Understanding attitudes, barriers and challenges in a small island nation to disease and partner notification for HIV and other sexually transmitted infections: a qualitative study

Abstract

BackgroundIn Barbados sexually transmitted infections (STIs) including HIV are not notifiable diseases and there is not a formal partner notification (PN) programme. Objectives were to understand likely attitudes, barriers, and challenges to introducing mandatory disease notification (DN) and partner notification (PN) for HIV and other STIs in a small island state.MethodsSix key informants identified study participants. Interviews were conducted, recorded, transcribed and analysed for content using standard methods.ResultsParticipants (16 males, 13 females, median age 59 years) included physicians, nurses, and representatives from governmental, youth, HIV, men’s, women’s, church, and private sector organisations.The median estimated acceptability by society of HIV/STI DN on a scale of 1 (unacceptable) to 5 (completely acceptable) was 3. Challenges included; maintaining confidentiality in a small island; public perception that confidentiality was poorly maintained; fear and stigma; testing might be deterred; reporting may not occur; enacting legislation would be difficult; and opposition by some opinion leaders.For PN, contract referral was the most acceptable method and provider referral the least. Contract referral unlike provider referral was not “a total suspension of rights” while taking into account that “people need a little gentle pressure sometimes”. Extra counselling would be needed to elicit contacts or to get patients to notify partners. Shame, stigma and discrimination in a small society may make PN unacceptable and deter testing. With patient referral procrastination may occur, and partners may react violently and not come in for care. With provider referral patients may have concerns about confidentiality including neighbours becoming suspicious if a home visit is used as the contact method. Successful contact tracing required time and effort. With contract referral people may neither inform contacts nor say that they did not.Strategies to overcome barriers to DN and PN included public education, enacting appropriate legislation to allow DN and PN, good patient counselling and maintaining confidentiality.ConclusionsThere was both concern that mandatory DN and PN would deter testing and recognition of the benefits. Public and practitioner education and enabling legislation would be necessary, and the public needed to be convinced that confidentiality would be maintained.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1794-2) contains supplementary material, which is available to authorized users.

Assisted HIV partner services training in three sub‐Saharan African countries: facilitators and barriers to sustainable approaches

“…Key topics covered in training include the core principles of aPS—elicitation of sexual partners, partner tracing and testing, and linkage‐to‐care—counselling and communication skills, managing resistance to partner notification and screening and monitoring intimate partner violence (IPV). The training curricula in these countries highlight the importance of effective communication and building rapport in a provider‐patient relationship to address client barriers to accepting aPS, including lack of trust in HCWs and fear of IPV, breaches in confidentiality and relationship dissolution . Trainees are taught the importance of maintaining confidentiality of clients’ information and how to successfully provide patient‐centred care—critical components in improving client cooperation in aPS activities.…”

Understanding Barriers to Scaling Up HIV Assisted Partner Services in Kenya

“…Mistrust in health workers and concerns about maintaining confidentiality were found to be barriers to partner notification in other settings as well. 9,13,14 If confidentiality is broken, many clients expressed a fear of stigma in the community and creating conflict in relationships. These fears are consistent with those found in other settings.…”

“…These fears are consistent with those found in other settings. [8][9][10][11][12][13] When HIV status is disclosed involuntarily, individuals have been found to experience increased perceived stigma from others. 15 To avoid fears of stigma and relationship conflicts, it is important that the client understands and trusts that confidentiality will be maintained.…”

“…Some qualitative studies in low-resource settings and in the United States have found that common barriers to HIV/sexually transmitted infection (STI) partner notification services are embarrassment, fear of relationship dissolution, fear of stigma, fear of losing financial support, and fear of violence. [8][9][10][11][12][13] Additionally, studies have found that lack of trust in healthcare workers and concerns about maintaining confidentiality pose barriers to partner notification. 9,13 This study aimed to qualitatively explore the client, community, and health system barriers to the implementation of APS in Kenya within the cluster randomized trial.…”

Addressing the First 90: A Highly Effective Partner Notification Approach Reaches Previously Undiagnosed Sexual Partners in Tanzania

“…The following methods of partner notification described in the literature are relevant to this study:With passive referral, health workers encourage index clients to notify and refer their partners for HTS on their own (simple) [12], or with an invitation card or additional information (enhanced).Under contract referral, health workers encourage index clients to refer their partners for HIV testing, with the understanding that a health worker will contact partners who do not visit the site by an agreed-upon date.With provider referral, a trained health worker locates and notifies partners immediately and directly, while maintaining the anonymity of the index client [9, 13, 14]. …”