Monica Sweeney

New York City Department of Health and Mental Hygiene, New York, United States

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Publications (11)26.48 Total impact

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    ABSTRACT: Unemployment is widespread among persons living with HIV (PLWH) who access publicly-funded service programs. Survival and quality-of-life gains due to effective antiretroviral regimens place more PLWH in a position to join/re-join the workforce. Using client data reported by New York City (NYC) Ryan White HIV service providers, we assessed baseline characteristics associated with current employment status. For 16,358 HIV-positive NYC Ryan White clients served in 2012, we examined employment status as of January 2013 against baseline measures for gender, age, race/ethnicity, birth country, education, marital status, housing status, CD4 count and viral load (VL). We constructed multivariate logistic regression models to identify predictors of employment. The sample at baseline was largely male (64%), >45 years old (61%), black or Hispanic (86%), US-born (60%), ≤high school-educated (73%), never married (39%), and stably housed (62%). Of those reporting clinical data, 58% had VL ≤400 and 59% had CD4 count ≥350. As of January 2013, employment status was full- or part-time for 1,979 (12%); "out of workforce" for 1,985 (12%); "unpaid volunteer" for 143 (1%); unemployed for 9,607 (59%); and missing/declined for 2,644 (16%). In multivariate logistic regression, modifiable factors associated with lack of employment included unstable housing (AOR: 3.76, CI=3.03-4.66), VL >400 (AOR: 1.14, CI=1.01-1.29) and CD4 <350 (AOR: 1.18, CI=1.04-1.33). Client baseline characteristics, including housing and clinical status, predicted employment. In a context of improved health outcomes, limited resources and healthcare systems change, it is important to understand subgroup differences in employment, and shape programs supporting employment and self-sufficiency among PLWH.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Understanding prior knowledge and experience with pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) is critical to its implementation. In fall 2011, NYC MSM were recruited via banner advertisements on six popular dating websites and asked questions about their knowledge and use of PrEP (n = 329). Overall, 123 (38 %) respondents reported knowledge of PrEP, of whom two (1.5 %) reported PrEP use in the past 6 months. Knowledge of PrEP was associated with high educational attainment, gay identity and recent HIV testing, suggesting an uneven dissemination of information about PrEP and missed opportunities for education. To avoid disparities in use during scale-up, MSM should be provided with additional information about PrEP.
    AIDS and Behavior 03/2013; · 3.49 Impact Factor
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    ABSTRACT: New York City (NYC) remains an epicenter of the HIV epidemic in the United States. Given the variety of evidence-based HIV prevention strategies available and the significant resources required to implement each of them, comparative studies are needed to identify how to maximize the number of HIV cases prevented most economically. A new model of HIV disease transmission was developed integrating information from a previously validated micro-simulation HIV disease progression model. Specification and parameterization of the model and its inputs, including the intervention portfolio, intervention effects and costs were conducted through a collaborative process between the academic modeling team and the NYC Department of Health and Mental Hygiene. The model projects the impact of different prevention strategies, or portfolios of prevention strategies, on the HIV epidemic in NYC. Ten unique interventions were able to provide a prevention benefit at an annual program cost of less than $360,000, the threshold for consideration as a cost-saving intervention (because of offsets by future HIV treatment costs averted). An optimized portfolio of these specific interventions could result in up to a 34% reduction in new HIV infections over the next 20 years. The cost-per-infection averted of the portfolio was estimated to be $106,378; the total cost was in excess of $2 billion (over the 20 year period, or approximately $100 million per year, on average). The cost-savings of prevented infections was estimated at more than $5 billion (or approximately $250 million per year, on average). Optimal implementation of a portfolio of evidence-based interventions can have a substantial, favorable impact on the ongoing HIV epidemic in NYC and provide future cost-saving despite significant initial costs.
