OPDV Bulletin:
The Connections Between Two Invisible Epidemics:
HIV and Domestic Violence

Even before certain public health laws were passed in the late 1990s, the HIV/AIDS service community and the domestic violence community have been acutely aware of the toll these epidemics take on their victims. Either problem on its own can be devastating. For those affected by both HIV and domestic violence, the potential threats to health and safety are enormous. It was essential that a linkage between these two service communities be formed.

Over the last few years, OPDV and the New York State Department of Health AIDS Institute have collaborated to build a partnership between the domestic violence and HIV/AIDS communities. This has included bringing together the New York State Coalition Against Domestic Violence (NYSCADV), local HIV and domestic violence advocates, and HIV providers to discuss how to best respond to emerging policy issues.

The need for partnership was heightened when the HIV Names Reporting and Contact/Partner Notification law (Chapter 163 of the Public Health Laws of 1998) was enacted. It requires HIV health care providers to report all cases of HIV, including the names of known partners, and it mandates partner notification. However, it also includes a regulation that the provider screen for domestic violence prior to asking clients to reveal the names of partners (and to defer notifying any partner who is identified as posing a domestic violence risk for the client).

Understanding the HIV Reporting and Partner Notification Law

HIV reporting requires that doctors report the names of all persons with HIV infection, HIV illness and AIDS to the Health Department. If they know the names of sex or needle-sharing partners of the HIV-positive client, they must report those too. The Health Department uses information about the HIV/AIDS epidemic to help plan prevention services and make sure health care and support services are available.

Partner notification is conducted to let people know that they may have been exposed to HIV. When a client tests positive for HIV, the health care provider and the client will determine the best way to notify known sexual or needle-sharing partners of the client. The programs that oversee this process are the Health Department's PartNer Assistance Program (PNAP) or Contact Notification Assistance Program (CNAP in New York City). A folder with answers to some common questions about the law is available by calling the New York State AIDS Hotline: 1-800-541-AIDS in English and 1-800-233-SIDA in Spanish.

The Domestic Violence Screening Protocol: It's no surprise that people respond to being told they've been exposed to HIV in a variety of ways. If that person is a victim of abuse, he or she may be reluctant to have a current or past partner be told of possible exposure due to fear of retaliation. This potentially dangerous situation prompted the development of the domestic violence screening protocol, to be used in all HIV-positive post-test counseling sessions. This domestic violence screening must take place prior to conducting any partner notification.

The purpose of this seven-step protocol is to identify any cases in which notification of a partner could lead to physical harm or some other severe threat to the health and safety of the client or someone close to him/her, such as a child. The screening should be conducted with all patients, male or female. The core of the domestic violence screening is a simple straightforward question: "What response would you anticipate from your partner if he or she were notified of possible exposure to HIV?" If the patient identifies concerns about the partner's reaction, a series of follow-up questions would be asked, such as:

• Have you ever felt afraid of your partner?
• Has your partner ever pushed, grabbed, slapped, choked or kicked you?
• Based on what you have told me, do you think that notification of this partner will have a severe negative effect on your physical health and safety or that of your children or someone close to you?

Communication is necessary to ensure that the client's safety continues to be the priority in decisions about proceeding with HIV partner notification.

If there is a risk of any form of domestic violence, the provider should refer the client for domestic violence services and the notification may be deferred. In the event of a deferral, public health staff will follow up with the provider in 30-120 days to determine whether deferral needs to continue. If so, it is important that the domestic violence risk continue to be assessed so that partner notification can eventually take place if the situation changes or if steps can be taken to ensure the client's safety. If the risk of severe domestic violence never disappears, notification will continue to be deferred. Ultimately, the regulations leave the decision of whether to proceed with partner notification to the professional judgment of the public health officer responsible, in consultation with the physician and, if possible, with the infected individual.

The Need for Training

During the development of the HIV Reporting & Partner Notification Law, OPDV and the AIDS Institute set out to assess the training and service delivery needs of these two communities. It became clear that there were numerous complex issues that needed to be addressed. HIV health and human service providers were not, at that time, being trained on domestic violence. Since state regulations require that all conversations with individuals seeking HIV testing take place in a confidential, private and safe manner, it is an ideal opportunity to also discuss domestic violence. The HIV service provider might well be the first contact a victim of domestic violence has with someone who could point them toward help and safety.

At the same time, many domestic violence providers and advocates were not familiar with public health messages on HIV prevention and the importance of early testing and treatment, and they may not have been aware of their responsibilities regarding HIV/AIDS confidentiality. HIV-positive victims of domestic violence often did not perceive domestic violence programs as a friendly environment for people living with HIV/AIDS.

Numerous programs were developed to respond to these training needs. Training for HIV health and human service providers was expanded to include the interrelationship between domestic violence and HIV/AIDS; the integration of domestic violence screening with HIV counseling, testing and partner notification services; and domestic violence in lesbian, gay, transgender and bisexual communities. HIV clinicians also received training on screening and partner notification. Domestic violence service providers have received HIV training that was tailored to residential and non-residential service delivery. (For more information about this free training program, contact NYSCADV at (518) 432-4864.)

Lesbian, Gay, Transgender and Bisexual Victims of Domestic Violence

The needs assessment also revealed that both HIV and domestic violence service providers are concerned about their ability to respond sensitively and effectively to lesbian, gay, transgender and bisexual (LGTB) victims of domestic violence. OPDV joined forces with the NYC Gay and Lesbian Anti-Violence Project and the AIDS Institute to develop a curriculum on domestic violence in LGTB communities. This training is now offered to health and human service providers by the AIDS Institute. See page 7 for an overview of this new curriculum.

Community Awareness

These activities have served to bring awareness of HIV/AIDS to the domestic violence community and domestic violence awareness to the HIV/AIDS service community. In addition to the above-mentioned accomplishments, there have been conferences, focus groups, submissions to public health journals and local collaborations (see page 8 for a brief description of the last).

All of these steps are intended to help professionals provide, and victims obtain, the best help available. HIV/AIDS is a devastating disease that affects families and communities. So does domestic violence. This is, indeed, the beginning of coordination and collaboration to better serve the needs of both domestic violence victims and people with HIV/AIDS.

For more information:

For information about a domestic violence and HIV community coalition in your area or about the trainings described above and other free trainings offered by the AIDS Institute, please call (518) 474-9866 or visit the Department of Health web site at: www.health.state.ny.us. Click on the HIV/AIDS link. This link will also connect you with information about HIV reporting, partner notification and domestic violence screening. For an overview of the connection between domestic violence and HIV/AIDS, visit the ODPV website at:

www.opdv.state.ny.us/professionals/health/hivaids.html or call Gwen Wright at (518) 457-5916.

Note: Information for this article was provided by Sue Klein and Rachel Iverson, AIDS Institute.