1. Effective Prevention in HIV Care
1 minute
 Introduce yourself and the purpose of Module 3.
Goal: To enhance the providers’ ability to discuss partner services and refer to the health department for support.
“In order to meet this goal, lets review the
objectives for this module.”
Trainer Note: All slide references are included as Handout 6 in the participant packet.
Effective Prevention in HIV Care
Module 3
Partner Services (PS)
Developed by:
The National Network of STD/HIV Prevention Training Centers, in conjunction with the AIDS Education & Training Centers 
Module 3 (Slide 1)

2. Learning Objectives: Module 3
 1 minute
 This module has 3 main learning objectives
 Convey slide content
“Let’s discuss breaking the chain of infection, which is one of the primary goals of Partner Services”
Upon completion of training, providers who care for
HIV-infected persons will be able to:
Define Partner Services (PS)
Explain the providers role in PS
Describe how to refer patients for Partner Services provided by state and local Health Departments 
Module 3 (Slide 2)

3. Breaking the Chain of Infection
 1 minute
Review the related components of the ASI framework and stress that PS is another way to intervene.
 As we moved through the modules today, we have been talking about an interlocking system of strategies that can help our patients live healthier lives ,and ways to intervene to lessen the likelihood of HIV transmission
 Think of these strategies as a Venn diagram, each
component supports and enhances the other and
contributes towards HIV prevention.
 Each component requires that we: 1. make no
assumptions, 2. maintain tact and respect, 3. use
open-ended questions, 4. ask specific questions, 5.
identify and correct misconceptions, 6. tailor the
strategy (the way to intervene) and 7. routinely integrate these concepts into all clinical encounters.
The above is important as anytime another person is involved with a behavior (i.e., sex) their attitudes and beliefs impact your patient’s ability to adopt a behavior or disclose their status. Things to keep in mind are partner attitude to condom use, power imbalances in the relationship, and intimate partner violence.
 Partner Services is part of a holistic approach to
Impacting the health and prevention needs of your
patient.
“Let’s move on to discuss perceptions about PS”
Clinical
Management
Behavioral
Counseling
Partner
Services
 Slide is animated:
Initial: The circles appear 
Module 3 (Slide 3)

4. What comes to mind when you hear the term
Quick Poll
 2 minutes
 To assess the preconceived concerns participants already have about partner services.
Interactive: Ask: “What comes to mind when you hear the term partner services?”
Write participant responses on easel
Expect answers like: sex police, intrusive, big brother, helpful service, confidentiality
Reinforce positive comments and remind that most concerns can be addressed through strong collaboration with local health departments
 Review the role of the clinician:
Provide information to the patient
Participate in parts of the PS process
Refer to Health Department
“This module is designed to help you better
understand PS and your role in the process.”
What comes to mind when you hear the term
Partner Services? 
Module 3 (Slide 4)

5. What are Partner Services (PS)?
 1 minute
 Review the definition for Partner Services
 Convey slide content
 Further describe the linkages (e.g., medical care,
drug rehabilitation, housing/food resources).
Transition: “So why do we do it?” (rhetorical question  go
to next slide)
Health Department services to assist PLWH with telling their sexual and needle-sharing partner(s) about possible exposure to HIV and other STDs
Are provided by trained, professional HD staff: Disease Investigation Specialists (DIS)
Are voluntary, confidential and free
Facilitate linkages to testing and services for partners
 Slide is animated:
Initial: Only Title and Heading appear
1st – 4th Click: One bullet appears per click 
Module 3 (Slide 5)

6. Rationale for Partner Services (PS)
Partner Services has proven to be a very effective prevention strategy.
GOALS:
to identify individuals who are unaware of their HIV and other STD status
link these partners to testing, care, treatment, counseling, and other prevention resources, as needed
To interrupt disease transmission and protect community health
 1 minute
 To explain the rationale for Partner Services.
 Convey slide content
Transition: “So what is the efficacy for PS?” (rhetorical question… go to next slide)
 Slide is animated:
Initial: Only Title and Heading appear
1st – 3rd Click: One bullet appears per click 
Module 3 (Slide 6)

