The Public Health tools we can’t afford to lose: Partner Notification and Motivational Interviewing

Looking back

The foundations of partner notification stretch back more than 150 years.

In the late 1700s and 1800s, STI’s were managed by policing and social control rather than public health. The Contagious Diseases Act (1864, 1866, 1869) targeted women in brutal ways, not the infection. Josephine Butler’s continued activism in 1883 challenged this injustice and pushed the system towards a more humane, rights-based approach.

By the early 1900s, organisations like the National Council for Combating Venereal Diseases began focusing on education and prevention. During the First World War, Colonel Harrison observed something that still holds in practice today: when patients were encouraged to inform their own partners, outcomes were far better than when the police were involved. This was the shift that was needed and moved from surveillance to collaboration.

Prior to the creation of the NHS in 1948, the UK already had a state funded sexual health service. By the end of the First World War in 1918, STI diagnosis and treatment were universally available and free at the point of use. This was one of the earliest examples of a national public health service.

The 20th century saw PN become a recognised professional practice and in 1971, contact tracers were employed in every London clinic. Training and courses on PN were introduced in 1981 and national standards were published in the DOH manual from 2004. The British Association of Sexual Health and HIV (BASHH) published its first comprehensive UK PN statement in 2012.

What began as a policing tool has evolved into a skilled, patient-centred public health intervention – and today, it’s a core part of sexual health advising practice.

Why Partner Notification still matters in 2026

Every time I talk patients through partner notification, I am reminded of how this can break the chains of infection, prevent reinfection, and protect people who may have no idea they may have been exposed to an STI. We know from evidence that PN is far more cost-effective at case-finding than screening for STIs, and that it contributes significantly to the cost-effectiveness of national screening programmes.

However, despite how effective PN is, I’ve watched its foundations slowly diminish across sexual health services through years of disinvestment, loss of sexual health adviser roles, and increasing and competing clinical pressures. This has meant that PN is no longer delivered with the consistency, skill, or protected time it requires. In some services, sexual health advisers – pivotal to PN and outbreak management – have disappeared entirely. It’s no wonder that syphilis infection is at its highest level since World War 2.

This is not a criticism of staff, but a reflection of a system that is stretched so thin that one of the most historic public health tools has been quietly ignored. Still, I am optimistically hopeful that through passion, expertise, influence, and activism PN will once again be restored to the powerful public health tool is has always been.

Motivational Interviewing and the conversations that matter

When I discovered MI, it completely changed my practice for the better. When sitting with someone who is anxious, ashamed, or overwhelmed, MI gives me a structure to help them move from those feelings and ambivalence to creating a plan to move forward. I like to think it respects autonomy, builds trust, and recognises that behavioural change doesn’t just happen because we tell people what to do. It happens because we create the conditions for them to choose it.

I’ve found that combining MI and PN conversations invaluable, as PN can sometimes be extremely emotionally charged with people worrying about blame, rejection, stigma or through worry of its impact on their relationships. Without a person-centred approach, it’s easy for these conversations to shut down or for people to disengage. Using MI allows me to explore barriers in a gentle way through open questions, affirm or validate the persons feelings, reflect through listening and summarising, guiding them towards a decision.

MI goes beyond PN and you can use it every day to support people with risk reduction, medication concordance, chemsex and recreational drug use harm reduction, contraceptive choices, and safer sex. These conversations are rarely straightforward, and I feel require patience, but MI gives me the tools to do that and to help people communicate what matters to them, identifying their own motivation and plan for change.

One of the things that helped me most when I first started using MI was the simple OARS approach (open questions, affirmations, reflections, and summaries). I don’t use it in rigid way, but having those four elements in mind gives me a steady structure to fall back on. If you’ve never used MI before, I’d genuinely encourage you to try adding even a small amount of it into your consultations. You’ll be surprised by how quickly it can transform the quality of your conversations.

Why Public Health Needs More of This

PN and MI are not skills to be used just in sexual health; they’re the tools that’s public health keeps saying it wants to prioritise. We talk a lot of prevention, early diagnosis, reducing inequalities, and supporting people to make informed choices, but these ambitions only become real through the quality of the conversations we have with people.

Sexual Health Advisers have been delivering this for decades. We’re used to working with complex scenarios, stigma, fear, and ambivalence. We’re used to helping people navigate risk, relationships, identity, and behavioural change. What MI and PN show, is that public health impact doesn’t always come from large programmes or high-tech interventions. Sometimes it comes from a single, skilled conversation that helps someone understand their risk, notify a partner, take treatment, or make a safer choice.

These moments are not often celebrated, but they change lives and protect our communities. My hope is that as public health continues to move into the future, we make and hold space for these approaches, not just in sexual health, but in wider public health.