December 6, 2010
Monica Sweeney: Meeting New York City’s Need for HIV/AIDS Public Health Options
by Cristina Gonzalez
Everywhere Monica Sweeney, MD, MPH, looked—whether at schools, private practices or the community in general—she saw a need for information and medical services for people living with the virus. Now, as the director of the New York City Bureau of HIV/AIDS Prevention and Control, Sweeney addresses those needs with prevention and treatment programs to help keep Big Apple residents healthy.
What attracted you to public health and public policy?
I’ve always had a public health consciousness before I knew to call it that. This is why my job is so exciting. I get to follow my inclination and work to try and fix problems before they exist.
How did you start working in HIV and AIDS?
I started working with HIV and AIDS before there was even a name for these illnesses. At the beginning of the HIV epidemic, many clinicians did not want to treat people who were infected. But I did. I wanted to make it an issue; I wanted to educate physicians that it was their duty to help people. And so I became interested in HIV policy and human rights issues. I also became more interested in the policies and practices as I saw HIV policy enacted that really didn’t work to help protect people.
The New York City Bureau of HIV/AIDS Prevention and Control develops programs and services that address issues from prevention to treatment. Tell us about some of its programs.
The bureau is a very broad spectrum kind of agency because we handle all the issues that deal with HIV prevention, such as treatment, support services, non-medical issues that affect health services, surveillance, epidemiology reports, monitoring and evaluation of programs and using data to review programs to gauge their success. But there are a few programs I want to mention.
First, there’s the condom initiative. In my book [Condom Sense: A Guide to Sexual Survival in the New Millennium], I wrote that the male condom is the best modern, cost-effective medical invention—ever. When used correctly and consistently, condoms can prevent many conditions and diseases. If we could just get people to use those 40 million condoms that we give out [each year], we could go a long way to decrease deaths [caused by sexually transmitted infections]. The City of New York has had the foresight to provide condoms since 1971. We are making sure the public keeps condoms in their awareness, in their pockets, in their suitcases and in their backpacks. We want to remind people all the time to never leave home without it. I love our condom program.
The second is the HIV status program. We want people to get the treatment they need. We’ve administered close to 400,000 HIV tests in the Bronx in the last few years—and that’s something I’m really proud of.
Finally, there’s our medical case management program. It’s not enough to learn your HIV status. If you’re HIV positive, just knowing your status doesn’t do anything for you or the epidemic unless you can link to treatment and stay in care. We have programs to return people to care and help them overcome the barriers that keep them from continuing treatment. We want people to know that whatever their issues are, they can get into treatment.
What do you think of the National HIV/AIDS Strategy, which the White House unveiled this past summer?
The plan is a wonderful national platform from which we can spring. But I have to say that we’ve compared what we’re already doing to the national plan and many of the things in the plan are currently in effect in New York City. We have one of the largest and oldest epidemics in the United States, so we’ve been working on improving things for a long time now.
What would you say is the major health care access issue (or issues) facing the minority community today?
There is no access issue related to physical buildings and hours and services and what’s available in New York City. For example, in this state, regardless of immigration or health insurance status, women are entitled to prenatal care. But in private practice, one woman came to see me only when it was time for her to deliver her child. The only access issue is where individuals place health on their priority list. In the black and Latino communities, where there are competing interests, health does not rise to the top. And so whether you’re talking about AIDS, diabetes, prevention, or health disparities, there is no difference [in how high on people’s priority list health is]. In New York we need to define access. That may not be the case in other places, but it is here. We have to work with people so they understand what their rights are and educate them about what’s available.
When it comes to HIV and AIDS, there are special issues, such as mistrust, stigma, myths and denial. These are issues for patients and physicians. We need to open up this dialogue and have frank conversations about how to get people into care and treatment.
What is one thing you want people to know about HIV and prevention?
Last year we held a contest to redesign the NYC Condom wrapper. The winning design had a power button on it and the designer said he wanted people to know that the power to practice safer sex was in their hands. That’s an important message: It only takes one person to practice safe sex, to say, “Let’s use a condom.” And for women who can’t negotiate that, we have female condoms. I want people to know that they should not trust what people say about their HIV status. You should act as if everyone is HIV positive and protect yourself. We want New York to be the safest city in the world to have sex in. In the end, when the moment comes, the individual makes a choice and can make the decision to protect himself or herself.
Search: M. Monica Sweeney, director of the New York City Bureau of HIV/AIDS Prevention and Control, HIV policy, minority health care access
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