Sharply rising cases of some sexually transmitted diseases — including a 26% rise in new syphilis infections reported last year — are prompting U.S. health officials to call for new prevention and treatment efforts.
“It is imperative that we … work to rebuild, innovate, and expand (STD) prevention in the U.S.,” said Dr. Leandro Mena of the U.S. Centers for Disease Control and Prevention in a speech Monday at a medical conference on sexually transmitted diseases.
Infections rates for some STDs, including gonorrhea and syphilis, have been rising for years. Last year the rate of syphilis cases reached its highest since 1991 and the total number of cases hit its highest since 1948. HIV cases are also on the rise, up 16% last year.
And an international outbreak of monkeypox, which is being spread mainly between men who have sex with other men, has further highlighted the nation’s worsening problem with diseases spread mostly through sex.
David Harvey, executive director of the National Coalition of STD Directors, called the situation “out of control.”
Officials are working on new approaches to the problem, such as home-test kits for some STDs that will make it easier for people to learn they are infected and to take steps to prevent spreading it to others, Mena said.
Another expert said a core part of any effort must work to increase the use of condoms.
“It’s pretty simple. More sexually transmitted infections occur when people are having more unprotected sex,” said Dr. Mike Saag, an infectious disease expert at the University of Alabama at Birmingham.
Syphilis is a bacterial disease that surfaces as genital sores but can ultimately lead to severe symptoms and death if left untreated.
New syphilis infections plummeted in the U.S. starting in the 1940s when antibiotics became widely available. They fell to their lowest ever by 1998, when fewer than 7,000 new cases were reported nationwide. The CDC was so encouraged by the progress it launched a plan to eliminate syphilis in the U.S.
But by 2002 cases began rising again, largely among gay and bisexual men, and they kept going. In late 2013, CDC ended its elimination campaign in the face of limited funding and escalating cases, which that year surpassed 17,000.
Get the Morning Rundown
Get a head start on the morning’s top stories.SIGN UPTHIS SITE IS PROTECTED BY RECAPTCHA PRIVACY POLICY | TERMS OF SERVICE
By 2020 cases had reached nearly 41,700 and they spiked even further last year, to more than 52,000.
The rate of cases has been rising, too, hitting about 16 per 100,000 people last year. That’s the highest in three decades.
Rates are highest in men who have sex with men, and among Black and Hispanic Americans and Native Americans. While the rate for women is lower than it is for men, officials noted that it’s has been rising more dramatically — up about 50% last year.
That ties to another problem — the rise in congenital syphilis, in which infected moms pass the disease on to their babies, potentially leading to death of the child or health problems like deafness and blindness. Annual congenital syphilis cases numbered only about 300 a decade ago; they surged to nearly 2,700 last year. Of last year’s tally, 211 were stillbirths or infant deaths, Mena said.
The increases in syphilis and other STDs may have several causes, experts say. Testing and prevention efforts have been hobbled by years of inadequate funding, and spread may have gotten worse — especially during the pandemic — as a result of delayed diagnosis and treatment. Drug and alcohol use may have contributed to risky sexual behavior. Condom use has been declining.
And there may have been a surge in sexual activity as people emerged from Covid-19 lockdowns. “People are feeling liberated,” Saag said.
The arrival of monkeypox added a large additional burden. CDC recently sent a letter to state and local health departments saying that their HIV and STD resources could be used to fight the monkeypox outbreak. But some experts say the government needs to provide more funding for STD work, not divert it.
Harvey’s group and some other public health organizations are pushing a proposal for more federal funding, including at least $500 million for STD clinics.
Mena, who last year became director of the CDC’s Division of STD Prevention, called for reducing stigma, broadening screening and treatment services, and supporting the development and accessibility of at-home testing. “I envision one day where getting tested (for STDs) can be as simple and as affordable as doing a home pregnancy test,” he said.
In July, a 35-year-old Black man from the Washington, D.C. area went from experiencing Covid-like symptoms to watching his body be overtaken by the aggravating, blistering boils of monkeypox. And yet, as he endured the agony and uncertainty that came with the disease, he said he had other, more pressing concerns.
The man, who asked to remain anonymous because of concerns related to the stigma associated with the disease, said he was alarmed by how difficult it was to find information on monkeypox and his doctor’s seeming dismissal of his concerns about his symptoms.
He said his case is an example of the concerning public health response to monkeypox, and, for the Black population in particular, follows a historical pattern of medical malfeasance and shortcomings.
The man said when he visited urgent care in early July, the doctor didn’t appear to take him seriously. “I asked if she was up on the latest CDC guidelines on monkeypox and she wasn’t,” he recalled. “So, she had to call the CDC to even get approval to administer me a test. She went on about how it would take an hour of paperwork and other stuff, so most doctors weren’t excited about giving the tests.”
The man, who is gay, said, “it was like a repeat performance” of some of the issues that came with the Covid pandemic, when Black people in many parts of the country had less access to treatment and vaccines, according to the Centers for Disease Control and Prevention.
Now with monkeypox, health care officials face the challenge of effectively communicating information about the spread of the outbreak without stigmatizing gay men. Public health officials interviewed by NBC News said managing that balance is critical to gaining public confidence to offset the intense mistrust of the medical establishment in the Black community. The poor response by health officials, the disparities in the vaccine rollout and the stigma associated with monkeypox have contributed to men questioning how the virus is spread — despite the data, experts say.
