Email updates

Keep up to date with the latest news and content from BMC International Health and Human Rights and BioMed Central.

Open Access Highly Accessed Research article

"If the patients decide not to tell what can we do?"- TB/HIV counsellors' dilemma on partner notification for HIV

Barnabas N Njozing123*, Kerstin E Edin24, Miguel San Sebastián2 and Anna-Karin Hurtig23

Author affiliations

1 St. Mary Soledad Catholic Hospital, Mankon, Bamenda, P.O.Box 157, Cameroon

2 Department of Public Health and Clinical Medicine, Unit of Epidemiology and Global Health, Umeå University, Umeå, 901 85, Sweden

3 Swedish Research School for Global Health, Umeå University, 901 85, Umeå, Sweden

4 Umeå Centre for Gender Studies, Umeå University, Sweden

For all author emails, please log on.

Citation and License

BMC International Health and Human Rights 2011, 11:6  doi:10.1186/1472-698X-11-6

Published: 3 June 2011

Abstract

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.