The activists suggested to the Health Department that they should partner with Prevention Point Philadelphia to reach out to intravenous drug users, people who do sex work, and people experiencing homelessness, de Marco said. The Health Department is in the process of arranging training with Prevention Point staff and “scheduling public trainings for trusted messengers,” which will be available in English and Spanish.
“Sex workers are being made eligible for the monkeypox vaccine as of Aug. 11,” the Health Department spokesperson said. “At this point we haven’t seen cases among healthcare workers or unhoused individuals who don’t also have other risk factors. However, these are important groups to watch, and we hope to be able to vaccinate these groups as soon as we have enough vaccine.”
Additionally, the spokesperson said that the Health Department team plans to do further outreach to communities of color via tabling events with Philadelphia organizations. Health Department staff have been meeting with specific organizations, “for feedback allowing us to provide up to date information at targeted locations.”
De Marco, Henderson and other members of the aforementioned organizations have also been calling for health institutions, including the Philadelphia Health Department, to stop framing the monkeypox outbreak in terms of its impact on LGBTQ communities, specifically men who have sex with men (MSM).
De Marco pointed out one potential peril of linking monkeypox to gay and bisexual men: not all men who have sex with men identify as part of the LGBTQ community. “They don’t identify as gay, they don’t accept the label, but they’re engaging in same-sex sex,” de Marco said. “They’re going to think, ‘if I go get treated for this, is this going to out me?’”
Another negative side effect of the LGBTQ-centric monkeypox messaging, is that it could perpetuate stigma against an already marginalized population, especially trans women of color, de Marco added. “I’m really thinking about Black and Latinx trans women. Not only are they killed, they’re brutalized. For them to be purveyors of monkeypox is not a good thing.”
In response to the issue of framing monkeypox as a disease that mostly impacts LGBTQ people, the Health Department spokesperson said in an email, “the Health Department recognizes the sensitivity of this issue and has made it a priority to communicate information with LGBTQ and MSM communities. The truth is that anyone regardless of sexual orientation or gender identity is at risk for infection. Currently, Health Department epidemiologists have found that the current outbreak of monkeypox has been more often in men who have sex with men who have had multiple partners in the past few weeks. That is not to say that it can only circulate between men who have sex with men and with multiple partners. Anyone can become infected with monkeypox and we do expect to see spread to other social and cultural networks.”
Henderson has called for broader testing and vaccination beyond LGBTQ communities.
“We really don’t know who’s getting [monkeypox] because they’re not testing everybody,” she said. “There have been cishet people who have shown up for testing presenting monkeypox symptoms, and then turned away by their physician because ‘it’s a gay disease.’ That’s what you’re seeing on socials and hearing from the media, and that needs to be corrected.”
Although Health Department staff are collaborating with healthcare providers to expand their testing capacity, limited vaccine supply is dampening their ability to broaden their vaccine efforts. Non-Philadelphia residents and non-citizens can get vaccinated against monkeypox in Philadelphia, provided they meet the Health Department’s criteria.
“The Health Department intends at some point to be able to vaccinate anyone who fits at-risk criteria,” the spokesperson said. “However, due to supply constraints we are only able to vaccinate those who have direct contact with known exposures. We understand frustrations and know that it is not the ideal situation. Unfortunately, at this time it is the best way of protecting residents who are at highest risk until we receive additional vaccine allocation from the federal government.”
Last week, the Food and Drug Administration (FDA) and CDC devised a plan to utilize less vaccine per dose in order to get more shots into more arms.
As for whether the activist groups felt that Health Department staffers were amenable to their suggestions, Henderson said, “they were very noncommittal with everything. It was one of those things [where they said] ‘this is what the CDC is saying.’”
Michele Zipkin is a reporter for the Philadelphia Gay News, where this story first appeared.