LGBTQ and HIV advocates rallied outside the local offices of the U.S. Department of Health and Human Services Monday, July 18, to demand speedier monkeypox testing and an increased supply of vaccines. More than 50 activists and elected officials joined the protest, organized by the Alice B. Toklas and Harvey Milk LGBTQ Democratic clubs.
"This is really about the community coming together and demanding that our government do better," said gay state Senator Scott Wiener (D-San Francisco). "What's most frustrating about this whole situation is that it was completely and utterly avoidable, and it's impacting the queer community in a very significant way. I'm old enough to remember HIV in the 1980s, when the federal government was completely ignoring our community and allowing a mass die-off of gay men. We can never, ever let anything like that happen again."
On July 15, the San Francisco Department of Public Health updated its monkeypox tally to 86 confirmed and probable cases, and the federal Centers for Disease Control and Prevention raised the national count to 1,972. While anyone can get monkeypox through close physical contact, the vast majority of cases in the current outbreak have been among gay, bisexual, and trans men, as well as other men who have sex with men.
According to Wiener, almost 90% of the monkeypox cases in the Bay Area and half of those in California are in San Francisco. When the state Legislature goes back in session on August 1, one of his highest priorities will be to obtain funding for local communities to expand testing and treatment. "We need to make sure that our state health authorities are prioritizing this community, which is being so deeply impacted by this virus," he said.
Dan Bernal, a gay man who's president of the San Francisco Health Commission and chief of staff for House Speaker Nancy Pelosi (D-San Francisco), said that she sent a letter today to Health and Human Services Secretary Xavier Becerra calling for faster action.
"This growing public health threat is taking a disproportionate toll on the LGBTQ community, particularly men who have sex with men and transgender individuals, who are facing stigma and fear similar to that which they endured in the early days of the HIV/AIDS epidemic," Pelosi wrote. "More must be done to expedite the distribution of the vaccine to curb this quickly expanding and painful public health threat."
Advocates have three key demands, according to San Francisco AIDS Foundation community mobilization manager Ande Stone. First, to streamline testing and "vastly expand" vaccine distribution; second, to ensure that the response is equitable for those who are most impacted, including men who have sex with men, trans and gender-nonconforming people, and sex workers; and third, to "fight the stigma associated with this outbreak."
Vaccines in short supply
The monkeypox virus spreads through close personal contact, including skin-to-skin contact, kissing, and respiratory droplets at close range, but it is not transmitted through the air over longer distances like the coronavirus that causes COVID-19. It is not yet known whether monkeypox is transmitted in semen, but it does spread through contact with sores during sex.
Related to smallpox but less severe, monkeypox causes flu-like symptoms, swollen lymph nodes and a rash. The sores, which may resemble common sexually transmitted infections such as herpes or syphilis, can appear anywhere on the body, including the throat, genitals, and anal area. Most people recover without treatment, but the sores can cause scarring and some patients have reported severe pain.
Smallpox vaccines can prevent monkeypox too. Because the monkeypox virus has a long incubation period, they can be used as both post-exposure prophylaxis for several days after exposure and as pre-exposure prophylaxis for individuals at risk. The new Jynneos vaccine, which involves two injections given a month apart, is currently in short supply, although the Biden administration has taken steps to increase access.
As of July 12, DHHS has distributed more than 132,000 Jynneos doses and has ordered 2.5 million more. After pressure from activists, the United States expects to receive nearly 800,000 finished doses that had been held up pending inspection of the Bavarian Nordic factory in Denmark, Dr. Peter Marks, director of the U.S. Food and Drug Administration's Center for Biologics Evaluation and Research, told reporters during a July 15 briefing.
Speaking at a virtual town hall on July 12, San Francisco Health Officer Dr. Susan Philip said that San Francisco had received 2,888 Jynneos doses and the city has requested 35,000 more from the state. On July 15, DPH announced on Twitter that it expects to get more than 4,000 additional does this week.
The city was forced to close a walk-up vaccine clinic at Zuckerberg San Francisco General Hospital and Trauma Center late last week after running out of doses. The San Francisco AIDS Foundation held a vaccine clinic on Sunday, July 17, but it was only able to accommodate 500 of the 3,700 people on its waiting list, according to Laura Thomas, SFAF's director of HIV and harm reduction policy.
"We in the community know how to take care of each other and we know how to take care of ourselves. It's no coincidence that it's our HIV organizations stepping up — this is what we were built to do," Thomas said at the rally. "We're good at this, but we need the tools. And right now that means vaccines. We need HHS, the FDA, and the CDC to get off their collective asses and give us the vaccine so that we can get it into the arms of people."
Experts are concerned that the slow pace of the response could allow monkeypox to become entrenched as a new endemic sexually transmitted infection. Speed is of the essence with major events coming up locally, including the Up Your Alley leather and fetish fair July 31, the Lazy Bear Weekend in Guerneville in early August, and the Folsom Street Fair in September.
"The time to stop monkeypox is not in the summer of 2023, it is right now," said Tom Temprano, a gay man who's the new political director for statewide LGBTQ advocacy organization Equality California. "Four thousand doses next week is not enough for San Francisco. We need 40,000 doses. We aren't seeing the urgency that is necessary to keep us safe."
Health officials urge anyone with a rash or other possible monkeypox symptoms to seek medical care and get tested. Those who don't have a regular provider can contact City Clinic on Seventh Street or SFAF's Magnet sexual health clinic in the Castro. Refrain from sex and other close physical contact until the results are known. People who test positive should avoid close contact until their sores heal completely, which takes about three weeks.
For the latest updates on vaccine eligibility and locations, click here.
To contact City Clinic, click here or call its new phone number, 628-217-6600. To contact SFAF's Magnet clinic at Strut,click here or call 415-581-1600.
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