Charles Sanchez: I’m Charles Sanchez for TheBody. I am at home with myself right now in Astoria, Queens, New York City. I’m so glad to be here.
Let me see if my guest is here, Dr. Demetre Daskalakis from the CDC. He’s an amazing man. He used to be our HIV guru. I’m proud our homeboy made it, made it to the bigtime. How are you?
Demetre Daskalakis: I’m good. That was easy. How’s it going?
Sanchez: Good. I’m well. How are you feeling today?
Daskalakis: Doing great. Thank you for having me.
Sanchez: Are you in D.C. right now?
Daskalakis: So, I am in my last day in New York City before I make my permanent Atlanta move.
Sanchez: Oh, my. Oh, you’re going to Atlanta. Ooh.
Daskalakis: The CDC’s in Atlanta, so I’m going to be—it’s going to be a little, a little adventure, driving down. But here I go. Very excited.
Sanchez: Do you already have an apartment and things?
Daskalakis: I do. I do.
Sanchez: How do you feel about moving during a pandemic? Another pandemic?
Daskalakis: Um, well, there are two answers to that question. So, answer one is, it’s harder to move during a pandemic. Not surprising. Of course, there are so many other, way more difficult, things happening in a pandemic, where, like, the work of moving is minor compared to what health care workers and what the community’s experiencing. But, still. Like, I’ve got to say, it’s probably easier to do it not in a pandemic.
But I do have one important benefit of a pandemic, which is that having left New York before, I don’t have any FOMO right now. Because, you know, all I do is work and go home. So I will continue to work and go home in Atlanta. So it’s a pretty good time to make a switch, from that perspective.
Sanchez: Well, though, Atlanta’s cool.
Daskalakis: Oh, yeah.
Sanchez: I mean, I make fun of the South a lot, and you do, too. But Atlanta’s really cool. It’s a beautiful city. And there’s a big clientele, I was going to say—clientele! A gay community that lives there.
Daskalakis: It’s good. I love Atlanta. I’m really excited. I mean, again, like I said, having left New York once, there was that sort of FOMO period of missing things in New York. And I think New York is going to spring back and be wonderful, sort of as the pandemic winds down—which hopefully will be sort of expeditious. I know, fingers crossed. But I think that, you know, looking forward to ATL. I can’t wait. It’s going to be great.
Plus, like, no one’s going to sneeze at 20 degrees warmer. Oh, no. It’s good.
Sanchez: Hopefully. Hopefully. And if they are, you know, you can make sure they wear masks around you, right? Because you’re, you know—you’re the big cheese now.
Daskalakis: You know, I think I’m probably going to be—CDC is working remotely. So I’ll probably be working in my apartment. So it’s going to feel about the same.
Sanchez: So, Mark S. King wanted me to ask if the CDC has been restricting you on wearing leather or harnesses in public.
Daskalakis: No. As evidenced by the fact of the Plus [magazine] cover, I think we’re good.
Sanchez: Are you wearing it underneath now?
Daskalakis: Always. No.
Sanchez: So, well, how has this pandemic been for you? I mean, you’ve been in New York. But how has it been feeling? How have you been dealing with it?
Daskalakis: I mean, it’s been complicated. When I was working in New York City, I was the incident commander for the Department of Health for COVID-19. So I was pretty much, you know—insulated is probably the wrong word, because I was like hermetically sealed into my job or into my workplace or apartment for a very long time.
From my perspective, you know, it’s been at times terrifying and at times, I think, exciting to see all the resilience of people in this big city who have managed to figure out a way to sort of be, even in the throes of the greatest public health emergency that we’ve had internationally for a long time.
I think I’ve been dealing with, you know—my husband is fantastic. Literally, he has saved my life over and over again by making sure that I continue to eat and sleep. And, you know, thank God for dogs. So those two things, I think, probably were the saving grace.
And also just, you know, I think everyone finds their way to deal. And I think for me it was a very busy time and so, it is, I think, also like a self-defense mechanism where you work so hard that sometimes it doesn’t always come to you, like, the great challenge, and the great loss, and also some of the great successes that have been demonstrated by what we’ve been through as a city, country, and world.
Lessons From the HIV Epidemic—One Year After COVID-19 Hit
Sanchez: Yeah. I think that it’s been really interesting to look back, especially because, here we are, in the anniversary—ugh—where we were a year ago.
Sanchez: And I remember my doctor telling me it was a literal shit show in the emergency room in New York City. He said there was diarrhea everywhere—which is something we don’t think about. But there was so much sickness and so much that we didn’t know. It’s amazing how much we—how far we’ve come, and amazing how far that we still have to go, just with regards to COVID.
Daskalakis: Yeah, no. Agreed.
I mean, this anniversary, I remember getting the call in New York saying that we had our first cases. Like, I remember that very moment in time and all of the sort of things that happened from there. So, having been preparing for all that time and then, here it is.
That anniversary shows you what we’ve been through. But also, it was fairly triggering. So.
Sanchez: Yeah. Absolutely. I think it was for a lot of people living with HIV. And, like, for me, too. I remember having the feeling—and still sometimes—is this what’s going to take me out? And I hadn’t felt that way since I was newly diagnosed with HIV. So it really was shocking on so many different levels to feel that feeling. I think that was really common.
Daskalakis: Yeah. I think for sure, that’s a really important comment, Charles. I think that for people living with HIV, especially people who potentially have been living with HIV for a while, the whole thing is triggering. Because it’s like another—it’s such a familiar territory.
But there are also things that were sort of so inspiring in it, from the early days of HIV—and I would say probably the early to mid-days of HIV—in terms of, like, how some parts of the resilience really were so familiar and, frankly, a bit more automatic. Because, like, the community had been through something like this. So I feel like it was a really interesting—I mean, you know, so much ink will be spilled on that part alone—like, the sort of fact that there’s like this synergy between the epidemic and the pandemic, in a way that is both, like, scary, but also, like, that let us sort of jump ahead.
I mean, I can talk about this forever, so you have to cut me off. But I feel like, for instance, just thinking about, you know, there was a pneumonia that no one understood in China.
Well, that already is triggering, right? Pneumonia no one understands and HIV were always triggering, and we’re approaching the 40th anniversary, right? So, there’s that.
And then, like, three or four weeks later—well, I can’t remember; it was fast—all of a sudden, there’s a sequence and a virus. And just thinking about the fact that so much of that ability to do that science and to sort of move the vaccine forward fast, that’s all on the back of HIV. And that really is on the back of not only scientists but the advocates that sort of made it happen, that the science could exist. So it’s like a really—this is going to be, you know, great books in the future written about this.
Sanchez: Yeah, I think it’s also amazing how the community of people have really banded together to take care of each other. I had more people in my HIV community kind of reaching out to me, especially early last year; just, “How are you?” You know? And I think that that’s something that we—that is unique to our community, that we really understand in a way that a lot of people don’t.
Daskalakis: Yeah. No, I agree.
Daskalakis’ New Gig: Bringing Equity and Sex Positivity to the CDC
Sanchez: So, as you move to Atlanta, what are your priorities with regards to HIV and messaging? And what are you going to be working on first?
Daskalakis: I’ll start by saying that landing at DHAP, at the Division of HIV at CDC, is a great gift. There are so many brilliant minds, and scientists, and people who have been doing this work, you know, for many, many years, if not decades. And I’m really excited to land there when I’m landing, with a new national strategy and the opportunity to sort of work to influence what its implementation looks like, as well as the path going forward.
But I feel like other than the stuff that we’re already doing, the ending the HIV epidemic work, which will blossom further and sort of rage on as we go through this pandemic, I think there’s three areas that I’m really, really sort of hyper-focused on. And the first is not going to be any surprise, having lived through, you know, so much in HIV, in COVID, and then in recent history in the U.S. You know, really, a very significant and different sort of focus on health equity is going to be one of our main focuses.
I’m going to actually drop the “health” for a second and just say “equity.” Because there’s going to really be a focus on looking introspectively to DHAP, as well as outside to our programs, to really make it actually do even more than what it’s done to improve equity. And by that, I mean really push towards a space of being more anti-racist and a space where, you know, we really realize that to actually make a difference, your investment of energy and resources has to be the main problem.
And the core problem is racism. And I’ll say racism, sexism—and everything else flows from those two: homophobia, transphobia, xenophobia, all of it. So I think equity’s number one.
Number two for me, which actually is 100% equity, but it’s like HIV-niche equity, is the way that I like to think about it, which is like the status-neutral idea. And so, really, the work that I’ve done before, sort of thinking about ways that programming and strategies can look more neutral and less about, like, “Am I negative? Am I living with HIV? Like, what’s the story?”
