SF Latino gay men are hard hit by monkeypox outbreak

  • by Liz Highleyman, BAR Contributor
  • Wednesday August 17, 2022
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Jorge Roman is director of clinical services at the San Francisco AIDS Foundation. Photo: Liz Highleyman
Jorge Roman is director of clinical services at the San Francisco AIDS Foundation. Photo: Liz Highleyman

Latino gay, bisexual, and other men who have sex with men account for nearly 30% of monkeypox cases in San Francisco, almost twice their share of the population, according to the latest data from the San Francisco Department of Public Health. In Santa Clara County, Latinos make up more than 40% of cases.

This disparity is also reflected in nationwide numbers, as more than half of people with monkeypox in the United States are now Black or Latino. The shift toward gay and bisexual men of color increasingly mirrors long-standing inequities in the U.S. HIV epidemic.

"The question we should be asking is why our system continues to fail our vulnerable communities," Jorge Roman, director of clinical services at the San Francisco AIDS Foundation, told the Bay Area Reporter. "If our systems do not use equity as the lens to respond to health crises, we should not be surprised when they disproportionately affect BIPOC (Black, indigenous and people of color) individuals."

As of August 16, DPH has reported 600 monkeypox cases in San Francisco. The Centers for Disease Control and Prevention has identified 12,689 cases in the United States and more than 38,000 cases worldwide, mostly in countries outside of Central and West Africa.

While anyone can get monkeypox through close physical contact, cases remain overwhelmingly concentrated among gay, bisexual, transgender, and other men who have sex with men. A new report from the CDC shows that 99% of cases with available data were among men, and 94% reported sex or other close intimate contact with other men.

SFAF and the Getting to Zero Consortium will hold a second monkeypox community town hall Tuesday, August 23. (More info below.)

The current monkeypox outbreak was first reported in May in the United Kingdom, with cases soon appearing in major cities in Europe, Canada, and the United States. While many of these early cases were among white men who reported international travel, the picture has since shifted.

The latest demographic breakdown from DPH shows that among cases with available data, 46% are white, 28% are Latino, 10% are Asian, 5% are Black, and 6% are multiracial or other. For comparison, the city's population is 40% white, 15% Latino, 35% Asian or Pacific Islander, 5% Black, and 7% multiracial.

Santa Clara County is now reporting 100 monkeypox cases. In late July, when case numbers were lower, health officials released a breakdown showing that 41% of cases were among Latinos, who make up 26% of the county's population. Alameda County, as of August 10, had 117 confirmed cases. No racial breakdown was available.

In contrast, in Los Angeles County, with 962 reported cases, 37% are Latino, 35% are white, and 11% are Black. The county's population is 49% Latino, 25% white, and 9% Black, so while Latinos account for the largest percentage of cases, it falls below their share of the population.

Statewide, California has identified 1,945 monkeypox cases as of August 11. Among those with available data, 40% are white, 38% are Latino, 11% are Black, and 7% are Asian. The state's population is 35% white, 40% Latino, 7% Black and 16% Asian or Pacific Islander, so white people are somewhat overrepresented, Asians are underrepresented, and Latinos are about on par with their population percentage.

Turning to the national numbers, the CDC had received case reports with demographic data for just 1,195 of the 2,891 cases identified through July 22, highlighting major gaps in state reporting. Of the cases with available data, 41% were white, 28% were Latino and 26% were Black. For comparison, the U.S. population is 59% white, 19% Latino, and 14% Black.

The CDC report may actually understate these disparities, as some jurisdictions with greater racial and ethnic diversity have not submitted demographic data and the proportion of cases among Black people has risen in recent weeks.

The national monkeypox public health emergency announced August 4 could encourage more states to share data with the CDC. "This public health emergency will allow us to explore additional strategies to get vaccines and treatments more quickly to impacted communities, and it will allow us to get more data from jurisdictions so we can effectively track and attack this outbreak," new national monkeypox response coordinator Bob Fenton told reporters during a media briefing.

Equitable vaccine distribution

Elsewhere in the country, some of the greatest monkeypox disparities are seen in the South. In Georgia, which now has 1,013 cases, 82% of cases with available data are Black, according to an August 8 provider webinar. What's more, 67% are living with HIV.

North Carolina has identified just 180 monkeypox cases, but unlike most other jurisdictions, the state has reported vaccination demographics. While 70% of cases are among Black men, this group has received less than a quarter of vaccines administered through August 8, the North Carolina Department of Health and Human Services said in a statement. Meanwhile, white people, who account for 19% of cases, received 67% of vaccine doses.

San Francisco and Santa Clara health officials are taking steps to avoid such inequities, working with organizations that serve heavily affected communities. Focused efforts in collaboration with community partners helped San Francisco reverse the disproportionately high COVID-19 rate among Latinos early in the pandemic and led to higher COVID vaccination rates for Latinos and Black people compared with white people (90%, 78%, and 74%, respectively).

As was the case with COVID vaccines in the spring of 2021, monkeypox vaccines remain in short supply, although the Zuckerberg San Francisco General Hospital and Trauma Center vaccine clinic has been able to serve all comers in recent days. The Jynneos vaccine is normally administered as two doses given four weeks apart, but in an effort to stretch the supply, federal officials on August 9 allowed providers to use a different injection technique that lets them split a single-dose vial into five doses. That technique has not been instituted yet in San Francisco as additional training is needed before it can be introduced.

"San Francisco is building upon our successes as a city ... to inform our strategy for the current monkeypox outbreak," DPH said in a statement sent to the B.A.R. "This includes partnering with Latinx community-based organizations to provide culturally sensitive information, resources, and vaccine access to those disproportionately affected. To ensure equitable access to the very limited monkeypox doses to those?individuals?and groups most impacted, SF DPH has a system in place to reserve vaccine appointments at our Zuckerberg San Francisco General vaccine clinic for individuals from BIPOC communities."

DPH said it is working with seven?organizations that serve these communities, including AGUILAS,?Instituto Familiar de la?Raza, and Mission?Neighborhood Health?Center.? In late July, DPH participated in eight events that provided monkeypox information to hundreds of people, including presentations at the Mexican consulate.

Santa Clara County Health Officer Dr. Sara Cody echoed the importance of community collaboration.

"We are doing all we can to vaccinate the people who need it most, with the limited vaccine supply available. We could not do this successfully without the support and collaboration of community partners and health care providers," she said. "Public health is about equity and making sure all people have access to the health care they need."

Those currently eligible for vaccines in SF include people who have had close contact with a person with monkeypox, those who have attended venues or events where a case was identified, gay and bisexual men and trans people who have had more than one sex partner in the past two weeks, sex workers of any sexual orientation or gender identity, and certain clinicians and laboratory workers.

Washington, D.C., recently became the first city to expand vaccine eligibility to include people of any sexual orientation or gender who have had multiple sex partners during the past two weeks. While monkeypox cases remain rare among cisgender women and heterosexual men, expanding eligibility — and basing it on behavior rather than identity — could help reach people who are at risk but don't consider themselves gay or bi and those who are hesitant to disclose their orientation.

SFAF and the Getting to Zero Consortium will hold a second monkeypox town hall Tuesday, August 23, at 6 p.m. According to an email announcement, this is a follow-up to the July meeting. Speakers will include San Francisco Health Officer Dr. Susan Philip; SFAF CEO Tyler TerMeer, Ph.D.; Dr. Hyman Scott of DPH and the Getting to Zero Steering Committee; and Dr. Brad Hare of the GTZ steering committee. There will be time set aside for questions. To register, click here. To submit a question, click here.

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