Monkeypox Response Woven Throughout Conversation at USCHA 2022
The response to the current nationwide monkeypox outbreak, which is having a disproportionate impact on people with and experiencing risk for HIV, was a topic of much discussion during the recent U.S. Conference on HIV/AIDS (USCHA). The conference, organized by NMACExit Disclaimer and held October 9-11, 2022, brought together nearly 3,000 participants from across the country. The conference included four sessions focused on monkeypox and the imperative of ensuring equity as the response unfolds. Below find information on those sessions and links to key resources.
“I was pleased that the response to the monkeypox outbreak was woven into the conversations at USCHA and I am grateful to all of our partners in the HIV community for engaging in the monkeypox response and promoting equitable access to information, vaccination, testing, and treatment for the communities most affected,” observed Kaye Hayes, Deputy Assistant Secretary for Infectious Disease and Director of the HHS Office of Infectious Disease and HIV/AIDS Policy, who is advising the White House’s National Monkeypox Response Team.
The Association of Nurses in AIDS Care (ANAC) presented a half-day institute focused on monkeypox. Two ANAC members and the organization’s executive director provided updates on the clinical presentation, diagnosis, management, and prevention of monkeypox. Jeffrey Kwong, DNP, MPH, FAANP, Professor at Rutgers School of Nursing, and Nurse Practitioner at New York City’s Gotham Medical Group, observed that clustered monkeypox lesions appear more commonly in people with HIV and that people with advanced or poorly controlled HIV are at risk for prolonged monkeypox infection, secondary bacterial infection, and other complications. He also highlighted concerns about equity in monkeypox vaccination with fewer Black/African American and Latino people receiving vaccines despite greater numbers of cases in these populations.
He and his fellow presenters also discussed the fact that because of monkeypox-associated stigma, some people with the virus are experiencing anxiety and loneliness while isolating during the disease course. They shared examples of how their clinics were offering psychosocial supports through calls from a healthcare provider or social worker. They also observed that to address concerns among some patients with both HIV and monkeypox about loss of income while isolating, some clinics have been able to tap into Ryan White HIV/AIDS Program (RWHAP) resources to help meet some short-term needs for emergency funds. (Access the slides from this session on the Monkeypox Information page of ANAC’s websiteExit Disclaimer.)
Monkeypox Institute Featured National Overview and Local Actions
During an October 9 session, Greg Millett, MPH, Vice President and Director of Public Policy for amfAR, provided an overview of the current state of the monkeypox outbreak in the U.S., highlighting what he characterized as good news and not-so-good news. Among the good news: there is a safe and effective vaccine and recent data showed that those vaccinated are 14-times less likely to get monkeypox than those not vaccinated. Also, the epi curve is declining in the U.S., largely because “gay men came to the rescue and changed behaviors to slow the spread.” For the not-so-good news, he pointed to the fact that early symptoms are not always noticeable and are often similar to those of other diseases, which can lead to misdiagnosis. He also highlighted new CDC data showing that HIV and STIs are highly prevalent among people with monkeypox in the U.S., with 38% having HIV. Finally, Mr. Millett highlighted how rapidly disparities in cases of monkeypox emerged among Black and Latino peopleExit Disclaimer.
Adding local perspectives to the conversation, Dr. DeMarc Hickson, Executive Director of Us Helping UsExit Disclaimer in Washington, DC, and Julio Frausto, Counselor at Los Angeles’ BienestarExit Disclaimer, discussed how their organizations responded early to the monkeypox outbreak in their communities with the goal of ensuring equitable access to services and preventing disparities. Us Helping Us organized community townhalls to share information and bust myths and collaborated with local health departments to offer a monkeypox vaccine clinic at their organization’s facilities to better reach the African American gay men they serve. Mr. Frausto highlighted community townhalls convened to share information and address concerns in the primarily Latino community of South Los Angeles as well as Bienestar’s monkeypox vaccination clinics launched in August.
Attendees Shared Feedback During Townhall
During a Monkeypox townhall session on October 10, conference participants were able to share their experiences, concerns, and recommendations with officials from CDC, HRSA, and the White House and hear from representatives of organizations engaged in the local responses in San Juan and Washington, DC. Among the issues raised were the need for the federal government to better counter media misinformation about monkeypox, particularly when it stigmatizes populations most affected; appreciation for the CDC and HRSA authorizations for state and local funding recipients to use some HIV resources for their monkeypox response; concern about new demands on already-strained state and local public health systems; a desire for more streamlined access to monkeypox vaccine and treatment; and concerns about what some participants perceived as local health department responses that were too slow and not optimally equitable. You can view the video of the townhall on NMAC’s YouTube page.
Closing Plenary Focused on Monkeypox Response
The conference closed with a plenary session focused on the national response to the monkeypox outbreak. The session featured presenters from CDC, HRSA’s RWHAP, and representatives from a health department and community-based organizations in New York, Los Angeles, and Boston discussing their agencies’ approaches to addressing the monkeypox outbreak. Dr. Demetre Daskalakis, Deputy Coordinator of the White House’s National Monkeypox Response Team (on detail from his role as Director of CDC’s Division of HIV Prevention), underscored that a syndemic approach to the response to monkeypox is essential given both the common risk factors and populations affected by HIV, STIs, and monkeypox. He applauded and encouraged the important roles the HIV community has played and will continue to play in the monkeypox response. He highlighted opportunities to connect those getting the monkeypox vaccine or treatment with HIV testing and PrEP or HIV treatment, vital actions to end both the monkeypox outbreak and HIV epidemic equitably across all populations. View the video of the closing plenary on NMAC’s YouTube page.