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10 MMWR May 10, 2002 Providers must be alert to the possibility of new or recurrent STDs and treat such conditions aggressively. Occurrence of an STD in an HIV-infected person is an indication of highrisk behavior and should prompt referral for counseling. Because many STDs are asymptomatic, routine screening for curable STDs (e.g., syphilis, gonorrhea, and chlamydia) should be performed at least yearly for sexually active persons. More frequent screening may be appropriate depending on individual risk behaviors, the local epidemiology of STDs, and whether incident STDs are detected by screening or by the presence of symptoms. Patients should receive, or be referred for, a thorough psychosocial evaluation, including ascertainment of behavioral factors indicating risk for transmitting HIV. Patients may require referral for specific behavioral intervention (e.g., a substance abuse program), for mental health disorders (e.g., depression), or for emotional distress. They may require assistance with securing and maintaining employment and housing. Women should be counseled or appropriately referred regarding reproductive choices and contraceptive options. Patients with multiple psychosocial problems may be candidates for prevention case management (27). The following are specific recommendations for counseling and referral. Persons who test positive for HIV antibody should be counseled, either on site or through referral, about the behavioral, psychosocial, and medical implications of HIV infection. Health-care providers should be alert for medical or psychosocial conditions that require immediate attention. Providers should assess persons for immediate care and support needs and link them to services in which healthcare personnel are experienced in providing care for HIV-infected patients, including services for medical care, substance abuse, mental health disorders, emotional distress, reproductive counseling, risk-reduction counseling, and prevention management. HIV-infected persons should be referred to these services as needed and followed up to ensure that referrals have been completed. Patients should be educated about what to expect in follow-up medical care. Management of Sex Partners and Injection-Drug Partners Clinicians evaluating HIV-infected persons should collect information to determine whether any partners should be notified about possible exposure to HIV (8). When referring to persons who are infected with HIV, the term “partner” includes not o<strong>nl</strong>y sex partners but also injection-drug users who share syringes or other injection equipment. The rationale for partner notification is that the early diagnosis and treatment of HIV infection in these partners possibly reduces morbidity and provides the opportunity to encourage riskreducing behaviors. Partner notification for HIV infection must be confidential and depends on the voluntary cooperation of the patient. Two complementary notification processes, patient referral and provider referral, can be used to identify partners. With patient referral, patients directly inform their partners of their exposure to HIV infection. With provider referral, trained health department personnel locate partners on the basis of the names, descriptions, and addresses provided by the patient. During the notification process, the confidentiality of patients is protected; their names are not revealed to partners who are notified. Many state health departments provide assistance, if requested, with provider-referral partner notification. The following are specific recommendations for implementing partner-notification procedures. HIV-infected patients should be encouraged to notify their partners and to refer them for counseling and testing. If requested by the patient, health-care providers should assist in this process, either directly or by referral to health department partner-notification programs. If patients are unwilling to notify their partners, or if they cannot ensure that their partners will seek counseling, physicians or health department personnel should use confidential procedures to notify partners. Special Considerations Pregnancy Voluntary counseling and HIV testing should be offered routinely to all pregnant women as early in pregnancy as possible (20). For women who decline these services, providers should continue to strongly encourage testing and to address concerns that pose obstacles to testing. Providing pregnant women with counseling and testing is particularly important not o<strong>nl</strong>y to maintain the health of the patient, but also because interventions (antiretroviral and obstetrical) are available that can reduce perinatal transmission of HIV. Once identified as being HIV-infected, pregnant women should be informed specifically about the risk for perinatal infection. Current evidence indicates that, in the absence of antiretroviral and other interventions, 15%–25% of infants born to HIV-infected mothers will become infected with HIV; such evidence also indicates that an additional 12%–14% are infected during breastfeeding in resource-limited settings where HIV-infected women breastfeed their infants into the second
Vol. 51 / RR-6 Recommendations and Reports 11 year of life (28). However, the risk of HIV transmission can be reduced substantially to
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Ipce Newsletter E 17 I p c e N E W
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Ipce Newsletter E 17 there were onl
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Ethics and ... Ethics The guideline
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Report of the Meeting Report of the
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Report part 2 2. Presentations and
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Report part 4 this is not ethical.
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Psychiatric Association Debates Lif
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Online Sex Abuse Cases not ... [Bac
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Online Sex Abuse Cases not ... thos
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Extreme sentences demanded trips to
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Age of Consent Campaign, 1886-1914,
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Is pedophilia a mental disorder [In
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Injuries Indicative of Abuse Class
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THE MEDICO-LEGAL TECHNICAL WORKING
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TABLE OF CONTENTS Introduction 7 Ou
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OUR GOALS It is the genuine hope of
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FORENSIC EVIDENCE AND LABORATORY RE
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APPENDICES � Appendix A: Abuse Do
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CLEAR EVIDENCE OF BLUNT FORCE OR PE
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Redundant Hymen: *Abundant hymenal
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The Smoking Gun: Archive < 1 2 3 4
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African-American Women Within the W
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The Appeal of Female Moral Reform,
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