So much that I’ve seen and what the literature will tell you about is, you’ve got two doors for people. And what happens is, you create stigma and duality, and you bring them into one door. And folks can access services and other things through one space. Like, it’s going to change the sort of institutional, I guess the right word is, status-ism, for lack of a better word, that’s sort of created by the sero divide between people living with HIV and people who are potentially folks who could benefit from prevention.
So, I mean, I think I’ve had lots of experience on the ground in New York City, sort of thinking about and doing this. So it’s a very significant piece of focus. Because, again, it’s not just saying, “We need a couple—we need to get rid of a couple doors and make it one.” Like, we need to start looking at people as people, and not their status.
And I don’t think that it’s a start. I think it’s already happened—but really in a very deliberate way, in a way to focus equity to create the strategies where we don’t only sort of think about this notion of status neutrality but say, like, “How are we going to make it happen on the ground?”
And then the last one is syndemics. I think it’s kind of a word in the biz, but like just to unpack it for people who don’t know what I mean is, there’s HIV, and HIV is a really important epidemic. But there’s a lot of other things happening contemporaneously, like increased rates of sexually transmitted infections. Viral hepatitis that’s happening not only in people who are having sex, but also in people who are injecting drugs.
So, really thinking about ways that HIV and my division, the Division of HIV and AIDS Prevention, how we can be leaders in trying to push forward syndemic work, realizing that humans don’t care if it’s coming from STD or viral hepatitis or HIV; they just care that the work is being done and the services are compassionate, culturally appropriate, and, frankly, status neutral and equitable.
So, those are my big three. There’s a lot of moving pieces. I kind of want a level set and say I wish I could flip the switch and have everything happen in a day. It’s going to take a little bit. But I’m really excited to go down the path.
So, wow. You’ve really got me going.
Sanchez: I love all of that stuff. I love all of that stuff.
Daskalakis: You got me going.
Sanchez: One of the things that is—well, thank you—one of the things that, I think, that is really important to me for you to be in the position is that you are someone who thinks about the whole person, who is sex-positive in his life. And I think that’s a big part of your brand, which I think is really missing in a lot of HIV messaging.
I was talking with a friend about, like, a lot of the commercials that we see for HIV medications. According to those commercials, we go to a lot of picnics. We go to a lot of fun runs. But, so, it doesn’t seem like it’s very, real life. So it’s nice to have someone like you, who is thinking about how real people are in real situations, and meeting people where they are.
Daskalakis: Yeah. I always—someone asked me recently, “What do you attribute success in sort of communicating these complex ideas to people?”
And my success is that I’m literally just like a vessel. You know, when you start your public health career by doing HIV testing at a sex club, you sort of learn how to talk to everybody and figure it out. And so I really feel that that’s like a critical piece of this, which is that thankfully I come from the experience of on-the-ground in a way that’s like, kind of unique. And so I’m thinking—I’m hoping—that I channel that, like I did in New York, into work that sort of hits all of our needs.
And so I appreciate [it], yeah. And, totally, I think the more we focus on people and the less we focus on status, the more we focus on social determinants, some of the things that people care about—like, how can we work better with housing, and better with employment? And so, these are all things that I want to sort of usher forward, and in the public health space.
Sanchez: How can we help people without judging them first?
Sanchez: That’s something that—I think I’m becoming more and more of a bleeding-heart liberal, more and more as I go along in my life. And those kinds of things, and I think—wasn’t Sex Worker Day yesterday? I think it was Sex Worker Awareness Day yesterday.
I noticed you were talking about going to a sex club to do HIV testing. You posted about that recently because the bathhouse, the West Side Club, I think, was closing? Which is amazing that they were around for so long, and this is what brought them down, was this pandemic that isn’t sexually related. It’s just amazing what the city has done.
Daskalakis: It’s oddly poetic for me in some ways, because my story of how I landed back in New York; actually, it’s oddly related—not oddly, it’s directly related—to that venue, which is that there was a case of HIV with rapid progression in like 2004 or 2005 (I can’t remember the year anymore, I’m getting old), and eventually the story was that the person who had that rapid disease progression with multi-drug-resistant HIV probably had their encounter at the West Side Club.
And so, I was sitting in Boston in a lab, and I was just like, “I love the lab. This is great. What a great place to be. But I need to go back and do—” something that I didn’t really know was public health. I was just like, “I’ve got something to intervene in that space in the community.”