    PLoS ONE 01/2013; 8(9):e73269. · 3.53 Impact Factor
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    ABSTRACT: Background: In 2006, the Centers for Disease Control and Prevention (CDC) recommended routine HIV screening for individuals aged 13-64 years in healthcare settings. Testing for persons aged ≥65 is encouraged with identifiable risk. In New York City (NYC), residents aged ≥65 accounted for 2% of new HIV diagnoses in 2010. However, 47% of them were diagnosed late in the course of infection, more than double the general NYC population (22%). We reviewed data from a 2011 survey on NYC residents' HIV testing behavior to assess the impact of CDC recommendations on older residents. Methods: A random telephone survey of NYC adults was conducted from June-August 2011. The survey collected information on demographics, HIV testing behavior, healthcare use, and sexual risk behavior. Results: Overall, 2,473 NYC residents completed the survey; 619 (25%) were aged ≥65 years, with 322 (13%) aged 65-74. Among those 65-74 years, 34% had sex within the last 12 months and 58% were never tested for HIV. Of those never tested, 93% saw a healthcare provider in the prior 12 months. Only 3% of them were offered an HIV test at their last healthcare visit, although 77% of respondents aged 65-74 said they would test on their healthcare provider's recommendation. Conclusions: Survey data from NYC residents aged 65-74 years suggest missed opportunities for HIV screening and case finding. Expansion of CDC recommendations to include those aged 65-74 could increase the number of older NYC residents tested by an estimated 214,000 and decrease late HIV diagnoses among this population.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
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    ABSTRACT: To describe the population of men who have sex with men (MSM) in New York City, compare their demographics, risk behaviors, and new HIV and primary and secondary (P&S) syphilis rates with those of men who have sex with women (MSW), and examine trends in infection rates among MSM. Population denominators and demographic and behavioral data were obtained from population-based surveys during 2005-2008. Numbers of new HIV and P&S syphilis diagnoses were extracted from city-wide disease surveillance registries. We calculated overall, age-specific and race/ethnicity-specific case rates and rate ratios for MSM and MSW and analyzed trends in MSM rates by age and race/ethnicity. The average prevalence of male same-sex behavior during 2005-2008 (5.0%; 95% CI: 4.5 to 5.6) differed by both age and race/ethnicity (2.3% among non-Hispanic black men; 7.4% among non-Hispanic white men). Compared with MSW, MSM differed significantly on all demographics and reported a higher prevalence of condom use at last sex (62.9% vs. 38.3%) and of past-year HIV testing (53.6% vs. 27.2%) but also more past-year sex partners. MSM HIV and P&S syphilis rates were 2526.9/100,000 and 707.0/100,000, each of which was over 140 times MSW rates. Rates were highest among young and black MSM. Over 4 years, HIV rates more than doubled and P&S syphilis rates increased 6-fold among 18-year-old to 29-year-old MSM. The substantial population of MSM in New York City is at high risk for acquisition of sexually transmitted infections given high rates of newly diagnosed infections and ongoing risk behaviors. Intensified and innovative efforts to implement and evaluate prevention programs are required.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 08/2011; 58(4):408-16. · 4.65 Impact Factor
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    ABSTRACT: In 2007, via a high-profile media campaign, the New York City Department of Health and Mental Hygiene (NYC DOHMH) introduced the "NYC Condom," the first specially packaged condom unique to a municipality. We conducted a survey to measure NYC Condom awareness of and experience with NYC Condoms and demand for alternative male condoms to be distributed by the DOHMH. Trained interviewers administered short, in-person surveys at five DOHMH-operated sexually transmitted disease (STD) clinics in Spring 2008. We systematically sampled eligible patients: NYC residents aged ≥18 years waiting to see a physician. We approached 539; 532 agreed to be screened (98.7% response rate); 462 completed the survey and provided NYC zip codes. Most respondents were male (56%), non-Hispanic black (64%), aged 18-24 years (43%) or 25-44 years (45%), employed (65%), and had a high school degree/general equivalency diploma or less (53%). Of those surveyed, 86% were aware of the NYC Condom, and 81% of those who obtained the condoms used them. NYC Condom users were more likely to have four or more sexual partners in the past 12 months (adjusted odds ratio [AOR] = 2.0, 95% confidence interval [CI] = 1.0-3.8), use condoms frequently (AOR = 2.1, 95% CI = 1.3-3.6), and name an alternative condom for distribution (AOR = 2.2, 95% CI = 1.3-3.9). The most frequently requested condom types respondents wanted DOHMH to provide were larger size (28%), ultra thin/extra sensitive (21%), and extra strength (16%). We found high rates of NYC Condom use. NYC Condom users reported more sexual partners than others, suggesting the condom initiative successfully reached higher-risk persons within the STD clinic population. Study results document the condom social marketing campaign's success.
