In 1998, Tiffany West’s college roommate suggested they enter a lottery that chose students from their school, the Xavier University of Louisiana in New Orleans, to do summer internships at the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta. West, who grew up in Florissant, Missouri, had been to Georgia to visit relatives and driven past the CDC campus, but that’s about it. “I knew what it was and where it was, but it just looked like a giant fortress on Clifton Road,” says West, 34, referring to the thoroughfare that abuts the campus.
Today, West is bureau chief of the surveillance and epidemiology branch at the Department of Health’s HIV/AIDS division in Washington, D.C. She is credited with helping to turn the city’s HIV/AIDS program from an embarrassment into an emblem of what can be done by local governments with talented employees and solid links to academia and the community. “I wasn’t a super overachiever like the geniuses I work with,” says West, whose father is a truck driver and whose mother works for a home healthcare agency. “But a lot of times there are really smart people who aren’t able to speak up. I speak my mind.”
I was at CDC with all these kids from Harvard and Yale and that really did build my confidence. That was a turning point in my career.
West’s CDC internship did not start off well. “They had me typing and filing,” she remembers. “I said, ‘I don’t want to do this all summer. You have to give me something else.’ ” Her boss loaned her an intro-to-epidemiology book and moved her to a project that made public education videos about disease outbreaks. “I didn’t know what epidemiology was,” West says. She ended up being selected as the summer intern of the year. “I was at CDC with all these kids from Harvard and Yale and that really did build my confidence,” she says. “That was a turning point in my career.”
West returned to New Orleans and a brutal schedule, completing her undergraduate degree while working what she not so fondly refers to as “vampire days" at The Gap, a clothing store. “I was night manager, 8 p.m. to 3 in the morning, and I’d go home, go to sleep, and go to class at 9:30 a.m., and then get out at 2 p.m., study 2 to 6, and take a nap from 6 to 7:30 before returning to work,” West says. After completing her degree, she took a 6-month break and then entered a master’s program at Tulane University’s School of Public Health, also in New Orleans, in 2001. She continued to work the vampire shift at the Gap through part of 2002.
A highlight of West’s time at Tulane, where she studied epidemiology and community health evaluation, was a fellowship with the Indian Health Service that took her to the Rosebud Sioux Indian Reservation in South Dakota. She worked on an injury prevention program, and it opened her eyes to the difference between theory and practice. The Sioux had had many injuries related to kids riding in the front seats of cars, so the program installed children’s car seats. One day, not long after she arrived, she saw a man who had received a car seat drive up to a 7/11 convenience store, his baby lying in the front seat and a brand new, empty car seat in the rear. “That was a life-changing experience because it gave me an alternative viewpoint about health behavior,” she says. “It taught me a lot about messaging.”
For a year after graduating from Tulane, West worked as a chronic disease epidemiologist at the Louisiana Office of Public Health. Then she landed back at CDC, which introduced her to the HIV/AIDS world. As a public health analyst in the HIV/AIDS prevention branch, West supported the National HIV Behavioral Surveillance (NHBS) project, an ongoing effort that studies prevalence of infection in specific risk groups in cities. “I was really happy at CDC,” West says. “It wasn’t necessarily what I expected: Working there is like being in military—it’s very hierarchical and very structured.” She enjoyed the work and took a special interest in D.C.’s public health department, which in 2005 received a drubbing from DC Appleseed, a grassroots organization that focuses on that city's problems. “There was all this talk about defunding them from projects,” West says. “I was the [NHBS] project officer for D.C. and said I’m going to make sure they don’t get defunded.”
The next year, the head of the HIV/AIDS program at D.C.’s health department offered West a job as a public health analyst. West’s academic adviser at Tulane, epidemiologist Manya Magnus, had recently moved to D.C. to work at George Washington University (GW) with Alan Greenberg, who had headed CDC’s HIV epidemiology branch. Magnus lobbied West to join them. “She said they were doing all these awesome things and that I had to come,” West says.
West quit CDC and packed her bags for D.C., which she had been to just once before on a site visit. “Everybody thought I was crazy,” she says. “All my CDC colleagues, my dad, but it was the best decision I ever made.”
Working with Magnus, Greenberg, and the rest of the team at GW, West evaluated the health department’s program, recruited new people, and came up with a playbook. A top priority was to issue an annual report about HIV cases in D.C., which, as DC Appleseed noted, the health department had never released. Soon they started issuing regular reports about the city’s epidemic. They adopted state-of-the-art techniques such as analyzing differences in average and cumulative viral levels in neighborhoods and various risk groups to assess the community viral load, a metric for guiding treatment and prevention efforts. (See this related story.)
Throughout the next 6 years, West was promoted to bureau chief and helped turn the city’s HIV/AIDS effort into a widely admired program that has received accolades from formerly vocal critics, including DC Appleseed. “I had a lot to live up to,” West says. “There were a lot of people expecting me to fail, but I didn’t. You have to believe in yourself and put in a lot of hard work. There are not a lot of people in public health who work harder than I do and want to make a difference more than I do.”
West says she may return to school to earn a Ph.D. someday, but for now she plans to stay put. “Every day I come to work I’m making a difference,” she says. “I know that sounds Pollyannaish but with public health it’s not clinical medicine where you treat a patient, they get sick, and come back. With public health you’re trying to do something on a scale that’s different from clinical medicine.” Besides, it beats working the night shift at The Gap. “This is my calling,” West says. “This is what I’m supposed to be doing in life.”