So, literally, that club, in effect, through some very circuitous way, brought me back to New York City. And so it’s really interesting that the month that I’m moving, it’s gone.
Sanchez: Yeah. Are you saying—? Is the West Side Club closing because you’re leaving town; is that what you’re saying?
Daskalakis: No, no, no. It’s just like a poetic moment for me, right? Although they were wonderful. They were wonderful to work with. But definitely it has this sort of poetic moment for me, where it’s like the thing that brought me is also now kind of going to go away. It just really means, you know, onward and upward to sort of the bigger shop and working on the national level. So, it’s good. It’s a bittersweet moment, which is why I posted about it.
Sanchez: Yeah. I think it was, well, bittersweet for a lot of us just to hear about those spaces closing. I mean, there are so few spaces for us left at all, even in just like regular gay bars and stuff. They’re all closing. And it’s really quite sad. So I’m hopeful that when this—
Daskalakis: I do believe that there is a high level of resilience. And so when things are able to resist again, I predict—I was just reading, somebody posted something about, “Are we waiting for things to come back to normal or for things to be different?” And so I feel the resilience is going to really be—what happens when this evolutionary thing has happened to us, where we have to change? And let’s see where it lands.
Because I think that so many of the things that, you know—especially in HIV—stuff that you’ve learned in COVID? Let’s not get rid of it. Let’s not get rid of telehealth. Let’s not get rid of self-testing. Those things are all amazing. And so, it will be fascinating to see, especially in the universe of nightlife and the gay universe, how things will rebound and how they’ll sort of evolve.
Sanchez: Well, I’m sure nightclubs will come back. We always gotta dance.
Daskalakis: Nightlife is resilient.
Daskalakis Answers Community Questions on Self-Testing and U=U
Sanchez: I have a question. A couple of people asked me to ask you some questions.
Sanchez: You brought up self-testing. Someone wanted me to ask about HIV self-testing best practices. What are your recommendations with those kinds of test? And are broader STD or STI self-tests going to be available?
Daskalakis: Yeah. So, first I’ll talk about HIV self-testing. It’s a great question. I think that the main goal of self-testing is to lower the threshold to let people get the tests that they need on their terms. So I think that that is the best practice, which is that it needs to be easy to get. And so I think that there is a lot of great work happening locally. There’s also work happening at CDC to allow accessibility of self-testing through online ordering.
But also there’s community-based organizations. I know that obviously we’re talking to people on a certain side of the digital divide. But for those who aren’t on that side, a lot of community-based organizations are also offering tests, self-test kits, without necessarily having to go through an online portal.
So I think that the whole point is to really get them out there, but then also make sure that the path to care is clear. And so, you know, really using resources to identify if you do test positive what the next step is. Because the next step is obviously link to care as soon as you can. And then also, for people who are testing, who are testing negative, it’s to consider strategies that may get you closer to practice.
Now, STI home testing: I think that that is a completely newer growth industry, in terms of how to do it. I think that in terms of strategies, I think that there is a lot of role to be played by laboratories. And I think that as we get deeper into the way home testing works, the more we can encourage labs to allow individuals to drop off their own samples for testing, I think the closer we’re going to get to the vision of being able to do home testing for STIs.
Interestingly, it’s more complicated because there’s not an FDA-approved test for gonorrhea, chlamydia, and syphilis. But working with the labs and advocacy around that I think is really critical to try to push the technology forward. The technology’s there. It’s just getting it actually working on the ground.
Sanchez: Well, one of the things I think we’ve learned from this COVID epidemic is how much people are afraid of science, or don’t believe science, or don’t want to hear about it. And that has really bled over to what I think is happening in the HIV world. So many people are—that’s one of the reasons we have so much stigma, is because people don’t want to believe science. They cloud it with other things. They cloud it with their thoughts about homosexuality or religion or anything else, when it’s really just about science and a virus, which doesn’t eliminate them.
Daskalakis: And there’s always so much work to do around stigma. But I think that a really valuable home base is that HIV is a virus, right? And, thankfully, we have miracles. We have the miracle of antiretrovirals that can treat and prevent HIV. Literally, it is among the—in my mind—miracles.
It prevents maternal-to-child transmission of HIV, right? Literally, the miracle of having interventions that work, that keep people healthy and also prevent this virus, is great.
