); Kevin D. Wells, Gerald L. Hoff, Human Immunodeficiency Virus Partner Notification in a Low Incidence Urban Community, 22 SEX.TRANS.DIS. 6:377 (1995).

45 HIV Surveillance and Name Reporting, ACLU Briefing Paper, October 1997.

46: Irva Hertz Picciotto, et al., HIV Test-Seeking Before and After the Restriction of Anonymous Testing in North Carolina, 86 AM.J.PUB.HEALTH 1446, 1448 (1996); Richard E. Hoffman, et al., Colorado Dept. of Health, Division of Disease Control and Environmental Epidemiology, HIV Anonymous Test Site Evaluations 7 (1992).

47: Pavia, supra note 4.

48: Cowan, supra note 25.

49 S. Laussucq, et al., Syphilis Contact Tracing in a New York City STD Clinic: Implications for HIV Partner Notification, Int'l Conf. On AIDS, 1989 Abs. #W.A.P. 84.

50: Landis, supra note 34.

51 Id.

52 Pavia, supra note 4.

53 Martin Fishbein and Mary Guinan, Behavioral Science and Public Health: A Necessary Partnership for HIV Prevention, 3 PUB.HEALTH REP. Supp. I: 5 (1996); David R. Holtgrave, et al., An Overview of the Effectiveness and Efficiency of HIV Prevention Programs, 110 PUB.HEALTH REP. 134 (1995).

54 Holtgrave, supra note 53.

55 Lisa Speissegger, At What Price Miracles?, Health Policy Tracking Service, National Conference of State Legislatures (1998).

56: Ellen M. Tedaldi, et al., Surveillance of HIV Antibody Testing in an Urban Academic Medical Center, XI INT.CONF.AIDS, Abstract #Mo.C. 1556 (1996).

57: Sheryl Gay Stolberg, AIDS Drugs Elude the Grasp of Many of the Poor, New York Times, October 14, 57 1997 at A-22.

58 Jaklyn Brookman, Client-Centered Counseling Utilizing a Harm Reduction Approach for Populations Resistant to Behavior Change, XI INT.CONF.AIDS, Abstract #Mo.D. 1757 (1996).

59 Pavia, supra note 4; Randolph F. Wycoff, Contact Tracing to Identify Human Immunodeficiency Virus Infection in a Rural Community, 259 JAMA 24:3563 (1988); Crystal, supra note 35.

60 Thomas A. Peterman, et al., HIV Partner Notification: Cost and Effectiveness Data from a Multicenter Randomized Controlled Trial, XI INT.CONF. AIDS, Abstract #Th.C. 4626 (1996).

61: In Connecticut, state disease intervention counselors receive a two week training course to develop skills for partner notification and receive instruction in how to comply with Connecticut law regarding notification and confidentiality. See Connecticut Department of Public Health, STD Control Program, Health Care Provider's Guide To AIDS Confidentiality Law.

CREDITS

American Civil Liberties Union
125 Broad Street, 18th floor
New York, NY 10004
(212) 549-2500

Nadine Strossen
President

Ira Glasser
Executive Director

Matthew Coles
Director, AIDS Project

AMERICAN CIVIL LIBERTIES UNION OF NORTHERN CALIFORNIA
1663 Mission Street, Suite 460
San Francisco, CA 94103
(415) 621-2488

Dorothy M. Ehrlich
Executive Director

The American Civil Liberties Union is a nationwide, nonpartisan organization of 275,000 members dedicated to preserving and defending the principles set forth in the Bill of Rights.

The ACLU of Northern Califorinia is the Northern California affiliate of the ACLU.

Founded in 1986, the AIDS Project of the ACLU works to protect the civil liberties of people with HIV and AIDS.

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