Data from the CDC found that, through July 22, 99% of cases were among men, 94% of whom reported recent sexual contact with males. The World Health Organization added that 98.7% of confirmed cases globally are in males, with 97.2% of those men reporting that they had sex with other men.
Black men across the country have been hit especially hard by the outbreak. Although Blacks make up roughly 12% of the population, they make up 38% of the most recent monkeypox cases, according to the CDC. In Atlanta, 71% of people with the infection, which can cause painful and irritating skin lesions, are Black men who have sex with men and about two-thirds of those men have HIV, according to the Georgia Health Department.
In North Carolina, one of the few states reporting on the monkeypox spread, 70% of those infected are Black men, with nearly all of the cases affecting men who have sex with men. However, only 24% of the vaccines in the state have gone to Black North Carolinians.
Those numbers worry Black gay men, as well as public health experts like Dr. Jayne Morgan, director of Piedmont HealthCare in Atlanta who hosts educational podcasts on monkeypox. She said the messaging has to be clear about who is at risk of contracting monkeypox and what preventive measures are available, all while being careful not to stigmatize specific groups of people.
Dr. Jayne Morgan.Courtesy Dr. Jayne Morgan
“We have the tools and enough information to stem this tide,” Dr. Morgan told NBC News. “Public health, like Covid, is about behavior. Monkeypox is being driven by behavior. And so behavior can also drive it in the opposite direction also.”
The 35-year-old D.C. resident, who no longer has monkeypox symptoms, called it “dangerous.”
David J. Johns, the executive director of the National Black Justice Coalition, a civil rights organization committed to empowering the Black LGBTQ community and people living with HIV/AIDS, said the attention monkeypox is receiving now is happening only because non-Black people are also impacted.
“The sad reality is that monkeypox isn’t new,” Johns said, adding that it has existed in Africa since the 1970s. “But because privileged white men from Western societies — in particular America — are now being impacted by something that otherwise only impacted disposable Africans, there is a now shift in the way that people are thinking about and talking about and are responding to a virus that has been impacting people for a lot longer than we otherwise want to acknowledge.”
Get the Morning Rundown
Get a head start on the morning’s top stories.SIGN UPTHIS SITE IS PROTECTED BY RECAPTCHA PRIVACY POLICY | TERMS OF SERVICE
Difficulty in being diagnosed and treated
The man from the D.C. area said that after a weekend of activities and attending “a crowded party” on July 10, he woke up the next day, “not feeling my best.” He was fatigued and had a fever of 102 and had trouble focusing. He left work early, believing he had contracted Covid.
He took a home test that came back negative. A test at urgent care confirmed he did not have the coronavirus. His fever eventually broke but he had a throbbing headache for days. And he said he experienced “rectal discomfort” and his blood pressure was elevated. Several days later, he began to feel better — but he noticed bumps on his face and arms.
After some resistance, the doctor finally swabbed the blisters on his face and wrists and sent him home with 800 milligrams of ibuprofen and a prescription for his anal pain. At his residence, he said he isolated himself in the attic. In the morning, he woke up to extreme throat soreness. He returned to urgent care, where the doctor again had to call the CDC to see how to treat him since he had been tested positive for monkeypox.
The physician was advised by the CDC to administer an antibiotic shot, which alleviated some of the throat pain. Meanwhile, the sores spread to other parts of his body — arms, legs, in particular.
But “it was kind of shocking,” he said, that his issues were not immediately addressed. He added he was given eight different numbers to call for assistance. “They dragged their feet the entire time.”
The man said he gave a list of the friends he had been in close contact with to the health department for contact tracing. He had already advised them to seek medical attention by the time the health department contacted them two weeks later. “And when they finally got someone, they were basically forced to say they had sex in order to get the vaccine,” he added, noting that his friends felt pressured to say they had sexual contact with him — even when some didn’t — in order to get immediate attention from health care professionals.
“When we talk about high-risk communities, we’re really talking about people who are sort of disaffected from the health care system,” Morgan said. “Stigma and discrimination for people in the LBGTQ community are already very high. And then if you add the Black race on top of that, and you have in monkeypox the same as we did with Covid — the black population is always the most vulnerable because we have the least resources, the least outreach and the most discrimination and stigma.”
In Los Angeles earlier in July, another Black man who also asked to remain anonymous because of the stigma associated with having the virus, outlined nearly identical concerns as the man in metro D.C. He, too, said he believed he didn’t contract the disease through sex. When symptoms occurred, he said he had difficulty finding a place that tested for monkeypox. And when he did locate a health center in downtown Los Angeles, the staff was “suited and booted as if I had a contagion,” he said, referring to the protective gear they wore.
Meanwhile, the disparity in those who have contracted monkeypox and those who have access to vaccines is glaring. While Black people account for about a third of monkeypox cases in the U.S., about 10% of vaccines have been administered to the group, according to the CDC.
The vaccine distribution disparities come as Dr. Rochelle Walensky, the head of the CDC, acknowledgedthat the agency must make drastic changes to respond better and faster to public health emergencies, following missteps during the Covid pandemic.
“We have learned less than nothing from Covid,” Stella Safo, a primary care physician at Mount Sinai who specializes in HIV treatment and is the founder of Just Equity for Health, told STAT News. “We’ve gone backwards.”