And so, at the core, making the science accessible, and that means to all communities, no matter what their gender is—male, female, trans—no matter what their race is or ethnicity; that’s where the rubber hits the road, which is where that sort of equity conversation becomes the pivotal conversation. Because the miracles exist. It’s just that people have to be able to touch the miracles.
Sanchez: Oh. Amen. That was really pretty. Well, Bruce Richman wouldn’t let me let this go without asking—
Daskalakis: Hi, Bruce!
Sanchez: He sent me like three pages of an email to ask you one question, which is—
Daskalakis: That’s OK. I love it.
Sanchez: When is the U.S. going to come up with a national U=U strategy campaign?
Daskalakis: Yeah. I think that the right answer is that everyone, I think, is—all the people that need to sort of buy into the notion of treatment as prevention, have bought in—U=U is powerful messaging. And I think that’s something that you’ll see even in our current Let’s Stop HIV Together [awareness campaign]. It’s super, super clear that there’s no one debating that the message that treatment prevents HIV and it’s super-powerful is going anywhere.
So I think again, with all of the coordination in the EHE [Ending the HIV Epidemic] space; I feel like the message is there and we’ll continue to amplify it.
Self-Care Is Key, Especially for the HIV Community
Sanchez: Fantastic. Well, gosh, it’s almost the end.
Daskalakis: It’s been great. I’m having a great time.
Sanchez: Is there anything else that you want to make sure and say? Any kind of message that you want us to take with you? Words of wisdom? Favorite poem? Recipe?
Daskalakis: I do, but it’s interesting—it’s not really an HIV message. Is that OK?
Sanchez: Yes, it is. It’s your time.
Daskalakis: I feel like one of the things that I used to do in New York when I was the incident commander was always take a minute to remind people that we have to acknowledge that the time that we’re living in right now is really hard.
And so, though I think having this virtual conversation and seeing your—it would have been way more fun to be in a studio and be together and be able to give you a hug and say, “Thanks for having me.”
And so I think it’s important for us to really acknowledge (a) that there’s trauma, that we’ve all been through a lot; and that there’s more to come but the goal is that we’re approaching things in a way together. And I think, as you said, Charles, the community, especially of people living with HIV and those who are affected by HIV and who come together, really acknowledge that trauma and that recent past.
And take care of yourself. So I just feel like, you know, for people who are listening and watching, I think this has to do with taking care of yourself, whether it’s prevention or treatment. That’s true.
But just really take a moment. Life is so fast right now. If you’re working, you may be on conference calls after conference calls, or working in person because you have no choice but to do that because of what you’re doing. So, really, a good one to think on is, self-care is important, and it matters. And so if you don’t take care of yourself, how are you going to take care of someone else?
And that almost sounded like a Drag Race quote. But I mean, I guess we can totally make it work.
Sanchez: It was totally RuPaul. Yeah.
Daskalakis: But I didn’t say it. I didn’t say it. It’s just like, as we’re sort of talking about March and the anniversary of everything that we’ve been through, it’s OK to say, “This hurts.” And so we hurt together. And I think that that’s right.
Sanchez: I think everything that we’re feeling right now is amplified by the stress, the collective stress, of this pandemic, and political stuff, and everything else that we’ve been going through. So, absolutely, to take time for yourself, to eat delicious things, to let yourself be a little fat if that’s what happening. You know, all those kinds of things just to soften the blows.
Daskalakis: Yeah. I think we’ve all learned ways to find joy, even in the solitude that happens. But that’s one message that has to do all about HIV and nothing to do with HIV at the same time—which is, you know, just self-care is so critical. And as we’re getting through this, everyone take a break. Take a moment and just—and breathe. I think that’s my advice. With a mask on. With a mask. But breathe.
Sanchez: And a cute mask, if you have a cute mask.
Daskalakis: Look, look. Just to prove it, look how cute. That’s my—
Sanchez: It is. Oh, my God, it’s just terribly cute.
Daskalakis: It’s an Atlanta mask. So I’m in New York, wearing an Atlanta mask. There you go.
Sanchez: Oh, my. Well, you’re just getting ready. You’re preparing yourself.
Daskalakis: I’m ready.
Sanchez: Thank you so much. Oh, my gosh. It was a long time to get you to be on this little show, and I just really appreciate you taking the time.
Daskalakis: Yeah. Thanks for rescheduling. I appreciate it. This was great. Really nice meeting you, and thank you for elevating all of the important information for people about HIV. So I really appreciate what you do. So, thank you for you.