    Journal of Urban Health 08/2011; 88(4):749-58. · 1.89 Impact Factor
  • M Monica Sweeney
    Annals of emergency medicine 07/2011; 58(1 Suppl 1):S174-5. · 4.33 Impact Factor
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    ABSTRACT: HIV infections among young men who have sex with men (YMSM), ages 13-29 in New York City have been steadily increasing over the last decade. To document the sexual onset and behavior of YMSM as a means for informing the development of new HIV prevention messaging. Cross-sectional study. Five hundred fifty-eight YMSM, with more than 60% racial/ethnic minorities. Young adults (25-29 years) reported a greater number of lifetime sexual partners, but the adolescents (13-17 years) and emerging adults (18-24 years) reported having their first sexual encounter with another man at a younger age. Black and Latino men first engaged in various sexual behaviors, including receptive anal intercourse, at a younger age than either Asian/Pacific Islander or white men, and were more likely to report an HIV-seropositive status. Across race/ethnicity, YMSM reported an equivalent number of recent male sex partners and selected both main and casual partners who were age and race/ethnicity matches. During the most recent sexual encounter with a casual male partner, black men were more likely than white men to have had unprotected receptive anal intercourse, whereas white men were more likely to report unprotected oral sex. Black YMSM reported more recent female partners than all other groups. Black and Latino YMSM may be at increased risk for seroconversion because they tend to start having sex with other men at a younger age than their white and Asian/Pacific Islander peers and because they engage in unprotected sexual behaviors with men of concordant race/ethnicity and of a similar age where levels of viremia may be more elevated but not because of the sheer number of sexual partners.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 03/2011; 56(3):285-91. · 4.65 Impact Factor
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    ABSTRACT: We assessed awareness and experience with the NYC Condom via surveys at 7 public events targeting priority condom distribution populations during 2007. Most respondents (76%) were aware of NYC Condoms. Of those that had obtained them, 69% had used them. Most (80%) wanted alternative condoms offered for free: 22% wanted ultra-thin, 18% extra-strength, and 14% larger-size. Six months after the NYC Condom launch, we found high levels of awareness and use. Because many wanted alternative condoms, the Department of Health and Mental Hygiene began distributing the 3 most-requested alternatives.
    American Journal of Public Health 12/2009; 99(12):2178-80. · 3.93 Impact Factor
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    ABSTRACT: Background: In 2006, CDC recommended routine HIV screening in healthcare settings. The New York City Department of Health and Mental Hygiene (NYCDOHMH) funds hospitals, clinics, and community-based organizations (CBOs) to conduct HIV testing. The goals of these testing programs are to increase the number of persons tested for HIV and to identify previously undiagnosed HIV cases. We sought to characterize the cost of finding new HIV cases in our funded programs. Methods: NYCDOHMH reviewed 2006 testing data from its testing programs. We matched identified HIV cases (i.e., persons testing HIV+ by Western blot) to NYCDOHMH's population-based HIV/AIDS Surveillance Registry to determine whether cases were newly diagnosed or repeat testers who were previously diagnosed. We calculated the cost to identify one newly-diagnosed case, comparing results for screening in healthcare settings with targeted testing in CBOs. Results: In 2006, 30,211 HIV tests were conducted by NYCDOHMH-funded programs, yielding 443 cases. Routine screening yielded 23,963 tests and identified 360 cases. Targeted testing yielded 6,258 tests and identified 83 cases. 59% of cases identified through screening were newly diagnosed, compared with 64% of cases identified through targeted testing. Median cost to identify one newly-diagnosed HIV case through routine screening and through targeted testing was $9,021 (range: $4,968$23,283) and $47,189 ($5,863$77,184), respectively. Conclusions: Cost to identify one newly-diagnosed HIV case is lower through routine screening in healthcare settings than through targeted testing in CBOs. However, some CBOs using targeted testing are as effective in identifying newly-diagnosed cases as some hospitals using routine screening.
    136st APHA Annual Meeting and Exposition 2008; 10/2008
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    ABSTRACT: We assessed awareness and ex- perience with the NYC Condom via surveys at 7 public events targeting priority condom distribution popu- lations during 2007. Most respon- dents (76%) were aware of NYC Condoms. Of those that had obtained them, 69% had used them. Most (80%) wanted alterna- tive condoms offered for free: 22% wanted ultra-thin, 18% extra- strength, and 14% larger-size. Six months after the NYC Condom launch, we found high levels of awareness and use. Because many wanted alternative condoms, the Department of Health and Mental Hygiene began distributing the 3 most-requested alternatives. (Am J Public Health. 2009;99:1-3. doi: