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LGBTQ advocates say the government is missing communities of color in its monkeypox response

“We had a chance to do better,” said Matthew Rose, a longtime advocate for health equality and HIV. “We know the challenges of Covid. Finding trusted messengers is so important, but we continue to send messages on a broad basis. Then we wait and say, ‘Look again at all this inequality.’”

Federal health officials said they are determined to smooth out the discrepancies.

The government announced on Thursday a pilot program that will make up to 50,000 vaccine doses against monkeypox available from the strategic national stockpile for states and places to distribute at LGBTQ events to better reach at-risk communities, including black and Latino individuals. Walensky said states’ requests for doses should also include information about “how they will address health equity in delivering both messages and vaccines.”

“We know it has been very important to work very closely with organizations and trusted messengers for the population,” Demetre Daskalakis, White House’s deputy coordinator for the monkeypox response, said at a briefing. “We will continue to do the work and go deeper into engagement.”

But the early CDC data on inequalities may underestimate the problem. Of the more than 13,500 confirmed cases of monkeypox in the US, the CDC only has race and ethnicity data on about 6,000, Walensky said. And only a handful of states, including California, New York and New Jersey, routinely report those failures for monkeypox cases.

In some states and cities, the differences are even greater than the national trend. in Georgia, about 82 percent of monkey pox patients are black, although black residents make up about a third of the state’s population. In North Carolina, Black patient makeup about 70 percent of cases, though they make up about one-fifth of the state’s population.

in San Francisco, 30 percent of cases belong to Latinos, twice the share of the city’s population. In New York City — home to one-fifth of the country’s monkey pox patients — two-thirds of those infected are black or Latinothough blacks and Latinos make up just over half of the city’s population.

In Texas, state health officials do not share race and ethnicity data publicly because data is missing for more than half of monkeypox patients, an agency spokesperson said. But state data requested by POLITICO shows that of the 452 cases for which demographic information exists, more than 42 percent are among black people.

In Washington state, health officials declined to release demographics because they are “still compiling and reconciling” their numbers. Maryland health officials alerted POLITICO to the CDC’s monkeypox mapthat does not contain information about race or ethnicity.

Without more transparency, LGBTQ health advocates and public health experts say it’s impossible to know whether monkeypox vaccination, testing and treatment are reaching those who need it most.

“We have seen historical and systemic discrimination when it comes to delivering effective prevention and treatment to these members of our community,” said Torrian Baskerville, director of HIV and health equality for the Human Rights Campaign, the LGBTQ education group. “As we’ve learned many times, a public health response that doesn’t focus on equitable care and treatment is a failed response.”

‘The same story’

While it’s not yet clear why communities of color are being hit so hard again in a new outbreak, public health experts believe a lack of targeted outreach to those communities is exacerbating existing inequalities.

“It’s the same old story, unfortunately,” said Jesus Ramirez-Valles, chief of the Department of Prevention Science at the University of California at San Francisco. ‘If you want to talk about abortion, how about a woman talking about it? This is exactly the same. You need an African-American young man to talk about this, a Latino man, an Asian-American gay man to talk about this in the language we use, through the channels we use.”

The same social determinants of health that put people of color at greater risk of contracting Covid-19 — including not having nutritious food, living in stressful environments due to high crime rates, lack of access to health care and facing public jobs — also play a role. a role in monkeypox, experts say.

“In any well-documented pandemic, the marginalized populations suffer the most,” said John Swartzberg, emeritus clinical professor of infectious diseases and vaccinology at UC Berkeley. “Covid-19 and monkey pox are no exception.”

Poverty, lack of education and living in environments of “toxic stress” can make it difficult for people to stay healthy, both sexually and otherwise, says Elena Rios, president and CEO of the National Hispanic Medical Association.

A study from the Williams Institute at the UCLA School of Law found that 47 percent of LGBTQ people of color live in low-income households, compared to 36 percent of their white counterparts, and 27 percent of LGBTQ people of color reported fair or poor health, compared to 22 percent for white LGBTQ adults. Separate research also shows that some communities of color are more likely to contract sexually transmitted infections than their white counterparts.

The kinds of jobs that people of color in America disproportionately do may also play a role in the outbreak, particularly in the early days of Covid-19, said Victoria Kirby York, deputy director of the National Black Justice Coalition.

