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An Interview with HAPIS Manager Debra Szwejda
Michigan HIV News, Spring 2005 Issue
Debra Szwejda has been manager of the Michigan Department of Community
Health’s HIV/AIDS Prevention and Intervention Section (MDCH-HAPIS), part of the
Division of Health, Wellness and Disease Control, since January 2000. In that
time, the Division has added an additional section, Minority Health/Health
Disparities Reduction, as
 well
as the most recent addition of the Maternal and Child Health Title IV Program
coming under the umbrella of HAPIS.
During Szwejda’s tenure administrations have changed in Lansing as well as
Washington, D.C. And today HIV/AIDS prevention and care both face as many
challenges as ever, with the Ryan White CARE Act¹ up for reauthorization this
fall and implementation of new requirements from the Centers for Disease Control
and Prevention (CDC) related to “Advancing HIV Prevention: New Strategies for a
Changing Epidemic²” in April 2003.
Michigan HIV & STD News Editor, Barb Wood interviewed Deb Szwejda shortly after
she returned from our nation’s capitol in April, 2005 where she was voted onto
the executive committee of NASTAD – the National Alliance of State and
Territorial AIDS Directors.
MHSN – You have quite an interesting education background – a BSN from the
University of Michigan followed by a master’ s degree from Western Michigan
University in public administration with a health care focus. How did your
direction change from providing care to being an administrator?
DS – I provided clinical care for many years, starting at age 20 when I was the
night charge nurse for a 40 bed pediatric unit at St. Lawrence Hospital in
Lansing. During the early 1980’s I was working as a clinical instructor at the
Lansing Community College’s nursing program, and seriously considering grad
school to obtain a master’s in nursing. However, about that time, Western
Michigan University implemented a health care focus to their master’s in public
administration program, with all evening classes, and that seemed to be a better
fit for me, as I had two very young children. After graduation in 1986, I
interned at the Department, in their maternal health programs, and the
Department’s current director, Janet Olszewski, was my section chief! I then
worked in public health consulting for a private firm for a few years, until
1992, when I was hired as a community prevention specialist in the Substance
Abuse Section of what was then the Center for Substance Abuse Services, now the
Office of Drug Control Policy.
MHSN – When you became the HAPIS manager many of us around the state already
knew you as the prevention section manager for the MDCH (former) Bureau of
Substance Abuse Services; you had a very close relationship with HAPIS and the
statewide HIV/AIDS planning bodies. Collaboration has always been the modus
operandi of HAPIS; how has the Section increased collaboration in the past five
years?
DS – Yes, for a few months, I was the acting prevention section manager, as well
as the communicable disease specialist for the Bureau since 1997. I felt an
immediate affinity for the HIV community and the programs and staff at HAPIS and
that hasn’t changed since I assumed my current position. Regarding
collaboration, we have certainly increased that, both inside and outside the
Department. We have enhanced significantly our relationship with Medicaid and
the Michigan Primary Care Association and the Federally Qualified Health Plans.
We also are working much more closely with the Bureau of Maternal and Child
Health, particularly around perinatal HIV transmission issues. Our relationship
with the Office of Drug Control Policy continues to be strong, and we have
recently forged some new contacts with the Department of Corrections. We have
also developed a relationship with the Community Dispute Resolution Services,
renewed our collaboration with Michigan Protection and Advocacy Services, and
enhanced our relationship with dentists through the Michigan Dental Program. We
continue to strengthen our partnerships with local public health and community
based organizations, and increased our collaboration with the Bureau of
Laboratories, both with implementation of rapid testing, and with the new
statute on lab based HIV reporting. Finally, we took the initiative to convene
quarterly All Titles meetings, with our Title I, III, IV and Part F partners.
MHSN – Getting back to substance abuse (SA) - the numbers of injection drug
use (IDU) related HIV infections have been dropping off in recent years in
Michigan - compared to the men who have sex with men (MSM) statistics.
Kaisernetwork.org recently reported that the North Carolina House is considering
a bill that would create and evaluate needle-exchange programs (NEPs) in that
state. We have had some very effective NEPs operating in several Michigan
communities under municipal approval. Isn’t there some collaboration going on
now to try to get some data on how these NEPs have affected Michigan’s IDU/ HIV
decreasing infection rates? And can you tell us about the Public Health
Administration’s request for a white paper on NEPs?
DS – The data do not yet show cause and effect relationships between decline in
HIV infections and increase in activity in needle exchange programs (NEPs), but
the fact that there could very well be cause and effect is encouraging. In spite
of limited funding for the programs in Grand Rapids, Benton Harbor, and SW
Detroit, volunteers operating on shoe-string budgets, often from cash out their
own pockets, manage to keep the programs alive and provide services on a regular
basis. The CHAG (Community Health Awareness Group) program has adequate funding
and operates more in the Cass Corridor, and HARC (HIV/AIDS Resource Center)
operates in Ann Arbor and Pittsfield Township.
The white paper is nearing completion. Anecdotal information from program
participants is encouraging for both NEP staff and those of us reviewing these
personal comments in Lansing, because the clientele state very clearly that the
programs make huge differences in their lives. They receive information about
housing, legal services, medical care, counseling, HIV/STD testing, food
pantries, drug treatment, as well as being able to obtain and exchange syringes
to reduce their likelihood of getting serious blood infections such as hepatitis
or HIV.
