In July, a 35-year-old black man from the Washington, DC area went from having Covid-like symptoms to watching his body be overtaken by the aggravating boils and blisters of monkeypox. And yet, as he endured the agony and uncertainty that comes with the disease, he said he had other, more pressing concerns.
The man, who asked to remain anonymous due to concerns about the stigma associated with the disease, said he was alarmed at the difficulty of finding information about monkeypox and his doctor’s apparent rejection of his concerns about her 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 historic pattern of wrongdoing and medical shortcomings.
The man said when he visited the emergency room in early July, the doctor did not seem to take him seriously. “I asked if she was aware of the latest CDC guidelines on monkeypox and she was not,” he recalled. “So she had to call the CDC to even get approval to give me a test. She explained that it would take an hour of paperwork and stuff, so most doctors weren’t happy to do the tests.
The man, who is gay, said ‘it felt like a repeat’ of some of the problems with the Covid pandemic, as black people in many parts of the country had less access to treatments and vaccines, according to the Centers for Disaster Control and Prevention.
Now, with monkeypox, health officials face the challenge of effectively communicating information about the epidemic’s spread without stigmatizing gay men. Public health officials interviewed by NBC News said managing that balance is key to gaining public trust to offset the medical establishment’s intense mistrust in the black community. The poor response from health officials, disparities in vaccine rollouts and the stigma associated with monkeypox have helped lead men to wonder how the virus spreads — despite the data, experts say.
Data from the CDC revealed that, through July 22, 99% of cases were in men, 94% of whom reported recent sexual contact with men. The World Health Organization added that 98.7% of confirmed cases worldwide are men, with 97.2% of these men reporting having had sex with other men.
Black men across the country have been particularly hard hit by the outbreak. Although blacks make up about 12% of the population, they account for 38% of the most recent cases of monkeypox, according to the CDC. In Atlanta, 71% of those infected, which can cause painful and itchy skin lesions, are black men who have sex with men and about two-thirds of those men have HIV, according to Georgia Health. department.
In North Carolina, one of the few states reports on the spread of monkeypox, 70% of those infected are black men, with almost all cases affecting men who have sex with men. However, only 24% of vaccines in the state have gone to black people in North Carolina.
These figures worry black gay men, as well as public health experts like Dr. Jayne Morgan, director of Piedmont HealthCare in Atlanta which organizes trainings podcasts on monkeypox. She said the message must be clear about who is at risk of contracting monkeypox and what preventive measures are available, while being careful not to stigmatize specific groups of people.
“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 behaviorally motivated. And so the behavior can also lead it in the opposite direction as well.
Health care experts believe that sex between men – both anal and oral – is likely the main driver of global transmission of monkeypox. Skin contact that accompanies sex, these experts say, is likely much less of a risk factor, citing studies published in peer-reviewed journals, as well as reports of national, regional and global health authoritiesas previously reported by NBC News.
The statistics, misinformation and errors in vaccine rollout have left black gay men fearful of seeing a repeat of the response and stigma that accompanied the HIV/AIDS epidemic of the 1980s.
The 35-year-old DC resident, who no longer has symptoms of monkeypox, called it “dangerous”.
David J. Johns, 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 currently only happens because non-blacks are also impacted.
“The sad reality is that monkeypox is not new,” Johns said, adding that it has existed in Africa since 1970s. “But because privileged white men in Western societies – especially America – are now being affected by something that otherwise only affected disposable Africans, there is now a change in the way people think, speak and react to a virus that has impacted people for far longer than we otherwise care to acknowledge.
Difficulty being diagnosed and treated
The DC-area man said that after a weekend of activity and attending “a crowded party” on July 10, he woke up the next day “not feeling his best.” form”. He was tired and had a fever of 102 and had trouble concentrating. He left work early, believing he had contracted Covid.
He took a home test which came back negative. An ER test confirmed he did not have the coronavirus. His fever eventually went down but he had a throbbing headache for days. And he said he had experienced “rectal discomfort” and his blood pressure was high. A few days later, he started to feel better, but noticed bumps on his face and arms.
After some resistance, the doctor finally dabbed 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 home, he says he isolated himself in the attic. In the morning he woke up with an extreme sore throat. He went back to urgent care, where the doctor again had to call the CDC to see how to treat him since he had tested positive for monkeypox.
The doctor was advised by the CDC to administer an antibiotic injection, which relieved some of the pain in his throat. During this time, the sores spread to other parts of his body – arms, legs, in particular.
But “it was a little shocking,” he said, that his issues weren’t immediately resolved. He added that he had been given eight different numbers to call for help. “They dragged their feet the whole time.”
The man said he gave a list of friends he had been in close contact with to the health department for contact tracing. He had already advised them to see a doctor by the time the health service contacted them two weeks later. “And when they finally got someone, they basically had to say they had sex to get vaccinated,” he added, noting that his friends felt compelled to say that they had had sexual contact with him – even when some did not – in order to get immediate attention from medical professionals.
“When we talk about high-risk communities, we’re really talking about people who are somehow unhappy with the health care system,” Morgan said. “Stigma and discrimination against people in the LBGTQ community is already very high. And then if you add the black race on top of that, and you have in monkeypox the same thing we did with Covid – the black population is still the most vulnerable because we have the least resources, the least awareness and the most discrimination and stigma.”
In Los Angeles earlier in July, another black man who also asked to remain anonymous due to the stigma associated with the virus, voiced concerns almost identical to those of the DC subway man. He, too, said he believed he had not contracted the disease. by sex. When the symptoms appeared, he said he had trouble finding a place that tested for monkeypox. And when he located a health center in downtown Los Angeles, staff were “in suits and booted like I had contagion,” he said, referring to the equipment of protection they wore.
Meanwhile, the disparity between those who have contracted monkeypox and those who have access to vaccines is blatant. While blacks account for about a third of monkeypox cases in the United States, about 10% of vaccines have been given to the group, According to the CDC.
The disparities in vaccine distribution come as Dr. Rochelle Walensky, the head of the CDC, acknowledged that the agency needs to make drastic changes to respond better and faster to public health emergencies, following missteps during the Covid pandemic.
“We learned less than nothing from Covid,” Stella Safo, a Mount Sinai primary care physician specializing in HIV treatment and founder of Just Equity for Health, told STAT. New. “We backed off.”
Dr Tyeese Gaines, a doctor who practices emergency medicine in Illinois and New Jersey, said more than two years of high alert over the coronavirus pandemic has created ‘panic fatigue’, infuriating people to the point where they are less able to protect against monkeypox.
“We had to tell people the reality of Covid-19,” Gaines said. “But eventually, people don’t want to hear it anymore. Some people say, ‘Oh, wow, there’s another scary virus. Let me be safer. But there is always a subset of people whose reaction to fear is not to become more conservative or follow the rules, but to act like it doesn’t exist and do the opposite.
It didn’t help that there was a history of public health issues in the black community, with the population not always receiving equal or adequate health care. “There are still many areas that need improvement if we seek to provide equitable health care that will allow everyone to have a fair chance at good health,” Gaines said. “I don’t think we’ve fixed everything yet.”