For many in the LGBTQ community, the emergence of monkeypox is drawing parallels to another major public health crisis that was first dismissed as a “gay disease,” until heterosexuals began contracting it. Health experts say while the risk remains very low for most people, it’s unwise to dismiss monkeypox as an illness passed exclusively by homosexual contact, nor should it be dismissed as an exclusively sexually transmitted disease.
The first human monkeypox case was identified in Africa in 1970, in an infant patient. According to the World Health Organization, the virus may thrive in various animal species, including squirrels, rats, and some primates. The virus may spread in animal-to-human contact.
As of August 8, 2022, more than 1,900 monkeypox cases were identified in New York State, including a handful of cases in Erie and Niagara counties.
Dr. Nancy Nielsen, Senior Associate Dean for Health Policy at the University at Buffalo Jacobs School of Medicine, says a vast majority of the infections so far in the 2022 outbreak have resulted from male-on-male intimate contact.
“The community that is mostly affected, 99 percent of the patients in our country and 98 percent worldwide, at least in Europe, are men who have sex with men,” she said. “But it may be from hugging, kissing, it doesn't have to be a sexual contact.”
Nielsen notices parallels between the broader public’s attitude toward monkeypox now and its attitude in the earliest years of the HIV-AIDS crisis, when it was first dismissed as a “gay disease.” Leaders in the LGBTQ community are also noticing it, and are concerned.
“For a lot of people in the LGBTQ community, we not only are seeing those parallels, for some people it is really stigmatizing being part of the community, with again the messaging being that this is an LGBTQ virus or this is just a disease that impacts, again, men who have sex with men,” said Ronald Piaseczny, president and co-founder of Niagara Pride, Inc. “That stigmatizing, unfortunately, can lead to harassment and discrimination. And so that's something that we just don't want to see happen.”
The general public paid more attention to HIV-AIDS when heterosexual patients were being identified. Some of the most notable patients included Indiana teenager Ryan White and tennis star Arthur Ashe, both of whom contracted that virus through tainted blood transfusions during medical procedures. Both later died of AIDS.
Research further discovered HIV could be spread through heterosexual contact involving an infected partner, and by sharing a contaminated hypodermic needle.
Nielsen points out that monkeypox could be spread by making contact with clothing that touched a lesion caused by the disease. The Centers for Disease Control and Prevention are also studying whether the virus could possibly be spread through respiratory secretions, such as droplets released by a cough.
In early August, the federal government moved to declare monkeypox a public health emergency. New York State did so in late July. The declaration frees up funds and eliminates some bureaucratic steps, accelerating the process of acquiring needed drugs and supplies. Similar declarations were declared early in the COVID pandemic.
“I think that the fewer hurdles we put in the way of diagnosing, treating and certainly preventing spread of an infectious disease like this one, which is very, very painful, is an important move,” Nielsen said.
Ronald Piaseczny, president and co-founder of Niagara Pride, recalls the public dismissed AIDS as a gay disease… that is, until high-profile heterosexual cases emerged, including teenager Ryan White and tennis star Arthur Ashe, both of whom contracted the virus through tainted blood transfusions.
A monkeypox vaccine has long existed, but some question whether the federal government waited too long to order doses after the first US case was confirmed in May. And supplies are limited, for both public health agencies and clinics which may administer shots.
While the United States owns the raw materials for the vaccine, Nielsen explains the vaccine is currently being manufactured only in Copenhagen, Denmark. The US finally placed orders for monkeypox vaccine three weeks after the first domestic case was identified, May 17.
Meanwhile, there’s an antiviral treatment known as Tecovirimat, or TPOXX, which is plentiful, but difficult to acquire.
”You have to do an investigational new drug application to the FDA,” Nielsen said. “To go back to where we started, the effect of declaring this a public health emergency may remove some but probably not all of those barriers to getting TPOXX. It is available. It's just a pain to go through.”
Clinics who may administer shots have another concern.
Currently, the federal program 340B allows qualified community health agencies to purchase medications at a reduced cost, then bill health insurers for the retail rate, using the financial difference to provide support for at-risk patients. Beginning next April, New York State will make changes that clinics fears will hinder their ability to assist underserved populations. Under the change, Medicaid patients enrolled in Mainstream Managed Care will receive their prescription drugs through Medicaid’s Fee-For-Service Pharmacy Program.
What worries clinics is that the change will eliminate a funding source needed to provide services to people most at risk in health crises, whether it be further spread of monkeypox or some other future health crisis.
“These are folks that provide a high percentage of care to the LGBTQ populations, to communities of color,” said Michael Lee, chief operating officer of Evergreen Health in Buffalo. “When I think about this carve out, I absolutely think it disproportionately impacts the safety net population because it's taking resources away from them, and the community health centers that provide care to them.”
In the meantime, Piaseczny points out that only one case of monkeypox had been recorded in Niagara County as of August 8, Western New Yorkers cross county lines frequently for work, school, or recreation. His message to the LGBTQ community, and to the broader public, is to be vigilant, and avoid practices that put them at risk of infection.
“Read up on it, find out what you can in terms of the virus. Reduce your risk, in terms of health practices, and then basically wherever it is possible to get the vaccine, go and do that,” Piaseczny said.
