Academic journal article Journal of Research Administration

Protecting the Privacy, Confidentiality, Relationships, and Medical Safety of Sex Partners in Partner Notification and Management Studies

Academic journal article Journal of Research Administration

Protecting the Privacy, Confidentiality, Relationships, and Medical Safety of Sex Partners in Partner Notification and Management Studies

Article excerpt

Abstract

The practice of partner notification and management is an important public health strategy in the control of sexually transmitted diseases. There are, however, concerns related to the ethical principle of beneficence about the potential for unintended negative consequences in scientific studies of new strategies for partner notification and management. These concerns include threats to privacy and confidentiality, the potential for breakdown in relationships, and side effects of medications provided for the treatment of sex partners. We conducted computerized and manual searches and reviewed the 10 most recent published articles on studies of partner notification and management. Procedures that can be used to protect participants and their partners include a truly informed consent and authorization process, use of stringent procedures for handling study data, training clinical and research staff members and study participants, and using appropriate wording and delivery modes to reach and inform the partners. We discuss the need for a forum to exchange information on ethical considerations, reflect on the conduct of scientific studies for new strategies of public health practice, and highlight the interactions between ethical considerations and generalizability of study results. Our aim is to enhance the compatibility of scientific goals, public health practice, and ethical principles.

Introduction

The practice of partner notification and management, also known as contact tracing or partner services, continues to be an important public health strategy in the control of infectious diseases, including such well-known infections as sexually transmitted diseases (STDs) and HIV and including such emerging infections as severe acute respiratory syndrome (SARS) and monkey pox. Health officials in the United States have been using the public health practice of notifying and treating sex partners as an important intervention to control the spread of syphilis, gonorrhea, and chlamydia (Centers for Disease Control and Prevention, 2001a). To reduce the rates of transmission of and re-infection with these bacterial STDs, it is important not only to treat the patient (also referred to as the index case) who is seeking care with effective antibiotics but also to provide medical evaluation and treatment to the sex partners (Centers for Disease Control and Prevention, 2002; Rothenberg & Potterat, 1999). Partner notification and management is also becoming an increasingly important strategy in the control of HIV infection, especially in the new era of highly effective therapy (Centers for Disease Control and Prevention, 2003a).

Concomitant with the public health practice of partner notification and management, investigators have conducted scientific studies to assess current practices of partner notification and management and to develop and evaluate new strategies (Martich, St. Lawrence, Hall, & Hartsfield, 2002). While public health practice is governed by public health law as stipulated in state laws and by the professional code of conduct for health care providers, investigators conducting scientific studies are governed by the federal regulations for the protection of human subjects (Gostin, 2000; Centers for Disease Control and Prevention, 2001b; Institute of Medicine, 2001). As required by the federal regulations (also known as the Common Rule), members of institutional review boards (IRBs) review and approve study protocols prior to execution of studies to ensure that rigorous procedures are in place to protect the rights and welfare of study participants (OPRR Reports, 1991). While study procedures are presented in great detail in study protocols, they are described very briefly in published articles. The rigorous debates and discussions that develop between investigators and IRBs are rarely summarized in published articles. As a result, the community of investigators and IRB members do not have the benefit of a cumulative source of information that highlights the ethical concerns raised and the procedures implemented to protect the rights and welfare of study participants. …

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