Improving Partner Notification: A Qualitative Study of Medical Case Managers, Disease Intervention Specialists and Men Who Have Sex with Men

Background: Approximately 21% of HIV infected individuals are unaware of their status.  Partner notification, or contact tracing, is the strategy whereby partners are notified of a potential exposure to a particular disease, including HIV.  Notably, the rate of newly diagnosed infections among tested partners ranges from 10-30%.  The program, however, is limited by suboptimal referral rates and difficulty eliciting partner names and contact information, particularly from men who have sex with men (MSM). 

Objectives: To improve our understanding of barriers to partner notification for MSM by exploring the knowledge, attitudes and experiences of medical case managers (MCMs), public health authorities responsible for partner notification known as Disease Intervention Specialists (DIS), and MSM. 

Methods: In partnership with the Connecticut Department of Public Health and AIDS Project New Haven, we are using a community-based participatory research approach to conduct a qualitative study with MCMs, DIS, and MSM.  The focus group and in-depth interviews are being recorded, transcribed and analyzed using grounded theory and the constant comparative method.  We will determine sample size by assessing for thematic saturation.    

Results:  To date, our sample includes 14 MCMs, 4 DIS and 13 MSM.  Emerging barriers to partner notification for MSM include: 1.) Persistent stigma around HIV and sexual orientation inhibiting open discussions about risk behaviors, HIV disclosure and partner notification; 2.) Multiple competing agendas of high-risk populations, de-prioritizing partner notification, 3.) Time and opportunities to develop trusting relationships; and 4.) Lack of clarity about how to make a direct referral to the Department of Public Health. 

Conclusions: Barriers to partner notification exist at multiple levels, involving MCMs, DIS and MSM. 

Implications for Programs, Policy, and Research: Efforts to improve the process of partner notification might benefit from enhancing training in communication skills for public health officials, a social marketing campaign, and streamlining the referral process.