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Racial disparities persist in monkeypox outbreak despite equity efforts

Percentage of cases for Black men grows amid overall decline

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Demetre Daskalakis, the face of LGBTQ outreach for the Biden Administration in monkeypox efforts, speaks as new cases are on the decline.

Racial disparities persist in response to the monkeypox outbreak as the numbers of Black and Latino men contracting the disease are now disproportionately high, but that inequity is getting new attention as overall cases drop.

Although overall new cases in the monkeypox outbreak are steadily on the decline after numbers peaked in the summer, a growing share of the continuing numbers belong to men who have sex with men who are racial minorities.

The latest numbers show the racial disparity dramatically. In the week of Sept. 4, Black people consisted of 41 percent of the cases and Latinos consisted of 27 percent, while 26 percent were white and three percent were Asian, according to data from the Centers for Disease Control.

Black people among the new cases of monkeypox were much smaller when numbers were first reported earlier in the summer. For example, the percentage was 18 on June 22 and as low as 8 percent June 8. The percentage of Latinos, as with white people, has been on the decline, although they’re still overrepresented in new cases in the context of their demographics in the U.S. population at large.

The disproportionate impact of new monkeypox cases on racial minorities hasn’t gone unnoticed. As a result, health officials are attempting to shift the focus of the monkeypox outbreak away from gay and bisexual men and other men who have sex with men more broadly and more toward men of color who are sexual minorities.

Sean Cahill, director of health policy research at the Boston-based Fenway Institute, said in an interview with the Washington Blade the racial disparities in the monkeypox outbreak are largely the result of Black and Latino men being “less likely to get vaccinated than their proportion of the population.”

“So they’re more vulnerable to monkeypox, and they’re less likely to get the vaccine,” Cahill said. “So that’s a real problem, and it’s really critical that you know, federal, state and local partners come together and really center equity in the response and try to reduce the burden on Black and Latino gay men, but also increase access to the vaccine to ensure that people can protect themselves.”

The Fenway Institute last week issued a blueprint calling for a more effective federal response to monkeypox, accusing the U.S. government of failing to effectively mobilize existing public health infrastructure to aid communities affected by the virus. The document outlines a range of possible actions, but also concludes marginalized communities are having difficulty accessing vaccines and treatments, which are concentrated at well-resourced institutions less accessible to communities of color.

Cahill, asked to characterize whether the numbers demonstrating racial disparity have changed over time or have remained stagnant, said any trends are difficult to determine because the data on racial demographics has been available only recently and “it’s very imperfect data.”

“I don’t know if it’s getting worse or better, the disproportionate racial ethnic impact,” Cahill said. “But it’s definitely there, and it doesn’t seem to be going away.”

The Biden administration, while touting the 20 percent decline in overall cases in the monkeypox outbreak, has also started to recognize the continued disproportionate impact of monkeypox on Black and Latino men who have sex with men.

Rochelle Walensky, director for the Centers for Disease Control & Prevention, said during a conference call with reporters the U.S. government approaches the decline with “cautious optimism.”

“Over the past several weeks, we have also seen the racial and ethnic makeup of this outbreak evolve,” Walensky said. “While monkeypox cases were first seen predominantly in non-Hispanic white men, in the last week, among the cases for which we have race and ethnicity data, non-Hispanic Black men represented 38 percent of cases, Latino or Hispanic men represented 25 percent of cases, and non-Hispanic white men represented 26 percent of cases.”

Among the efforts the Biden administration has undertaken is a pilot program for vaccines reserved for large events and equity. Monkeypox vaccines have been administered to more than 10,000 people, including at Southern Decadence in New Orleans, Atlanta Black Gay Pride, Charlotte Pride, Boise Pride Festival, and Oakland Pride and Pridefest.

Demetre Daskalakis, the face of LGBTQ outreach for the Biden administration in monkeypox efforts and deputy director the White House monkeypox task force, was among those promoting the pilot program in equity efforts during a conference call with reporters.

“Health departments will use their local experience and connection to the community to identify hyperlocal strategies to improve vaccine access to communities of color, specifically those that are overrepresented in this outbreak,” Daskalakis said.

David Johns, executive director of the National Black Justice Coalition, said in the racial disparities in the monkeypox outbreak are consistent with other trends in public health.

