The CDC has raised the alert level on a monkeypox (MPXV) outbreak in the United States and HHS announced that it will be ramping up testing and a vaccine distribution for those most at-risk, which includes some members of the LGBTQ+ community and people living with HIV.
MPXV is a disease that can make you sick, including a rash, which may look like pimples or blisters, often with an earlier flu-like illness. While the current outbreak in the U.S. has high rates of known cases among gay and bisexual men and transgender and non-binary people, this virus is not limited by gender or sexuality and can spread to anyone, anywhere through close, personal, often skin-to-skin contact.
Health officials and advocates are urging people to seek treatment and available prevention options, including vaccines when available.
Monkeypox (MPXV) is a disease caused by the monkeypox virus, which is in the same family as smallpox, although much less severe. Its name is characterized by the pox illness that occurs upon infection, leading to an outbreak of lesions spreading from the face to the rest of the body, including the genital areas.
MPXV was first discovered in 1958 in a research monkey facility. The first case of MPXV in 2022 was reported on May 7th in the United Kingdom and was linked to an individual who had recently traveled from Nigeria. The current outbreak has known cases in Europe, Africa and the Americas. The first case in the United States was on May 18, 2022.
According to the CDC, monkeypox (MPXV) can spread from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed. The illness typically lasts 2-4 weeks. People who do not have MPXV symptoms cannot spread the virus to others.
MPXV can spread between people mostly “through direct contact with infectious rash, sores, scabs, saliva and respiratory secretions.” It can be passed on through extended physical skin-to-skin contact, including between sexual partners during intimate, close contact. This includes but is not limited to “activities like kissing, cuddling, or touching parts of the body with MPXV sores.”
MPXV sores can also appear on the mouth, vagina, or anus, but it can also spread through any kind of oral, vaginal or anal sex by touching the genitals or mouth of a person with symptoms of MPXV who may have sores inside the body.
Risk of exposure is not limited to skin contact, the virus can also be spread through objects like clothes, bed sheets, sex toys, fetish gear, and other surfaces that have been used by someone with MPXV.
Rash or lesions will typically begin to appear in 1-3 days after the initial fever, “often beginning on the face then spreading to other parts of the body.” However, be aware of skin rashes or lesions that may be isolated to one part of your body and if you note any unexpected or unexplained changes, see a healthcare provider. The CDC notes that MPXV begins with:
Swollen lymph nodes
The incubation period lasts anywhere from 2-4 weeks, and individuals remain infectious until lesions have completely healed and scabs have fallen off.
Avoid skin-to-skin contact: Sharing direct and personal skin-to-skin contact should be avoided, and there is a higher likelihood of contracting monkeypox (MPXV) at events hosted in enclosed spaces where people can be expected to have minimal to no clothing. Large outdoor events where people are fully clothed offer you more safety by minimizing your risk of exposure through skin-to-skin contact.
Sex: Think carefully deeply about sexual activity and how/if to have sex. Do not participate in any intimate activities if you have flu-like symptoms or have developed any unusual rashes or lesions on your body. (SEE THE SECTION BELOW ABOUT SEX)
Hand washing: Practice good hand washing, especially after encountering a person with MPXV.
Avoid infected surfaces: With unwashed materials and objects that have been exposed to direct and intimate contact with someone who has MPXV. The virus can be spread through prolonged respiratory secretions or contact with a lesion or rash, not only person-to-person, but through contaminated objects that have not been properly cleaned.
Mask up: Masks are encouraged to help prevent the spread through respiratory droplets in situations with face-to-face contact
Isolate: Quarantine yourself from others if you have become exposed to or infected with MPXV. Avoid contact with those who have the infection.
Vaccine: HHS has ramped up testing and vaccine strategy with more than 200k doses to be distributed in the coming. (SEE MORE BELOW ABOUT VACCINE INFO)
Talk with your health care provider: Health officials recommend talking to your healthcare provider about getting the smallpox vaccine within two weeks of exposure to someone diagnosed with MPXV.
