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Frerichs, R.R. HIV Contact Tracing.

SEA-AIDS Network, June 10, 1998.

R.R. Frerichs Posting

Should spouses of persons found to be HIV infected be notified? As routine testing of pregnant women proceeds in many Asian countries, the question of how best to inform partners takes on new urgency for the region. 

In a recent article from Thailand, the authors wrote, "most women are tested for HIV, syphilis, and hepatitis B at first antenatal clinic visit and at third trimester" (Siriwasin W et al. HIV prevalence, risk and partner serodiscordance among pregnant women in Bangkok. JAMA 280 (1) 49-54, 1998).

They further reported that 307 HIV-positive women coming to two Bangkok hospitals and their current partners were tested for HIV. Eighty-one (26.4%) of the male partners of the 307 infected women were HIV negative, and thus benefited from learning that they were are risk of becoming infected. The HIV discordant couples (i.e., women positive and men negative) were together shorter (1.9 years) then the HIV concordant couples (i.e., both positive; 2.2 years), pointing to the importance of extended sexual contact for viral transmission.

Should public health officials in high prevalence areas of Asia promote contact tracing of spouses as another important prevention tool? Some interesting thoughts on both contact tracing and HIV reporting appeared in a recent interview of the United States Surgeon General, Dr. David Satcher (Frankel DH, Rovner J. Heading up the American dream of health. Lancet 1998; 352, 978-81, September 19, 1998).

When asked, "Do you favor reporting names and contact tracing for HIV infection?," Dr. Satcher replied "I believe that we have to move to a system of reporting HIV that would allow us to identify people as early as possible after they are infected. You see, we have come to the point in our technology, if you will, whereby it's as important to report HIV as it is to report AIDS, because the sooner we identify people and treat them, the better the prognosis. That's one thing. But also, the more likely it is that we can reduce the spread of the virus."

So what happens if treatment as defined in the United States is not available to HIV infected persons in Asia? Is the goals of "reducing the spread of the virus" which Dr. Satcher talks about sufficient important in high prevalence areas in Asia to warrant contact tracing even if expensive treatment modalities are not available?

Surgeon General Satcher goes on in the Lancet interview to opine: "So for many reasons, I think it is time for us to move forward. I agree with people who are concerned about confidentiality and about whether in fact people who are identified as being HIV positive will suffer some consequences. And therefore I think the government has to make the commitment to protect those people. We haven't done that yet, but I think that's what we have to do. We have to be willing to stand behind the programme, similar to what we have done with vaccine safety. The government set up a trust fund to protect people against vaccine injuries, and I think it's going to be just as important to protect people who have HIV."

Should contact tracing be avoided in Asia until confidentiality and anti-discrimination laws are in place that protect HIV infected persons from disclosure or harm? If so, does this mean that spouses should not be told of their partners' HIV infection until the legal system has fully responded? Dr. Satcher partially addresses the urgency for HIV detection in the concluding portion of the Lancet interview by stating, "But we [in the United States] do need HIV reporting.

People can argue on name versus other forms of identifiers. Obviously, name reporting gives us more opportunities to intervene. I think that's where we are with this epidemic. We need to be able to intervene, to help people, and to take whatever steps are necessary to minimize the risk of spread, and to get people in treatment as early as possible."

Do health officials in high-prevalence Asian countries share his goals? If so, what steps are being followed in various Asian countries to contact spouses and how successful (or unsuccessful) have such efforts been in limiting further viral spread?