Credibility Among Gay Men Gives Leverage to New York City's New Chief of H.I.V. Prevention

Published: July 22, 2014

At the height of a meningitis outbreak last year among gay and bisexual men in New York City, Demetre Daskalakis, a wiry AIDS doctor and gay health activist, spent late nights and early mornings in the city’s sex clubs and bathhouses. There, he would strip off his leather jacket and, in his muscle T-shirt, talk the men around him into letting him inject them with meningitis vaccines.

Dr. Daskalakis was given the go-ahead and free vaccine by the city, after city officials found that their own efforts to infiltrate the clubs and house parties, where the meningitis was believed to be spreading, were mostly met with suspicion and hostility. The vaccination campaign ultimately reached at least 16,000 people and was credited with curbing an outbreak that some feared would become the next AIDS epidemic.

Now Dr. Daskalakis, 40, is about to become the consummate insider, as the city’s new $180,000-a-year assistant health commissioner in charge of the Bureau of H.I.V./AIDS Prevention and Control, starting in September.

In his new role, he and his colleagues at the health department hope that he will be able to leverage his acceptance among gay people, and history of taking H.I.V. treatment into the trenches, to reach a population that has not always trusted authority. They also hope he will be able to reach marginalized groups like young black and Latino men who have sex with men but who, for social or cultural reasons, do not identify as gay or bisexual.

“He understands the science, he’s a dedicated physician who has really been on the front lines of care, and he’s an activist and an advocate,” said Dr. Mary Bassett, the de Blasio administration’s health commissioner, who spent many years working on AIDS prevention in sub-Saharan Africa.

Dr. Daskalakis takes over one of the largest bureaus within the health department, with 200 employees and a $200 million budget, at a critical moment in the history of the virus that causes AIDS. The department seemed to be signaling a new commitment to gay issues this year when it sent a delegation of about 50 people to the Gay Pride Parade for the first time in recent memory. (The free condoms and lubrication ran out after three blocks.)

Many top researchers believe that even without a cure or a vaccine, AIDS can be defeated within the next 10 years or so. Last month, Gov. Andrew M. Cuomo announced a plan to aggressively identify, track and treat people with H.I.V. infection with the aim of bringing AIDS in the state below epidemic levels by 2020.

For the first time since the early days of the epidemic in 1983, H.I.V., the virus that causes AIDS, fell off the list of top 10 causes of death in the city in 2012. The number of new annual H.I.V. diagnoses in New York City has fallen by more than 33 percent since 2003, to 3,141 in 2012, the last year for which data is available. There were about 115,000 people living with H.I.V. or AIDS in New York City at the end of 2012.

Dr. Daskalakis said he wanted to build on those successes by making more use of social media to reach gay and bisexual men who find partners through the Internet, and by making the drug Truvada available to prevent H.I.V. infection as well as to treat it, which the governor has also proposed to do.

He also said he would avoid the graphic scare campaigns used by the Bloomberg administration, like one television ad showing images of anal cancer and other effects of AIDS. One of his predecessors, Dr. Monica Sweeney, and Larry Kramer, the writer and AIDS activist, defended the scare tactics as a way of defeating complacency about unprotected sex, but some gay rights groups thought the ads needlessly stigmatized people with H.I.V.

While not disputing that the ads might have worked, Dr. Daskalakis said, “Life with H.I.V. or risk of H.I.V. — my personal perspective is that that’s scary enough.” (He is H.I.V.-negative.)

Dr. Daskalakis grew up outside Washington and graduated from Columbia University and New York University School of Medicine. He became interested in AIDS first as a student at Columbia, when he was touched by the AIDS memorial quilt, and then as a medical student at Bellevue Hospital Center, N.Y.U.’s teaching hospital, where he worked on the H.I.V. ward.

“I was on the cusp of seeing the devastation,” he said. “The bar is much higher now to make it better.”

Last year he was one of OUT magazine’s 100 most compelling people of the year. He made a reputation in 2006 as the founder of the “Men’s Sexual Health Project,” which entailed going into sex clubs and bathhouses to test men for H.I.V. and other sexually transmitted diseases and to refer them to care.

“It’s in my dharma,” he said, of working with the bathhouses and sex clubs, where he is on a first-name basis as “Dr. Demetre.”

But, he added, they are a waning factor in gay life.

“The other big bathhouse we have no control over is the Internet,” which presents novel problems because “obviously you can’t test virtually.”

He is on the board of Gay Men’s Health Crisis, one of the best-known activist groups, and on the antiviral advisory committee for the United States Food and Drug Administration.

“This couldn’t come at a more interesting time,” said Mitchell Warren, executive director of AVAC, a group based in New York City that advocates H.I.V. prevention. “There’s been this drumbeat about ending the epidemic, but there is nothing guaranteed. If you can’t do it in New York City, you can’t do it in New York State.”

Dr. Daskalakis, now medical director of ambulatory H.I.V. services at Mount Sinai Hospital, does not follow the mold of the staid, doctor-knows-best public health official. In an interview the other day in his new city office in Long Island City, Queens, he looked conservative in a buttoned-up suit and neatly trimmed beard. But on his Facebook page, alongside his wedding pictures are photos of his body tattoos as well as one in which he and his husband, Michael Macneal, a fitness instructor, are dressed in drag — Dr. Daskalakis wearing a brassy red wig — and flipping their middle fingers.

The photograph, Dr. Daskalakis said Monday, was taken at a charity event for AIDS. If it is provocative, that is only fitting, he said. “H.I.V. is a risqué disease and I don’t really apologize for my lifestyle,” he said. “We raised a fair amount of money for the AIDS Walk because of this. People live their lives in social media. It makes it more visible.”

Correction: 

An article in some editions on Tuesday about Dr. Demetre Daskalakis’s appointment as an assistant health commissioner in New York City omitted part of the name of the bureau that he heads. It is the Bureau of H.I.V./AIDS Prevention and Control, not the Bureau of H.I.V./AIDS Prevention. The article also misstated the bureau’s budget. It is $200 million, not $20 million.

Full text of article available at link below –

Leave a Reply