Sex is a natural part of life. It’s important if you are engaging in sexual activity to know the facts. Here is how to best minimize risk and tips from the CDC:
When to avoid sex: If you or your partner has or recently had monkeypox symptoms,or you have a new or unexplained rash, immediately isolate and see a healthcare provider. In some cases, symptoms may be mild, and some people may not even know they have monkeypox.
Contactless sexual activities: Reducing your chances of spreading the virus would include getting more creative in contactless sex such as virtual sex, or masturbation at least 6 feet away. Avoid kissing, cover lesions and rashes, and wash sheets, clothes and sex toys. Do not share sex toys.
Communicate: Be transparent with sexual partners about any recent illnesses or new sores you’ve experienced and be aware of anything new on you or your partner’s body.
To be clear. Monkeypox is NOT a “gay” disease. As we learned from the HIV epidemic,
framing it as a “gay” disease is misleading and hinders us from properly stopping the outbreak. Just like many members of our community, we’re concerned about the spread of MPXV. We recognize that the virus has been able to easily spread through close, skin-to-skin contact within our community.
While MPXV can spread to anyone, anywhere through close, personal, often skin-to-skin contact regardless of gender or sexual orientation, it’s true that health officials have tracked a substantial percentage of the cases among men who have sex with men.
Since this virus is typically passed on through direct contact once it's introduced to a community, it is more likely to spread through that community among those who are in close contact with each other.
It’s important to recognize that
Health officials note that high rates amongst MSM could be due to gay men being more proactive toward their sexual health (seeking testing, treatment, knowledge sharing) compared to other communities. Over the past several weeks, we’ve seen the LGBTQ+ community doing what we’re best at: caring for each other, raising awareness and acting on sound public health guidance.
We’ve seen historical and systemic discrimination when it comes to delivering effective prevention and treatment especially to these members of our community. It’s critically important that care providers, public health officials and the media continue to provide a clear, scientific, evidence-based response to prevent the spread of misinformation.
The LGBTQ+ community has for decades been faced with stigma in health care offices and news stories alike just because of who we are. This reality is compounded for people of multiple marginalized identities. Causing unnecessary fear will potentially endanger lives and lead to destructive policies. Every person, no matter your sexuality or gender identity, should take proper precautions and listen to guidance from health officials in order to stay safe.
We urge public health officials to prioritize outreach to BIPOC LGBTQ+ community members and people living with HIV.
This means prioritizing vaccine sites in key LGBTQ communities, partnering with minority-led and community-based organizations to ensure a more equitable distribution and ensuring that these leaders are at the table.
Regarding illness after infection, the available data indicates that people with advanced and unmanaged HIV can be at a higher risk of severe or prolonged disease. This is why it’s extremely important to seek care and follow your prescribed treatment if you’re living with HIV.
Reports from European countries where most patients are on effective ART have noted no deaths or evident excess in hospitalizations thus far among people with HIV and monkeypox.
Additionally, the WHO has stated that “people with HIV…who take antiretroviral therapy and have a robust immune system have not reported a more severe course of disease.” More info on monkeypox and HIV can be found here
As vaccines and testing ramp up across the country, it’s important to note that vaccine availability might be limited in certain areas. Doses are typically being supplied to cities/states 30 hours after their orders are placed. A treatment for smallpox, TPOXX, is available to people who are experiencing extreme pain from lesions with plenty of national supply. Please visit the vaccine tracker or contact your local health department to see if vaccines are offered in your area.
JYNNEOS (also known as Imvamune or Imvanex) is one of only two currently licensed vaccines in the United States to prevent smallpox have been approved by the U.S. by the FDA for the prevention of MPXV. State and local health departments will also have the option to use the ACAM200 vaccine. However, that vaccine carries greater risk of certain serious side effects.
Post-exposure: The CDC recommends the sooner you get vaccinated the better, especially if you believe you have been exposed within the last 4-14 days as the symptoms can still be lessened. If you are past this time-frame, or have already recovered from MPXV, experts still recommend the vaccine for effective protection against future infection. experts still recommend the vaccine for effective protection against future infection. More information about vaccines are here.
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