Moving Clients from

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Moving Clients fromKiss and Tell to Tell and
KissSupporting Conversations Around Patient
Self Disclosure of HIV or STD StatusGreg
Mehlhaff, BS, Assistant DirectorLinda DeSantis,
M.Ed., Behavioral Training CoordinatorAlice
Gandelman, MPH, Director
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CA STD/HIV Prevention Training Center (CA PTC)

• www.stdhivtraining.org

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Supporting Self Disclosure of HIV/STD Status

• Another option for STD partner management
• Course developed to enhance provider skill
• Address complex issues around disclosure
• Many patients need skills and assistance
• Similar issues with patients infected with HIV
  and other STDs
• HIV/STD co-infection

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Missed Opportunities?

• Sex partners 3-named, 7-known, but refused to
  name.
• Sex partners 1-named, 1-marginal, 4-known, but
  declined to name.
• Reported 2 sexual partners (declined to release
  locating information)
• Sex partners 2-named, 23-known, but declined to
  name.
• Reported 4 sex partners during the interview
  period (declined to name)

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Rationale

• Important prevention intervention for persons
  living with HIV/STD
• Most infected persons want to prevent
  transmission to others
• Many want to disclose their HIV serostatus
• Many want to talk to their providers about
  disclosure issues
• 75 choose to self disclose their HIV status to
  partners (CA PCRS data)

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Disclosure Activity
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Challenging Clients/Patients

• Resistant to giving partner names
• Distrustful of Public Health
• Anonymous partners
• Internet partners/CSV partners
• Only one partner (steady, spouse)
• May have substance use or mental health issues
• Concerns about confidentiality
• Personal safety/fear of violence

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Missed Opportunities!

• Sex partners 3-named, 7-known, but refused to
  name.
• Sex partners 1-named, 1-marginal, 4-known, but
  declined to name.
• Reported 2 sexual partners (declined to release
  locating information)
• Sex partners 2-named, 23-known, but declined to
  name.
• Reported 4 sex partners during the interview
  period (declined to name)

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The Model

• 4-Step model to facilitate positive disclosure
  outcome
• 1) Transition from topic at hand to self
  disclosure
• 2) Discuss whom the client is considering telling
• explore concerns, benefits, confidentiality,
  other things client might also be disclosing
• 3) Coach client regarding a specific disclosure
• anticipated reaction of person being disclosed to
  (DV)
• offer opportunity to practice (what s/he will
  say)
• provide appropriate referrals
• 4)Summarize discussion

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Self Disclosure in Syphilis Partner Management?

• Potential disadvantages
• Difficult to document notification
• May take more time to Tx partners
• Uncertainty that patient will follow through
• Patient may not be clear about disease or action
  to take
• Potential advantages
• Might be most acceptable option for patient
• More effective with email notifications
• Anonymous partners may be seen again in same
  setting
• May be able to maintain primary relationship
• Use fewer program resources
• Dual disease disclosure (Syphilis/HIV)

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Conclusions

• May prevent or address missed opportunities
• Less emphasis on how to effectively disclose, or
  of potential consequences of disclosure
• Developed training to increase providers comfort
  and skill level to effectively discuss HIV/STD
  disclosure issues with their clients/patients
• Discussion of HIV/STD status can be very risky
  for clients/patients and providers

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Contacts

• Linda DeSantis, M.Ed., Behavioral Training
  Coordinator
• CA STD/HIV Prevention Training Center
• CA DHS/STD Control Branch
• 510-883-6661
• ldesanti_at_dhs.ca.gov
• Greg Mehlhaff, BS, Assistant Director
• CA STD/HIV Prevention Training Center
• CA DHS/STD Control Branch
• 510-883-6649
• gmehlhaf_at_dhs.ca.gov
• Alice Gandelman, MPH, Chief Disease Prevention
  Section
• Director, CA STD/HIV Prevention Training Center
• STD Control Branch
• 1947 Center Street, Suite 201
• Berkeley, CA  94704
• ph [phone], fax [phone]
• agandelm_at_dhs.ca.gov