7. Partner Services Outcomes
Systematic literature review of studies evaluating effectiveness of PS
9 studies included
Range of 1-8 partners identified per patient
Mean of 67% of partners found, and notified of potential exposure
Mean of 63% of those notified were tested
20% of those tested were positive
Health Department Referral Option was most cost effective
 1 minute
 To describe the efficacy of PS from Hogben study.
 PS provides an opportunity to:
Identify undiagnosed HIV infections, and to offer testing and linkage to care.
In this review of 9 studies, results were consistent across all studies, showing that 20% of persons located, informed and tested through Health Department Partner Services programs were newly identified as HIV-positive.
 Reference article this slide is based on titled, “The
Effectiveness of HIV Partner Counseling and
Referral Services in Increasing Identification of HIV
Positive Individuals”. See Legend on left.
Handout 6: provides reference on slide
 Hogben et al. (2007). The effectiveness of HIV partner counseling and referral services in increasing identification of HIV-positive individuals. American Journal of Preventive Medicine, 33(2s), S89-S100. 
Hogben et al, AJPM, 2007.
Handout 6
Module 3 (Slide 7)

8. The Argument for Prevention Through Testing and Diagnosis
 1 minute
 Provide argument for prevention through testing
and diagnosis.
 These data stem from the CDC Surveillance Report published in 2011.
 This slide underscores the need and importance of PS, which identifies and links sex partners to HIV/STD testing. Here among those routed to testing, 20% with undiagnosed HIV are associated with greater than 50% of sexual transmission.
 Identifying newly infected individuals who may have impact on very high viral loads, reduce transmission by changing risk behavior and linkage to care.
This study further supports the idea that notifying, testing and diagnosing partners with undiagnosed HIV can significantly enhance the likelihood of persons accessing prevention and treatment.
Handout 6: Slide references
“So lets talk about the services the Health Department can provide to your patient.”
20% (234,000) with undiagnosed HIV are associated with >50% of sexual transmission
80% (936,000) with diagnosed HIV are more likely to access prevention and treatment
Marks et al, AIDS, 2006.; Campsmith et al, JAIDS, 2010.
CDC, HIV in the United States; [Factsheet].
 Marks et al. (2006). Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS, 20(10),
 Campsmith et al. (2010). Undiagnosed HIV prevalence among adults and adolescents in the United States at the end of Journal of Acquired Immune Deficiency Syndromes, 53(5),
 Centers for Disease Control and Prevention (CDC). HIV in the United States [Factsheet]. 
Module 3 (Slide 8)

9. For your patient’s partners:
What Health Department Partner Services Can Provide for your Patients and their Partners
 1 minute
To explain what the Health Department can do for patients and their partners
Convey slide content
If clinicians can explain PS well to patients, and how it is benefit to them, patients will be more receptive to referral.
on: “So let’s talk about the value of utilizing Health
Department staff for this service.”
For your patient:
Talk with your patients to identify partners
Discuss and determine best strategy for notification of each partner
Perform the notifications, if patient chooses
Linkage to other needed social and medical services
For your patient’s partners:
Provide access to testing, linkage to care and other prevention services, if HIV positive
Provide counseling and education for reducing behavioral risks of STD/HIV transmission
 Slide is animated:
Initial: Title and primary bullets (red text) appear
1st – 3rd Click: One sub-bullet (blue text) appears per click 
Module 3 (Slide 9)

10. How Do Patients Feel About Health Department Partner Services?
 1 minute
To show patients view PS favorably and that PS should routinely be offered to PLWHA.
 Patient’s attitudes towards HD partner services are
more positive than commonly perceived. For
example, in a recent study…(refer to the Golden et.
al paper provided as Handout 5). Convey slide content.
“While research shows that many patients may feel comfortable with the health department notifying their partners, some patients may prefer to tell their partners themselves.”
Handout 5: Printed copy of Golden study provided
Handout 6: Reference of Golden study
Seattle survey of persons w/recently reported HIV (80% MSM)
84% agreed (somewhat/strongly) the health department should routinely offer everyone diagnosed with HIV help in notifying their partners
20% would want help notifying at least one partner from the last six months
 Golden et al. (2003). Support among persons infected with HIV for routine health department contact for HIV partner notification. Journal of Acquired Immune Deficiency Syndromes, 32, 
Handout 5 & 6
Golden et al, JAIDS , 2003.
Module 3 (Slide 10)

