It’s not often that a tattooed, muscled leather daddy—one who’s a celeb on the local gay party scene and regularly posts shirtless selfies on Instagram with hashtags like #nastypig and #zaddy—leaves New York City to work in the upper ranks of the federal government.
But that’s exactly what’s about to happen to Demetre Daskalakis, M.D., M.P.H., the deputy health commissioner in charge of NYC’s response to HIV and other infectious diseases since 2014. On Nov. 17, the Centers for Disease Control (CDC) announced that Daskalakis, 47, would become the federal public health agency’s next director of the Division of HIV/AIDS Prevention (DHAP) on Dec. 21.
He will succeed Eugene McCray, M.D., a CDC longtimer who took the position in 2014 and retired in September.
“This move is the culmination of a lot of my career,” Daskalakis told TheBody on a call the day after his hiring went public. “I’m really enthusiastic that CDC decided to include me in their future.”
In NYC, an HIV Policy Chief With True Community Ties
The official announcement of Daskalakis’ appointment read: “Many of you working in the field of HIV prevention know Dr. Daskalakis, as he was integral in designing and leading many HIV and STD programs in New York City, including their Ending the Epidemic program, which is credited with decreasing HIV incidence to an historic low.”
That’s a dry way of saying that, in NYC’s nearly 40 years of grappling with HIV, no health official has ever taken on the epidemic with the baked-into-the-community, sex-positive gusto of Daskalakis. He first came to public attention in 2013 when, while still an HIV doctor and professor at NYC Health + Hospitals/Bellevue, he would spend the night at sex clubs giving gay men shots to protect them against meningitis, which was circulating in the community at the time.
Once he came to the NYC health department in 2014, Daskalakis launched a barrage of eye-catching initiatives that, in the past six years, have driven HIV rates in New York City to record lows and put the city on track to all but end its HIV epidemic. Those initiatives have often put a premium on working closely with small community groups, frequently serving hard-hit populations like gay Black men, Black transgender women or drug users, that were often overlooked or shut out by previous city HIV prevention officials. Daskalakis often worked closely on these campaigns with grassroots partners including ACT UP, Housing Works, and Treatment Action Group.
Along the way, he earned widespread applause from city HIV activists. “I think the number one thing Demetre has done in New York is to step forward where others have been cautious and paint a vision of what we could do as a city to end HIV,” said Housing Works CEO Charles King, who says that he and Daskalakis often talked by phone first thing in the morning or late at night. “He needed no convincing to come on to the Ending the Epidemic (EtE) campaign, and he used every tool in his DOH [New York City Department of Health and Mental Hygiene] toolbox, and then invented new tools, to further that agenda. And he brought his personality to it in such a huge, enthusiastic way.”
Dakalakis would employ everything from dance parties in the street (at which he would DJ) to “Pose”-style voguing competitions to massive subway campaigns featuring posters in which real New Yorkers (including himself, bare-chested) of all races, genders, and sexual orientations exhorted their neighbors to plug into the city’s new-and-improved sexual health clinics.
He’s forged close ties with community activists, who say he has a characteristic that’s historically rare among health bureaucrats: the ability to truly listen to people in communities on the ground and work with them to create programs, rather than simply (and condescendingly) imposing a mandate on them.
“He’s one of the main reasons that Black and Brown transgender-led groups got funded the past few years, because of initiatives that he created,” said Kiara St. James, executive director of the New York Transgender Advocacy Group. “He truly believes in investing in the communities that are most impacted.”
Daskalakis says that his greatest regret, as he finishes up his work in NYC, is that he could not get viral suppression rates (i.e., the percentage of people living with HIV who have an undetectable viral load) up to 95% or higher. “So much of that has to do with systemic racism and issues around mental health and drug use,” he said. “That’s the hardest nut to crack, though we’ve made major strides in that direction.”
Widespread Praise Within the HIV Community for Daskalakis’ New Gig
Daskalakis’ success in NYC has been followed closely the past several years by HIV advocates nationwide. In interviews with TheBody, nearly a dozen of these advocates applauded his move to the CDC—especially at a moment when the incoming Biden administration is trying to reestablish the social-justice framework for public health begun by the Obama administration, one that is heavy on special attention towards Black, Brown and LGBTQ communities, but that was severely damaged by the Trump administration.
“He has a good track record,” said Raniyah Copeland, president and CEO of the Black AIDS Institute. “The successes he’s had in New York give me great hope and excitement that they could be mirrored across the country. I’m also planning on holding him accountable, as I would anybody in that role.”
Copeland was echoed by Jesse Milan, head of AIDS United. “He’s an inspired choice,” Milan said. “He’s been a visionary for quite some time, and I think he’s going to help take [HIV prevention] at CDC to a new level, as we enter a new administration. I think the goal of ending the epidemic by 2025 [which the Biden campaign committed to, versus the Trump Administration’s goal of 2030] will be substantially achieved because of the work he’s going to be mounting.”
Dazon Dixon Diallo, founder and president of Atlanta-based SisterLove, which focuses on Black women living with or at risk for HIV, said, “I already sent him a note saying ‘Welcome to Atlanta, where the players play.’ I think it’s a wonderful decision. If Demetre can bring an iota of what he’s doing in New York to the national stage, everyone will benefit. He’s one of those rare birds that’s not afraid of innovation.”