Dr. Tyeese Gaines.Courtesy Dr. Tyeese Gaines
Dr. Tyeese Gaines, a physician who practices emergency medicine in Illinois and New Jersey, said the more than two years of being on alert from the coronavirus pandemic has created “panic fatigue,” exasperating people to the point where they are less apt to protect themselves against monkeypox.
“We needed to tell people the reality of Covid-19,” Gaines said. “But eventually people just don’t want to hear it anymore. Some people say: ‘Oh, wow, there’s another scary virus. Let me be safer.’ But there’s still a subset of people whose response to fear is not to become more conservative or to follow whatever the rules are, but actually to act like it doesn’t exist and do the opposite.”
For many gay and bisexual men, the sprawling and chaotic monkeypox outbreak has upended a summer that was supposed to be a well-earned opportunity — following the peak of the Covid crisis — to finally have some fun and revel with their gay brothers without the threat of viral infection hanging over them.
Soon after Memorial Day, however, these men, as well as transgender individuals and other queer people — GBTQ for short, because lesbians’ monkeypox risk is remote — were met head-on with harrowing reports about monkeypox’s often devastating and disfiguring effects on the body. Next came anger and frustration over what queer activists characterize as the Biden administration’s fumbling initial response to the outbreak.
Lost amid the frantic media and public health reports about monkeypox epidemiology, the delayed vaccine deliveries and the squabbling over how best to communicate about the virus are the millions of GBTQ people whose happiness, well-being and connection to one another have in many cases been considerably compromised by the mere threat of monkeypox infection.
Guillermo Rojas spent the summer in his native Mexico City because of the high rates of monkeypox in New York, where he now lives. Benjamin Ryan
“Life has sort of halted,” said Guillermo Rojas, 29, a Mexican citizen and public administration graduate student in New York City. “This was supposed to be the great summer that everything went back and opened.”
Dr. Alex Keuroghlian, a psychiatrist at the LGBTQ-health-focused Fenway Institute in Boston, said the outbreak has “been extremely distressing for community members and is also triggering in that it harkens back to the early days of the AIDS epidemic. It has a chilling effect on people’s sense of community, cohesion and belonging.”
Fortunately, there has been at most one U.S. monkeypox death in the U.S. — a potential case in a severely immunocompromised person in Texas is under investigation — even as the national case count has swelled to 19,465 diagnoses. And after a slow start, the federal government has now doled out approximately 800,000 vaccine vials, with a heady supply arriving in short order.
People lined up outside of Department of Health & Mental Hygiene clinic on June 23, 2022 in New York.Tayfun Coskun / Anadolu Agency via Getty Images
Over 100 gay, bisexual, transgender and queer people responded to an NBC News online survey seeking to learn about how monkeypox has affected their lives. What this diverse cross-section of the community most had in common were missed opportunities. They wrote about sex they never had, dates they never went on and gatherings with friends they avoided.
All that avoidance, the respondents made evident, was enmeshed in a cat’s cradle of fear — of contagion, of pain and suffering, of lonely and potentially financially ruinous weeks of isolation at home should they contract the virus.
They spoke of a summer they had hoped would prove invincible but that for them has turned out to be anything but.
A decade of sexual liberation, interrupted
Over the past 10 years, the introduction of PrEP, the HIV prevention pill, and the emergence of landmark studies proving that successfully treating HIV blocks transmission of the virus have cultivated a resurgent sexual liberation among many GBTQ people. Long-standing anxieties about HIV have eased, and hookup apps have made meeting sexual partners as convenient as procuring takeout — hence the term “ordering in.” As a result, people like Rojas have felt free to explore and revel in sex in a way queer people haven’t since the AIDS epidemic brought to a crashing close the sexual freedoms gay men enjoyed during the 1970s.
Then, in 2020, a new viral plague kept all of society cooped up and longing for freedom.
“Post-Covid,” said Rojas, recalling how he experienced the free-spirited bacchanalia into which monkeypox arrived in New York City this spring, “everybody went crazy, and there were sex parties all over town.”
Monkeypox swiftly pushed the contemporary safer-sex playbook out the window. Queer people have been left scrambling for answers about how to protect themselves and have expressed bewilderment as they’ve struggled to process mixed messaging from public health leaders and journalists about what poses a substantial risk of infection.
Rojas was one of the first U.S. residents to receive the prized monkeypox vaccine, in late June. But even with the benefit of his first jab of the two-dose vaccine, he has still sharply curtailed what he had hoped would be a long-awaited libertine summer.
“I’ve stopped going to sex parties,” he said, given that public health authorities identified such gatherings of men as major monkeypox risk factors. “I also stopped having sex with people who live off their OnlyFans. I additionally stopped cruising at the gym, I did not continue to go to Fire Island, and I stopped attending orgies.”
Evidence suggests a recent tidal shift in sexual behaviors in responses to monkeypox. According to the American Men’s Internet Survey, which conducted an online poll in early August of 824 gay, bisexual and other men who have sex with men, 48% reported reducing their number of sexual partners because of the outbreak, while 50% reduced hook-ups and 49% reduced partners met on hookup apps or at sex venues.