11. Partner Services Benefits and Common Concerns
3 minutes
To brainstorm and discuss benefits and common
concerns regarding PS for patients and clinicians.
active: Ask: “What are the benefits and concerns of
clinicians and patients regarding PS?”
Listen to comments only
Click to reveal slide text
Remember to address the specific concerns elicited during brainstorm that are not in the table (some may be covered by local PS representative or could be tabled until then).
 Health Department PS programs are designed to
identify and respond to these concerns.
 The success of the outcome of PS, especially the
degree to which a patient participates in the
service, is based on how well a clinician presents
the benefits of the service, including Health
Department referral.
Common concerns: Health department PS programs are designed to minimize and respond to these concerns. As we move through this module we will also address all of these concerns.
“We know that legal issues are a large concern and
act as a large barrier to providing PS for some
clinicians; so now we are going to have a brief
discussion on legal issues.” 
Benefits to patient
Help with disclosure to partner(s)
Fulfills ethical desires for patient
Benefits to clinician
Fulfills public health and ethical concerns
Can be performed by non-clinical staff
Common Concerns
Confidentiality
Potential for intimate partner violence
Time involved
Unclear legal expectations
 Slide is animated:
Initial: Only column headings are listed
1st Click: ALL bullets appear 
Module 3 (Slide 11)

12. A brief overview related to
1 minute
Transition: Transitional slide: “Many clinicians have concerns
surrounding PS and the law - - this section will
highlight the clinician’s role regarding the law. Because reporting requirements and other
expectations vary by area, _(guest speaker)_
from the _(program name)___ is here to talk
about laws and other aspects of the _(state or
local area)__ program that may be important to
you.”
Laws and Regulations
A brief overview related to
informing partners 
Module 3 (Slide 12)

13. Becoming Familiar with Local Reporting Requirements
 2 minute
To acknowledge differences in reporting requirements and direct participants to where they can find support. (can be covered by local HD expert or module 3 trainer)
Reporting requirements for STD and HIV vary from state to state. Diseases that are reportable in every state are: Syphilis, Gonorrhea, Chlamydia, AIDS, HIV. Chancroid is reportable in many states. In most states, both labs and providers are required to report.
Requirements regarding HOW (i.e. electronic, fax, mail), WHEN (within x-number of days), WHAT demographic and clinical information (lab results) to report vary from state to state. Consult with your local STD/HIV program to learn the requirements for your jurisdiction. Most states require both provider and lab reporting of these indicators. CDC, CSTE publish surveillance case definition that guides what needs to be reported.
Some states have laws regarding a patient’s duty to inform partners of HIV, and/or require clinician’s to make a good faith effort to notify partners. This usually means the clinician will:
1. Tell patients about the need to notify partners
2. Discuss PS with patients
3. Refer patients to the HD PS
4. Document what was done in the record.
Handout 1: NASTAD/NCSD websites for state and local HIV/STD program contacts to inquire about reportable diseases in your state and how to report.
“Lets now talk about local reporting
requirements.”
STD/HIV requirements for reporting differ by state
Consult with state STD/HIV program and policy offices
Some areas also have laws and regulations about duty to inform partners of their exposure to HIV 
Handout 1
Module 3 (Slide 13)

14. Local Reporting Requirements & PS Program Guidelines
10 minutes
 To provide a local perspective on PS
A local health department guest speaker uses these 10 minutes to discuss the local approach to the issues listed on this slide . If the case example in this module is not applicable to the local area for the training, it is recommended that the local HD expert provide a real life case scenario of PS in action. If this is done, then the case scenario can be skipped later in the module.
 While going through each bullet, give the
information pertinent to your region.
 Most program areas will concentrate on discussing
partners within the last 1 year when
considering time frame of exposure, unless
otherwise requested by the patient or as local/state
policy dictates.
Transition:
“Let’s turn our attention to ways in which PS can help patients to notify their partners”
Laws specific to clinicians
How Health Department staff coordinate with clinicians to provide PS
Protecting confidentiality/data security systems
Time frame for PS
Reporting of names/demographics to other agencies
Referrals from other jurisdictions for partner services
Spousal Referral
 REMINDER: Thank local speaker and ask him/her to remain available to help the group at the end of the presentation for further individual discussion. 
Module 3 (Slide 14)

