Memorandum Date: MAY 3 1990From: Assistant Secretary for HealthSubject: PHS Policy on Partner NotificationTo: Assistant Secretary for Health Surgeon General PHS Agency Heads PHS Agency AIDS Coordinators Deputy Assistant Secretaries for Health OASH Staff Office Directors Regional Health Administrators Attached is a copy of the new PHS policy on sex and needle-sharing partner notification, which I am asking you to implement immediately. This policy, which amends the August 1988 policy, provides PHS health-care personnel with guidance regarding their obligation to notify sex and needle-sharing partners of HIV- infected individuals who are cared for by PHS personnel as part of their official duties at a PHS facility. Alerting persons who are at risk of their possible exposure to HIV is a crucial element in AIDS prevention efforts. Informed persons are able to seek medical monitoring of their own health and, if appropriate, receive treatment at an earlier stage to minimize HIV disease progression. Such knowledge also is important for motivating and assisting persons to change high-risk behaviors and maintain safe behaviors. PHS is fully committed to partner notification as an HIV prevention strategy, and I look forward to your support in the application of this policy. James O. Mason, M.D., Dr.P.H. Attachment PHS POLICY ON PARTNER NOTIFICATION Introduction 1. This policy provides PHS health care personnel with guidance regarding their obligation to notify sex and needle-sharing partners* of HIV-infected individuals who are cared for by these personnel as part of their official duties at a PHS facility. The policy is intended to cover only the limited circumstances where the personnel are employed by the PHS at a PHS facility. *Refers to current and recent sex and needle-sharing partners (i.e., at least those within the last 12 months) and hereafter will be referred to in this policy only as "partners." The policy does not cover contractors, grantees, or PHS personnel on detail to non-PHS facilities. However, PHS Agency Heads have discretion and are encouraged, where appropriate, to extend the policy to contractors carrying out activities at PHS facilities. PHS Agency Heads may also issue instructions and guidelines in implementation of this policy, as long as the instructions and guidelines are consistent with the policy. 2. The policy addresses instances where, in the course of carrying out PHS activities, including post-test counseling, PHS personnel learn the name of an HIV-infected individual and the names of partners. The policy in no way affects anonymous testing or requires PHS personnel to collect the names of HIV- infected individuals and their partners if personnel would not otherwise do so in carrying out their PHS responsibilities. Policy To the extent possible, known partners of a person with HIV infection shall be notified that they may have been exposed to HIV and should be encouraged to be counseled and tested. Under usual circumstances, this process is preferably carried out in collaboration with HIV prevention activities of local public health departments. Applicability This policy is applicable to clinical activities at PHS facilities carried out by PHS personnel, where there is a physician-patient relationship or health care is otherwise provided. The facilities involved are (1) the NIH Clinical Center, (2) Indian Health Service hospitals and clinics, (3) employee health clinics, and (4) other PHS facilities engaged in clinical activities of a similar nature. Informed Consent When identifiers are to be collected (i.e., information which can link test results to an identifiable individual), testing for HIV infection is to be carried out only with the informed consent of the individual to be tested. As part of the consent, the individual shall be informed that in the event of a confirmed HIV positive test (1) the individual will be so advised and expected to inform all partners, and (2) if the individual is unwilling or unable to notify such partners, the PHS facility will take steps to do so or otherwise satisfy itself that notification will be made. Counseling To ensure that accurate and useful information regarding the implications of infection with HIV are available, whenever practical, PHS facilities should have trained counselors available to advise HIV-infected individuals and their partners. In the absence of trained counselors, or where geographically not feasible, PHS facilities shall develop arrangements for such counseling by other trained counselors, for example, those from local health departments. Such counseling preferably should be provided on-site at the time of the initial notification. Post-test counseling should be provided to all persons tested, whether seropositive or not. Whether, or not PHS personnel have the names of infected individuals or specific partners, counseling of a person with HIV infection shall include emphasis on the importance of notifying partners and urging them to be counseled and tested. Notification Notification of partners remains the primary responsibility of each individual who tests positive. Effort shall be made to persuade the individual (1) to carry out this responsibility and (2) to indicate to partners that counseling and testing are available or can be arranged through the PHS facility. Each PHS facility shall develop procedures (e.g., in collaboration with HIV prevention activities of local health departments) for (1) verifying that current and recent partners have been notified, where the HIV-infected individual has agreed to do the notifying, and (2) notifying or assuring the notification of partners, whenever possible, where their identities are known to the facility but the HIV-infected individual is not willing or able to notify them. Confidentiality When the PHS facility undertakes a process of partner notification, confidentiality shall be maintained by not releasing or acknowledging the identity of the HIV-infected individual to partners or the identity or medical status of any partners who may be seen as a result of notification activities. Exceptions PHS Agency Heads may grant exceptions to this policy on a case by case basis in which compelling, documented circumstances militate against notification. This authority may be delegated to personnel not lower than that of branch chief or equivalent. PHS Agency Heads may grant exceptions to this policy for a class or group of patient, with the prior approval of the Assistant Secretary for Health, in special circumstances where compelling, documented, public health considerations justify a class or group exception. Where an individual has previously been found to have HIV infection and has undergone counseling and partner notification activities, there may be no necessity to have the process repeated. This determination in each case should be made by the PHS facility based upon whether information concerning additional partners has come to the facility's attention.