“It’s just a small, temporary break until everybody gets the vaccine,” said Rojas, who remained so concerned about living in the nation’s monkeypox epicenter that he decamped to his family’s home in Mexico City for the summer.
Fighting over — and for — sexual freedom
Not everyone in the queer community has been on the same page regarding monkeypox precautions. Just as battles over mask mandates and school closures have turned neighbor against neighbor during the Covid pandemic, fierce internecine conflicts have arisen among GBTQ people this summer about the best ways to respond to and communicate about monkeypox.
Michael Weinstein, the president of the Los Angeles-based AIDS Healthcare Foundation, dusted off his outspoken antipathy toward PrEP and published a scathing rebuke of the sexual liberties the HIV-prevention pill has facilitated in an op-ed titled “Monkeypox Reckoning” in the Los Angeles Blade on Monday. Notorious for an unapologetically strident, moralizing and fear-based approach to HIV-prevention communication, one that is far out of step with that of the vast majority of the public health community, Weinstein decried “a wholesale abandonment of safer sex promotion in favor of PrEP.”
“There has always been a sex radical group that has defined gay liberation as absolute sexual freedom,” Weinstein wrote, blaming monkeypox on those freedoms.
For another man named Michael, who like some people interviewed preferred to go only by his first name to shield his privacy, protecting himself against monkeypox by sacrificing the very sexual freedoms that Weinstein castigates has come, he said, at a great cost.
“I am not changing my behavior with an attitude of cheerful, take-one-for-the-team compliance,” said Michael, 42, who works in education in Philadelphia. “Instead, I find the situation fearful, miserable and diminishing. I am experiencing this outbreak as a serious setback to something that is very important to me, namely sexual freedom.
“Sex,” he continued, “isn’t just a frivolous pastime. For many of us, sex has serious meaning, sex is one of the things that makes life worth living.”
LaRon Nelson is an associate professor of nursing and public health at Yale University and a long-time researcher in the HIV field.Mara Lavitt
After more than two years of Covid restrictions, the arrival on U.S. shores of yet another major virus has also dealt a blow to the already strained mental health of many queer people, said LaRon Nelson, an associate professor of nursing and public health at Yale University.
“The fear of contracting monkeypox and the concern about access to the vaccine have led people to isolate or continue to isolate,” Nelson said. “That chronic exposure to this type of stress also comes at the expense of their psychological well-being.”
J.J. Ryan, a bisexual trans man assigned female at birth, spent the height of the Covid pandemic transitioning.
“I felt like I was just surviving before. I wasn’t really living,” Ryan, 34, said of his pre-transition life. “So I was really excited to get out and live my life — for this to finally be my ‘hot boy summer.’” Instead, he said, he has sadly “sharply reduced” his sexual exploration.
Fears of resurgent discrimination
With so many broken social, romantic, familial and sexual connections lying in pieces around them, many of the respondents to NBC News’ survey said they further dreaded that the monkeypox outbreak would fuel discrimination, hate and even violence toward LGBTQ people.
There is evidence — including a recent attack in Washington, D.C. — that such fears are beginning to manifest.
“My greatest worry in all of this is the turning of the clock back to less and less acceptance society-wise,” said Ryan, who is a Ph.D. student and a policy researcher at a nonprofit research organization in Washington.
John Pachankis is a psychologist at the Yale School of Public Health and a leading researcher of LGBTQ mental health.Michael Benabib
John Pachankis, a psychologist at the Yale School of Public Health, noted how for the past two decades, queer advocacy organizations have pushed “a narrative that gay people are just like everyone else” in a successful effort to secure many civil rights protections. He spoke to the conflict that members of this community now face when the particulars of gay sex lie at the heart of the monkeypox outbreak and, as during the AIDS crisis, have become fodder for intense public debate.
“In the context of the real threat of those rights’ being taken away,” Pachankis said, referring to the recent rising tide of anti-LGBTQ sentiment and policies in the U.S., “the last thing that you want to do is disconfirm that narrative — even if the picture is a little more nuanced, even if gay people do live distinct lives from straight people, even if they express their sexuality more creatively, some might say more authentically.”
Get the Morning Rundown
Get a head start on the morning’s top stories.SIGN UPTHIS SITE IS PROTECTED BY RECAPTCHA PRIVACY POLICY | TERMS OF SERVICE
Brian Minalga works in the HIV field in Seattle.Courtesy Brian Minalga
Brian Minalga, 36, who is gender nonbinary and works in the HIV field in Seattle, said: “There’s this idea that there are good people with good behaviors having the good type of sex. It’s moralistic and puritanical.”
Recapitulating racial disparities
For queer people of color, the outbreak has brought an unwelcome recapitulation of the racial health disparities that have characterized both the HIV and the Covid epidemics in the U.S.
“We saw monkeypox start with more affluent white gay men, and then eventually it seeped into more diverse networks, and that includes men of color,” said Gregorio Millett, the director of public policy at amfAR, The Foundation for AIDS Research.
The Centers for Disease Control and Prevention and various state andlocal health departmentshavereported that monkeypox is indeed already disproportionately affecting Blacks and Latinos. And yet outsize shares of the vaccines have tended to go to whites — thanks, health advocates say, to structural factors that favor access to more privileged members of society.
Watching such patterns play out “is painful,” said Carlos E. Rodríguez-Díaz, an associate professor at the Milken Institute School of Public Health at George Washington University, “because it’s a reminder of the presence of systemic racism.”