15. 5 Partner Referral Options: At-A-Glance
 1 minute
 To provide a quick overview of the 5 options
 Summary of chart: “Health Department can do it, you can do it, you can try it and if doesn't
work out then the Health Department can do it., or you can do it together with a Health Department staff person”
 This module will outline in detail the Health Department referral option. It is important that the patient understands that despite what referral option they may choose, the Health Department is a resource and will provide support.
Handout:
Handout 3: Defining the 5 PS Options
Handout 6: Slide reference for MMWR on PS
Recommendations
Transition: “Let’s look at the individual dynamics and
mechanics of the Health Department Referral option.”
Type of Options
Who notifies and refers this partner?
1) Health Department Referral
Trained Health Department staff (DIS)
2) Patient Referral
Patient with coaching from Health Department staff
3) Contract Referral
Patient makes initial attempt; if unsuccessful, Health Department staff conducts referral
4) Dual Referral
Patient agrees to disclose HIV status with Health Department staff present
5) Third-Party Referral
Providers other than health department, who are trained in Partner Services
 Centers for Disease Control and Prevention (CDC). (2008). Recommendations for Partner Service Programs for HIV infection, Syphilis, Gonorrhea, and Chlamydial Infection. MMWR, 57(#RR-9), 1-92. 
Handout 3 & 6
Recommendations for Partner Services Programs for HIV Infection, Syphilis, Gonorrhea, and Chlamydial Infection, MMWR, Oct 2008
Module 3 (Slide 15)

16. The Provider’s Role: Referring to Partner Services
 1 minute
To present the providers’s role in referring patients for PS
 Convey slide content, this module will cover how to explain Health Department Referral process to your patients
 Stress the ongoing nature of partner service needs. There may be new partners, or a change in the readiness to notify partners.
 It is anticipated that participants may raise questions regarding how to handle “willful exposure”, especially in regards to discussions around partners as part of ongoing care.
Consult local Health Department personnel regarding local regulations and practices
Handout 1: Provides a web-based link to the National Alliance of State and Territorial AIDS Directors (NASTAD), which can provide guidance to individual states related to: state laws, regulations and statutes concerning PS, and issues such as ‘willful exposure.’
As web sites may not always be up to date, rely on your official state and local agencies to provide you with the most accurate information.
 There may be limitations depending on local Health Department capacity and resources.
Transition:
At initial visit, ask all patients whether their sex and needle-sharing partners have been informed of exposure to HIV
Briefly explain Health Department PS, and refer all appropriate patients
At follow-up visits, routinely ask patients about new partners who have not been informed of exposure to HIV
Also ask patients whether Health Department has contacted them to discuss PS
 Slide is animated:
Initial: Title and 3 bullets appear
1st Click: “Refer all patients to Partner Services” appears
 Centers for Disease Control and Prevention (CDC). (2003). Incorporating HIV prevention into the medical care of persons living with HIV: Recommendations of CDC, the Health Resources and Services Administration, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR, 52(#RR-12), 1-24. 
CDC, MMWR , 2003.
Module 3 (Slide 16)

17. How to Bring Up the Subject of Partners
 1 minute
 To discuss different ways to bring up the subjects
of partners with patients
 There are many ways to bring up the subject of
partners, this is just one example.
 The subject of partners should not be a one-time
occurrence, but should be a routine part of a
patient’s care where the subject is brought up at
various points of care.
 Keep it simple.
 Make it a routine standard of care.
 Normalizing statement: “I ask all of my patients
about their partners…”
Handout: Handout 2: Sample Transitional Phrases for the
Provider to use when bringing up the subject of
PS. Encourage providers to review and find the
statement they like best.
Transition: “Now lets talk about the Health Department staff known as DIS and what the Health Department referral will be like for your patient.”
“Now that we’ve talked about ways to keep you healthy, let’s talk about ways to keep your partner(s) healthy. How do you feel about telling your partner(s) they’ve been exposed to HIV?” 
Handout 2
Module 3 (Slide 17)

18. Who are DIS, and What Do They Do?
 1 minute
 To explain the role of DIS
 Convey slide content
 The expertise of staff, assurance of confidentiality,
and that it is fast, helps assure linkages to services.
Advantage to patient and clinician – notification is handled quickly and sensitively by experts
Handout:
Handout 4: How Health Department Personnel
Protect Confidentiality
Transition:
Trained and experienced staff who provide PS and other counseling services for persons with HIV and STD, and their partners, in both field and clinic settings
DIS training includes strong emphasis on confidentiality
No information about your patient is ever given to the partner
Rapid notification is the goal (usually hours)
Trained to handle intimate partner violence and difficult relationship situations
Relieves you and your staff of those duties 
Handout 4
Module 3 (Slide 18)

