New York's partner notification rules to be ready soon

The New York Department of Health expects to issue draft regulations in March explaining the provisions of the State's new partner notification law. After a 45-day period for public comment, the regulations will go into effect. Senate Bill 4422-B requires that public health officials notify spouses, sex partners, and needle-sharing partners that they have been exposed to HIV. Community-based AIDS organizations opposed the law, but most are now resigned to working with notification of partners and names-based HIV reporting. A number of questions remain, including whether the rules will apply only to new cases. Administering the program may take 120 additional health workers, and computer systems in many counties will need to be upgraded.     

Congress begins discussions on partner notification bill

Representatives Gary Ackerman and Tom Coburn have introduced a HIV Partner Protection Act that would identify partners who are at risk for HIV and provide them with information on appropriate treatment or counseling programs. The legislation is patterned after New York's partner notification law and requires that physicians confidentially notify public health departments of patients who are HIV-positive, and provide names of the patient's sex and drug partners. Leading AIDS policy groups and the Centers for Disease Control and Prevention have criticized the legislation, fearing that mandatory reporting may cause people to avoid diagnosis and treatment. Ryan White funding may be tied to compliance with this legislation.     

Lawmaker proposes major shift in HIV prevention policies

Rep. Tom Coburn (R-OK) introduced in Congress a bill that would mandate the reporting of all HIV cases and impose criminal sanctions on people who knowingly transmit the virus through sex or drug needles. According to Coburn, his HIV Prevention Act of 1996 emphasizes partner notification as a way of identifying possible carriers of the virus. Other prevention policy changes proposed by Coburn include: encouraging States to make it a felony for a person to knowingly transmit HIV to another person; requiring States to keep central registries of all HIV infections; allowing doctors to deny treatment to any patient who refuses to take an HIV-antibody test prior to an invasive medical procedure; requiring an HIV-positive doctor to inform the patient before performing any invasive medical procedure; allowing funeral directors to deny bodies that have not been tested for HIV antibodies; and requiring States to enact laws requiring anyone accused of a sex-related crime to undergo HIV-antibody testing within 48 hours of indictment. Coburn's bill, H.R. 3937, has eleven cosponsors, all Republicans. Legislation passed earlier this year mandates spousal notification, and more than 30 States already have partner notification procedures.     

Name-based notification bill sails through New York Senate

The New York Senate approved a bill requiring public health officials to notify spouses, sexual partners, and needle-sharing partners of HIV-positive people, that they have been exposed to the virus. Under S. 4422-A, physicians are required to report HIV-positive patients, by name, to the State Department of Health, so as to begin the process of partner notification and statewide HIV case surveillance. AIDS activists consider the new law coercive and less effective than growing programs that reinforce safer-sex messages. The current notification system, which allows the physician or patient the option of notifying the State Health Department, has sometimes been assessed as a failure. A compromise is being considered that involves telling the State Department the names of the partners to contact, while protecting the confidentiality of the HIV-positive patient by assigning the patient a unique identifier number. This would allow tracking of the HIV surveillance data, without comprising the confidentiality of the HIV-positive patient.     

New York governor signs bill to track HIV cases by name

Senate Bill 4422-B, a partner notification bill that uses name-based reporting to track HIV cases, was signed by New York Governor George Pataki on July 7, 1998. The new legislation requires physicians to report the names of all HIV-positive patients to the State Department of Health so that public officials can notify spouses, sexual partners, and needle-sharing partners of possible exposure. This information will become part of a State-wide case surveillance system. Patient advocacy and civil liberties groups did not support the bill, stating that it would erode the physician-patient relationship by breaching confidentiality. The new legislation does not apply to anonymous testing sites, although once individuals begin HIV-related medical treatment, their name will be sent to the State.     

Tracking sexual contacts of HIV patients: a study of physician practices.

Notification of sexual partners of HIV-infected individuals has become a focus of debate at local, state, and national levels. Issues of confidentiality and ethical concerns continue to pose challenges to state and local health departments addressing this issue. We conducted a telephone survey with physicians in Syracuse, New York to ascertain opinions about HIV partner notification and the role of public health agencies in that notification process. In general, physicians mostly relied upon the HIV-infected individuals to notify their own partners but were supportive of enhanced efforts regarding partner notification.     

Senate passes Ryan White Act; no vote set in House

The Senate voted July 27 to reauthorize the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act for another five years. Senator Jesse Helms, R-N.C., offered several amendments to cap funding for the program and to make it difficult for gay men to receive Federal money for care or treatment services. Three of his five amendments passed: 1) a ban on Ryan White funds being used to promote homosexuality as natural or normal; 2) a change in participation, from mandatory to voluntary, in the workplace training program offered to Federal employees; and 3) a requirement that States notify the spouses of anyone who tests positive for HIV antibodies. Although angry with Helms' amendments and speeches attacking homosexuality, AIDS activists are pleased with the Senate results.     

