San Francisco Community Health Center
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By Maanvi Singh, The Guardian

Originally published in The Guardian July 21, 2022. Click here to view original article.

San Francisco leaders and LGBTQ+ advocacy groups gathered this week in front of the US Health and Human Services’ regional office to protest what they see as a sluggish response to the monkeypox outbreak.

“There’s a lot of anger and it’s totally justified,” said state senator Scott Wiener, who joined protesters from the Alice B Toklas LGBTQ Democratic Club, San Francisco Aids Foundation and Harvey Milk LGBTQ Democratic Club and other groups demanding increased access to monkeypox vaccines, testing and therapeutics for an outbreak that so far has been disproportionately affecting gay and bisexual men.

In San Francisco, where prominent LGBTQ+ advocacy groups that 40 years ago led protests against a government that ignored and undermined the Aids crisis, “there’s a lot of PTSD in the community”, Wiener said. Gay and bisexual men are left once again wondering why their community is being failed by the federal government, he added.

Although monkeypox has gained an initial foothold among networks of men who have sex with men, it could have taken off among any other social group, epidemiologists say. It can spread through very close contact, such as skin-to-skin contact including during sex, or by sharing infected items like clothing and bedding.

“It doesn’t escape me that we’re once again in a moment where there’s a lack of urgency when a public health crisis is impacting cis and trans men as well as non-binary folks within the same social and sexual networks,” said Tyler TerMeer, CEO of the San Francisco Aids foundation. “And personally, as someone who is a Black gay man who has been living with HIV for 18 years, it is hard for me to not question whether or not there would be a more robust response to this outbreak if it first began spreading among another population.”

For weeks, the leaders of local health organizations in San Francisco have been advocating for easier, broader access to testing and more vaccine doses. Their concerns have been echoed by leaders in other major cities, where epidemiologists warn that early delays in rolling out tests mean that the actual number of cases likely outnumber the confirmed ones.

San Francisco tallied 141 cases of monkeypox as of Wednesday.

Meanwhile, the city’s health department quickly said an initial allocation of 2,300 doses of Jynneos, the best vaccine against monkeypox, was far from enough. This week, it will receive an additional 4,200 doses – a fraction of the 35,000 that were requested for its most vulnerable populations. A drop-in vaccine clinic at the San Francisco general hospital opened Wednesday, but said it has only 300 shots to offer each day.

Christopher Artalejo-Price, a San Franciscan who works with the Aids foundation and in nightlife , said he made his way across the Bay Bridge to get his vaccine in Berkeley. He waited three hours during his first try – only to be told that the clinic had run out of doses, and then went back another day and waited eight hours before getting his shot.

“I brought my lunch, and a bottle of water. I brought a charger for my phone – I had to take work calls while I was waiting in line,” he said. Those who were queued up traded tips on where to go nearby to use the restroom and held each other’s spots. “And I felt so lucky because I had a job where I could ask my boss for the time off to do this,” he said. “It was just a really humbling and sad moment.”

In a letter to Xavier Becerra, the US Health and Human Services secretary, Nancy Pelosi, the House speaker and representative of San Francisco, said the current vaccine supply was “woefully inadequate”.

The US has had a small stockpile of the vaccine, and has ordered millions more. But the factory that produces the vaccine has been shut since last August, due to a planned expansion, and shipments are expected to trickle in slowly. Public health experts have criticized the government’s reliance on a single manufacturer, and its failure to set up an alternative means of producing and stockpiling the vaccine ahead of the outbreak.

San Francisco activists compared these delays and misjudgments not only to the early days of the Aids epidemic, but also to the US Covid-19 response – and initial delays in rolling out testing and guidance.

“We should have been able to quickly control this outbreak,” Wiener said. “And instead it’s like Mad Max Thunderdome to get a vaccine.”

‘We have a lot of work to do’

Treatment for those who test positive also remains difficult to access, San Francisco healthcare and LGBTQ+ advocacy agencies said. To access TPOXX, an FDA-approved and stockpiled drug that may ease the sometimes severe symptoms of monkeypox, providers have to submit lengthy paperwork to the Centers for Disease Control and Prevention, which many smaller hospitals and clinics don’t have the capacity to do. As a result, “members of the gay community have been messaging each other to try to find it and are growing increasingly angry that they cannot access the one drug that could ease the suffering of people with monkeypox”, wrote physician Jay K Varma and health activist Joseph Osmundson in Stat, a health and medicine publication.

Monkeypox is rarely fatal, but the disease can be very painful for some. And for those who have been exposed or infected, long isolation periods can be physically or economically infeasible. “We just can’t let this spread in our community,” Wiener said.

Health workers and advocates also worry that the scarce options for testing and vaccination are leaving out gay and trans people in San Francisco who are unhoused, and those who cannot easily access information about health resources.

Throughout the Covid-19 pandemic, health workers from the San Francisco Community Health Centre have been taking information, tests and vaccines out to the streets, to meet patients where they are, said the organization’s CEO Lance Toma. Smaller health centers and clinics working with marginalized communities will need the resources, access and funding to do the same with monkeypox tests and vaccines, he said.

“We also just need to do more in terms of educating our patients about monkeypox, the risks, and how to stay safe – we have a lot of work to do,” he said, noting that one recent patient showing symptoms had very little awareness of the outbreak, and was diagnosed only after he came into the clinic for unrelated reasons.

“The bottom line is that there’s been such a tepid response to this outbreak at all levels,” Toma said. “And I feel like the folks that we serve – especially folks who are homeless, the trans community, and even gay men of color – we’re always last in line for resources.”