19. Explaining PS to Patients
“The health department has special staff who can help you decide about the best way to let your partners know that they need an HIV test.”
Clarify misconceptions
Free and confidential
If patient is hesitant: “I think I can tell them all myself”
Explain that DIS can help practice how to do this
Check in at next visit
 1 minute
To demonstrate how the provider can explain PS to the patient when Health Department referrals are made.
Convey slide content
When explaining the Health Department referral to patients it is important to clarify any misconceptions they may have about these services and stress the free and confidential aspects that we have just discussed.
Acknowledge that use of these services may be difficult for the patient since it is the first step towards what could be their first disclosure experience. If the patient prefers to tell their partner themselves, let them know that DIS can help them practice disclosure if they would like that service.
Be sure to check in with the patient at the next visit regardless of the option chosen. This will help the patient understand the importance of disclosure and ensure they have the support needed.
Handout 2: Sample Transitional Phrases for talking to your patient about PS referral
“So what does it look like when the Health
Department performs this service for you and your
patients?” (rhetorical question  go to next slide) 
Handout 2
Module 3 (Slide 19)

20. Partner Services: Trained DIS in Action
 2 minutes
 Here’s a short video clip of a specially trained
DIS locating a potentially exposed partner
 Emphasize that this is a demonstration of
confirming a partner’s identity.
 Preface the video clip by stating “I want you to focus on the content of the video and the words and
actions taken by the DIS to confirm she is
speaking with the correct person. I recognize the
setting may not seem realistic, but the process
remains the same.”
Video cli: Play video clip
 The PS provider always checks descriptive
information prior to approaching a partner as
another way of confirming the partner’s identity.
Transition: “Clinicians are often concerned, or at least need
to know what to tell their patients, about how the
health department conducts a partner
notification.” .
Clinicians often ask how DIS notify partners
Video demonstration of a Health Department DIS confirming the identity of a partner
 To run the video:
Double click on the speaker icon in the lower right hand corner to begin the video.
Once the video ends, click the slide to continue the slide presentation.
 Set-up is required prior to the presentation:
Before the presentation, you will need to save both the PowerPoint presentations and the separate MPEG files (the video files) on the hard drive of the computer you will be using in order to have the video run correctly.
Test this out prior to the training.
 Video Clip is from the CDC’s HIV PS Training video dated May 2000
Module 3 (Slide 20)

21. Partner Services: Trained DIS in Action
 2 minutes
 Here’s a short video clip of a specially trained
DIS notifying a potentially exposed partner
 DIS will:
Ensure they are talking to the right person
Identify self
Secure private area to talk
Deliver message
Answer questions/provide business card
Video Clip: Play video clip
 This was also the manner in which those involved
with the real life case were notified of their exposure
to HIV.
PS works most effectively when trained, experienced HD DIS provide this service.
Transition: “Now that you have we have gone through what the Health Department can do, seen the DIS in action, lets review the core messages to provide to patients. ”
Video demonstration of a DIS notifying a partner of her exposure to HIV
 To run the video:
Double click on the speaker icon in the lower right hand corner to begin the video.
Once the video ends, click the slide to continue the slide presentation.
 Set-up is required prior to the presentation:
Before the presentation, you will need to save both the PowerPoint presentations and the separate MPEG files (the video files) on the hard drive of the computer you will be using in order to have the video run correctly.
Test this out prior to the training.
 Video Clip is from the CDC’s HIV PS Training video dated May 2000
Module 3 (Slide 21)

22. Core Messages for Patients
 1 minute
To describe the main points of PS from a patient’s perspectives
Convey slide content
Transition: “Using the information presented so far as well as the information the local speaker gave you, we are going to ask you to take a few moments to practice bringing up the topic of partners with a patient, describing partner referral options and discussing the value of linking with the Health Department.”
Partner Services is a Health Department program
Helps patients decide how to inform partners of possible exposure to HIV
Provides a trained DIS who can notify partners without ever mentioning the original patient’s name or other identifying information
PS is a confidential service that a person elects to use
This is a free and ongoing service that can be accessed at any time 
Module 3 (Slide 22)

