Dear Mr. Fenton

NMAC logo

Mr. Robert J. Fenton Jr.

National Monkeypox Coordinator
The White House
Washington, DC

Dear Mr. Fenton,

Congratulations on your appointment as the National Monkeypox (MPV) Coordinator. Kudos on the White House announcement on alternative dosing.

There are concerns about implementation. Like you, NMAC will follow the science.

NMAC (formerly National Minority AIDS Council) leads with race to end the HIV epidemic. Thanks to an unrestricted educational grant from Gilead, the agency has put together the moniker www.monkeypoxtruth.org. This program, like our mission, leads with race to stop MPV. Our work prioritizes MPV vaccine equity and overcoming vaccine hesitancy, particularly for gay men of color, the transgender community, Black women, and sex workers.

Thankfully, Dr. Demetre Daskalakis is on your team. He has our full support. Given the reality that gay and bisexual men, especially Black and Brown gay men, are 98% of people with MPV, there is a critical need to address equity.

Policy Priorities

  1. More MPX Vaccines
  2. Fight for Vaccine Equity
  3. Overcoming Vaccine Hesitancy
  4. Culture Wars

The number one priority is more vaccines. NMAC urges you to quickly overcome any impediments to getting vaccines into arms. While alternative dosing was a good first step, the virus is quickly spreading. Each day, I read the new US case count and worry. Community is watching and losing patience.

Recent data said 63% of people with MPV are people of color. NMAC is concerned that history will repeat itself and this becomes another on a long list of challenges impacting communities that are overwhelmed by too many issues. If COVID taught us anything, there needs to be vaccine equity plans at the start. We cannot be an afterthought.

Given the numbers, www.monkeypoxtruth.org will hold-up and tell the stories of Black and Latinx gay and bisexual men. We will also tell stories from the frontlines. Leading our efforts are:

 Daniel Driffin         Damián Cabrera

On Wednesday, our first monkeypox e-newsletter goes out for free to the entire NMAC mailing list. You will get three pieces of email each week which could be annoying, so we ask for your patience. We are still working out the kinks. At some point, we hope MPV will just go away or at least the need for a weekly newsletter will.

Vaccine hesitancy is a challenge when reaching gay men of color, particularly Black and Latinx men. The White House needs to support targeted education and training. General outreach won’t work. While the HIV community has decades reaching these communities, as we’ve seen from PrEP, it has not always been successful. Do not let history repeat itself.

MPV may be used by extremists to say gay men are sick and undeserving. Once again, it all sounds too familiar and impossible. The political, moral, and ethical contradictions abound. Vaccine education programs may require outreach and campaigns that they will find offensive. Let’s not kid ourselves: MPV sits in the middle of the culture wars.

I hope you can visit an LGBTQ clinic. During these times without enough vaccine, your support and work to get them shots is critically needed. As we’ve learned with COVID, we must take care of our heroes on the front lines.

Monkeypox, like HIV, is more than numbers. There already is too much stigma. Sometimes with social media it feels like the early days on steroids. Please come out of the gate fighting MPV stigma. Like HIV stigma, it comes from a place of homophobia and racism. In this political climate, it is particularly dangerous.

Yours in the Struggle,

Paul Kawata

Paul Kawata

USCHA Almost Sold Out

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Thank you to everyone who registered early for the 2022 United States Conference on AIDS. The meeting had the largest number of early bird registrations. Close to 3,000 folks are on the list to attend. As a result, NMAC made the difficult decision to keep registration open for only 500 more delegates. It is first come first served and we will close when we reach capacity.

The conference made this difficult decision because it is unfair to take people’s money when there are so few reasonably priced hotel rooms still available in San Juan. USCHA has sold out of the group rate at five hotels. Hotel rooms are still available in San Juan, just not at the lower negotiated USCHA group rates. Now the gathering must refer people to Airbnb or more expensive hotels. While USCHA gets no support, most of Airbnb’s rental fees go to locals who can use the money. We will only provide buses between official conference hotels and the Puerto Rico Conference Center. Please make sure your Airbnb is close to an official hotel so you can catch the free USCHA bus.

