Reducing the Risk of Domestic Violence against HIV-Positive Women: The Application and Efficacy of New York's Partner Notification Deferral Mandate

By Chappell, Sarah | Duke Journal of Gender Law & Policy, June 2015 | Go to article overview

Reducing the Risk of Domestic Violence against HIV-Positive Women: The Application and Efficacy of New York's Partner Notification Deferral Mandate


Chappell, Sarah, Duke Journal of Gender Law & Policy


INTRODUCTION

Domestic violence is a distressingly common problem among women living with HIV. Women with HIV are more likely to experience domestic violence, and women who experience domestic violence are at greater risk of HIV transmission. (1) HIV diagnoses interact with domestic violence in a complicated way, offering abusive partners new ways to commit acts of violence and exert control, whether by threatening to disclose their victims' status to others if they try to leave or by preventing patients from taking their medication. partner notification, although purportedly voluntary, presents unique risks for patients who are trapped in violent relationships. Although estimates of the prevalence of post-disclosure violence vary, women's stories suggest that post-disclosure violence is experienced and perceived as a real threat to safety. In querying what states can do to address the concerns of women living with HIV who are also victims of domestic violence when conducting partner notification, one possible solution is to implement a domestic violence screening and deferral policy, as enacted in New York.

This article addresses New York's attempted solution and considers various modifications to that state's particular policy. Although this article mainly focuses on New York, many of the referenced statistics and studies examine other geographic locations, and the analysis could apply to any state with some partner notification program that is not completely voluntary for all patients. This article also focuses on heterosexual relationships, with the male as the abusive partner and the female as the abused partner. The focus results not from a lack of concern for domestic violence in same-sex relationships, but due to the fact that much of the available literature focuses on opposite-sex relationships. The New York policy is not gendered, however, and much of the analysis could still apply to same-sex relationships.

In Part II, I present background information on partner notification programs and their justifications, domestic violence, and the interrelationship between HIV and domestic violence. The purpose of this section is not to make any judgment about the necessity or wisdom of partner notification programs in general. Partner notification programs have been widely adopted by states, and have been encouraged by the Centers for Disease Control and Prevention, as a public health measure; legislators and administrators clearly believe that they are effective (and cost-effective) in preventing the spread of HIV. In Part III, I conduct an interests analysis of partner notification, focusing on patients and partners in abusive relationships. I also review New York's policy of screening patients for domestic violence and granting deferrals to some of those patients and present criticisms of some aspects of the program's execution. I consider the noncompliance of many physicians and the availability of anonymous testing as alternatives to the codified deferral program. In Part IV, I recommend certain changes to New York's policy, including increased physician training and a more comprehensive "script" for domestic violence screenings. Even with these changes in place, New York's solution might not be ideal. However, absent the elimination of (involuntary) partner notification programs entirely, individuals concerned about the impact of involuntary notification on abused patients must find some way to identify and protect those patients most at risk of disclosure-related violence.

I. BACKGROUND: PARTNER NOTIFICATION, DOMESTIC VIOLENCE, AND HIV

Partner notification, also known as "contact tracing," and, more recently, as partner "services," (2) has been defined by the Centers for Disease Control and Prevention as "a process through which infected persons are interviewed to elicit information about their partners, who can then be confidentially notified of their possible exposure or potential risk. …

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