No Small Change

An Interview with Ellen Ives, December 2001

Michigan HIV News, Spring 2002 Issue

You could count on one hand Randy Pope's original Special Office on AIDS Prevention (SOAP) staff members in the mid 1980's. That founding group has since evolved into the HIV/AIDS Prevention and Intervention Section (HAPIS) with a staff now of 45. Ellen Ives started working as a trainer on a contract basis for SOAP in the summer of 1987. Her departure at the STD and HIV Conference in December was the biggest loss to HAPIS since Pope's retirement in 1999.

Several people you may remember have graduated from Ellen Ives' top notch Training Unit, Loretta Davis-Satterla, Harry Simpson, Odalis Martin. And Andrea Battle Kelly, while still with the unit, is now a CDC public health advisor.

News: In the years you have been with (HAPIS), the prevention philosophy of the unit evolved over time.

Ives: Sometimes I think the more things change the more they stay the same. In the past few years we have seen a lot of recycling old ideas or coming back to old ideas. I think when I started, a lot of our education was focused on general public education, teaching the basics, dispelling hysteria and fear. That I would say has been a pretty significant change. Over time we have been trying to get away from that, targeting the folks who really need the information, making the information much more specific, much more concrete, much more behavioral skill focused.

At the same time - certainly at a national level - there's been recognition, in the past year or so, that a return to basics needs to happen. Some of the stigmatization/discrimination that we dealt with in the beginning of the epidemic is still going on and research shows a lot of it is based on fear.

News: And ignorance

Ives: Yes.

News: How have you seen the groups that you've trained evolve over time?

Ives: We are certainly training a lot more folks who come from the communities at risk now. In the beginning it was (either general public) or much more medical orientation or social worker types. Our trainings now certainly have more folks from CBOs and who come from the communities that are at most risk.

News: Do you think that statewide, we are going in the direction that we need to for prevention?
In being diplomatic, I guess I would say that in terms of prevention, there are clearly research based areas of prevention which have not traditionally been supported by the state health department - that are difficult to support from a governmental level because of the controversial nature of the programs that would be required - ok we're talking about harm reduction. Other states have been able to do prevention programming that target men who have sex with men and injection drug users that are more behaviorally based and research drive than what we have been able to do here.

In addition to leading the HAPIS Training Unit, Ellen Ives has either taken the lead or been a key player in several statewide conferences for over a decade. For many years there were two conferences. One was for HIV Educators with involvement of the American Red Cross, Michigan Department of Education and the Michigan PTA along with (at the time MDPH). The other was the HIV counselor update. When funding got tighter these two melded. Then when HAPIS and the STD Section came under the same department at MDCH, the conference expanded to become the STD & HIV Update. Andrea Battle Kelly took the reins for a couple of years, but Ellen got them back for her last year.

Ives also has been a key player in what was originally the AIDS and Adolescents Committee - now the HIV and STD and Adolescents Networking Committee. "It's been going on in various forms since about 1989," said Ives. That group has put on many conferences - "originally staff development for youth serving staff and then the focus changed to youth."

In December, Ives left HAPIS to go to a new position with Michigan Public Health Institute (MPHI) as Senior Project Coordinator for the Michigan Abstinence Partnership. "MPHI, along with MDCH, coordinates the grant funding for community coalitions around abstinence for young people ages 9 - 14 (although they can go up to age 17)," said Ives. "MPHI essentially monitors those community contracts and provides technical assistance." Ives is now the lead consultant for the team of three other community consultants and an evaluation specialist for the program. This had some who know Ellen Ives pretty curious. The Michigan Abstinence Partnership?

News: You're coming out of a culture that promotes giving kids all of the information - how do you …

Ives: How do I reconcile this? I would say that the work that the Abstinence Partnership community coalitions do … is really the foundation laying work for keeping people healthier, longer. It's youth assets building, youth empowerment - really helping to develop that strong internal foundation for young people - before they're at risk for HIV and other STDS.

News: Well we can hope that it's before.

Ives: Well, right. And the other thing I would say - although this viewpoint may not be shared with everyone in the Abstinence coalitions - my viewpoint would be that the abstinence piece is an important piece, although it shouldn't be the only piece in a given community.

News: Does each of these coalitions have its own program that gets approved?

Ives: They have to respond to an RFP. MPHI and MDCH coordinate the grant review. From what I have seen so far, they make sure that the program is research and skills-based and effective.

News: What are you looking forward to? You have been working with (HAPIS) for fourteen years, what are you looking forward to in this change?

Ives: (Laughs) Well, I would say I am looking forward to change itself. I look forward to working with a new group of people who from what I have seen so far are energetic, committed and compassionate as well in a little bit different field. Certainly, it will take me back to my schooling and other studies on adolescent health. I look forward to some different kinds of tasks. I am not going to be doing training; I may a little training coordination; I may do a few presentations. That's not going to be my focus. My focus is going to be more on program evaluation and contract monitoring and providing technical assistance, and some supervision. I'm looking forward to stretching my wings in other directions, using other skills.

News: Any final words on your departure from HAPIS?

Ives: I would just like to say that this has been a wonderful work experience for me and I have met so many incredibly inspiring people in this field. And people who have dealt with huge numbers of challenges in their lives and faced them with courage and with grace, and commitment and compassion for other people. I have met a lot of professionals in this field who may not be facing HIV for themselves or an immediate family but who have extended their compassion for those who are more directly affected by the epidemic. And I think I will miss a little bit of that passion and that fire in my new field.

Another thing that I want to say is that what I have learned - it sounds a little simplistic, but - just how incredibly challenging behavior change is. And how we constantly underestimate the difficulty of it. And how even people who have been working in HIV for a long time underestimate the difficulty of behavior change for other people. How challenging it is to remain client-centered…that is going to remain a core challenge for HIV prevention. And how hard it is for people to grasp how hard behavior change is. That provides challenges for people who are making decisions about laws and policies, and for people who are making decisions about media campaigns, and for people who are sitting there counseling somebody.

Until more folks - especially at the higher decision making levels - can really understand and grasp in a personalized way how difficult behavior change is and what is needed for behavior change more than just telling people "Don't do it," we're just going to continue to have new infections….

It's very easy to be simplistic about behavior change and very difficult to take the time and have the patience to look at the complexity of it.

The one thing that really excites me about the Abstinence Partnership is that a lot of the work that they do really does look at the complexity of what determines what behavior people choose. It has to do with core foundation stuff about who we are as people, what we believe about ourselves, the strengths that we have and our belief in those strengths.

Unfortunately by the time we see individuals in counseling and testing sites, when they are 35-40 or 25, it's a lot harder to build those foundations at those ages… and a lot more expensive.

And so, off she went - on to new battles, as a Marine you might say, to persevere in the work of public health, reaching adolescents - those on the shores of adulthood. To be sure she will attack this with the smooth calm and rationale that is her hallmark. Who better to help determine the "arms control" of the increasing flow of dollars to abstinence programs than our former comrade.

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