II am a 29 year old gay male living in New York City during the first major wave of monkeypox infections in the United States. As the CEO and co-founder of a healthcare start-up, I’m very connected to the world of public health – especially public health that impacts LGBTQ+ people.
So I figured I could get the monkeypox shot quite easily. But it took me weeks to do it. It’s even more difficult for people in my community who have less time and fewer resources. What can be done to fix this?
I got off the 4 train in a huge crowd of masked strangers at the Bedford Park Boulevard subway station in the Bronx. Old men, young men, trans people, able-bodied and disabled people: we were all on our way to get vaccinated at the Bronx High School of Science.
To get to this point, I had to identify my own health risk. Some of the questions – Did I have enough promiscuous sex to qualify for vaccination? Did I have anonymous sex? Was it unprotected? With multiple partners? Where did you meet? In the past two weeks? “I wouldn’t want to answer in front of my closest friends. Not to mention, who decides what “promiscuous sex” is anyway? ! It is not a factual term, but full of judgment.
Then I had to search for appointments online and get one before they ran out, a time-consuming task.
In the crowd heading to Bronx High School of Science, it was surreal to see people who had survived AIDS in the 1980s next to my generation of LGBTQ+ people. While HIV is no longer a death sentence with access to the right preventive measures (PrEP) and treatment (antiretroviral therapy), the community trauma remains. We came from all over New York to protect ourselves, our communities and the general public.
When I opened my Grindr app (a location-based online social networking and dating app for gay, bi, trans, and queer people), I was shocked to see hundreds of people online in my immediate vicinity. The Bronx High School of Science isn’t a typical stop for the LGBTQ+ community on Sundays – it’s not a brunch in Manhattan’s West Village – but we did get to travel outside of our neighborhoods and boroughs in a common goal. My friends and I have noticed that people using Grindr have started not only reporting their Covid vaccination status, but also their Monkeypox vaccination status. Grindr is even encourage users to get vaccinated. (You know public health has dropped the ball when a gay hookup app promotes vaccination ahead of local or state public health agencies.)
It’s obvious to me – and should be obvious to everyone – that the LGBTQ+ community wants to do its part to stop the spread of monkeypox. But just as PrEP is a necessary tool to limit the spread of HIV, other public health tools are also needed to fight monkeypox.
One of the older guys in line, probably in his 60s, wore a shirt bearing the iconic ACT UP slogan “SILENCE = DEATH” emphasizing the connection between the AIDS epidemic and this monkeypox epidemic. While self-identification unfairly forces LGBTQ+ people to access health care services, what other groups claim this level of health awareness? With Covid-19, individuals were supposed to protect themselves, but public health was more expected to provide additional tools like remote diagnostic tests, realistic protocols and guidelines, and possibly easily accessible vaccines. . With monkeypox, the World Health Organization and the Centers for Disease Control and Prevention have asked men who have sex with men to reduce or stop sexual activity with new partners and get vaccinated, although they offer little information on how to do this.
There is a limit to what the LGBTQ+ community can accomplish without greater institutional support. (Hello, feds! What have you done? Robert Fenton was named the White House monkeypox coordinator, but not before three states had already declared states of emergency.)
The first New York clinic, in Manhattan’s Chelsea neighborhood, to offer 1,000 doses of the monkeypox vaccine had to close its line after about 90 minutes. The San Francisco Department of Health confirmed that clinics across the city ran out of monkeypox vaccines in less than a day in early August. Georgia emerged as a monkey pox hot spotbut health service websites routinely crash when vaccination appointment links go live due to overwhelming demand, leaving many citizens no closer to a vaccine than before.
When I went to see a nurse at Bronx High School of Science, there was some confusion about whether I could get a second dose of the vaccine. At the time, public health officials were trying to decide whether to expand the vaccine supply by vaccinating more people with one dose rather than fully vaccinating fewer people with two doses, which would result in protection for the immediate future, but less long-term durability.
After my first vaccination, the Biden administration authorized the use of one-fifth of the doses of the Jynneos monkeypox vaccine. Although it sounds like a good idea, health care workers struggle to learn how to administer the vaccine intradermally when needed, which regularly results in wasted doses. Why was this plan authorized before health services could effectively operationalize the split dosing plan?
The lack of vaccines is not the only problem. Screening for monkeypox is limited and the WHO and the CDC encourages people to limit their sexual partners, which is not an effective long-term solution. Note the huge spike in sexually transmitted infections during Covid-19, including a 24% increase in the rate of primary and secondary syphilis among women of childbearing age at a time when people were expected to socially distance themselves. (Also imagine straight people being singled out to stop having sex as a public health measure!)
Tests also need to be more accessible. Health departments across the country should consider activating monkeypox home diagnostics to help the LGBTQ+ community as a whole combat the spread. This would allow at-risk members of this community to access care without publicly identifying themselves, as well as parents, shift workers, people with disabilities and others who may not have the resources to obtain care outside the home. The Center for American Progress reported that 31% of LGBTQ+ people living outside of metropolitan areas would find it very difficult, if not impossible, to access more than one community health center or clinic.
Some hospitals, clinics and public health initiatives have built on the popularity of telehealth, the use of which has increased by more than 150% during the Covid-19 pandemic, to improve access to healthcare with continued telemedicine options and home diagnostic tests. Home diagnostics are currently used in STI testing, fertility screening, primary care, medication management, chronic care, and more. Why not use this option to increase access to monkeypox testing and remote care, especially when multiple studies (Kaiser Family Foundation, Rutgers Universityand others) show that telehealth is an effective way to reach the LGBTQ+ community? A FDA Approved Monkeypox Test can detect monkeypox from a lesion sample, which is no different than a test for herpes.
The wider public health community must take action to stop monkeypox like it did with Covid-19 – free vaccines for all, improving access through telehealth, enabling Operation Warp Speed to accelerate the development of vaccines and therapies against monkeypox, and major information campaigns to raise awareness of the disease. Much of the LGBTQ+ community has had to fight back, as it continues to do with the AIDS epidemic. It is time for greater institutional support to contain the virus.
David Stein is the CEO and co-founder of Ash Wellness, a New York-based company that works with partners to enable home testing programs.