23. Skills Practice
GOAL: To enhance comfort with bringing up the subject of partners, and discussing the value of using the health department PS to notify partners
Use 5 minutes to practice bringing up the subject of partners, and discussing how the health department can help your patient
Then stop, switch roles, and take an additional 5 minutes to practice
15 minutes (total)
 To practice bringing up the subject of partners,
describing partner referral options and discussing
the value of using the health department to notify
partners and provide linkages to care and other
services.
 Convey slide content
Practice with colleague – 10 minutes
Group debrief – 5 minutes
Module 3 Skills Practice
Pair up with a colleague (you can have participants count off 1 and 2).
Take a moment to review the Skills Practice handout (tell the “ones” they are the patient first and the “twos” they are the provider, and then when you call time they will switch roles).
Take 5 minutes to practice bringing up the subject of partners, and discussing how the health department can help your patient.
Then stop, switch roles and take another 5 minutes to practice.
Participants can use the ASI provider card provided in Module 1 as Handout 3 for this practice.
 Present this slide for the duration of the skills practice 
Module 3 (Slide 23)

24. Skills Practice: Group Processing
15 minutes (total)
 To debrief the skills practice, have
participants share their experiences as both
the provider and the patient.
 Use the following questions to debrief with the
group, convey slide content.
 The CDC Fact Sheet about Partner Services is a
great place to refer participants for further
suggestions or assistance that may come up as
you discuss the “sticking points.”
NOTE: The next 3 slides are optional and are hidden if you local PS expert provided a case study more relevant to that local jurisdiction you do not need to cover. It is recommended that you always include a case study in the module 3 either this one, or one provided by local PS expert. You must un-hide them to view.
What were the “sticking points”?
Were there any questions posed by the “patient” which were a challenge to answer?
CDC Fact Sheet for PS:
 Present this slide to facilitate discussion of the skills exercise. 
Module 3 (Slide 24)

25. PS In Action: “Real Life”
THE NEXT 3 SLIDES ARE OPTIONAL
 1 minute
 The purpose of these next 3 slides is to demonstrate how PS can effectively work as a service.
 It shows how 2 different jurisdictions and staff coordinated efforts to find partners and how those partners were affected.
 It also exemplifies how PS is offered to the original male patient a year later at an EIP session and that others were named.
 Unfortunately, these slides address the fact that not all partners are always found.
 This is a true story. Names will not be mentioned.
STORY:
A 22 year-old, heterosexual male elects to test for HIV in a correctional setting. His reason for incarceration was violation of drug probation. (He did not shoot drugs). When he tested positive, a local health department worker was dispatched to the prison to provide PS to the inmate. The time frame used with this patient was 2-3 years back because he had already been incarcerated for 1 year. He wanted the worker to notify 3 female partners. 1 female was never found, however the other 2 women were both found in the same city.
A 22 year-old male tests HIV-positive in a correctional setting
PS is offered and he names 3 women
Two partners were notified (a 19 year-old, and a 20 year-old)
Third partner was “un-locatable”
Both elected to test for HIV & both were positive
 Facilitator should be very familiar with the story 
Module 3 (Slide 25)

26. “Real Life” - The Partners
OPTIONAL SLIDE
 2 minutes
 To demonstrate how PS can effectively work as a service
 Continuation of STORY:
 The first partner to be located was his 19 year-old, steady sex partner. This young woman was about to enter nursing school and had come from a very religious family background. She was found at her place of work and was spoken to in a private area away from her co-workers. She found it very difficult to believe she had been exposed to HIV. When she did test for HIV, she was found to be infected. Again, she refused to believe the test result and tested 3 additional times. Each time the same result. She was extremely bitter and angry at her situation because she had only had sex with 1 man in her life and knew her source of infection. She had no other risk factors- no drug use. This woman was offered PS and named back the original patient. She also chose to enter the Early Intervention Program. In the end, after his release from prison, she reunited with the man who had infected her.
 The 20 year-old partner, at the time of being notified of her possible exposure to HIV, was on her way to college in the Midwest. She was indignant about her lack of risk stating that she did not have sex with men, only women. This woman agreed to take an HIV test and was infected. At the time of receiving this news, PS was offered. She elected to use the service and in fact opted for a Dual Referral of her steady, female partner. The partner was waiting in the lobby and was brought in to a private room with the worker and infected patient. The patient told the partner of her positive status in the presence of the worker and the worker supported the patient by answering medical questions only. The female partner was tested and was negative. The 2 women stayed together and moved to the Midwest so the one could start college as planned. The 20 year-old woman entered college and returned annually to the EIP clinic in her home state for care, because she did not want anyone to find out about her health status. She made this annual visit for 3 years.
The 19 year-old
Named the original patient and said he was her only lifetime partner
She entered an Early Intervention Program
No risk factors other than unprotected sex
The 20 year-old
She was leaving the area to attend college when she received her positive test result
Notified her female partner in the presence of PS provider (Dual Partner Management Option)
She also entered EIP and returned annually for care
 Facilitator should be very familiar with the story 
Module 3 (Slide 26)