Matthew Rose, 36, a health equity advocate in Washington, D.C., spoke to the myriad ways he and his Black gay peers have been dehumanized over time. He said he feared that monkeypox, the very name of which evokes a racist trope, will only worsen matters.
“For Black gay men, the last thing you need is to add a whole other discussion where you become this Black vector of disease,” he said.
Three viruses, one sense of fear
For some GBTQ people, fears of contagion instilled during the height of the Covid pandemic have primed further anxieties about monkeypox. The rueful history of the early AIDS epidemic serves as yet another backdrop.
“I decided several weeks ago that intimate contact isn’t worth the risk until I am fully vaccinated and the infection rate is under control,” said Steven Dwyer, 68, who is retired and based out of Baltimore and has been living with HIV since the mid-1980s. “As a long-term AIDS survivor, I learned it’s better to get informed about disease outbreaks that could affect me.”
The plight of Jason, a Los Angeles-area screenwriter in his late 20s, is a particularly profound example of the way crippling anxieties about infectious disease can be all-consuming. Jason has lived with obsessive compulsive disorder since childhood. It causes him intense dread of contagion and contamination, as well as various compulsions in response to such thoughts and stimuli. Fear of Covid left him largely housebound. Now the monkeypox outbreak has magnified those fears just as he was starting to feel more comfortable with venturing outside.
Jason lives with his boyfriend, and they’re monogamous, so contracting monkeypox sexually isn’t a concern. But suggestions that casual contact or contaminated surfaces can transmit monkeypox have left him reluctant to push his luck with his OCD. Consequently, for Jason, it’s as if those cloistered first few months of the Covid pandemic never ended.
“I am probably one of the only people I know that still doesn’t really go out much,” he said.
Many other GBTQ people said monkeypox has led them to question going to crowded spaces, such as concerts, bars and clubs — enjoyable outings and chances to connect with fellow queer people after having lived through the lonely and dull height of Covid.
Jason has been agonizing over whether to attend an upcoming concert of a performer he loves, something he has been looking forward to for years since it got delayed because of the pandemic. And in a recent interview, Dwyer, who travels constantly, expressed concern about contracting monkeypox from hotel linens.
Worries about monkeypox transmission even led to the cancellationof a major concert at the Southern Decadence celebration in New Orleans, which takes place over Labor Day weekend — even though it was to have been held outdoors.
Ryan said that when he visited his family in Philadelphia before he got his first monkeypox vaccination, his mother was hesitant to hug him for fear of the virus. That only aggravated his own worries about perhaps unknowingly passing monkeypox to his young niece and nephew.
Ben Rosen is a psychotherapist at the LGBTQ-focused Harlem United in New York.Brent Unkrich
Such hesitance from family members, said Ben Rosen, a psychotherapist at Harlem United in New York, parallels the cold shoulder many gay men got during the early AIDS crisis, “where people are being told, ‘Oh maybe you shouldn’tcome visit.’”
Recent research suggests, however, that anxieties about monkeypox transmission in public settings and other relatively casual scenarios are most likely misplaced or at least grossly overblown. According to researchpapers and reportsfrom globalhealth authorities, cases of nonsexual transmission are uncommon to rare.
Last week, Dwyer concluded that bed sheets don’t actually pose a substantial risk.
Dr. Demetre Daskalakis was recently appointed as the White House national monkeypox response deputy coordinator.Benjamin Ryan
On an Aug. 19 call with reporters, Dr. Demetre Daskalakis, the deputy for the White House’s monkeypox response, said he believesattending crowded concerts is generally a low-risk activity. Merely brushing by someone, he said, is likely to be “low or no risk.”
Christopher Vasquez, 39, the director of communications at the National Center for Lesbian Rights in San Francisco, said: “I think we need to be very careful about overreacting and shutting down events. Especially after two-plus years of the LGBTQ community feeling the effects of loneliness and depression because of Covid.”
The great work begins
Praising the myriad ways queer activists have fought for a better response to monkeypox, including faster and broader access to vaccines, Keuroghlian of the Fenway Institute said, “The silver lining is to see the amazing ability of our community to organize with solidarity and to articulate their needs.”
There are signs such efforts are bearing fruit.
Recent reports suggest transmission slowdowns in New York, Chicago and San Francisco — likely the result, experts theorize, of changes in sexual behavior, increased vaccination and possibly immunity from past infection.
With the challenging summer coming to a close, Guillermo Rojas is freshly back in New York for the fall semester of his graduate studies at Columbia University. Sitting in Manhattan’s Lincoln Center on a humid late-summer afternoon just after a cloudburst, he expressed optimism over the future of the outbreak.
“As people start getting vaccinated and the second vaccine starts kicking in for most people, things should get back to normal,” he said.
He got his own second shot on Wednesday.
Editor’s note: NBC News would like to hear from people who have recovered from monkeypox infection. If you have, please fill out this confidential online survey, and we may contact you for an interview.
Today U.S. District Judge Reed O’Connor ruled in Braidwood Management v. Becerra against a provision of the Affordable Care Act that requires employers to provide insurance coverage for PrEP (Pre-exposure prophylaxis), a medication that prevents the transmission of HIV. The judge ruled that the ACA mandate violates employers’ rights under the Religious Freedom Restoration Act. Read the ruling in the case (courtesy of Chris Geidner)here.
