The risk of domestic violence and women with HIV infection: implications for partner notification, public policy, and the law.

Partner notification has emerged as an important strategy in the fight against acquired immunodeficiency syndrome (AIDS), and states have now adopted a plethora of laws that encourage or mandate notification, often without the patient's consent. As human immunodeficiency virus (HIV) infection continues to spread among women, the future development of AIDS control strategies and public health laws must be shaped by concern for the safety and autonomy of patients who face a risk of domestic violence. Three distinct recommendations flow from this premise. First, all HIV-infected women should be assessed for the risk of domestic violence and offered appropriate interventions. Second, where a risk of abuse is indicated, partners should never be notified without the patient's consent. State laws that presently permit involuntary notification should be repealed or amended. Third, laws that punish a patient's refusal to notify partners should also be modified or repealed.

Domestic violence and partner notification: implications for treatment and counseling of women with HIV.

Current public health policy encourages partner notification to protect those at risk of HIV infection. Provider experiences with partner notification, domestic violence, and women with HIV compel a reassessment of this strategy. In a survey of 136 health care providers in Baltimore, substantial numbers reported knowledge of their HIV-infected patients' experiences with domestic violence before and after partner notification. Providers believed that fear of physical abuse, emotional abuse, and abandonment are important reasons why many female patients resist partner notification. Provider opposition to partner notification was strong in cases where female patients faced a risk of domestic violence. The realization that HIV-infected women fear and experience domestic violence has broad implications for health care practice. The authors recommend changes in provider practices to insure that the risk of domestic violence is identified and addressed, and that partner notification strategies do not threaten the safety of HIV-infected women. They also highlight areas for further research on the connections among partner notification, domestic violence, and women with HIV.