“You have a mix of people of color who have jobs that put them in touch with more people on a daily basis — service industry jobs, retail… people staffing DMVs or Social Security offices,” Kirby York said.

Monkeypox is not airborne and therefore not nearly as contagious as SARS-CoV-2. The CDC said the virus spreads primarily through intimate contact, including sex. But the agency said it can also spread through direct contact with someone else’s monkeypox rash, or by touching objects, such as bedding or towels, that have been used by someone with monkeypox.

Seeing how the early phase of the pandemic hit communities of color the hardest has raised public and official awareness about the systemic inequalities in the national health care system.

“I think Covid-19 has awakened people to the opportunity to understand that racial and ethnic communities live in a world of health inequalities,” Rios said. “They have social determinants in their lives that actually contribute to why there are more diseases in our poor communities or in our racially mixed communities.”

But that makes it even more frustrating to see the same patterns emerging in the government’s response to monkeypox, proponents say — especially when it comes to reports about the virus, how it’s spreading and how to get a vaccine.

The CDC said it has been working to get information about monkey pox in black and Latino communities by reaching out to community organizations and spreading the word about where black and Latino gay and bisexual men come together online, such as the social app Jack’d. and the Deviant Events website. It has also collaborated with LGBTQ figures Shea Couleé from RuPaul’s Drag Race and Billy Porter from the FX TV series Pose.

But the message is still not reaching black and brown communities, LGBTQ advocates said, and many are concerned that the inequalities in vaccine distribution already coming to light could exacerbate racial inequalities in this outbreak.

Low-paying jobs can also make it “difficult to take the time or the resources to get medical care or learn what even happens to MPV,” Kirby York said, using an acronym for the virus.

“If you work in corporate America, there might be an email about MPV or Covid from the HR department that everyone sees. You have a chance to get that information into your day-to-day life,” she said. “If you don’t work in an environment like that, it’s a lot harder.”

“If there are no ads, billboards, public service announcements on black radio, specialized messages for health care providers and clinics in black neighborhoods, you are not reaching the black LGBTQ+ community.”

‘Let’s do it better’

Local officials make adjustments to compensate.

In Chicago, where Latinos about 31 percent of casesPublic Health Commissioner Allison Arwady said public health officials have prioritized distributing monkeypox vaccines to suppliers serving primarily a Latino population.

She said it shows results in increasing the proportion of the city’s vaccinated population that are Latino: “I can already tell you that in the past week we’ve seen that move from 14 percent to 16 percent.”

In Atlanta, where the vast majority of monkey pox cases are among black men, vaccine supply is also improving, said Eric Paulk, deputy director of Georgia Equality. But he worries that this may not apply to high-risk people who live outside the city.

“There’s Atlanta, and then there’s the rest of Georgia,” he said. “My concerns are about what the distribution looks like outside the Atlanta metro.”

Both structural and cultural barriers, including ongoing homophobia, “may be more prevalent in other parts of the state,” he said.

One of the most important things health officials can do, lawyers said, is to be open about the data and the disparities they see. In North Carolina, for example, the state issued a press release proclaim oneself for not reaching the black community. While 70 percent of cases in North Carolina are in black men, only 24 percent of vaccines have gone to black recipients.

In response, Health and Human Services Secretary Kody Kinsley said the state is now targeting black men who have sex with men. A recent vaccine event at private parties in Mecklenburg County — home to Charlotte and the epicenter of the state’s outbreak — vaccinated 174 people, 98 percent of them black men.

“We need to make our most powerful tool – vaccines – available to this community,” Kinsley said. “In this way, we will close this gap by continuing to rely on action with education about harm-reduction strategies that people can use to reduce their exposure, as well as vaccination.”

That approach deserves praise from some within the North Carolina LGBTQ community.

“Amid concerns, problems and mistrust, they are willing to come forward and say, ‘Even if we haven’t done great in the past, we want to do better, and here’s our commitment to do that’ said Rebby Kern, director of education policy at Equality NC. “The level of transparency that we’ve seen on the ground at this point is important… to say, ‘Here’s the inequality. We have essentially failed to achieve the goal here. Let’s do better.’”

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