“There have been so many opportunities to learn ways to address health inequities before they grow,” Johns said. “That Black people continue to be disproportionately impacted by this newest health epidemic is additional evidence of how white supremacy works and the importance of democratized responses to crises.”

Biden health officials, asked by the Washington Blade during the virtual meeting why the administration’s stated goal of equity in managing the monkeypox outbreak isn’t producing racial equity among new cases, restated their efforts and talked about the difficulty in achieving that goal.

Walensky, who has also had a lead role in the Biden administration combating the coronavirus pandemic, said racial disparities in the monkeypox outbreak “is not uncommon for many infectious diseases, quite unfortunately,” and defended the U.S. government’s approach to monkeypox.

“And it is exactly for these reasons why we started on these pilot projects before we even saw the shifts in data, as that is often the case in infectious diseases that we have more vulnerable population — racial and ethnic minorities — who are most impacted later on,” Walensky added. “And so, we anticipated this. We have embarked on these activities to address this in exactly this moment.”

Daskalakis, following up in defense of the Biden administration’s efforts on equity, said he’s “spoken to providers on the ground and also promoters at these events who have noted that this effort is really unprecedented in terms of reaching deeply into these communities.”

“I think all of our commitment in the administration is to really focus efforts on equity to resolve the issues that we’re seeing. It is a hard effort and it’s a challenge,” Daskalakis added. “And I think that the way to address equity is intentionally, and this is an example of intentional work to address equity.”

With the racial disparity in the monkeypox outbreak ongoing, health observers say additional efforts are needed to reach out to marginalized communities to ensure they have access to public messaging and vaccinations.

Cahill said although people of color in urban areas go to LGBTQ centers to receive health care, many of them are also getting care through other facilities that aren’t LGBTQ-specific, such as emergency rooms and urgent care clinics .

“I think providing some training and technical assistance to those healthcare organizations in how to provide affirming care to bisexual men could be an important approach and could make it so that people might be more likely to disclose same-sex behavior in those contexts,” Cahill said.

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Mississippi

Art used to spotlight people of color lost to AIDS in the South

National AIDS Memorial, Southern AIDS Coalition created Change the Pattern exhibit

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The National AIDS Memorial and Southern AIDS Coalition have announced a new initiative to raise awareness about the impact of HIV/AIDS among communities of color in the South. (Photo courtesy of the National AIDS Memorial)

The National AIDS Memorial has joined forces with the Southern AIDS Coalition to stage a series of art exhibitions and educational forums to honor Black and Brown people in the South who have been lost to HIV/AIDS.

The initiative, titled Change the Pattern, began in Jackson, Miss., on Wednesday with curated quilt exhibitions, displays, educational forums, advocacy, storytelling and quilt-making, according to a press release from the National AIDS Memorial. A $2.4 million grant from the biopharmaceutical company Gilead Sciences, Inc., funded Change the Pattern.

More than 500 hand-stitched quilt panels from the area were featured in what the National AIDS Memorial says is “the largest display of the AIDS Memorial Quilt ever” in Mississippi.

“By creating an empowering message and safe spaces for conversation, we can uplift, inspire and make progress toward ending the HIV epidemic, challenge cultural stigmas and continue the legacy of advocacy that the quilt represents,” said National AIDS Memorial CEO John Cunningham in the release. 

Change the Pattern was announced in honor of Southern HIV/AIDS Awareness Day during the Southern AIDS Coalition’s annual Saving Ourselves Symposium that took place in August. 

The conference, which was heavily attended by LGBTQ activists from the South, featured 100 quilt panels, and attendees participated in quilt-making workshops to make new quilt panels representing their loved ones.

Interested LGBTQ advocacy organizations in the South were invited to apply for funding to support local quilt-making workshops in their communities so as to ensure that the legacies of Black and Brown people are captured through newly-sewn panels on the quilt through the Memorial’s Call My Name program, according to the National AIDS Memorial press release. 

The application process opened on Sept. 15 with up to 35 eligible organizations receiving as much as $5,000 to support hosting local workshops. 

The first major Change the Pattern Quilt was founded 35 years ago as a visual representation of the need to end stigma and provide equitable resources to communities most impacted by HIV/AIDS, according to Southern AIDS Coalition Executive Director Dafina Ward.