Hotel rooms have been set aside for scholarship recipients. They do not need to worry. Thanks to our major sponsors Gilead, ViiV Healthcare, Janssen, and Merck, USCHA is giving away a record number of scholarships. However, we still turned down many very qualified applicants. Moises Agosto, NMAC’s Treatment Director, put together an article about the scholarship process for Thursday’s e-newsletter.

There is very limited exhibit space. Around 90% of the exhibit hall has been reserved. It will be sold out soon. Exhibitors get passes to attend the conference. Click here to reserve a booth. Given the challenges of shipping to Puerto Rico, we encourage them to use San Juan based companies for printing, booths, receptions, and give aways. Not only does this bring much needed resources to the local community, but it also lets you bypass shipping headaches. Many partners host private receptions, so please consider working with the local community to identify locations and businesses that support the HIV community. USCHA is the first large conference in PR to happen since COVID and locals are excited for our meeting.

As an example of working with regional providers, USCHA contracted with Connecting Paths to sew all the conference bags. Connecting Paths is a local nonprofit that fosters community entrepreneurship in Puerto Rico. Since hurricane Maria (2018) they have trained 87 women and 20 of these women are sewing the conference bags. Please watch their Spanish language YouTube video to learn more. USCHA is an opportunity to bring much needed economic development to Puerto Rico. Please support the businesses that support the local HIV community.

While space is very limited, we want to encourage our federal partners to send key staff to meet with attendees. The community desperately needs your leadership and partnership to complete our mission to end the HIV epidemic by 2030. Show up to show your support for the leaders on the frontlines. There may be budgetary issues since the meeting happens in the new fiscal year and NMAC is willing to work to make any needed accommodations. Please contact Tara Barnes-Darby for assistance.

NMAC wants to thank the local host committee co-chairs:

Joey Pons

Jose Joaquin Mulinelli

I’ve put hyperlinks to their emails so that you can contact them about restaurants, bars, and companies that support the HIV community in San Juan and Puerto Rico. NMAC also has staff who live in San Juan. Damian can answer questions about local agencies, culture, and community. Please email Damian with any questions.

It’s only July and the meeting is almost sold out. Most people will think it’s because we are going to PR. I want to believe our movement is committed to language justice, reaching the Latinx community, and learning in an environment when English is the second language. Building a movement is key to our ability to end the epidemic. USCHA is the place where we come together to check-in, learn, and nurture our family. The world is going crazy, and we need each other more than ever.


Damian Cabrera-Candelaria
Program Manger Treatment

Yours in the Struggle,

Paul Kawata

Paul Kawata

A Call to Plan

This is not a joke. In the middle of a world out of control, it’s time for the CDC to review the science on monkeypox (MPX) and recommend that all sexually active gay and bisexual men, regardless of their HIV status, get the MPX vaccine. NMAC makes this request to trigger the development of national, state, and local plans. Between the World Health Organization’s (WHO) declaration and the data in the New England Journal of Medicine (NEJM), where 41% of the people who got MPX are also living with HIV, it’s time to move from monitoring to planning.

Last weekend the WHO declared monkeypox a public health emergency of international concern. There are over 16,500 cases in 74 countries. In the US, there are 2,800 cases in 44 states, DC, and Puerto Rico. A recent article quoted the NEJM that said 95% of MPX cases were transmitted through sexual activity. Ninety-eight percent of the people who got MPX were gay or bisexual men. Forty-one percent were living with HIV. The declaration and science cannot be ignored. There needs to be a new standard of care that recommends and implements initiatives so all sexually active gay and bisexual men get the MPX vaccine.

While the recommendation prioritizes sexually active gay and bisexual men, vaccination targets may need to be expanded if we are unable to control MPX. Plans should include the transgender community, sex workers, and staff who work where there is sexual activity (bathhouses, saunas, and sex clubs). Due to shortages, there is not enough vaccine. This failure will not be forgotten. Hopefully, the system will be fully stocked in September. The next 45 days should prioritize planning. Vaccine equity and overcoming vaccine hesitancy are key. NMAC is particularly concerned about reaching people of color. The COVID vaccine roll-out showed it’s not enough to just make the vaccine available. There are too many who are unaware of MPX and/or who do not trust the system. Plans must prioritize hard to reach communities.

