In an encouraging development, the MPV (monkeypox) outbreak’s spread is slowing in New York City. However, the risk for MPV is concentrating in low-income communities of color, as we’ve already seen with HIV and COVID-19.
MPV case rates are disproportionately higher for gay and bisexual Black and Latinx men—and their vaccination rate is significantly lower than that of their white and Asian counterparts.
Unless that changes, there is a very real risk that Black and Latinx men will be left grappling with MPV after it abates in the rest of the population—repeating the same inequities that persist with HIV and COVID-19.
In NYC, Latinx and Black men who have sex with men (MSM) make up 61.4% of reported MPV cases—but they have obtained only 36% percent of MPV vaccine doses, according to NYC Department of Health and Mental Hygiene data. (In NYC, 3,683 people were diagnosed with MPV as of Oct. 20.)
What’s more, there is overlap between MPV and HIV cases. Five months into the outbreak, fully 40% of people diagnosed with MPV nationally are also living with HIV, according to the Centers for Disease Control and Prevention.
As with MPV, Black people are most at risk for HIV, with diagnoses at six times the rate of white people. Black people made up 42% of new HIV diagnoses in 2019.
Mirrors HIV, COVID-19 Disparities
When the MPV outbreak started in late May, GMHC warned that the same racial and income disparities that have affected prevention and treatment with HIV and COVID-19 would repeat with MPV—as did other HIV and LGBTQ advocates, as well as public health experts.
“The parallels are scary. First, the denial, then the blaming, the slow response, the missed opportunities, and finally, the disproportionate impact on Black, other people of color, and poor communities,” wrote Black AIDS Institute founder Phill Wilson, in an eloquent article in The Reckoning.
“For someone like me, the déjà vu is traumatizing. We have a 41-year-old and counting HIV/AIDS pandemic today because people ignored the information right in front of their faces, driven by benign and malicious racism,” Wilson wrote.
Public health experts attribute the overall decline in new cases to greater vaccine availability and behavioral changes among MSM to avoid transmission.
In the current outbreak, the MPV virus has most commonly spread through close physical contact during sex among gay, bisexual and other MSM. (According to CDC data, 94% of cases nationally reported male-to-male sexual or close, intimate contact in the three weeks before symptoms appeared.)
But the MPV outbreak has revealed sharp disparities in access to testing, vaccines, and treatment—particularly for Black people. Black men account for 27.2% of cases in NYC, but they’ve obtained only 12.7% of vaccine doses.
By contrast, white men make up only 22.9% of cases and have received 48.1% of MPV vaccine doses, while Asian-American men account for just 3.5% of cases and 10.9% of doses. (The NYC Health Department has administered 143,135 doses as of Oct. 20, but its demographic data does not break out first and second doses.)
Last month, GMHC and other community-based organizations started outreach campaigns focused on MSM in Black and Latinx communities most at risk for MPV to expand access to testing, vaccinations, care, and prevention resources. The MPV outreach is a partnership with the NYC Health Department, supported by a new MPV Awareness Prevention Partnership (MAPP) grant.
People in Black and Latinx communities at greater risk for MPV may not be aware of vaccination options or fear stigma. What’s more, people of color are less likely than white people to have health insurance coverage and a regular doctor—and more likely to have HIV, diabetes, and other conditions that can put people at greater risk for new infections.
The NYC Health Department has asked GMHC to concentrate on the Bronx neighborhoods of Mott Haven, Melrose, Morrisania, Crotona, Fordham, and University Heights. These neighborhoods are among the Bronx zip codes that collectively make up over half of New York City’s COVID-19 cases, with a high rate of other health disparities, according to the NYC Taskforce on Racial Inclusion and Equity.
Good Prevention Tools
The good news is we have the tools to prevent new MPV infections and mitigate the outbreak, so it’s a very different situation than with COVID-19. Two doses of the JYNNEOS vaccine, taken four weeks apart, effectively prevent MPV infections, as do prevention tactics like avoiding skin-to-skin contact.
What’s more, there generally isn’t the same vaccine hesitancy as with COVID-19 vaccines. When GMHC’s prevention staff reach out to clients and community members about MPV vaccination, the response has been good. People are generally eager to get vaccinated, because MPV is a visible, painful disease.
And the vaccine supply has finally caught up with the need, after an acute initial shortage caused by the federal government’s delayed response. The NYC Health Department now has a sufficient supply of both first and second doses and has expanded eligibility to anyone who feels at risk, while vaccination sites are accepting walk-in appointments.
Encouragingly, most people diagnosed with MPV have had mild to moderate symptoms—and people living with HIV don’t experience MPV more severely if their immune systems are healthy because they are taking HIV medication, according to a Sept. 29 report from the CDC.
But MPV can be a very serious infection. While death is quite rare, it can cause rashes that scar and painful lesions in the mouth, anus, and genitals.
Most of the severe MPV cases tracked by the CDC have been for people living with untreated HIV. Those who are not virally suppressed (with low CD4 counts below 350 cells/ml) are more likely to be hospitalized from MPV, according to the CDC, although it cautions the data is still limited.
Since MPV can affect people with a weakened immune system more severely, it’s important for people at risk for HIV or living with HIV to get the MPV vaccination. Contact GMHC online for help navigating a first-dose MPV vaccination appointment or leave a message on our MPV Warmline at (212) 367-1306, and our team will respond quickly.
People testing positive for MPV should also get tested for HIV and STIs if they’re in a higher risk group—and, if needed, connected to HIV medication. Contact GMHC through our HIV/STI testing page or call (212) 367-1100 for free, confidential HIV and STI testing and counseling. Find up to date information about MPV at gmhc.org/mpv.