Ivy Hill(they/them pronouns), Community Health Program Director of the Campaign for Southern Equality, said today:
“This ruling is about imposing extreme religious beliefs – not, as it purports, about protecting religious freedom: Far right extremist judges are attacking privacy and access to health care.”
“We must be increasing access to life-saving medications like PrEP, not using it as the latest political wedge to attack LGBTQ people in the South. Whether it’s access to abortion, trans-affirming care, birth control, or PrEP, we are seeing dangerous action from activist courts intervening in Americans’ healthcare decisions – and we must push back.”
PrEP is a daily pill used widely for HIV prevention by individuals who are HIV-negative but at high risk for exposure, including men who have sex with men, people who are in a sexual relationship with an HIV-positive partner, and people who have recently injected drugs. Daily PrEP use can reduce the risk of HIV infection from sex by more than 90%.
PrEP is an especially critical strategy for HIV prevention in the South, the epicenter of the modern HIV crisis in the United States. According to 2016- 2017 CDC data, one-half of all HIV diagnoses occur in the South, 47% of HIV related deaths happened in the South, and 46% of people living with HIV live in the South. In the Campaign for Southern Equality’s Report of the 2019 Southern LGBTQ Health Survey(direct link to HIV data), we found that respondents’ reported rates of living with HIV more than 15 times higher than the national rate, with 5% of respondents saying they are living with HIV and 10.4% saying that they don’t know their status.
Judge O’Connor has a long history of ruling against the Affordable Care Act, and a history of rulings that harm the LGBTQ community, including opinions that overreached on marriage rights for same-sex couples and a decision on anti-LGBTQ workplace discrimination that blatantly violated the U.S. Supreme Court’s ruling in Bostock v. Clayton County.
This summer the Campaign for Southern Equality launched a new campaign, Meeting the Moment in the LGBTQ South to mobilize responses to growing anti-LGBTQ attacks, such as this ruling. Learn more about Meeting the Moment here.
The number of new monkeypox cases in the United States has fallen by 40% since early August — a signal that the country’s outbreak could be abating.
According to an NBC News analysis of data from the Centers for Disease Control and Prevention, the seven-day average of new reported cases decreased from a daily average of 465 on Aug. 10, to 281 on Aug. 31.
The overall drop in cases is largely driven by falling case counts in big cities including New York City and Los Angeles.
Much of that decrease, experts say, may be attributed to conscious changes in behavior among people most at risk for monkeypox — men who have sex with men and others in their sexual networks.
Dr. Jay Varma, director of the Center for Pandemic Prevention and Response at Weill Cornell Medicine in New York City, cited research from the CDC that found a 50% drop in risky hookups. According to the New York City Department of Health, cases fell consistently throughout the month of August.
Men who have sex with men “take their health seriously,” Varma said. “This is born of experience with the HIV epidemic and intensive activism.”
The rollout of vaccines may have also played a role in the decline. As of Aug. 30, 352,675 doses of monkeypox vaccine had been administered in areas of the country that report such data.
Cases are also falling in European countries, including Germany and the Netherlands, World Health Organization Director-General Tedros Adhanom Ghebreyesus said Wednesday in a briefing.
With the right public health messaging, vaccines and treatments, it’s possible, he said, that the virus can be eliminated, at least in Europe.
“This is an outbreak that can be stopped,” he said.
While the drop in cases in the U.S. is promising, the national numbers are “only one measure” of what’s truly happening with the outbreak, said Dr. Bruce Y. Lee, a professor of health policy and management at the City University of New York Graduate School of Public Health.
“What we really want to know is the geographic spread of the virus,” Lee said.
While cases are falling in big cities, including Los Angeles, Miami and New York, other parts are the country are still seeing an increase, said Dr. Kristin Englund, an infectious diseases expert at the Cleveland Clinic.
“For those of us in smaller city areas,” she said, “we’re actually still seeing a pretty robust number of patients presenting with monkeypox.”
Englund noted that big cities have had very successful vaccination campaigns, while she and her colleagues have had to limit monkeypox vaccine doses to those who are at highest risk for either infection or the most severe outcomes.
“We need a lot more” vaccines, Englund said, to mirror the declines seen in other cities.
Public health officials are continuing with vaccination efforts across the country, with the White House announcing Tuesday additional steps to offer testing and vaccinations at large LGBTQ events.
“We are expecting tens of thousands of people in New Orleans over this Labor Day weekend,” Louisiana Gov. John Bel Edwards said during a briefing this week.
Edwards said the federal government has sent public health teams to New Orleans to help set up monkeypox testing and vaccination sites ahead of the annual celebration.
Despite the efforts to curb monkeypox spread, some public health officials are concerned that the virus will settle into vulnerable areas, such as communities of color, that historically have barriers to appropriate medical care.
It’s those vulnerable populations, Varma said, that could continue to drive the epidemic.
“I would love to see a continued sustained decline in monkeypox cases,” he said. “But I don’t think that’s what’s likely to happen.”
Texas has reported its first death of a person diagnosed with monkeypox.
The unnamed man lived in Harris County, the state’s largest county, containing Houston and several nearby suburbs. He was also “severely immunocompromised,” the Texas Department of State Health Services said in a statement issued on Tuesday. The statement provided no other identifying information about the man.