The WHO declaration validates the need for leadership and funding from the White House. Since the White House’s MPX response is coordinated by the National Security Agency (NSA), it’s time to bring everyone together to plan how to plan. Vaccine equity and overcoming vaccine hesitancy may create new pathways to educate about PrEP and/or U=U. While MPX and HIV impact the same communities, we don’t know much about the specific impact the virus that causes HIV has on MPX. Does viral load impact MPX outcomes? Since there are different versions of the MPX vaccine, is there a need to recommend a specific vaccine for people who are immune compromised? While there is a shortage, should we prioritize getting at least one MVA vaccine?

Why is HIV getting involved in MPX? These viruses impact the same communities and HIV has the infrastructure to support this huge lift. However, it is too big a task and requires coordination across multiple movements. Vaccine experts may not understand how to reach the target communities. The data and experience of vaccinating all sexually active gay men could support efforts to end the HIV epidemic. While many health departments have already started, there needs to be a coordinated national response. The sooner we vaccinate, the better our chances of stopping MPX from becoming another epidemic. It starts with an emergency transfer of $100 million to be drawn broadly from HHS. Federal guidance to health departments to reprogram HIV and COVID funds. Support for the National Coalition of STD Directors request for $100 million in new federal funding. But we can’t wait for Congress.

This is too much and our plates are already full. I really hoped to avoid this burden, but the virus had other plans.  The thought of vaccinating all sexually active gay and bisexual men is overwhelming. This is a very heavy lift that is going to take money, planning, and coordination across multiple sectors.

I got the monkeypox vaccine (MPXV)! Normally I would not share this information, but there is too much slut shaming, particularly from other gay men! I’m shocked I tell you. It’s a vaccine, not a lifestyle. Getting it says I care about my health. It’s the same smallpox vaccine that has been around for decades. Many older Americans got the shot; however, routine vaccinations stopped in 1972. If you don’t recall getting the vaccine, it is OK to get another dose. Talk to your doctor.

There are multiple versions. I got the MVA vaccine which is built around a weaker version of the virus and is much safer. The ACAM2000 vaccine contains active virus and is not recommended for immune compromised individuals. Are PLHIV considered immune compromised if they have an undetectable viral load? Once again, the role of treatment education is critical to our field.

Like the COVID vaccine, MPX vaccines needs to be free. Given the large percentage of PLHIV who might also get MPX, HRSA needs a MPX strategy for Ryan White clients. Can their infrastructure be used to vaccinate sexually active PLHIV? What about gay men who are HIV negative? While the data is clear, more science is needed. Hopefully, answers and strategies will be shared at the International AIDS Conference and/or the National Ryan White Conference. NMAC’s Treatment Division will have MPX updates at the 2022 United States Conference on HIV/AIDS. We will also try to get vaccines onsite at the meeting.

I got my MVA vaccine in Canada. It’s free, even for tourists. Why does Canada have enough MVA vaccines, even for tourists, but we have to wait until September in the US? You’ve got to love the Canadian healthcare system. Mobile vaccine clinics are set-up in the Gay Village of Montreal. A handsome young man in scrubs asked me to talk about monkeypox (MPX). I said, “I’m a tourist”, he said “it didn’t matter.” For folks going to the International AIDS Conference in Montreal, schedule an appointment and visit the mobile clinics in the Village. The site is in French, so click on the FR language icon in the upper right corner and it will change to English. When putting together plans, think outside the box. Set-up clinics in the places where gay and bisexual men gather.

 

 

Thank you to the National Council of STD Directors for their leadership on this issue. For more information on MPX go to their Command Center. There is also a letter from community to Secretary Becerra that outlines multiple requests. Also check out the O’Neill/amfAR brief on Monkey and Meningococcal Disease Outbreaks that more fully outlines concerns.

The White House needs to lead with community to develop a domestic strategy to stop MPX before it becomes another epidemic. Sexually active gay men, regardless of their HIV status, need to get the MVA vaccine. Because there is a vaccine, MPX might go away quickly, another in a long list of faded viruses, but right now no one knows. Unfortunately, this is not a joke.

Yours in the Struggle,

Paul Kawata

Paul Kawata