August 7, 2014
As a prescient college student and gay New Yorker in 1994, Demetre Daskalakis, M.D., vowed "I'm going to take care of HIV. I don't want anyone to get this, and I don't want anyone to die anymore."
This vision took him to medical school (where he snuck into AIDS wards as a young medical student) and into the labs and clinics where the fight against HIV has progressed but never ended. And it took him into the heart of the epidemic in New York City, where he led HIV prevention efforts and testing in bathhouses and sex clubs. Now, Daskalakis will leave his role as medical director of the HIV/AIDS services at Mount Sinai Hospital to serve as assistant health commissioner in New York City's Bureau of HIV/AIDS Prevention and Control, overseeing a $200-million budget and programs spanning testing, prevention, services, care and treatment. Terri Wilder spoke with Daskalakis as he prepared to lead efforts against HIV/AIDS in one of the U.S. cities hardest hit by the disease.
I always thought of the New York City Department of Health as the largest Department of Health in the country and the epicenter of the HIV epidemic. Can you tell me why you would be interested in going to the largest Department of Health, in the middle of the epicenter of where HIV is?
My New York story is the reason why. I was a student at Columbia University as an undergrad and while I was there, I really became a New Yorker, and became a gay New Yorker. I experienced nightlife and that piece of the universe. It was sometime around 1994 that I, along with a few other people -- I was a resident advisor and a community program assistant, is what they called us -- decided that we were going to do something that was gay health oriented, and about HIV. So we decided to do a benefit for a direct service organization and then, also, bring a display of the AIDS Memorial Quilt here.
Thinking of myself as a pretty good transplanted Virginian who lives in New York, I thought this was a great opportunity to do something nice for the city that was about HIV. And so I had no idea of what I was really getting myself into because it was the pivotal moment in my career that showed me that I was going to do HIV in the future, and specifically do HIV medicine. Because I remember the day that we actually laid the quilt down; it was before antiretroviral therapy as we know it kicked in. All of a sudden, I was surrounded by people who were mourning folks on the quilt, and who were really sick themselves.
I remember standing there that day really exhausted -- because it's a really daunting task to get that quilt out and laid out -- and said, "I'm going to take care of HIV. I don't want anyone to get this, and I don't want anyone to die anymore." There was a very adolescent decision, but this core decision made me do HIV.
I went to medical school in New York, and I had experience with HIV on the Bellevue wards, because I actually snuck on to the AIDS ward. I wasn't allowed on it -- as a medical student, there were some restrictions. I figured out that the best way to do it was to sneak on, so I snuck on so I could learn something about HIV medicine. And then I decided that it would be good to see the world, and see how other people do medicine.
Ultimately, I matched for my residency in Boston, at the Harvard program, Beth Israel Deaconess Medical Center. That place was fabulous. It inspired me to keep doing HIV medicine, with a couple of significant mentors who showed the way of doing primary care for HIV.
Who were they?
John Doweiko and Howard Libman were two of the doctors whom I worked with in Boston who were very inspiring when I was a resident, to keep going. And Chief Resident Wendy Stead, who was not that much older than me, but was the smartest person I knew, and the most compassionate HIV doctor. She really taught me the path.
Then I decided to stay in Boston. I did my fellowship at the Brigham and Women's/Mass General program, where I'm literally surrounded by the Raj Gandhis and Paul Saxes of the world, and all of these fabulous HIV doctors with the Partners AIDS Research Center -- now that's called Rangon Center. I ultimately met Eric Rosenberg. Eric Rosenberg was a researcher in acute HIV infection/immunology. And I decided that I was going to be one of his mentees, that I was going to be in his lab.
I never wanted to do lab work; I always wanted to just do community-oriented health. I went into the lab and it was great. I was doing work. I was getting results. And I remember just sitting -- it was February, and I was sitting -- googling Lord-knows-what, and I saw news saying that there was a case of acute HIV infection in New York City, with rapid progression to AIDS and multi-drug resistance. And this cascade of feelings happened to me there. I said, "Why am I in Boston? I've kind of lost my way. I signed up for this because of the population in New York that inspired me to do this." All of a sudden, I find myself with cell cultures and petri dishes and exciting academia and I was away from what brought me to this story.
Tom Frieden was on the television talking about this case. I ran downstairs and started calling people to see if there were any jobs available in New York, because I wanted to come back and focus more on clinical stuff, and potentially more public health-oriented approaches to HIV.
Ultimately, Judith Aberg decided that she saw some potential in me and offered me a job to come back to NYU/Bellevue, and I did. And that case drove the rest of my story. Soon thereafter they said that that case of acute HIV infection was transmitted by somebody who had an encounter with a person living with HIV at a bathhouse in the city. That made me decide that, well, then we're going to start doing something in the bathhouses, and do HIV testing and prevention there.
On the back of some research funding, I was able to start a program and then, soon thereafter, the city funded it through HHC [Health and Hospitals Corporation] to actually continue doing HIV testing as a clinical service. So, really, my entire story of why I'm doing what I'm doing revolves around the public health of the city. Being away from the epicenter was killing me, at one point.
Spiritually killing me. That day, I knew I was not where I was supposed to be. And so I decided to come back to the epicenter and, having worked with the Department of Health and having seen some of the good that they can do, when the opportunity arose to become the assistant commissioner, I jumped on it. Even though I'm happy where I am at Mount Sinai and love doing my clinical duties, I always feel like a lot of my strength comes from the programmatic piece, and from the piece that revolves around public health. Sometimes I would feel as if I couldn't really focus on that. So that's where the decision came from. I'm going from a clinical venue to a more public health venue.
The truth is, in the context of my time, I also went back to Harvard and I got my master's of public health. I was just thinking about it this morning, that sometimes my happiest times in the last four or five years were in the setting of crunching numbers in a public health environment, and talking about program development and cost effectiveness and environmental medicine -- all the things that come with public health. So it just seemed as if that same case that brought me back to New York was, in some ways, leading me right down the path, right back to New York City.
How did you decide, "I'm going to apply?" What was it that kind of intersected in order for you to say, "Yes, I'm going to apply to be the assistant commissioner in the largest Department of Health in the country"?
True story: Dr. Aberg, who is now the chief of infectious diseases at Mount Sinai and who has been my mentor in New York since the day I landed here in 2005, sent this email out to me to forward to other people, which I did.
And it was that job description?
Right. And I did forward it. But that same day I emailed the Department of Health. I emailed Dr. Varma and I said, "Hey, Dr. Varma, remember me? I'm the guy from meningitis vaccines, and I'm going to apply for this when it becomes open."
And he said, "OK, keep an eye out. When it becomes open, throw your application in. That sounds great." And then I called. And since I did work with the city, I called some people and I said, "What do you think?" And the response was, "Totally. Do it."
I had a lot of soul searching. I talked to my husband. I talked to some of my folks from the past, my doctors in the past. I called Paul Sax, and I said, "What do I do?" And everybody seemed to agree with my idea -- that this maybe would be a good thing for me to do next.
Can you tell me specifically something that somebody said to you that made you go, "You know what? I really do need to do this."
It's not really something that someone said to me, but something that someone sent to me: Mark Harrington.
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