HIV PARTNER NOTIFICATION:
Why Coercion Won't Work
An American Civil Liberties Union Report
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
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.
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
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
III. THE EMERGENCE OF NEW PROPOSALS FOR COERCIVE
HIV PARTNER NOTIFICATION
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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.
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
V. THE ACLU SUPPORTS AND ENCOURAGES VOLUNTARY PARTNER
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.
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.
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.
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.
American Civil Liberties Union - AIDS Project
American Civil Liberties Union of Northern California
APPENDIX OF STATE LAWS ON HIV PARTNER NOTIFICATION
§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
§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 &
§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
§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
General Statutes of
§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.
§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
§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.
§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
§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
§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
§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
§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.
§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.
§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.
§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
§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
§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.
§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."
§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
§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.
§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
§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
§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
§191.686(4) -- all anonymous test sites are required to initiate partner
notification when submitting test results to individuals who test
positive for HIV.
§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,
§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
§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.
§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
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
§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.
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
§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
§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
§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
North Dakota Century
§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
§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.
§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.
§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.
§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
§7608 -- a court may issue an order to allow access to confidential HIV
related information upon a showing of compelling need.
General Laws of
§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.
§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.
§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
§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 &
§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
§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
Utah Code Annotated
§26-63.5 -- the department of health shall utilize contact tracing and
other methods for partner identification and notification.
§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
§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
§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.
§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.
§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
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.
7 MICH.STAT.ANN. §14.15
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
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.
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).
27: Andrus, supra note
28: Brandt, supra note
2; Arthur H. Rosenberg, Compulsory Disclosure Statutes, 280 N.ENG.J.MED.
29: See, e.g., Lawrence
O. Gostin and William J. Curran, The Limits of Compulsion in Controlling
AIDS, 29 Hastings Center Report, December 1986.
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).
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
40 Landis, supra note
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
48: Cowan, supra note
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
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
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
American Civil Liberties Union
125 Broad Street, 18th floor
New York, NY 10004
Director, AIDS Project
AMERICAN CIVIL LIBERTIES UNION OF NORTHERN CALIFORNIA
1663 Mission Street, Suite 460
San Francisco, CA 94103
Dorothy M. Ehrlich
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
Founded in 1986, the AIDS Project of the ACLU works to protect the civil
liberties of people with HIV and AIDS.