In June, Washington, DC, Mayor Adrian M. Fenty and the city’s Department of Health director Pierre Vigilance announced Nnemdi Kamanu Elias, MD, as the interim senior deputy director for the city’s HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA).

This announcement came after Shannon L. Hader abruptly resigned from her successful three-year post as the head of HAHSTA, a move that surprised many people. Hader was the longest-serving director in the past 10 years.

Hader’s efforts led to the 2008 Epidemiological Update, which found that 3 percent of DC residents were living with HIV/AIDS, which was the highest rate of any city in the country.

With this surveillance information, HAHSTA was able to improve the district’s response to its HIV/AIDS epidemic through partnerships with community-based organizations to increase testing services, prevention campaigns (such as free condoms) and linkage to HIV care and treatment.

Elias, who joined HAHSTA in 2009, will pick up where Hader left off by using her experiences as the department’s chief medical officer, during which she implemented policies for the department’s ongoing HIV-related projects.

She also served as a senior manager at the European and Developing Countries Clinical Trials Partnership in the Netherlands, an organization supporting the development of clinical interventions for HIV/AIDS and other diseases in Africa.

Elias doesn’t know how long she will serve as HAHSTA’s interim senior deputy director or if the position will become permanent, but she is willing to serve as long as she is needed.

She recently spoke with POZ about her new role, the current period of transition at HAHSTA and the challenges still facing the department.

In the last decade, senior deputy directors haven’t held the position for longer than three years. How has this frequent turnover affected DC’s progress in fighting HIV/AIDS?

I know prior to the last few years, I heard the changes were quite disruptive. Over the past three years, under Shannon’s leadership, we have made tremendous progress. I think that we were able to recover from all the changes that HAHSTA had to go through.

The one thing about a true leader or leadership structure is that they should not depend on the personnel. The leader empowers those on the front lines, empowers the team to ensure that they are able to carry out what needs to be done. Even though Shannon moved on, she did build a good team, a good structure and put protocols in place.

I think it’s very important that we have continuity in leadership. Our mission has not changed, even though the leadership has changed. What’s important to me is that we just keep on going, that we keep our momentum, we keep implementing programs and we maintain our partnerships.

Have these frequent senior deputy director changes affected staff morale?

Our staff is pretty resilient. They’ve been able to keep their eyes on the prize. For people that work in the field of HIV, what brings them to it is a certain passion, a certain drive and willingness or a desire to see results.

I don’t think it has diminished staff morale at all. I would even say that they want to prove even more that they have something to offer, even in the face of the changes that have occurred.

What training and/or support have the HAHSTA staff, including yourself, received during this transition to help you respond to the district’s HIV/AIDS epidemic?

Mayor Fenty declared in 2007 that HIV was his No. 1 public health priority, and with the support of him and his staff we’ve been able to continue to do what we need to do.

Additionally, Councilman David A. Catania (who is the chairman of the committee on health), the city administrator’s office and the offices of the Department of Health director Pierre Vigilance have all been extremely supportive.

What challenges remain for you as the interim senior deputy director?

One of our main challenges—probably one that affects a lot of HIV programs around the country—has to do with [potential funding problems with the AIDS Drug Assistance Program]…. We have to ensure that as we bring people into care that we are able to get them the drugs that they need. I’m hoping that over the next few months, we’re able to move clients off ADAP.

Working with the department of health care finance, we are going to ensure that a larger portion of our ADAP clients will be able to be moved to Medicaid. In addition, we are going to be reaching out to some pharmaceutical companies to see whether they will be able to work with us in creating a bridge for these clients, just in case we do still see a shortfall.

How do you plan to build on the department’s successes of the last three years?

One thing that is very important is that we continue to maintain and grow our partnerships. One is the M•A•C AIDS Fund, which is supporting the availability of the second-generation female condoms in DC. I think it’s a great step in helping to empower women in their sexual relationships.

Another partnership is the DC Partnership for HIV/AIDS Progress with the National Institutes of Health, whose long-term goal is to reduce HIV transmission and ensure that people are linked to care.

We also want to continue our relationship with our major funders, such as the CDC, HRSA and HUD, which funds our housing program.

What roles do community leaders such as the mayor, the Health Department director and City Council members play in HAHSTA’s progress?

Everything. In DC, with our epidemic, which is what we call a modern epidemic, it’s also a severe one because it exceeds the prevalence of 1 percent. Ours is about 3.2 percent, and it’s modern because the modes of transmission are several: in heterosexuals, injection drug users, men who have sex with men.

When you have such a complex epidemic and such a severe epidemic, you just cannot go it alone. It involves input from federal, local and community partners and academia, really everyone. Without high profile political leadership in the form of the city council or the mayor, we would not have been able to go as far as we have.

Without our frontline providers, such as our community partners, who are out there in the field actually implementing and doing the work, there’s no way that we would’ve gone as far as we have.

And without the support of the Department of Health, we wouldn’t have been able to go as far as we have. Given the complexity and the severity of our epidemic, we absolutely need every single sector on board.