LGBTQ advocates say government is missing communities of color in its monkeypox response


“We had a chance to do better,” said Matthew Rose, a longtime health equity and HIV advocate. “We know the challenges from Covid. Finding reliable messengers is very important, but we continue to send broad-based messaging. Then we wait, and say, ‘Look at all this inequality again.'”

Federal health officials said they were determined to eliminate inequalities.

The administration announced a pilot program Thursday that will make 50,000 monkeypox vaccine doses available to states and territories from the Strategic National Stockpile to be distributed in LGBTQ programs to better reach at-risk communities, including Black and Latino individuals. Valensky said states’ requests for doses should include “messaging as well as information about how they will address health equity in the delivery of the vaccine.”

“We know it’s been really important for the population to work closely with organizations and trusted messengers,” Demetre Daskalakis, deputy coordinator for the White House monkeypox response, said during a briefing. “We continue to work and go deeper into engagement.”

But early CDC data on inequalities may compound the problem. Valensky said that of the more than 13,500 confirmed American monkeypox cases, the CDC only has race and ethnicity data for 6,000. And only a handful of states, including California, New York and New Jersey, regularly report those breakdowns for monkeypox cases.

In some states and cities, inequalities exceed the national trend. in Georgia, About 82 percent of monkeypox patients are black., although black residents make up about a third of the state’s population. in North Carolina, make black patients About 70 percent of the cases, although they account for about one-fifth of the state’s population.

in San Francisco, 30 percent cases There are Latinos, who make up twice the size of the city’s population. In New York City — home to the fifth of the nation’s monkeypox patients — Two-thirds of those infected are black or LatinoAlthough black and Latino people make up slightly more than half of the city’s population.

In Texas, state health officials Do not share race and ethnicity data publicly Because data is missing for more than half of monkeypox patients, a spokesman for the agency said. But state data requested by Politico shows that of the 452 cases for which demographic information is present, more than 42 percent are among black people.

In Washington state, health officials declined to release any demographic data because they are “still compiling and collating” their figures. Maryland health officials point to Politico CDC’s monkeypox mapIncluding no information about race or ethnicity.

Without more transparency, LGBTQ health advocates and public health experts say it is impossible to know whether vaccination, testing and treatment for monkeypox is reaching those who need it most.

“When it comes to delivering effective prevention and treatment to these members of our community, we have seen historical and systemic discrimination,” said Torian Baskerville, LGBTQ advocacy group director of HIV and health equity for Human Rights Campaigns. “As we have learned many times, a public health response that is not focused on equitable care and treatment is a failed response.”

‘the same old story’

While it’s not yet clear why communities of color are once again being hit so hard in another outbreak, public health experts agree that a lack of targeted access for those communities can exacerbate existing inequalities. is increasing.

“It’s the same old story, unfortunately,” said Jesus Ramirez-Wells, head of the University of California San Francisco’s department of preventive science. “If you want to talk about abortion, how is a woman speaking about you? That’s exactly the same with it. You need an African American young man talking about this, a Latino man, An Asian American gay man is talking about this in the language we use, through the channels we use.”

The same social determinants of health that put people of color at greater risk for contracting COVID-19 – including lack of access to nutritious food, living in high-stress environments due to high crime rates, lack of access to health care and the public Including the shortage – the jobs being faced – are also playing a role with monkeypox, experts said.

“In every pandemic where there is good documentation, marginalized populations suffer the most,” said John Swartzberg, clinical professor emeritus of infectious diseases and vaccinology at UC Berkeley. “Covid-19 and monkeypox are no exception.”

Poverty, lack of education and living in “toxic stress” environments can make it difficult for people to live healthy, sexually and otherwise, said Elena Rios, president and CEO of the National Hispanic Medical Association.

A study by the Williams Institute The UCLA School of Law found that 47 percent of LGBTQ people of color live in a lower-income household than 36 percent of their white counterparts, and 27 percent of LGBTQ people reported fair or poor health, compared to 22 percent Is. For white LGBTQ adults. Separate research also shows that Some communities of color contract sexually transmitted infections at higher rates. compared to their white counterparts.

Victoria Kirby York, deputy executive director of the National Black Justice Coalition, said the kind of work disparately done in America by people of color could also play a role in the outbreak, as she did in the early days of COVID-19. .