To answer your question about the white paper, we anticipate completion of this
document by Memorial Day and full approval sometime this summer.
MHSN – You’ve just had your fifth year anniversary with HAPIS, and the
Section has gone through a lot of change during those years; what has been the
most challenging so far?
DS – By far the most challenging is the struggle to provide more services with
fewer resources and additional federal requirements. When your funding increases
every year, as it did in the 1990’s, everyone is happy. However, as resources
dwindle, and we are forced to get creative and target our resources where we
believe they will be most effective, controversy is created. Change is difficult
to adjust to for all of us. And with the increasing numbers of Persons Living
with HIV/AIDS (PLWH/As) in care and case management, it is a true challenge
locally as well, as ASOs (AIDS service organizations) struggle to provide
quality services to an increasing client load.
MHSN – As HAPIS manager you oversee the management and distribution of Ryan
White CARE Act Title II, CDC prevention and state funding through grants to
agencies, local health departments and hospitals around the state. As well as
monitoring the use of those funds, HAPIS also provides technical assistance and
training to those agencies and others. Budget cuts have become standard and the
forecast does not look good for future funding for CARE or prevention. Does
HAPIS plan administrative cut backs so that the loss does not fall entirely on
programs?
DS –We have already made significant cutbacks over the last few years. I have
fewer staff, particularly in the Continuum of Care Unit, than I did five years
ago. We are also restricting travel, as well as supply and computer purchases.
Currently, we are looking at different ways to absorb our latest prevention and
care cuts; ideally without decreasing funding for effective and cost efficient
services.
MHSN – ADAP is a big concern for those who need CARE; some states are in dire
straights with their AIDS Drug Assistance Programs. The Michigan DAP has
operated very successfully for many years; and our DAP has yet to deny anyone
who qualified. Do you see the expanded testing required by CDC flooding this
system in the future?
DS – No, I don’t see overwhelming numbers of clients becoming eligible for ADAP
as a result of expanded testing. However, our overall number of PLWHAs eligible
for ADAP keeps increasing. Five years ago, we had approximately 800 clients on
the program; currently we have over 1,800. We continue to conduct cost
projections routinely. I am concerned about the 10 Billion cut in Medicaid that
recently passed Congress.
MHSN – One of your roles as HAPIS Manager is to co-chair the Michigan
HIV/AIDS Council (MHAC); between April 2002 and 2003 the state had to adjust to
phasing out the regional planning bodies and Michigan now relies solely on MHAC
for community planning activities. How would you say everyone has adjusted and
are we now getting the input we need to make wise decisions?
DS – As I said previously, change is hard for everyone, and this was
particularly difficult for our many local activists, who were committed to
community planning over the years. However, as a result of the reconfiguration,
HAPIS has been able to allocate the cost savings to direct services to benefit
clients, which is my bottom line. Overall, the reconfigured MHAC is functioning
very well; the committees (particularly needs assessment and comprehensive plan)
are meeting regularly, making decisions regarding priority setting by population
and factors, as well as revising the Statewide Coordinated Statement of Need.
The African American Workgroup deserves particular recognition; due to their
efforts, we had an overwhelming community response to the Black AIDS Awareness
Campaign this year.
MHSN – Our latest assigned CDC project officer for the state, Vicky Rayle,
said at the last MHAC meeting that this was one of the most amazing and
energetic groups of people she has met in her 20 years working with health
departments and in her current role with the CDC. How do you think your
experience with HAPIS and your role as the HAPIS co-chair for MHAC, will affect
your new leadership role with NASTAD?
DS – I feel like I have been preparing for this expanded leadership role for
several years. Being manager of HAPIS involved a significant amount of
on-the-job training, assisted by my very competent staff, and I feel I have
grown into this role over the years. Certainly, my time as chair of MHAC,
dealing with the myriad complex and sometimes controversial issues we have had
has enhanced my skills. And I totally agree with our project officer; we have a
wonderful group of people on MHAC. Meeting with the community is one of the most
enjoyable aspects of this job.
MHSN – HAPIS has just taken under its umbrella the MDCH Maternal and Child
Health Title IV Program. Tell us more about that, please.
DS – We had been working very closely with the Title IV program, particularly in
the last few years, on perinatal HIV issues and following up on missed treatment
opportunities. HIV issues are just one of many program areas for the Bureau of
Maternal and Child Health, and both the Bureau and our Division felt that the
Title IV program was a better fit in HAPIS, whose primary focus is HIV. The
transition has been very smooth, and I am very excited to have this program on
board.
MHSN – What is the biggest challenge you see ahead for HAPIS?
DS – As I previously mentioned, funding constraints coupled with increased
federal non-funded mandates, will be an ongoing challenge in the next few years,
both at the state and local level. In addition, implementation of the Medicare
Part D prescription program, Medicaid cuts, increased scrutiny and
accountability contained in new reporting requirements such as PEMS is a
challenge. And, most importantly, finding ways to address the vast disparity in
communities of color around HIV challenges us all; we have to find a way to make
a difference in these populations.
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