“The case is under investigation to determine what role monkeypox played in the death,” the department wrote.
In a Tuesday White House press briefing, Dr. Jennifer McQuiston with the Centers for Disease Control and Prevention (CDC) expressed sympathy for the man’s passing, and said that the CDC will also conduct an inquiry into the conditions that contributed to the man’s death. She also warned against panicking about other possible monkeypox-related deaths.
“I think it’s important to emphasize that deaths due to monkeypox, while possible, remain very rare,” McQuiston said. “In most cases, people are experiencing infection that resolves over time. And there have been very few deaths even recorded globally. Out of over 40,000 cases around the world, only a handful of fatalities have been reported.”
In mid-August, the World Health Organization (WHO) reported that there had been 12 deaths of people infected with monkeypox worldwide. Health authorities have urged men who have sex with men (MSM) to get vaccinated against the illness, to reduce sexual partners, and to get tested and quarantine if they experience any symptoms.
The briefing also confirmed that the White House is continuing its strategy of making vaccines and mobile testing facilities available to communities ahead of scheduled public events that are popular with MSM, such as Atlanta Black Pride and Southern Decadence in New Orleans, Louisiana.
“[It’s] a great opportunity to get folks ready for the event in terms of getting some vaccines on the ground early, but also, a great opportunity to reach people who won’t go to a clinic or a vaccine effort, but will feel comfortable in, frankly, less stigmatizing spaces that can occur in the events,” Dr. Demetre Daskalakis, the White House National Monkeypox Response Deputy Coordinator, said.
On Monday, the Department of Health and Human Services (HHS) announced $11 million in funding to domestically produce the Jynneos smallpox vaccine in Grand Rapids, Michigan. The vaccine is being used to limit monkeypox’s spread.
Previously, the global supply of the vaccine came entirely from a tiny company in Denmark called Bavarian Nordic whose distribution had been hampered by a company’s lab renovation and supply chain disruptions.
President Joe Biden declared a national state of emergency for monkeypox in early August. The WHO also declared monkeypox a Public Health Emergency of International Concern in late July.
In late August, the U.S. Food and Drug Administration approved the vaccine to be administered intradermally in order to stretch out the supply of available vaccines. The intradermal method could stretch the nation’s vaccine supply fivefold and has been found to be effective when vaccinating against rabies and polio.
The Biden administration on Tuesday announced plans to expand the response to the monkeypox outbreak by providing vaccinations and education at large LGBTQ-centered events around the country following a recent pilot program carried out in Charlotte, N.C.
Demetre Daskalakis [photo], deputy director for the White House’s national monkeypox response, stated during a briefing that the administration was aiming to make its response more “intentional and targeted.”
“Given the progress we’ve made toward making the tools available to end this outbreak, our vaccine strategy is to meet people where they seek services, care or community — especially in communities of color. We know that Prides and other large LGBTQI+ focused events can do just that,” Daskalakis said.
Read the full article. Last year Daskalakis was a grand marshal for New York City Pride.
A federal court has blocked efforts by the Biden administration to ensure trans people are never discriminated against by religious doctors when seeking heathcare.
But the US Court of Appeals for the Fifth Circuit unanimously ruled Friday (26 August) that the Department of Health and Human Resources (HHS) mandate is “in violation of its sincerely held religious beliefs” by not letting medical providers withhold care “on the basis of sex”
The three-judge panel upheld a lower court’s ruling that Franciscan Alliance, a Catholic healthcare network covering Indiana and Illinois, was right to seek out a permanent injunction against the policy.
Franciscan Alliance said the network’s nearly 20,000 doctors and medical providers should not have to provide gender-affirming healthcare or abortion treatments.
The group’s lawyers from the religious liberty group Becket said stopping health professionals from discriminating and denying care to trans people was an unlawful overreach, the Washington Times reported.
To do so, they claimed, would also go against the Religious Land Use and Institutionalized Persons Act (RLUIPA) and the Religious Freedom and Restoration Act (RFRA).
And the judges, two of whom were appointed by Donald Trump, agreed.
“We have recognised that the loss of freedoms guaranteed by the First Amendment, RLUIPA, and RFRA all constitute per se irreparable harm,” wrote Trump appointee judge Don Willett in the ruling.
Fellow Trump-appointee judge Kurt Englehardt and George Bush appointee judge Jennifer Walker Elrod joined him in the ruling.
The appeal ended a years-long battle between religious freedom and healthcare access.
Franciscan Alliance lodged a lawsuit against the policy in December 2016 with the district court for the Northern District of Texas, setting the stage for a legal back-and-forth between the network, federal officials and LGBTQ+ activists.
Though Trump scrapped the rule, president Joe Biden brought it back. The district court sided with Franciscan Alliance in 2019, prompting the federal government and the ACLU to appeal the court’s decision.
“This ruling is a major victory for conscience rights and compassionate medical care in America,” said Joseph Davis, counsel at Becket, in a statement.
“Doctors cannot do their jobs and comply with the Hippocratic Oath if the government requires them to perform harmful, irreversible procedures against their conscience and medical expertise.”
The Hippocratic Oath, an ancient oath of ethics, requires physicians, among other things, to “do no harm” and do everything they can to care for their patients.