27. “Real Life”- Back to the 22 Year-Old Male Patient
OPTIONAL SLIDE
 1 minute
 To demonstrate how PS can effectively work as a service
 Continuation of STORY:
So what about the man who was originally spoken to? Well, when he was released, his steady girlfriend (the 19 year-old woman) notified the health department worker so the worker could go to this man and let him know he had been exposed to HIV. No names or other identifying information was given to him. The worker already knew his status, but could not tell the partner or him that she (the worker) possessed this information. When this man was notified, he told the worker he was already infected. Subsequently, he was offered PS. He was linked to medical care and he and the 19 year-old steady girlfriend went to the EIP clinic routinely together. At the EIP clinic, he was asked about any new partners since he had been released, he named an additional 3 partners. 1 of those 3 partners was a 16 year-old girl who had given birth to his child. She was unable to be located. The status of the other 2 partners is unknown.
Summarize the real life story outcomes and highlight the efficacy of PS
 Stress the ongoing nature of PS services to address the
changing needs and life circumstances of patients.
 Acknowledge the limitations and challenges of PS (i.e.,
not finding all partners) to support the value of all options
to notify as many partners as possible.
 Also that even with the best of efforts we are not going to
be 100% successful in preventing new infections.
Combining good, effective risk-reduction counseling with
all PS efforts and partner discussions will add value to
our services.
Transition: “So we have seen how PS can work, but what laws and regulations did the PS providers in this example need to be familiar with?”
After being released from prison, he names 3 additional partners at an EIP session
1 of the 3 new partners was a 16 year-old girl who had recently given birth to his child
PS providers were unable to locate these 3 partners
In Summary
Confidentiality was maintained for all patients and their partners
Multiple jurisdictions were involved
2 of the 3 initial partners for the male were found and neither would otherwise have suspected they were infected
 Facilitator should be very familiar with the story 
Module 3 (Slide 27)

28. What is one thing you will change in your practice…?
 1 minute
 To interact with the group about lessons learned from this module
Interactive: Briefly survey group: Ask “What is one thing you will change in your practice?”
What is one thing you will change in your practice…?
Slide is animated:
Initial: Blank
1st Click: Words appear 
Module 3 (Slide 28)

29. ASK SCREEN INTERVENE PARTNER SERVICES BRIEF BEHAVIORAL INTERVENTIONS
 1 minute
 To remind participants this is a multi-module course
and to illustrate topics to be covered in subsequent
modules
 Mention topics to be covered in upcoming (and
previous) modules:
Module 1: Risk Screening and STD Screening
The rationale of implementing this curriculum is based on emerging trends and current national prevention efforts.
Give ways to overcome existing barriers to risk screening and assessment.
Provide examples of risk assessment techniques that enhance the type of information gathered.
List the benefits, types of tests, when and where of STD screening.
Module 2: Prevention Interventions
Prevention messages can help guide patients toward safer behavioral goals.
Misconceptions of patients can be identified and addressed.
Brief behavioral prevention interventions/ Brief risk reduction counseling.
Module 3: Partner Services
Describe local laws and regulations relevant to partner notification and disclosure.
Multiple disclosure options exist.
Bring up partner disclosure with all patients.
BRIEF BEHAVIORAL INTERVENTIONS
ADDRESSING
MISCONCEPTIONS
PREVENTION MESSAGES
STD SCREENING
RISK SCREENING 
Module 3 (Slide 29)