In June, Jamal Lance noticed a rare rash around his groin. He ignored it until days later when it spread to various other parts of his body.
“My doctor said it was monkeypox. I had no idea,” said the 29-year-old, who lives in downtown Oakland. He had heard of the viral infection just months before, but when he noticed the rash, he said, “It was too late, and I had caught it.”
Monkeypox vaccination rates have increased by 20% across California since August and the overall number of cases is down. But new infections continue to be recorded, especially among certain groups: According to the Centers for Disease Control and Prevention, more than 90% of cases have affected men reporting recent sexual activity with other men. Locally, cases also occur primarily in gay men who, like Lance, are Black or Latinx. And many of those men are, like Lance, finding out about the risk—and the availability of vaccines—too late.
California now has over 5,000 cases of monkeypox, more than any other state. Alameda County has 238 of the state’s cases.
“While new cases are reported, it’s important to note that the rate of new cases has declined statewide and locally from their summer peak,” said Alameda County Health Care Services Agency spokesperson Neetu Balram, who said getting more gay men of color vaccinated to bring down cases remains the county’s immediate goal.
Alameda County data show that 68% of infected individuals identify as gay, lesbian, or same-gender loving, and that 64% of cases have occurred primarily in gay men who are Black or Latinx.
But as of October, just 7% of the state’s Black or African American population was fully vaccinated against monkeypox, according to recent data from the California Department of Public Health. In Alameda County, the vaccination rate among Black people was even lower: just 5% of the population had received at least one dose of the two-dose vaccine.
To encourage vaccination, the Alameda County Public Health Department has opened five walk-up vaccine centers. They include the Glenn Burke Wellness Clinic at the Oakland LGBTQ Community Center and Steamworks Baths in Berkeley, according to Balram.
At the same time, advocacy groups like the Oakland LGBTQ Community Center have set up public information outreach centers, at sites including the T-Mobile store at the corner of Lakeshore and Lakeside, near the Grand Lake Farmers Market on Lake Park Ave, and at the Oakland Pride Parade and Festival back in September, where the center also administered vaccines.
Executive Director Joe Hawkins said that the Oakland LGBTQ Community Center has vaccinated about 2,000 people in Alameda County against monkeypox since July. But while the center’s programming focuses on marginalized communities, Hawkins said that the most significant fraction of those vaccinated by the center to date has been white. Of 2,000 vaccinated individuals, 25% were Latinx, 30% were Black, and 35% were white.
“What’s the use of vaccines if information about the virus is not that intense around the community?” he said. He pointed to continuing cases of HIV among gay men of color, despite decades of information about prevention. With monkeypox, he said, the pattern may continue, especially if some individuals think the vaccine is not necessary, or might not be safe.
The Alameda County Health Department has prioritized monkeypox vaccination among gay and bisexual men, including persons living with HIV.
“If you are a gay or bisexual man, trans person, or any man who has sex with men or trans people, we encourage you to get vaccinated and get your second dose,” said George Ayala, deputy director of the Alameda County Health Care Services Agency’s Public Health Department. “The vaccine is safe.”
In the U.S., two vaccines are available for monkeypox prevention: ACAM2000, manufactured by Emergent Product Development in Gaithersburg, Maryland, and JYNNEOS, manufactured by Bavarian Nordic in Hellerap, Denmark. Only JYNNEOS, the vaccine administered in Alameda county’s campaigns, is safe for use in adults with HIV, no matter how suppressed their immune systems are, according to the Centers for Disease Control and Prevention.
In Alameda County, a third of monkeypox cases are in Black and Latinx gay men living with HIV.
Centers for Disease Control and Prevention data show that nationally, about 40% of U.S. monkeypox patients are also infected with HIV. The agency’s most recent report on the monkeypox outbreak stated that while scientists still do not know whether HIV infection increases the likelihood of getting sick from monkeypox, it does increase the risk of severe monkeypox, which can result in hospitalization or death.
“Monkeypox and HIV have collided with tragic effects,” said CDC Monkeypox Incident Commander Jonathan Mermin. “Access to monkeypox and HIV prevention and treatment matters—for people’s lives and public health.”
This collision also appears to put men of color at even higher risk. A report on patients hospitalized with severe monkeypox, released by the CDC last month, revealed that of the 57 severe cases the agency consulted on, more than two-thirds were Black men with HIV infection.
Hawkins said a pragmatic public health strategy is key to averting a replay of the AIDS pandemic, especially for sexual minorities. “We need a proper response,” he said, “a quick and proper response to any health issue that we are coming up against.”
Correction: This article originally stated that monkeypox case rates in California had risen since August. While new cases continue to be reported, the overall rate of infections has declined since its summer peak. The article was updated to reflect this on Nov. 14, 2022, at 3:25 p.m. PT.