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Monkeypox arrives in D.C. — what’s the big deal?

Most cases identified in gay or bisexual men

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On June 4, the D.C. Department of Health confirmed its first case of Monkeypox from a resident who recently travelled back from Europe. D.C. now joins 11 other states with this potentially deadly disease. So far, most cases have been identified in gay or bisexual men.

With Pride events taking place in D.C. and around the world this month, how concerned should we be? Is this the tip of the iceberg? Let’s break it down.

What is Monkeypox?

Monkeypox is caused by a virus similar to its more deadly cousin Smallpox. Scientists identified Monkeypox in 1958 first in monkeys (hence the name) and later in humans in the 1970s. Despite the name, bush animals and rodents are the natural reservoir for the virus.

How did we first hear about this strain of Monkeypox?

In May, health officials first identified an outbreak of Monkeypox in Spain, which then spread to the U.K. While some women and children have developed the disease, most cases were disproportionally found in gay and bisexual men. Health agencies traced those exposures back to gay dance parties, saunas, and intimate activities.

What are the symptoms of Monkeypox?

Symptoms often start with headache, fever, muscle aches, and swollen lymph glands. Within 1-3 days of the fever, a rash with blisters typically develops on the face, hands, and soles of the feet. In more recent cases, however, patients have seen lesions around the mouth and groin only. The lesions can appear flat or raised, fluid filled and then slough off into a scab, lasting 2-4 weeks. While most cases go away without treatment, Monkeypox can be deadly with a death rate of 3-6%.

How does Monkeypox spread?

In the past, most Monkeypox outbreaks outside of Africa were caused by imported animals. Now, the virus has appeared to spread between people within a community. Monkeypox virus is transmitted in several ways with the most common coming from direct skin-to-skin or mouth-to-skin contact with an infected person, infected animal, or a contaminated surface or linens. Ulcers or lesions are particularly infectious. Monkeypox is not a sexually transmitted illness, but can transmit during sexual contact.

Why are more gay men being seen with Monkeypox?

While there is a disproportionate rise in Monkeypox cases among the LGBTQ community, Monkeypox is not a “gay disease.” It can be transmitted between anyone.

Stigmatizing the virus has dangerous consequences and will only make matters worse. That said, the virus was likely introduced first in the gay community and then spread. Secondly, most Monkeypox cases have been identified in STI clinics. Because of positive sexual health awareness and practices, gay and bisexual men are more frequently screened for STIs and seek evaluation when new rashes occur.

What do I do if I think I have Monkeypox?

If you develop a fever, swollen lymph glands and a rash, you should contact your healthcare provider and self-isolate.

So is this a big deal?

Maybe — but it’s still early.

We are learning more about the severity of this Monkeypox strain. What we know so far is Monkeypox is not COVID-19, and scientists have already developed a vaccine. However, with the sudden emergence of Monkeypox outside where the virus is typically found demonstrating person to person spread, healthcare professionals and the public are appropriately concerned.

So what does this all mean?

Know the facts about Monkeypox to reduce your risk. Avoid close intimate contact with individuals who have symptoms. Wash your hands and clean surfaces in high traffic areas. And if you develop new skin rashes or unexplained blisters, isolate and alert your healthcare provider. For more, visit WHO.

Dr. N. Adam Brown is an emergency physician, COVID expert, health communicator, and strategist.

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Health

MISTR announces it’s now prescribing DoxyPE

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MISTR, the telemedicine provider that offers free online PrEP and long-term HIV care in all 50 states, D.C., and Puerto Rico, announced it is now prescribing Doxycycline Post-Exposure Prophylaxis (DoxyPEP), an antibiotic that reduces bacterial STIs, including gonorrhea, chlamydia, and syphilis. Patients can now use MISTR’s telehealth platform to receive DoxyPEP online for free, according to a release from the company.

With this launch, MISTR plans to offer patients access to post-exposure care, in addition to its existing preventive and long-term HIV treatment options, which include PrEP and antiretroviral therapy (ART). This comes at a time when the rate of STIs continue to rise. In 2022, more than 2.5 million cases of syphilis, gonorrhea, and chlamydia were reported in the U.S; of that population, gay and bisexual men are disproportionately affected, the company reported.

“Despite an ongoing STI epidemic affecting the LGBTQ+ community, there are few resources available for this underserved, vulnerable community to get the preventative medication they need,” said Tristan Schukraft, CEO and founder of MISTR. “I’m proud that MISTR is democratizing access to PrEP, HIV care, and now DoxyPEP.”

