What Health Care Providers Need to Know about Partner Services

Twelve to thirteen people contract HIV every day in New York State. Over 300 New Yorkers become infected with Chlamydia, gonorrhea or syphilis each day.

Many of these people have no symptoms and are unaware of exposure or infection. It may take several weeks or months (and sometimes years) for signs of infection to become apparent. During this time, infected partners may unknowingly continue to spread the infection to others. Partner Services is an evidence-based public health intervention that can help to break the chain of infection.

Partner Services is a free program offered by the New York State Department of Health and the New York City Department of Health and Mental Hygiene. Partner Services helps people recently diagnosed with Chlamydia, gonorrhea, syphilis, and HIV plan how to best notify their sexual and/or needle-sharing partners of an exposure to an STD/HIV, and link them to testing. Partner Services is voluntary and confidential.

Partner Services staff can assist providers with techniques on how to quickly and effectively communicate the importance of Partner Services referral to your patients. Partner Services will work with each patient to identify sexual partners and/or needle-sharing partners (as appropriate), and will develop a plan to notify each partner while protecting the patient's identity. Staff can also help patients who choose to notify their partners themselves.

What happens in Partner Services?

When a new confirmed case of HIV, Chlamydia, gonorrhea or syphilis is reported to the Department of Health, Partner Services can work with the patient to create a plan to inform any sexual and/or needle-sharing partners about an exposure to the STD/HIV. Health care providers are integral to quickly connecting patients to Partner Services. A Partner Services Specialist will interview the patient in a private, confidential setting. The Specialist will ask the patient to share information about recent behaviors, including places where they meet partners (including the Internet) and other contact information about their partners.

The sexual and/or needle-sharing partners are then contacted by phone, mail or e-mail to arrange a meeting with the Partner Services Specialist to inform them confidentially about their STD/HIV exposure.

Throughout the notification process, names or identifiers (including the dates of exposure) are never revealed to the partners. The anonymity and privacy of the original patient is the highest priority.

All partners are offered free STD and HIV counseling and testing services. Additionally, referrals to substance abuse, mental health and other social services are offered as appropriate. Subsequent HIV care services and STD screenings are also available.

Health care providers play a vital role in Partner Services

The connection between health care providers and patients is critical in helping to identify sexual and needle-sharing partners. Health care providers have this opportunity to prevent the further spread of STD and HIV infection. It provides a chance to talk to the patient about their behaviors and their future well-being. Equally important, a positive diagnosis provides an ideal opportunity to inform the person's partners, many of whom may not know that they have an STD or HIV.

Medical providers, test counselors and other healthcare professionals play a key role in Partner Services. Health care providers can inform their patient of the value and importance of Partner Services. It only takes a few minutes, but presenting Partner Services in a positive light will help your patients' partners and could prevent hundreds of new infections and save many lives.

How is Partner Services initiated?

Partner Services can be initiated in two ways:

  • Direct expedited referral from a provider (or a patient self-referral) is often the fastest way to stop the spread of infection. The Department of Health encourages health care providers to talk with their patients about Partner Services, and to quickly connect their patients to the Partner Services program in their area.
  • The second way to initiate Partner Services is through disease reporting. Both laboratory and provider reporting is required in New York State for Chlamydia, gonorrhea, syphilis and HIV. Based on local priorities, those case reports are automatically assigned to a Partner Services program for follow-up. This happens even at initial laboratory reporting, and occasionally the health department may learn about a case before the providers has an opportunity to notify the patient. Outside of NYC, Partner Services staff may initiate the contact to the provider to offer Partner Services assistance for priority cases.

There are also specific requirements for providers to report known contacts and the status of partner assistance for newly diagnosed HIV and AIDS cases. Although provider reporting helps ensure that these cases are followed, it is recommended that providers also use the expedited referral process above, to ensure patients and their partners receive timely Partner Services.

There are important legal requirements specific to HIV reporting and sex or needle-sharing partners. Visit NYSDOH's HIV Reporting Law information or NYC DOHMH's HIV Reporting Law information online.

How does Partner Services work in areas outside of New York City?

Partner Services is tailored to the needs of each patient and disease. The Partner Services Specialist will work with each patient to identify their needs for partner notification, and will provide the highest quality service to assist the patient.

The Centers for Disease Control and Prevention (CDC) recommends active health department involvement in providing partner services for all newly diagnosed cases of syphilis and HIV. Direct involvement in partner services for Chlamydia and gonorrhea infection is often focused on high-priority cases. Additional strategies may be used for the remainder of cases (e.g., expedited partner therapy).