Lawmaker renews plan for major shift in prevention policies

U.S. Representative Tom Coburn (R-OK) restructured his HIV Prevention Act but AIDS policy advocates are not receptive to it. Coburn proposes mandatory reporting of all HIV cases and imposing criminal sanctions on people who knowingly transmit the virus. His bill includes partner notification, mandatory testing for insurance company applicants, and regulations regarding adopted children. AIDS policy advocates denounce the legislation, claiming similar plans that emphasize coercive testing tactics and policies have been judged ineffective.     

General practitioner notifications of gastroenteritis and food poisoning: cause for concern

BACKGROUND: Under the Public Health (Infectious Diseases) Regulations 1988, all doctors are required by law to notify suspected cases of specific infections and food poisoning. Doctors' propensity to notify is known to be low, and we sought to quantify this locally. METHODS: From July 2000 to June 2002, we conducted a baseline audit of notifications by Wakefield GPs of cases of suspected gastrointestinal infection or food poisoning. We repeated the audit during 2005-06, following a series of local interventions to improve notification. RESULTS: The baseline audit demonstrated considerable variation in reporting behaviour and timeliness of notification. Following the re-audit, we found that notification rates and timeliness had not improved, indeed they had deteriorated. CONCLUSION: We suggest that the current notification system is not working in respect of gastroenteritis and food poisoning, and should be either substantially revised or abandoned.     

Experiences of a state-sponsored notification and screening program for asbestos workers

Worker notification can involve a broad range of activities including medical screening, personal and mass communications, cohort identification and tracing, and even litigation. The inclusion or exclusion of various supporting activities in a worker notification program may pose significant medical, public health, financial, logistical, and even legal implications for targeted individuals as well as for the agencies involved. This report describes some experiences in a state-sponsored notification and screening program of approximately 4,500 asbestos workers in Minnesota. In this program, a variety of factors led to the decision to provide medical screening to 1,101 workers and 451 spouses. It is anticipated that another 3,400 workers will be notified but not screened. A follow-up survey of notified workers showed overwhelming support for this program. It is estimated that this program will cost more than $650,000 by its completion. The decision to institute medical screening and other support activities should be made with careful consideration of the diverse implications of these activities to the individuals, communities, and agencies involved. © 1993 Wiley-Liss, Inc.     

Methodologic issues in risk communications to workers

Until the late 1980s, epidemiologists in general did not individually notify subjects of the results of epidemiological studies. Now that they are beginning to do so, the question arises of how best to notify those involved. In general, the methods, the processes and the policies related to effectively communicating risks to workers have not been thoroughly examined in the scientific literature. This is especially true in situations where workers have already experienced the exposures that led to increased risks for disease. The recent increasing numbers of notifications have raised several methodologic issues, which are examined in terms of: (1) the content of notification, (2) the process of notification, and (3) the evaluation of the impact and effectiveness of notification. Too often in the discussions concerning notification, attention is paid to the content but the process and evaluation are rarely considered. The potential impact and effectiveness of notification have been raised as reasons for or against notification, but rarely has there been a concerted effort to evaluate a notification in this regard. This workshop was designed to address all these issues. The ultimate goal is to improve communications for workers. © 1993 Wiley-Liss, Inc.     

云南、广西两省四县（区）人类免疫缺陷病毒感染者检测结果告知意愿及影响因素分析

目的了解云南、广西两省四县（区）人类免疫缺陷病毒（HIV）感染者检测结果的告知意愿及影响因素。方法采用方便抽样,对云南和广西两省四县（区）于2008年1～12月期间检出的HIV感染者采用自行编制的匿名问卷进行一对一调查,调查HIV阳性人群HIV检测阳性结果的告知对象、告知意愿及相关影响因素。结果361名调查对象中,愿意将HIV检测阳性结果告知固定性伴、非固定性伴、亲人和朋友的比例分别占72．6％,22．0％,63．2％和6．2％。单因素和多因素Logistic回归分析结果显示,年龄（OR=3．73,95％CI：1．22—11．38）,艾滋病知识知晓（OR=63．13,95％CI：20．76～191．97）与探讨性伴告知（OR=2．32,95％CI：1．01～5．79）在固定性伴告知意愿上的差别有统计学意义。结论部分HIV感染者不愿意将HIV阳性状态告知他人,应进一步开展艾滋病健康教育,不断提高HIV检测阳性结果的告知意愿,减少家庭或同伴感染概率,防止HIV二代传播。     

More and faster notification of infectious disease if notification is carried out by the laboratories instead of the diagnosing physician