Study after study has shown that trans people who receive gender-affirming healthcare are significantly less likely than those who have not to experience depression and anxiety, and consider suicide/
The spread of monkeypox is causing men who have sex with men (MSM) to reduce their numbers of sexual partners, according to survey results released this week by the Centers of Disease Control and Prevention (CDC).
The CDC’s survey found that 48 percent of respondents had reduced their number of sexual partners, 50 had reduced their number of one-night stands, and 49 percent reduced the amount of sex they had with men that they’d met through hookup apps, The Hill reported.
The publication noted that local public health officials have been hesitant to suggest that people practice sexual abstinence as a key approach to avoiding possible exposure, noting that the strategy may be ineffective even though the federal government championed it during the HIV/AIDS epidemic of the 1980s and ’90s.
There are just over 15,000 cases of monkeypox in the U.S. as of Monday, according to the CDC. However, infectious disease experts think this number is likely an undercount. President Joe Biden declared a national state of emergency for monkeypox in early August. The World Health Organization (WHO) also declared monkeypox a Public Health Emergency of International Concern in late July.
However, one report suggested that the high case numbers among MSM may have to do with the fact that queer men seek medical treatment more often than heterosexual individuals.
The recent increase in cases nationwide has revealed the fact that the U.S. doesn’t have enough vaccine doses available to meet public demand. To help stretch the current reserve, the U.S. Food and Drug Administration recently approved the vaccine to be administered intradermally — that is, into the skin’s superficial layers — rather than through its usual subcutaneous method which injects the vaccine into the fat and connective tissues between the skin and muscular layers.
The intradermal method could stretch the nation’s vaccine supply fivefold and has been found to be effective when vaccinating against rabies and polio.
However, some LGBTQ individuals have criticized the government for what they say is an inadequate response to the outbreak.
“I’ve been really disappointed in our leaders, especially those who were in office during the onslaught of the AIDS crisis, like President [Joe] Biden and Speaker [Nancy] Pelosi,” nonbinary Queer Eye reality TV star Jonathan Van Ness told USA Today.
“Once again, we’re seeing too little action taken until the situation has ballooned out of control,” they added. “If nothing changes, we’ll continue to experience failures like this response, which has been plagued with too few tests, lack of access to treatments, inadequate vaccine supply, and ambiguous guidance.”
“In many ways, I believe it’s been fueled by homophobia and transphobia,” Ness said. “When an outbreak affects mainly men who have sex with men, some portion of our elected legislators will have no incentive to act… which is obviously messed up because people’s lives are at stake, and there are queer people in all 50 states.”
New research suggests the strain of monkeypox involved in the current global outbreak is predominantly sexually transmitted.
As of Wednesday (17 August), there have been more than 35,000 confirmed cases of monkeypox across 92 countries and territories since the beginning of the outbreak in April 2022, according to the World Health Organization (WHO). Most of these are among men who have sex with men.
In the earlier stages of the outbreak, experts insisted there was no evidence that monkeypox was a sexually transmitted virus, and that it was mostly transmitted by skin-to-skin contact, but mounting research is suggesting otherwise.
On Sunday (14 August), Dr Jeffrey Klausner of University of Southern California and Dr Lao-Tzu Allan-Blitz from Brigham and Women’s Hospital in Boston and Harvard published an essay explaining why they believe the virus is largely sexually transmitted.
‘Mounting evidence’
In their essay, which has been submitted to a scientific journal for publication, the two experts admitted that the issue is still up for debate, but listed several reasons for the “mounting evidence that sexual transmission is the most common mode of transmission” of monkeypox.
It claims people most at risk of contracting monkeypox is the same demographic at risk of contracting other sexually transmitted infections, for example those “attending sex-on-site venues, multiple recent sex partners, and condomless receptive anal intercourse”.
Secondly, studies from the UK, the US, Italy and Spain have documented initial lesions “occurring at the genitalia, rectum, and oropharynx”, indicating that these locations are where the virus first entered the body.
But, the authors add, calling the outbreak a sexually transmitted infection is “double edged.”
“The stigma surrounding sexually transmitted infections in gay men and other sex with men limits healthcare seeking and partner-notification behaviours directly subverting our primary means of outbreak control – namely, early identification and behaviour change in infected individuals.
“Furthermore, such stigma can fuel further homophobia, particularly in areas without human rights protections for individuals who engage in same-sex relationships.
“Conversely, failure to appropriately identify and disseminate to the public the predominant mode of transmission will likely perpetuate behaviours that are driving transmission.”
Other experts have spoken on the topic.
Dr Paul Adamson, an infectious disease specialist at the UCLA School of Medicine, told NBC News: “At this point, I’m not sure we can say it is primarily the sexual transmission and not the skin-to-skin contact that also occurs during sex that is contributing to the most transmission during this current outbreak.
“However, emerging data seems to suggest that monkeypox might be more efficiently transmitted sexually.”
He also suggested that the scientific community may be slow to accept monkeypox as a predominantly sexually transmitted virus because of how it has historically been transmitted in countries where the virus is endemic.
“Historically, the primary mode of transmission of monkeypox was through skin-skin contact, though there might have been some suggestion of sexual transmission in prior outbreaks,” he said.
“It takes some time and additional data to overturn our understanding of transmission.”