There are eight basic steps for Partner Services:

  1. A patient tests positive for HIV, syphilis, Chlamydia, or gonorrhea. Some areas in New York State conduct Partner Services based on the priority of the case; some patients with Chlamydia or gonorrhea may not automatically receive Partner Services.
  2. The health care provider contacts the Partner Services to see if a Partner Services Specialist can meet with the patient at the time of the scheduled visit, or arrange a time convenient to the patient soon after. In some cases, the provider may be contacted first by the health department to offer Partner Services assistance, based on the lab report.
  3. The health care provider informs the patient of the diagnosis. As part of the counseling, the provider discusses the importance and benefits of meeting with a Partner Services Specialist.
  4. The patient meets with a Partner Services Specialist, who explains the program, and assists the patient in making a notification plan for each partner, including assessment of domestic violence risk. For patients with an HIV diagnosis, Partner Services can serve as the proxy in identifying partners, conducting domestic violence screening and the notification plan, and can assist in completing Partner/Contact Information on the Medical Provider Report Form (DOH-4189).
  5. The patient provides information to help find partners that they want the Partner Services Specialist to notify. Contact information could include: first name, last name, age, address, phone number, and e-mail or internet screen name. A physical description also helps to locate and confirm partners.
  6. A Partner Services Specialist contacts partners via phone or e-mail to set up a face-to-face meeting, to let them know that they have been exposed to an STD/HIV. No names, dates of exposure, or details about the encounter or the original patient are revealed to the partner.
  7. Partners are offered free confidential STD and HIV screening and counseling, as well as referrals for other prevention services as needed.
  8. Partners receive test results. Treatment and referral for medical care, STD/HIV screening or other services are provided if needed.

How does Partner Services work in New York City?

For patients diagnosed with HIV, providers are required to report known partners to the NYC Health Department by calling CNAP at 212-693-1419 or 311 or by filling out a Provider Report Form. The form is available on the NYC Health Department's web site. CNAP can assist providers with partner elicitation and notification. Patients can also call CNAP directly for assistance with anonymous notification of their partners.

Once Partner Services (or CNAP) services are offered, the information that is collected, and how partners are contacted is similar to how the Partner Services program is offered in the rest of New York State.

Internet Partner Services: A New Public Health Tool

The New York State Department of Health has been successful in using the internet as an informational tool to assist in notifying partners of their exposure to STD/HIV. Some patients only have contact information for their sex partners through internet sources (e-mail addresses, website screen names or profiles). In cases in which traditional contact information cannot be found, the Department follows a specific Internet Partner Services protocol to contact sex partners through the internet-based communications that the partners use.

When you are talking to your patients about their sex partners, it is important to ask about how they use the internet to meet sexual partners. This information is valuable, and often allows us to notify people who otherwise would not be reachable. For more information on how internet Partner Services is used and how you can help, contact your local Partner Services program (PDF, 165 KB, 1pg.).

Can I help to notify the partners myself?

Partner Services includes not only notifying a partner of possible exposure, but also problem-solving the partner's concerns, providing risk reduction counseling and linking the partner to testing, including rapid testing, at the time of the notification. This in-depth discussion takes specific skills and time. For these reasons, CDC recommends active health department involvement by trained Partner Services Specialists.

There are times when health care providers may want or need to play a role in notifying partners. For example, a patient may bring their partner in for the appointment, and request the health care provider to notify, or help notify the partner in the clinical setting. Any notification conducted by a health care provider must be done so with the index patients' consent.

Like any skill area, anyone engaging in partner notification should have specific training. Partner Services can assist and help prepare providers who wish to play a direct role in notifying their patients. The New York State STD/HIV Prevention Training Center provides a recommended training sequence for both Partner Services Specialists and for providers who may want to get training in this area.

The most critical role the health care provider can play in Partner Services is actively linking the patient and the health department. Without the health care provider contacting Partner Services and arranging a meeting with the patient, a significant amount of time may pass before Partner Services learns of a positive test result. This delay hinders the opportunities to break the cycle of STD/HIV infection.

What if I have any questions about Partner Services, how to refer patients, or completing paperwork? Who can I contact for Partner Services?

Each region in New York State has a Partner Services Contact, dedicated to providing health care providers with technical assistance and appropriate referrals to Partner Services staff. Additionally, many counties provide Partner Services directly through the local health department.

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