Bay Windows - November 6, 2003
Ethan Jacobs, ejacobs@baywindows.com.

"[McGuire's] been one of the few public officials who's been willing to talk about sex and drugs," said Rebecca Haag, executive director for the AIDS Action Committee.

As the official responsible for crafting the state's response to the AIDS epidemic McGuire's willingness to talk about sex and drugs has come in handy, whether in advocating for needle exchange programs or talking about the ways that teen sexual activity puts youth at risk for contracting HIV. And in her time with the Bureau McGuire has used her position to build important relationships between the state, HIV/AIDS service providers, and people who are HIV positive or at risk for contracting the virus. But after five-and-one-half years of service McGuire stepped down from her position Oct. 31 to begin teaching at the Bouv College of Health Sciences at Northeastern University.

"I've already actually begun teaching there and plan to focus a lot of my research and writing interests on state public health policy, including HIV, and [I] look at it as a real opportunity," said McGuire. "If there's one drawback to this wonderful position [at the Bureau] it's that the opportunity to reflect and write is limited. And I think I've spent a lot of my life going back and forth between theory and practice."

Much of that theory and practice has taken place in the Commonwealth. After serving as the head of the AIDS Action Council, a Washington, D.C.-based lobbying and advocacy group, in the late 1980s, McGuire came to Boston in 1990 to pursue a graduate degree at the Harvard School of Public Health. During the 1990s she traveled around the country as a consultant, including several periods of work with the Bay State's HIV/AIDS Bureau and other DPH bureaus. By the time she became the HIV/AIDS Bureau's director in 1998 she already had a sense of the state's response to AIDS.

McGuire said her tenure at the Bureau began at a turning point in the AIDS epidemic, when studies were showing the effectiveness of drug combination therapy in maintaining the health of people living with HIV. As a result she focused much of her efforts on encouraging people to get tested.

"The 80s and arguably well into the early 90s had a period of time first when there was no medication, so there was a sense of, 'Why get tested?'" said McGuire. She said that in the early years of the AIDS crisis counselors warned clients that an HIV diagnosis would make them a target for discrimination and that they should weigh that against the benefits of knowing their status.

She acknowledged that discrimination is "still a potential reality, but it became important from a public health perspective for the state and practitioners to be saying, 'There's something we can do - you have a real choice here,' and really moving towards affirmatively saying that knowing [your status] is a good thing."

When McGuire came on board at the Bureau she embarked on a radical 18 month restructuring campaign, shifting around personnel and offices and programs in an effort to help the Bureau adapt to HIV as a long-term health crisis.

She also continued what she said was a tradition in the state of involving health providers, HIV positive people, and other community members in developing the state's HIV/AIDS policies. She cited as an example the HIV Surveillance Implementation Team, which developed the HIV/AIDS Surveillance Program to monitor HIV diagnoses in the state.

"[The Implementation Team included] people from all walks of life," said McGuire. "It was people living with the disease, epidemiologists. We had cryptologists that we brought in, we had clinicians who worried that there were barriers, we had lawyers who said 'Absolutely no way are you going to use names [in the surveillance reports],' and it was a very rich group of individuals. ... It was a great example of a cross disciplinary, lay and expert, approach to a politically charged issue that had a remarkable outcome that became a standard for many other jurisdictions."

McGuire's colleagues said that her work with the Bureau has helped strengthen HIV/AIDS services in the Bay State.

Douglas Brooks, director of evaluation and planning at JRI Health, said that without McGuire's efforts, "HIV programming and policy would have suffered in the Commonwealth." Brooks said JRI will present McGuire with the inaugural JRI Health Award for Social Justice at a fundraiser Dec. 4, honoring her work with the Bureau.

Haag pointed to McGuire's background in both public policy and public health as a critical factor in her success in the Bureau.

"She's been excellent at articulating the public policy that needs to exist to support [the Bureau's] programs," said Haag.

Yet despite McGuire's success the recent years have not been kind to the Bureau. As a result of the state's budget crisis the Bureau lost $20 million from its previous $52 million annual budget, and McGuire has faced the unenviable task of choosing which programs to put on the chopping block. Her first priority has been providing treatment for HIV positive individuals.

"[It's] jeopardized, but still at this point we're able to say that if you have HIV in this state you have no financial barrier to getting the drugs and getting care," said McGuire.

Prevention efforts aimed at youth, on the other hand, have been almost entirely dropped. She said the Bureau's data shows an increase in HIV among youth over the past four years. McGuire said that she had planned to overhaul the state's approach to HIV/AIDS issues around youth, but now there are no resources to do so. She said other factors, such as the national push for abstinence-only sex education, loss of funding for school health and family planning programs, and loss to programs around youth drug use and gay and lesbian youth only exacerbate the problem.

"So we are wholly unprepared at the moment to really address what's going on with youth," said McGuire.

McGuire also had to put aside plans to expand needle exchange programs. She said that there are only four needle exchange sites around the state, and the cities with the highest rates of HIV transmission through IV drug use have no needle exchange programs.

The Bureau had hoped to create women-centered prevention programs, develop an integrated approach to prevention around all sexually transmitted diseases (STDs), and develop strategies for notifying the sex partners of people who test positive for HIV.

Despite these seemingly insurmountable challenges McGuire tried to keep a sense of perspective about the Bureau's rapidly shrinking budget.

"The first thing I like to do is say that the budget line isn't really because I came in at this point," she said, laughing. McGuire explained that during her time in Washington, D.C., she worked with cities that have been forced to make do with scant resources to deal with the AIDS epidemic.

"So, at a personal level I think that's what allows me to keep doing it, is that the work's still in front of you, the epidemic hasn't gone away," said McGuire.

Indeed, McGuire said that leaving the Bureau does not mean she is stepping back from working on HIV/AIDS issues.

"I don't expect [my career change] to mean that I'm not going to be active," said McGuire. "And it may well be that there's different things that I can do and say at this time outside of government than are possible inside government."

For the time being Kevin Cranston will serve as acting director of the Bureau while the state conducts a search for McGuire's successor. Cranston served as deputy director since 1995, and prior to that he worked in the state Department of Education.

McGuire said that a vital factor in dealing with the loss of funding to the AIDS programs is community involvement.

"We [in state government] do the best we can, which sometimes means that we don't do everything that either we want to do or needs to be done," said McGuire. "But that means we're also providing endless opportunities for the community to push us to do the right thing, and I would say that this is one of those times right now."

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