In group texts and on social media, word is spreading among the Bay Area’s various queer communities: Monkeypox is out there.
As of July 5, San Francisco’s official count of confirmed and suspected cases stood at 40, more than double the prior week’s total of 16. With Pride Weekend and its associated parties likely accounting for much of this increase, event organizers have been notifying attendees of positive cases, encouraging them to report any symptoms and get vaccinated.
According to public-health experts, an increase in case counts among LGBTQ+ populations is partly attributable to reduced stigma around STI testing as a result of sustained outreach campaigns.
Or, as Frank Strona, the monkeypox incident management team lead for the San Francisco Department of Public Health, puts it, “Gay, bi and trans men are accustomed to taking care of our own. We’re more in touch with providers and our public-health teams.”
However, the city’s first confirmed case was logged only in early June. Since then, mass notifications during and after Pride season have informed people who may have been exposed. Public health officials are quick to note that, with large-scale festivals like Up Your Alley and the much-larger Folsom Street Fair looming, the potential for greater community transmission is high.
Monkeypox is “almost exclusively in men who have sex with men, particularly those with multiple partners,” said John Swartzberg, clinical professor emeritus at UC Berkeley's School of Public Health. “But that’s not going to remain the case. If it becomes endemic, then having sex with multiple partners is going to put everyone at risk, and then it will spill over into the general population.”
On July 6, DPH emailed an informational flyer to its community partners, urging them to post it in public areas like hallways and bathrooms.
Ken Rowe, the proprietor of Eros, a bathhouse geared toward the gay community, told The Standard he would happily comply even though few of his customers had so far raised concerns. While “Pride was good” for business, Eros nonetheless operates below capacity and with limited hours at its new location in the Tenderloin. Additionally, his clientele has experience with infectious diseases.
“It’s an annual thing, from MRSA to super-syphilis, a lot of airborne stuff,” he adds. “My understanding with monkeypox is, if you’ve had the smallpox vaccine, there’s some carryover with that—and those of us 50 and older have had that. Quite frankly, that’s a big chunk of our population.”
That is true. Also, the virus spreads chiefly through close contact, and cases usually resolve on their own. All the same, monkeypox—with its evocative name, its unsightly rash, its potential for lifelong scarring, and the fact that this outbreak has coincided with yet another Omicron variant—is something of a readymade public-health villain.
Additionally, the supply of vaccines has been limited, with DPH only just receiving its first large shipment from the state. According to Strona, his department is in talks with Folsom Street Events and other organizers to distribute vaccines at this summer’s outdoor fairs.
“We’re always very present at street fairs,” Strona says. “So there could be vaccinations on-site. You have to get two shots over 28 days, so it’s a bit of a logistical challenge…We have an outreach engagement team working with venues to see what is possible.”
Angel Adeyoha, executive director of Folsom Street Events, confirms that this is the plan. In 2021, Up Your Alley and the Folsom Street Fair saw 400 and 1,100 vaccines administered, respectively.
“This year we are going to include monkeypox vaccines,” they said, adding that people don’t even have to enter the festival to receive a shot, as the DPH booths are just outside the gates for maximum access.
“Monkeypox has had some spikes after Pride,” Adeyoda said, “and we are the target demo as far as trying to reach folks. I think that that is one of our mandates to continue creating these spaces: to make sure we’re working with public health to reach our communtiy, with safety information and practical interventions.”
Beyond these annual events, clinics such as Strut, a health center in the Castro affiliated with the San Francisco AIDS Foundation, may also be crucial to slowing monkeypox’s spread.
“There is an infrastructure already in place,” said Dr. Peter Chin-Hong, an infectious disease expert at the University of California, San Francisco. “For example, I think there’s talk of repurposing some of the Covid vaccine sites for mass immunizations, or using some of the infrastructure of diagnostics and contact-tracing developed for Covid.”
This increasingly coordinated response is not limited to San Francisco, either, Contra Costa County has set up a vaccine-distribution clinic on Thursday, July 7, with a small number of shots available.
“We’re hoping to get more doses, and this clinic this week is one way to see if there’s interest in the community, or awareness of the vaccine,” said Paul Leung, the county’s public health communicable disease programs chief.
Leung confirmed that, at present, Contra Costa County has no confirmed cases in its residents. So why establish a clinic?
“Certainly we know it’s in the Bay Area,” he said. “Many people live in one jurisdiction and play in another, and we’re interconnected in this way. The state, given this limited supply [of vaccine], divvied it up among counties, and we’re playing our part as a Bay Area neighbor. We recognize that people could be at risk.”
While the politicization of the Covid vaccine has certainly led to hesitancy and outright resistance among Americans, Leung believes that the situation may different with monkeypox.
LGBTQ-identified people, he says, “are aware and have experienced terrible diseases that have impacted their lives. This is a way for them to get ahead of it. If anything, let’s cheer on these folks who have reported symptoms … like a terrible rash or bumpy pox on your skin.”
Still, even with this infrastructure, DPH’s Strona believes that San Francisco’s case count is almost certain to go up before it goes down.
“What I’m telling my friends is, if you’ve been in large events where somebody has monkeypox, pull back from socializing and other parties,” he says. “Do a self-assessment for a couple weeks. If you do find symptoms, then let your providers know—and be in touch.”