The Work Ahead: Tackling HIV Prevention on a National Scale
Daskalakis will have a full plate waiting for him at CDC. Advocates say that his first priority must be a kind of COVID-era “listening tour” (i.e., likely over Zoom rather than in person) of different HIV advocacy communities around the country, which can differ sharply from brash, blunt NYC—especially in areas like the Deep South, where there is a long tradition of religiosity and conservatism.
Daskalakis said that as soon as his NYC work is finished, that’s exactly what he intends to do.
“I think the key ingredient [in the success we had in NYC] was community engagement, an investment of both mental and physical resources into communities,” he said. “I’m going to CDC with a huge amount of humility around having to learn what I don’t know about other parts of the country. I’m excited to hear as many viewpoints as possible about what’s happening on the ground.”
Then there’ll be his work threading the CDC needle through the ongoing national Ending the HIV Epidemic in America (EHE) plan, for which dozens of localities and states around the country have been drafting plans to begin executing in 2021. There has been only bare-bones federal guidance up to this point on common priorities, and Daskalakis will have to play a huge role making sure that certain components—such as the importance of housing and Medicaid expansion in states who don’t have it yet—are pushed across localities, despite their regional differences.
“He’s done technical assistance for other jurisdictions [than New York] since before there even was an EHE plan, including working with them on how to engage communities,” noted Housing Works’ organizing director Jaron Benjamin. “I think he’ll really set the tone of [jurisdictions having] a good faith partner on EHE.”
And, among other tasks, he’ll be charged with making sure that prevention tools like HIV home-testing and PrEP (both the current oral variety and the forthcoming long-acting injectable version will be expanded and funded in a way that prioritizes communities that, the past decade, have had the least success accessing them—among them, Black, low-income, transgender, and rural people.
“In places where we’re already seeing movement with PrEP—like with Black women—he needs to push it all the way to the end, really go in and finish the job,” Copeland said. “And maybe it’s time to go in and look at [the] Ryan White [CARE Act, which funds treatment and services for low-income people living with HIV], because it excludes HIV-negative people [who are at risk].”
Is Daskalakis Really the Right Man at the Right Time for the CDC?
As widely as Daskalakis is seen in the HIV world as having slam-dunked his time in NYC, he comes into the CDC as a white gay man—succeeding McCray, a Black gay man—at a time when the brunt of the HIV epidemic in the U.S. falls on Black communities. (A few people TheBody spoke with noted that the job could’ve also been promisingly filled by such longtime advocates as amfAR’s Greg Millett or Morehouse Medical school’s David Malebranche, M.D., both of whom are Black gay men.)
Could that create blind spots?
Most advocates—of all races—who spoke to TheBody didn’t think so. “Demetre has a long history of understanding how the Black community, the trans community, and poor communities are most impacted, and his work has demonstrated that,” said Kelsey Louie, who heads New York City’s longtime HIV service and advocacy organization GMHC. Louie noted that Daskalakis played a big role in the city’s World AIDS Day Awareness Kiki Ball, which centered around youngish queer Black and Brown social networks.
“He knows when to talk—and when to be quiet and listen,” said Ace Robinson, director of the NMAC Training Center to End the HIV Epidemic in America. “He can go to a community he's not a part of and sit in a room and hold himself accountable to being responsive to what he's heard.”
That, among other reasons, is why “Demetre’s the best person for the job right now,” said Dixon Diallo of SisterLove. “It’s not like New York City hasn’t been predominantly Black and Brown. When you bring your white privilege to support leadership and treat people equitably, you get good results.”
Copeland of Black AIDS Institute agreed, but also said she’d be looking to see if Daskalakis would robustly and vocally frame his CDC work as an antiracist project—especially after this summer, when more than 1,000 CDC employees publicly called out the agency for “a pervasive and toxic culture of racial aggressions, bullying and marginalization” against Black workers—and, she said, agency leadership replied with silence.
Copeland said she wants to see Daskalakis fight to make sure that CDC funding goes proportionately toward Black-led agencies, to call out racism as a public health issue in order to push resources in the right direction, and to make sure that Black and Brown CDC staffers beneath him are being heard and addressed.
“White people have a unique role to play in dismantling these systems,” she said. “I hope he shows up and shows out in this role.”
Daskalakis said he intended to do so. “In any strategy to end the epidemic, the critical piece is really trying to make racial equity the centerpiece,” he said. He called current work in the HIV field “the A-plus student when it comes to centering equity.”
Finally, there is the question of how Daskalakis’ image, which has elevated him to rockstar status in New York City—out-and-proud, sex-positive, playfully THOTty on both Instagram and at parties (in pre-COVID days)—will play on a national stage, especially given that right-wing media likes to call out the excesses of liberals.
But advocates don’t think that’ll be an issue. “Whether state health officials like the cool gay guy doesn’t matter inasmuch as he controls the money that they want,” says King of Housing Works. “I think in places like Texas, you have people in the big city health departments who want to do the right thing [on HIV prevention] but are under the thumb of repressive state governments. But with Demetre now controlling their funding, he can give them permission to do things they always wanted to”—like bold and sexy campaigns promoting PrEP—“but felt constrained from.”
As for Daskalakis himself, he says that the same question was asked when he moved into a government role in New York City six years ago. “So I’ll continue to be me as we proceed through more intense work.”
In other words, that THOTty Instagram feed will not be shutting down anytime soon?