“Change the Pattern is a call to action and change in the South,” said Ward. “Quilt-making has such a deep cultural connection in the Black community and in the South. The sharing and telling of these powerful stories through the quilt, coupled with advocacy and open dialogue, can help end HIV-related stigma and bring the stories of those we’ve lost to light.”

As the Change the Pattern initiative occurs, conversations about how to handle health epidemics within LGBTQ communities of color have become national topics, especially with the prevalence of monkeypox cases amongst Black gay men.

Despite earlier panic about the disease, the Centers for Diseases Control and Prevention in a report released on Wednesday said that individuals who were vaccinated against the disease were less likely to be affected over the summer compared to those who weren’t. 

The effectiveness and duration of immunity after a single dose, however, is not known, and few individuals in the current outbreak have completed the recommended two-dose series, according to the report. 

The most recent CDC data reports that 25,509 monkeypox cases have thus far been confirmed in the U.S. Only one death has been reported.

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U.S. Federal Courts

Doctor, transgender spouse indicted for passing information to Russia

Jamie Lee Henry first active-duty Army officer to come out as trans

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Jamie Lee Henry and their spouse Anna Gabrielian (Photos from social media)

A federal grand jury on Wednesday handed down an indictment of a Johns Hopkins anesthesiologist and her spouse, a doctor and major in the U.S. Army, with conspiracy and for the disclosure of individually identifiable health information related to their efforts to assist Russia in connection with the conflict in Ukraine.

The office of the U.S. Attorney for the District of Maryland in a press release stated Anna Gabrielian, 36, and her spouse, Jamie Lee Henry, 39, both of Rockville, Md., both of whom had secret clearances, were attempting to provide medical information about members of the military to the Russian government.

Gabrielian and Henry met with an individual they believed to be associated with the Russian government, but who was, in fact, an Federal Bureau of Investigation Undercover Agent.

Court documents indicate Gabrielian told the FBI agent posing as a Russian operative that she had previously reached out to the Russian Embassy by email and phone, offering Russia her and her spouses’ assistance.

According to the U.S. Attorney’s office, Gabrielian told the FBI agent that, although Henry knew of Gabrielian’s interaction with the Russian Embassy, she never mentioned Henry’s name to the Russian Embassy.

In the narrative released by the U.S. Attorney’s office, on Aug. 17, 2022, Gabrielian met with the FBI at a hotel in Baltimore. During that meeting, Gabrielian told the FBI she was motivated by patriotism toward Russia to provide any assistance she could to Russia, even if it meant being fired or going to jail. 

She proposed potential cover stories for her meeting with the “Russians” and stressed the need for “plausible deniability” in the event she was confronted by American authorities. Gabrielian also told the FBI that, as a military officer, Henry was currently a more important source for Russia than she was, because they had more helpful information, including how the U.S. military establishes an army hospital in war conditions and information about previous training provided by the U.S. military to Ukrainian military personnel. 

Henry identifies as a “transgender military physician” on their Twitter account.

Henry received public attention in 2015 after becoming the first known active-duty Army officer to come out as trans.

Henry was at one point a member of SPARTA, the nation’s largest nonprofit representing actively-serving trans U.S. servicemembers. A spokesperson for SPARTA, in an emailed statement commenting on the announcement of the arrest and indictment of Henry and their spouse told the Washington Blade:

“Transgender people are as diverse as the societies to which they belong. One’s gender identity neither increases nor decreases a propensity towards alleged criminal activity.”

As stated in the indictment, Gabrielian is an anesthesiologist and worked at Medical Institution 1 in Baltimore.  

Henry, a major in the U.S. Army who held a secret-level security clearance, is Gabrielian’s spouse and a doctor. During the time of the alleged conspiracy, Henry worked as a staff internist stationed at Fort Bragg, the home of the Army’s XVIII Airborne Corps, headquarters of the U.S. Army Special Operations Command and the Womack Army Medical Center.

Gabrielian was scheduled to have initial appearance at 11:30 a.m. on Thursday in U.S. District Court in Baltimore before U.S. Magistrate Judge Brendan A. Hurson. Henry is also expected to have an initial appearance today, although a time has not yet been set.

Full statement from SPARTA:

“SPARTA, a non-profit advocacy organization representing transgender Service members in the United States, is saddened to learn of the arrest and indictment of Jamie Lee Henry, an officer in the U.S. Army and a medical doctor.

