OOn July 23, the World Health Organization made monkeypox a public emergency of international concern (PHEIC). It was a contentious decision, with WHO Director General Dr. Tedros Adhanom Ghebreyesus making the final call and overruling the WHO’s Emergency Committee. The advisory committee’s disagreements mirrored debates unfolding among public officials, on social media, and in opinion pages over the last several weeks. Is monkeypox a public health emergency when it’s “just” spreading among gay and bisexual men and trans women? How concerned should transgender women and men as well as children be?
These questions reflect concerns over stigmatization and the best way to spend limited resources. These questions also reflect an individualistic approach to public health. Instead of asking them what monkeypox means to them, NowPublic should ask questions about how and where the monkeypox epidemic could strike them in the near future.
Monkeypox spreads more easily if it’s not stopped. A few cases have been reported in women, and some children. This is due to the transmission of household virus. Monkeypox in healthy individuals can cause severe pain and even disfigurement. However, it can cause death in immunocompromised patients, infants and children as well as pregnant women. All of this population would be in serious danger if monkeypox was established in the United States.
It will be safer for men to have sex without transferring the virus. With a very limited amount of monkeypox vaccine, public health officials must be able to target vaccines fairly for maximum impact.
It won’t be enough to vaccinate close contacts of people with monkeypox to stop the spread. Many cases go undiagnosed because public health officers have not been able to track all transmission routes. Meanwhile the risk of monkeypox (and other sexually transmissible diseases) isn’t evenly distributed among gay and bisexual men and trans women, and targeting all of them would outstrip supply. These strategies can also be stigmatized based upon their identity.
Recent changes by the CDC to the monkeypox vaccination eligibility include those who are aware that a person’s sexual partner has been diagnosed with the disease or have had multiple sexual partners within the last 14 days. This approach is dependent on individuals having access to testing. In some countries, clinicians are more likely to test than others.
Public health officers could also target monkeypox vaccines for gay, bisexual, and transgender men and women with HIV. Taking medications to protect against HIV infection. Afterall, there’s a lot of overlap between these populations and those at risk for monkeypox. However, PrEP is only available to 25% of eligible Americans. This percentage drops to 16% and 9 respectively for Blacks and Hispanics. This strategy could leave many vulnerable and increase existing racial-ethnic disparities.
It is because of this that some LGBTQ activists have advocated for more aggressive outreach. “We talk about two kinds of surveillance. Passive surveillance, where I show up to my doctor’s office,” says Dr. Gregg Gonsalves, an epidemiologist at the Yale School of Public Health and a longtime AIDS activist. “Active surveillance is where we go out and we seek cases actively by going where people are at. There are parties, social venues, sex clubs where we could be doing monkeypox testing,” he says. This is especially important for gay-friendly communities, because both gay and straight sex may be stigmatized and the providers might not be as informed.
New York City is the epicenter for monkeypox. However, there are still disparities in accessing monkeypox vaccine. The city’s health department offered appointments for first doses of monkeypox vaccine through an online web portal and promoted them on Twitter. These initial doses were administered in the Chelsea area at a clinic for sexual health.
Continue reading: Monkeypox vaccines are difficult to find
According to Gonsalves, “It was in the middle of the day. It was in a predominantly gay white neighborhood… It really was targeted at a demographic that will be first in line for everything. This is the problem with relying on passive surveillance and people coming to you.” According to Dr. Michael Levasseur, an epidemiologist at Drexel University, “The demographics of that population may not actually reflect the highest risk group. I’m not even sure that we know the highest risk group in New York City at the moment.”
Granted, three-quarters of the city’s cases had been reported in Chelsea, a neighborhood that is known for having a large LGBTQ community, but that’s also a reflection of awareness and access to testing. While more laboratories are now offering monkeypox testing services, many doctors are not aware of the condition or are unwilling to perform tests on patients. To get tested you must be an advocate, as this can disadvantage already marginalized groups.
In Central Harlem, the NYC Health Department opened a second vaccine site to reach more communities of color. But, not all those who were able to access monkeypox vaccinations have been there. white men. NYC also launched last week three mass vaccination sitesThe Bronx and Queens were also open, as was Brooklyn. You had to know the facts, be able to wait in line, be willing to get the vaccine and have the necessary day off to receive the monkeypox vaccination.
What is the best way for public health officers to carry out active surveillance Gonsalves referred to to ensure that monkeypox vaccinations are given to everyone equally and those most at-risk? The Rapid Epidemiologic Study of Prevalence, Virus Network and Demographics of Mousepox Infection (RESPNDMI) may help to pinpoint the source of this epidemic. Your chance of being exposed to monkeypox is determined by the likelihood that someone within your social network may have it. This study could help to clarify, for instance, the importance of dating apps versus group sex at large events and parties in spreading monkeypox. “A network map can tell us, given that vaccine is so scarce, the most important demographics of folk who need to get vaccine first, not just to protect themselves, but actually to slow the spread,” says Dr. Joe Osmundson, a molecular microbiologist at New York University and co-Principal Investigator of the RESPND-MI study.
When vaccines were first distributed at mass vaccination centres and pharmacies, there was a large racial gap in the vaccination rate. The gap in vaccination rates was closed by officials from public health who met people at their doorsteps. Trusted messengers were used to help reach individuals of color that might be hesitant about the health system.
Similar to the sexual health clinics, they may not offer a universal solution for vaccination and monkeypox testing. While some may find sexual health clinics more inviting, others might be afraid of being visited one. Due to the limited hours they are open on weekdays, some may be restricted from accessing sexual health clinics.
It isn’t new for public health officials to meet members of the LGBTQ community where they are. In 2013, there was a national outbreak of meningitis affecting gay men and women. Health officials across the country formed partnerships with LGBTQ organizations and established meningitis vaccination distribution programs. Chicago has a different approach to monkeypox than New York City.
According to Massimo Pacilli, Chicago’s Deputy Commissioner for Disease Control, “The vaccine isn’t indicated for the general public nor, at this point, for any MSM.” Chicago is distributing monkeypox vaccines through venues like gay bathhouses and bars to target those at highest risk. “We’re not having to screen out when people present because we’re doing so upstream by doing the outreach in a different way,” says Pacilli. He says that monkeypox vaccination “is intentionally decentralized. And because of that, the modes by which any individual comes to vaccine is also very diverse.”
To expand your capacity, another reason for LGBTQ community groups to partner is. New York City Department of Health and Mental Hygiene (NYC) is among the most well-funded health departments in America. Yet, they’re not the only one. strugglingThe monkeypox crisis required them to quickly respond and be strong. “COVID has overwhelmed many public health departments, and they could use the help, frankly, of LGBTQ and HIV/AIDS organizations,” in controlling monkeypox, says Gonsalves.
But even as public health officials try to control the transmission of monkeypox among gay and bisexual men and trans women in this country, it’s important not to forget that monkeypox has been spreading in West and Central Africa for years. MSM communities are not the only source of monkeypox transmission. Local epidemiology will be a key component of any strategy to control monkeypox. Countries like Nigeria that ban gay sex will make social and sexual mapping even more difficult. Unfortunately, wealthy nations have been hoarding monkeypox vaccination supplies as much as COVID vaccines. All countries will be at risk if access to monkeypox vaccination isn’t made equitable.
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