Kirby York said, “You have a mix of people of color who do jobs that expose them to more people on a day-to-day basis — service industry jobs, retail… people who work in the DMV or Social Security offices. employees.”

Monkeypox is not airborne, and therefore nowhere near as contagious as SARS-CoV-2. The CDC said the virus is mostly spread through intimate contact, which includes sex. But the agency said it can also be spread by direct contact with another person’s monkeypox rash, or by touching objects such as bedding or towels that someone has used with monkeypox.

Noting how the hardest-hit communities of color in the early stages of the pandemic have raised public and official awareness of systemic inequalities in the nation’s health care system.

“I think COVID-19 has awakened people to the opportunity to understand that racial and ethnic communities live in a world of health inequalities,” Rios said. “There are social determinants in their lives that actually contribute to why there are more diseases in our poorer communities or our racially mixed communities.”

But it makes it even more disappointing to see similar patterns in the government’s response to monkeypox, advocates say – especially when it comes to messaging about the virus, how it spreads, and how a vaccine is received. Do it.

The CDC said it has worked with community-based organizations to obtain information about monkeypox in Black and Latino communities and spread the word where Black and Latino gay and bisexual men gather online, such as social App Jacked and Website Deviant Events. It has also collaborated with LGBTQ’s Shia Cooley from RuPaul’s Drag Race and Billy Porter from the FX TV series Pose.

but the message is still not there to reach black and brown communities, LGBTQ advocates said, and many are concerned that the disparity in vaccine distribution already unfolding could worsen the racial disparities in this outbreak.

Low-paying jobs “can make it difficult to take the time or resources to get medical care or learn about what’s going on with MPV,” said Kirby York, using an acronym for the virus.

“Working in corporate America, there might be an email about MPV or COVID that comes from the human resources department that everyone sees. You have a chance to get that information in your daily life,” she said. “If you don’t work in that kind of environment, it’s a lot harder.”

“If Black radio doesn’t have ads, billboards, public service announcements, special messages for health care providers and clinics that are in Black neighborhoods, you’re not reaching the Black LGBTQ+ community.”

‘Let’s do better’

Local officials are making adjustments to compensate.

in Chicago, where Latinos make up about 31 percent of casesPublic Health Commissioner Alison Arvadi said public health officials have prioritized distributing monkeypox vaccines to providers who primarily serve the Latino population.

She said this is showing results in increasing the share of the city’s vaccinated population that is Latino: “Already, I can tell you we’ve seen a 14 percent to 16 percent increase in the past week.”

In Atlanta, where the majority of monkeypox cases are in black men, the supply of the vaccine is also improving, said Eric Pollock, deputy director of Georgia Equality. But he worries that may not apply to at-risk people living outside the city.

“There’s Atlanta, and then there’s the rest of Georgia,” he said. “My concern is about what distribution looks like outside of the Atlanta subway.”

Structural and cultural barriers, including persistent homophobia, “may be more prevalent in other parts of the state,” he said.

One of the most important things health officials can do, advocates said, is to be open about the data and the disparities they see. For example, in North Carolina, the state published a press release calling itself For failing to reach the black community. While 70 percent of cases in North Carolina are in black men, only 24 percent of vaccines have gone to black recipients.

In response, Health and Human Services Secretary Cody Kinsale said the state is now specifically targeting its access to black men who have sex with men. A recent vaccine program at private parties in Mecklenburg County – home of Charlotte and the epicenter of the state’s outbreak – vaccinated 174 people, 98 percent of whom were black men.

“We need to make our most powerful tool for this community — vaccines — accessible,” Kinsale said. “This is how we are going to close this gap by continuing to lean toward action, with education about harm reduction strategies that people can take in place to reduce their risk, but then also vaccination. “

This approach is earning praise from some in North Carolina’s LGBTQ community.

“Between the anxiety and the trouble and the disbelief, they are ready to come forward and say, ‘Even though we haven’t done very well in the past, we want to do better, and we have a commitment to do so,'” at Equality NC. Reby Kern, director of education policy, said. “The level of transparency we’ve seen on the ground right now is important… to say, ‘There’s inequality here. We’ve essentially got no trace of it. Let’s do better.'”


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