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"If the patients decide not to tell what can we do?"- TB/HIV counsellors' dilemma on partner notification for HIV
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BACKGROUND: There is a global consensus towards universal access to human immunodeficiency virus (HIV) services consequent to the increasing availability of antiretroviral therapy. However, to benefit from these services, knowledge of one's HIV status is critical. Partner notification for HIV is an important component of HIV counselling because it is an effective strategy to prevent secondary transmission, and promote early diagnosis and prompt treatment of HIV patients' sexual partners. However, counsellors are often frustrated by the reluctance of HIV-positive patients to voluntarily notify their sexual partners. This study aimed to explore tuberculosis (TB)/HIV counsellors' perspectives regarding confidentiality and partner notification. METHODS: Qualitative research interviews were conducted in the Northwest Region of Cameroon with 30 TB/HIV counsellors in 4 treatment centres, and 2 legal professionals between September and December 2009. Situational Analysis (positional map) was used for data analysis. RESULTS: Confidentiality issues were perceived to be handled properly despite concerns about patients' reluctance to report cases of violation due to apprehension of reprisals from health care staffs. All the respondents encouraged voluntary partner notification, and held four varying positions when confronted with patients who refused to voluntarily notify their partners. Position one focused on absolute respect of patients' autonomy; position two balanced between the respect of patients' autonomy and their partners' safety; position three wished for protection of sexual partners at risk of HIV infection and legal protection for counsellors; and position four requested making HIV testing and partner notification routine processes. CONCLUSION: Counsellors regularly encounter ethical, legal and moral dilemmas between respecting patients' confidentiality and autonomy, and protecting patients' sexual partners at risk of HIV infection.This reflects the complexity of partner notification and demonstrates that no single approach is optimal, but instead certain contextual factors and a combination of different approaches should be considered. Meanwhile, adopting a human rights perspective in HIV programmes will balance the interests of both patients and their partners, and ultimately enhance universal access to HIV services.
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The most commonly mentioned barrier was individuals' concerns about potential harm or other negative consequences, even despite very little evidence of actual harm.
“Overall, the most commonly mentioned barrier was individuals' concerns about potential harm or other negative consequences (e.g. fear of relationship break-up, violence, loss of social and financial support) (108, 124, 128-130, 136, 140-144, 146-164), even despite very little evidence of actual harm.”
From Updated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis) and new recommendations on syphilis testing and partner services (2024) · cites this paper as [129]
The Results (‘Dealing with partner notification’; page not provided) identify fear of marital problems—including blame, assault and divorce—as the major reason counsellors gave for patients’ reluctance to notify partners. The Discussion says there is a lack of empirical evidence for undesirable consequences of *provider referral*, but does not establish that there is very little evidence of actual harm from disclosure generally. It also notes that divorce following disclosure has been reported in other studies. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPatients' main reason for preferring simple patient referral was to maintain privacy.
“Similar to health workers, patients' main reason for preferring simple patient referral was to maintain privacy (124, 128, 129).”
From Updated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis) and new recommendations on syphilis testing and partner services (2024) · cites this paper as [129]
In Results > Dealing with partner notification (page unavailable), a counsellor reports that some patients would rather notify partners themselves than have a counsellor do it. The paper also discusses patients’ confidentiality concerns, but it does not establish that maintaining privacy was patients’ main reason for preferring patient referral. (LLM, conf=0.78)
Experimental — accuracy not yet measuredSome health workers prefer simple patient referral because they feel it is the patient's responsibility to inform partners and because it assures the patient's privacy.
“Some health workers prefer simple patient referral for the reason that they feel it is the patient's responsibility to inform their partners (127) and because it assures the patient's privacy (120, 128-130).”
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Metadata
- Authors
- Njozing, B. N., Edin, K. E., Sebastián, M. S., & Hurtig, A.-K.
- Affiliations
- Umeå University (SE)
- Corresponding author
- Njozing, Barnabas N
- Venue
- BMC International Health and Human Rights
- Published
- 2011-06-03
- Volume
- 11
- Issue
- 1
- Pages
- 6-6
- ISSN
- 1472-698X (ISSN-L)
- PMC
- PMC3119031
- OpenAlex
- W2011985293
- Cited by
- 26
- References
- 39
- Citations by year
- 2026: 2 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 2 · 2019: 1 · 2018: 2 · 2017: 1 · 2016: 1 · 2015: 1 · 2014: 4 · 2013: 5 · 2012: 2
- FWCI
- 2.38
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC International Health and Human Rights (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DiVA at Umeå University (Umeå University) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Forskningsrådet för Arbetsliv och Socialvetenskap (2006-1512)
- Västerbotten Läns Landsting
- Topics
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Social Sciences › Law › Medical and Health Sciences Research
- Keywords
- HIV partner notification, confidentiality, patient autonomy, legal dilemmas, HIV testing, rights-based approach, Cameroon
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