SPARTA has long advocated for the inclusion and total equity for transgender persons throughout the United States uniformed services. Today, thousands are serving honorably and authentically at home stations worldwide.

The actions alleged in the indictment do not reflect Henry’s identity as transgender. Their alleged actions are those of an individual and should not be taken as a representation of transgender people broadly or transgender members of the military specifically.

All people in the United States are entitled to the same rights, including due process and the presumption of innocence in this case. SPARTA does not condone any actions alleged in the indictment and expects the process to play out fairly and equitably as it would for anyone accused of a crime.”

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The unvaccinated are 14 times more likely to contract monkeypox: health officials

Guidance updated to allow shots in places other than forearm

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U.S. health officials are celebrating data finding the monkeypox contraction is lower among people who are vaccinated.

U.S. health officials are celebrating preliminary data on the vaccine used in the monkeypox outbreak, which has led them to conclude eligible persons who didn’t get a shot were 14 times more likely to become infected than those who are vaccinated.

The new data, as described by health officials on the White House monkeypox task force during a call with reporters on Wednesday, comes as the overall number of new cases of monkeypox is in sharp decline, although considerable racial disparities persist in the remaining cases as Black and Latino people are overrepresented in the numbers.

Rochelle Walensky, director of the Centers for Disease Control & Prevention, said during the conference call the preliminary data — collected from 32 states between July 2022 and September 2022 — provides an early shapshot of the effectiveness of the vaccine and cause for optimism on the path forward.

“These new data provide us with a level of cautious optimism that the vaccine is working as intended,” Walkensky said. “These early findings and similar results from studies and other countries suggest even one dose of the monkeypox vaccine offers at least some initial protection against infection.”

Walensky during the conference call admitted the data is incomplete in numerous ways. For example, the data is based on information on individuals who have obtained only the first shot as opposed to both shots in the two-shot vaccination process. (The data showing positive results from individuals who have only one shot contradicts previous warnings from the same U.S. health officials that one shot of the monkeypox vaccine was insufficient.)

The data also makes no distinction between individuals who have obtained a shot through subcutaneous injection, a more traditional approach to vaccine administration, as opposed to intradermal injection, which is a newer approach adopted in the U.S. guidance amid the early vaccine shortage. Skeptics of the new approach have said data is limited to support the idea the intradermal injection is effective, particularly among immunocompromised people with HIV who have been at higher risk of contracting monkeypox.

Not enumerated as part of the data were underlying numbers leading health officials to conclude the unvaccinated were 14 times more likely to contract monkeypox as opposed to those with a shot, as well as any limiting principle on the definition of eligible persons. Also unclear from the data is whether individual practices in sexual behavior had any role in the results.

Despite the positive data on the monkeypox vaccine based on one shot, U.S. health officials warned during the conference call the two-shot approach to vaccine administration is consistent with their guidance and more effective.

Demetre Daskalakis, the Biden administration’s face of LGBTQ outreach for monkeypox and deputy coordinator for the White House monkeypox task force, made the case that for individuals at risk obtaining a second dose is “really important.”

“So we see some response after the first [shot] in the laboratory, but the really high responses that we want to really get — that you know, level 10 forcefield as opposed to the level five forcefield — doesn’t happen until the second dose,” Daskalakis said. “So the important message is this just tells us to keep on trucking forward because we need that second dose at arms that people haven’t gotten the first should start their series of two vaccines.”

Also during the call, health officials said they would be expanding opportunities for vaccines as pre exposure prophylaxis, as opposed to practices in certain regions granting vaccines in their limited supply to individuals who meet certain criteria or have had risk of exposure.

The Centers of Disease Control & Prevention, officials said, is also updating its guidance to allow injection of the vaccines in places other than a patient’s arm.

Daskalakis said fear of stigma about getting a noticeable shot in the forearm after obtaining a monkeypox vaccine was a key part of the decision to issue the new guidance on implementation.

“Many jurisdictions and advocates have told us that some people declined vaccine to monkeypox because of the stigma associated with the visible but temporary mark often left on their forearm,” Daskalakis said. “New guidance from CDC allows people who don’t want to risk a visible mark on their forearm to offer a vaccine on their skin by their shoulder or their upper back. Those are areas more frequently covered by clothes.”

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