The San Juan Daily Star
Community outreach organizations ramp up efforts to curb monkeypox
By Alejandra M. Jover Tovar
Special to The Star
NMAC, formerly known as the National Minorities AIDS Council, held a press conference via Zoom on Monday where the efforts made by the Biden administration and local organizations to curb the spread of monkeypox were discussed.
The viral illness appears predominantly among gay and bisexual men who have sex with other men. However, no one with an active sex life is immune.
The conference was part of the U.S. Conference on HIV-Aids held in San Juan.
Dr. Maya Rockeymoore Cummings, the moderator of the virtual encounter, noted that the strategy to stop monkeypox derives from the lessons learned during the AIDS epidemic in the 1980s and now the COVID-19 pandemic.
“The HIV community knows how to mobilize,” she said, naming early detection and community outreach as the pillars for stopping the spread of the disease.
“Black and Latinx gay men are disproportionately at higher risk but are receiving a disproportionately smaller share of monkeypox vaccines,” Rockeymoore Cummings said. “This is unacceptable, and it would be remiss if I didn’t point out that because of the HIV epidemic, we now have a roadmap to equitably address viral diseases impacting vulnerable communities.”
“The studies show that culturally competent outreach engagement and services make a positive and lasting difference,” she said. “As a result, the equitable approach to addressing monkeypox is to turn to the same organizations to lead the effort, as the evidence suggests.”
The parallels between monkeypox and HIV are inescapable, Rockeymoore Cummings said. The community remembers the stigma tied to the lesions that Kaposi sarcoma had on HIV patients and, now, the lesions that monkeypox manifest on those infected.
It is precisely that stigma that keeps infected patients at bay, isolated and worsening, so the Biden administration and community-based organizations are aggressively educating people about the disease and inviting them to come into the light and get treated and vaccinated.
Dr. Demetre Daskalakis, from the White House Monkeypox Response Team, said “monkeypox is not a disease that lives in isolation.”
“Our strategy has, at its core, equity and increasing the availability of testing and vaccines,” he said. “We have been able to fund organizations to improve what they have been able to do, and from very early on, this complex outbreak has required a big pivot. … The approach has been to target the population, and when you look at the vaccines that have been administered, we’ve had a lot of second doses but not many first doses, so we have to reach more people.”
That is why efforts to reach the black and brown communities disproportionately affected by the illness have been centered on organizations already working with HIV patients, who know where to go, who to talk to, and how to approach them.
In fact, one of the lessons learned, Daskalakis said, was that “people didn’t like the vaccine in the forearm [because of the stigma associated with HIV and the mark the vaccine could leave], so we’ve administered it in the back or upper shoulder.”
Damián Cabrera of NMAC added that “we have learned a lot over the years.”
“We understood well that representation is important and to be able to trust the community,” he said. “People trust us, and we want to make sure that we put the information in an understandable way. We, in collaboration with the Health Department, were able to do a vaccination clinic over the weekend; we provided information about monkeypox to the community. To combat doubts, information has to be present in communities of color.”
Dr. Maribel Acevedo-Quiñones, from Centro Ararat (a community-based center that works with HIV patients,) said “it has been a difficult time in Puerto Rico with the hurricane, the pandemic and the intersectionality with monkeypox.”
“With COVID, we have learned that we have to start working hard, hit hard, and hit early,” she said. “We have the sexual health clinic because we [encourage] participants to get vaccinated, and we make plans to have vaccines available in our phlebotomy area every day. We vaccinate people every day. … The opportunity is to come together and do assessments and reassessments to close those gaps that we are having at the root of this situation.”
Dr. Melissa Marzán, the senior epidemiologist at the island Department of Health, said meanwhile that “since the beginning of May, when we started to see the information, we started to develop a monkeypox response at the local level.”
“In addition, we started a process to train healthcare providers,” she said. “This was news to providers, but we also started conversations with communities. Most of the epidemiology was related to gay and bisexual men who had sex with men, and we held weekly calls to ensure all the strategies were the right ones. We started the vaccination process in the health centers but were unsuccessful, so we started doing local activities in the communities and increased vaccination.”
“Approximately how many people have been affected by monkeypox in Puerto Rico, and are we seeing a prevalence in certain municipalities?” the STAR asked.
“We have 189 cases, mostly in the [San Juan] metropolitan area. In Centro Ararat, we also have the same experience,” Acevedo-Quiñones said. “We have evaluated 55 suspected cases; most of them are from the metropolitan area, and another thing we have seen is the prevalence among people diagnosed with HIV and those who are in PReP (pre-exposure prophylaxis), and then those who walk into the clinic because they have a lesion. That is the same trend; we are also paying attention to other areas in Puerto Rico, and we are willing to serve any community.”