OBJECTIVE: To investigate if notification by the laboratories of a number of Group B diseases (meningococcal disease, whooping cough and hepatitis A) which according to the Communicable Disease Law of 999 must be reported to the local public health authority, would increase the number of reports and the speed at which the reports were made. DESIGN: Comparative study. METHOD: In the participating regions (Den Bosch and north-east Brabant) it was decided that the laboratories would notify the authorities of cases ofmeningococcal disease, whooping cough and hepatitis A. The notifications were compared with those from the middle-Brabant region which was used as a control. This took place in 1997/'98, prior to the start of the notification project and in 2000/'02 when it was running. The number of positive cases of infectious disease confirmed by the laboratories that were reported to the local health authorities and to the Inspectorate of Public Health Services was examined - this is known as the degree of notification. The number of days from diagnosis to notification of the local health authorities was also examined - this is known as the speed of notification. RESULTS: The degree of notification for these three diseases improved from 6I-89% to 87-95% if the authorities were notified by the laboratories. In the control region the degree of notification improved from 29-4I% to 54-60%. The speed of notification increased significantly if notification was done by the laboratories. CONCLUSION: Based on these results it is recommended that the Communicable Disease Law be adapted to allow the laboratories to notify the authorities of cases of infectious disease.     

Evaluation issues in the drake chemical workers notification and health registry study

The Drake Chemical Workers' Health Registry combined notification of workers about bladder cancer risk with access to a free program for screening and diagnosis. Evaluation of the project has given rise to several findings and new research questions. Findings in this article illustrate the following evaluation issues: 1) studying the combination of strategies that are most effective and cost effective to notify workers of their disease risks, 2) determining the realistic yield from strategies to gain participation in health screening and other protective services for notified workers, 3) identifying the notification strategies that were most effective for different kinds of participants, 4) using process evaluation to identify key activities for ensuring continued participation of cohort members in screening, and 5) examining the extent to which participants are willing to quit smoking to protect their health. © 1993 Wiley-Liss, Inc.     

Lawmakers introduce bill for name-based notification

H.R. 4331, an HIV Partner Protection Act introduced by Reps. Gary Ackerman and Tom Coburn, would require that states report the names of people infected with HIV to the health department. In addition, these people would have to tell public health officials the names of current and past sex or needle-sharing partners. All of the information would remain confidential. Ten million dollars would be made available annually for 4 years to help States develop these partner-notification programs. This act is similar to legislation that was recently adopted in New York State.     

Infectious disease notification--a neglected legal requirement

The Acheson Report expressed concern about doctors' knowledge of the infectious disease notification system. This study was undertaken in order to quantify doctors' knowledge of the system, and guide action to improve its efficiency. A survey of 176 hospital doctors in one large Health District showed that, although 82% knew of the legal obligation to notify, 70% did not know where to obtain a notification form, and 40% did not know whom to notify. Over a third of those surveyed did not know that food poisoning and tuberculosis are notifiable diseases. Proposed changes in the law relating to infectious disease control will not compensate for such lack of knowledge. Consultants in Communicable Disease Control should take the lead in improving this vital information system.     

Congenital Rubella Syndrome in Child of Woman without Known Risk Factors,New Jersey,USA

We report a case of congenital rubella syndrome in a child born to a vaccinated New Jersey woman who had not traveled internationally. Although rubella and congenital rubella syndrome have been eliminated from the United States, clinicians should remain vigilant and immediately notify public health authorities when either is suspected.     

Beach communications: a need for evaluation of current approaches

Aims: Programs to notify the public about water quality at beaches are developed at the state and local levels. We sought to characterize the messages and message delivery options in use, and information about the effectiveness of these beach notification programs. Methods: A telephone survey of 37 US state, tribal and territorial and 18 county, city or local beach programs was conducted to characterize current public notification practices and any evaluations of those practices. Results: Beach notification practices vary substantially at the state and local levels. Color-coded signs or flags are commonly used, but not universally, and the color schemes and their meanings vary. New communication approaches utilizing text messaging and the internet are in use or under development for local use. Few communication methods had undergone systematic evaluations of their content, delivery methods or effectiveness in promoting behavior change. Conclusion: The prevention of waterborne illness requires communications that effectively promote the avoidance of swimming when water quality is impaired. Current communication practices are variable and generally have not undergone formal evaluations for their effectiveness. It is not known whether or how they impact health risk.     

Partner notification

The Association of State and Territorial Health Officials (ASTHO) supports partner notification, but is troubled by the methods advocated by the HIV Partner Protection Act (H.R. 4431). H.R. 4431 is a "one-size-fits-all" solution that requires all states to adopt programs to notify the sex or needle-sharing partners of people with HIV. ASTHO believes that states are already improving their existing notification programs, and H.R. 4431 does not allow for the individual needs of each state.     

Partner notification in the control of human immunodeficiency virus infection.

Partner notification should be standard public health practice in the control of human immunodeficiency virus (HIV) infection. A universal partner notification program for the United States is affordable, operationally manageable, and can effectively reach high-risk persons. Such a focused approach personalizes the epidemic and probably enhances the efficacy of risk reduction messages. Confidentiality protections are attainable. Voluntary partner notification is acceptable to our constituents; while counseling is "mandatory," testing is optional. Evidence of partner notification's usefulness as a case prevention tool should be a by-product of program outcomes and not a prerequisite for its implementation.