Dr. Demetre Daskalakis will soon leave his position as deputy commissioner for disease control at the New York City Department of Health and move to the Centers for Disease Control and Prevention in Atlanta, where he will oversee the U.S. HIV/AIDS prevention office.
In New York, Daskalakis designed a plan that helped the city achieve the U.N. goals of 90-90-90, meaning that 90% of those with HIV were tested, 90% of those tested went on treatment and 90% of those in treatment saw their viral levels drop so low the virus was undetectable in the blood stream and they could not infect anyone else. Achieving this goal would effectively end HIV/AIDS.
In New York, Governor Andrew Cuomo detailed a plan called Ending the AIDS Epidemic throughout the state. Under Daskalakis' guidance in New York City, this program reduced AIDS-related illnesses from the third-leading cause of premature death in 2000 to the 10th by 2017.
He spoke recently with VOA. His interview has been edited for brevity and clarity.
VOA: The Ending the Epidemic program in New York City is credited with decreasing HIV transmissions to a historic low. How did you do that?
Dr. Demetre Daskalakis: "It took a village; many, many people, and the very first people that helped design the program were actually the community and advocates that let me and others really know where we had gaps.
"Ending the Epidemic program in the city was really a supplemental strategy that added to the programs that were already working through CDC funding as well as through HERSA funding the Ryan White.
(The Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services, is the primary federal agency for improving health care to people who are geographically isolated, economically or medically vulnerable.
Ryan White was a teenager when he became a national spokesperson for HIV/AIDS, helping to educate people about the disease, which he acquired through a blood transfusion. The Ryan White HIV/AIDS program provides services for more than half of people living with diagnosed HIV in the United States.)
VOA: Do you think that the U.S. should have an HIV-specific response? Or, should the U.S. expand the entire health care system and make health care more accessible … in schools and minority neighborhoods, engaging people in better overall health care, especially hourly wage earners and making testing a part of annual physical exams?
Daskalakis: "My answer would be to expand health care. … Access to health care becomes critical both from the perspective of testing, treatment and prevention, as a large piece of HIV prevention now, even pre-exposure prophylaxis (a measure to prevent or slow disease) is highly medical."
VOA: How do you get to the teenagers, especially the young men?
Daskalakis: "I think it's really bringing them to the table in a very, very hands-on definitive way to better understand what they need in terms of delivery of HIV prevention and care.
"The COVID story is another great example. You need that community input from the people who are at the front line and at the edge of the epidemic, to be able to figure out how to solve the epidemic.
"Much of what we did in New York City with Ending the Epidemic came directly from communities. For instance, the work that we did with transgender-led organizations, we literally listened to what the transgender-led organizations needed, and we designed something to fit that need.
"So that's how you make an impact on younger men and others who are at risk.
"There's a mythology that those populations are hard to find. And public health is actually where they come. So, I think this is a great moment to remind people that we actually do access that population every day as they come looking for sexual health services and other services through public health. We just have to bake into that HIV services and other services that actually support the goals of ending the epidemic."
VOA: So, this gets us into what's called the social determinants of health. You have stigma against the populations that are most at risk, you know, men who have sex with men, the trans community. How do you get past that?
Daskalakis: "The most important piece of stigma that happens with HIV, and probably all disease categories, has to do with systemic racism that we have in this country.
"Something that I'm excited to work with at the CDC … is … how do you center that black and brown people are more and more likely to get HIV and have worse outcomes? I think that centering of health equity is one of the probably most critical lessons that I've learned in New York City."
VOA: But it's not just race. There's a certain moral outlook as well. Some groups look at homosexuality as being immoral and sinful. How do you get people to look at it as a disease and not as a moral issue?
Daskalakis: "The innovations that I worked on in New York City, which is the notion of taking a strategy for HIV that is status neutral. And by that, I'm really designing services for the folks who need them, rather than necessarily, creating services that are targeting, which is a terrible word, a certain population, or someone with a certain HIV status negative or positive. So that's something that I carry with me (to the CDC) and will be one of the areas that I explore deeply in my new position, which is how we can make the U.S. more status neutral? If you … focus on the services that people need to maintain health, you're actually addressing the barrier of people coming to that service."
"The tools are there. The question is, how do you put them into a plan that works, and how can we make that better? And so that's going to be the challenge and that's one of the reasons that I accepted the position (at the CDC) in the end.
"And so, it's challenging. It's hard. It's going to be my challenge. It's going to be our nation's challenge. It's is going to be our challenge in ending the HIV epidemic.”