An NIH-funded study published by the New England Journal of Medicine in April 2023 found that doxycycline as post-exposure prophylaxis, now known as DoxyPEP, reduced syphilis by 87%, chlamydia by 88%, and gonorrhea by 55% in individuals taking HIV PrEP, and reduced syphilis by 77%, chlamydia by 74% and gonorrhea by 57% in people living with HIV. 

MISTR is a telemedicine platform offering free online access to pre-exposure prophylaxis (PrEP) and long-term HIV care Visit mistr.com for more information.

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Health

UNAIDS to commemorate Zero Discrimination Day’s 10th anniversary

UN agency urges global action to protect human rights

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A UNAIDS anti-discrimination exhibit at Tocumen International Airport in Panama in 2018. (Washington Blade photo by Michael K. Lavers)

As the world marks the 10th anniversary of Zero Discrimination Day; UNAIDS is sounding the alarm on the increasing threats to human rights, calling for renewed efforts to protect the rights of all individuals as a fundamental step towards ensuring health for everyone.

Established by UNAIDS a decade ago, Zero Discrimination Day aims to promote equality and fairness regardless of gender, age, sexuality, ethnicity or HIV status. The progress achieved over the past years is now in jeopardy, however, due to rising attacks on the rights of women, LGBTQ people and other marginalized communities.

UNAIDS Executive Director Winnie Byanyima emphasized the critical link between protecting human rights and safeguarding public health. 

“The attacks on rights are a threat to freedom and democracy and are harmful to health,” she said in a press release. “Stigma and discrimination obstruct HIV prevention, testing, treatment and care and hold back progress towards ending AIDS by 2030. It is only by protecting everyone’s rights that we can protect everyone’s health.”

Despite challenges, there has been notable progress. 

At the onset of the AIDS pandemic more than 40 years ago, two-thirds of countries criminalized consensual same-sex sexual relations. They are now decriminalized in two-thirds of countries. An additional 38 countries around the world have pledged to end HIV-related stigma and discrimination, contributing to positive changes that include 50 million more girls attending school compared to 2015.

To sustain and enhance these advancements; UNAIDS urges global support for women’s rights movements, LGBTQ rights, racial justice, economic justice, climate justice and peace initiatives. By standing with communities advocating for their rights, the U.N. aims to reinforce the collective effort towards a more inclusive and equitable world.

Zero Discrimination Day is observed on March 1.

Events and activities that will take place around the world throughout the month will serve as reminders of the essential lesson and call to action: Protecting everyone’s health is synonymous with protecting everyone’s rights.

“Through upholding rights for all, we will be able to achieve the Sustainable Development Goals and secure a safer, fairer, kinder and happier world — for everyone,” said Byanyima.

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New CDC report finds transgender women at higher risk for HIV

More than 1,600 people in seven cities surveyed

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The Centers for Disease Control and Prevention in Atlanta (Photo courtesy of the CDC)

The Centers for Disease Control and Prevention issued a new study report this week that revealed that restricted by employment and housing discrimination and lack of access to needed gender-affirming healthcare for transgender women increasing the risk of contracting HIV. 

Researchers reviewed data from a 2019-2020 survey, the National HIV Behavioral Surveillance Among Transgender Women, which found that the demographics of HIV/AIDS have been disproportionally high, especially among Black and Latina trans women, who had experienced employment and housing discrimination coupled with lack of access to gender-affirming healthcare.

The Jan. 25 Morbidity and Mortality Weekly Report was based on data studies of more than 1,600 trans women in seven major urban locales. Participants from Atlanta, Los Angeles, New Orleans, New York, Philadelphia, San Francisco and Seattle were chosen by referrals from people and community-based organizations who knew or were part of the local population of trans women.

The study’s researchers noted: “Employment discrimination occurs at the overlapping nexus of poverty, homelessness, incarceration, health insurance, disability, food insecurity and survival sex work. These issues are interconnected.”

The study stated that trans women’s inability to access quality healthcare, including gender-affirming treatment or access to PrEP, and can expose them to potential incarceration as many turn to “survival sex work” and violence, which increases the risk of contracting HIV. 

The study’s author’s pointed out: “When economically marginalized transgender women are refused employment, this refusal cyclically contributes to economic hardships. This analysis …demonstrates the importance of transgender women working and living with dignity and without fear of unfair treatment.”

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