Category: Ending the Epidemic

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.

To be honest, I’m pissed I got COVID. Like everyone, I’m doing the best that I can, but it is not possible to live in a bubble and still have a life. I am over it. By “it” I mean all the things that don’t make sense. Why are we having culture wars in the middle of a pandemic? When we most need to be united, we find ourselves divided. Instead of working together, we are fighting of the soul of the country. Maybe the pandemic really was the catalyst for change. The virus brought to the surface what had been badly hiding for too long.

I was on a zoom with Dr. Rachel Levine, the Assistant Secretary for Health. Yes, I’m that Queen, dropping names like I drop bombs. I shared concerns about a certain member of Congress and was Dr. Levine OK? She says she’s fine, but I’m worried. The congresswoman’s dog whistles can lead to real harm. She put Dr. Levine in the crosshairs of hate. The White House and HHS have made sure she is safe. In addition to being a pediatrician and four-star admiral, she is living proof that we are everywhere, and we are not going away.

If the radical right follows their regular formula, they will begin to question the abilities of multiple senior LGBTQ officials, trying to generate fear about the large number of homosexuals working in the administration. Our pride makes another community afraid and angry. Dr. Levine gives me hope, but to the some she is a sign of the end of days.

The problem is there is no compromise or middle ground. We are not going back into the closet. I am a Queen, not a punching bag. I deserve to live a life free from prejudice and discrimination in all my outrageousness. Some people may see me as an exaggeration, but they underestimate me at their peril.

We have decades of experience fighting against a world that wished us dead, literally and figuratively. Our ability to work in coalition with like minded communities serves everyone. It starts with a strategy for survival in a world that hates us, who we love, the color of our skin, our gender, or how we choose to express our gender. If we spend too much time trying to fit into their box of acceptability, we lose everything that makes us special. Don’t be less so somebody can feel more. We deserve to be here and to sit at the table. In the fight to end HIV, our voice is critical.

It may be the fever from COVID, but I can’t believe the Supreme Court and, as a result, our country are again reviewing the legality of abortion, sodomy, school prayer, and affirmative action. Issues that were long ago decided are now at risk. Justices who sold themselves as conservatives are actually very radical. While it may have been a smart short term power play, I don’t think they are prepared for the civil unrest that will follow. This Supreme Court is just starting to reveal its true nature and will set off the reckoning that is coming for all of us.

Since I had to isolate at home, I got to catch up on RuPaul’s Drag Race. I love the show because it celebrates being different. This program showed the world the art of drag. If Mama Ru taught us anything, it’s to tell your unique story in all its beauty and drama. Take the things that caused shame and transform them into your greatest strengths. I can’t imagine living the life my good Japanese parents envisioned for me. Coming out was one of the most courageous acts of treason I’ve ever accomplished. I murdered the man my parents wanted me to be to become the Queen I was supposed to be.

We live in a representative democracy, where citizens elect officials to represent them in Washington, DC. This November is a call to the ballot box! The America we want can only happen if we get people who believe in choice, equality, housing, and healthcare to vote in their interests. As leaders, our job is to educate our communities. To help them understand that this really is a fight for the soul of America.

We must stay together! It is too easy to pick off causes as a strategy to create community infighting. There are real enemies, and it’s not each other. Some feel protected because of their urban bubbles. Please understand no one is safe. Justice Thomas clearly telegraphed next steps. He literally gave state Attorneys General a roadmap for the next issues to bring to the Court. There is no secret agenda. It is all out in the open.

His confidence comes from the nature of Supreme Court rules. They are appointed for life so, even with the first Black women to be on the court, it is a numbers game, and they have the justices to radically change our world. Our only recourse is Congress and the Presidency. That is why November is so important. We all have a part to play in this fight.

There are very specific rules for nonprofits including federal, state, county, and city regulations. NMAC would never suggest illegal activities, but now is the time to walk that line. Ending the HIV epidemic in America requires funding at a level that only the federal government can provide. Private HIV donors should consider supporting voter registration and getting out the vote activities in HIV, STD, and Hepatitis organizations. Without financial support, it is difficult to ask already over stretched nonprofits to take on more work.

It starts by getting staff, clients, and donors to register to vote. Given the divisive nature of the issues, there is little middle ground. Both sides have outlined their priorities and now it is a fight for the hearts and soul of Americans. Can we get people to care enough about our issues to vote? Unfortunately, we must lean into the trauma of not voting.

SOCTUS decisions put November in play. People are pissed, and we need to channel that energy into voter turnout. We don’t need to stoke the fire; the urgency is self-evident when you watch the news. Just give our constituents constructive options that can lead to lasting change.

As we learned from the early days of the HIV epidemic, we must fight while also being gutted by the realities of the moment. After Trump, flipping the Supreme Court, COVID, Black Lives Matter, climate change, immigration, the election, Jan. 6, wildfires, gun violence, police killing Black men, record number of murders, Asian violence, don’t say gay, withdrawal from Afghanistan, inflation, gas prices, BA2 variants, one million Americans dead from COVID, a war in Ukraine, recession, and Supreme Court decisions on guns, abortion, and school prayer, we have more than enough justification. Fighting for Our Lives is the theme for the 2022 United States Conference on AIDS. Our HIV legacy speaks to the current moment.

Once again, people like me are being used to scare voters. The right exploits fears of homosexuals as a wedge issue to get their base to the polls. They also use abortion, gun control, and liberals. This year’s Pride Reception was not just a party, but also a statement of support, one that is needed and appreciated. The world is going crazy. As seen in Idaho, it’s not a safe time for homosexuals. Going to the White House felt even more critical.

It was the who’s who of Washington. This administration has so many senior LGBTQ staff, not all of them could join him on stage when he signed an Executive Order aimed at protecting LBGTQ people. There was a time when we were welcomed into the East Room. I moved to Washington at the start of Reagan’s second term to fight an epidemic. Back then it was impossible to think about a time when community would be welcomed into the White House. The world is changing and that is why so many people are up in arms. Any shift in power, no matter how slight, can have long term ramifications. Dr. King said, “the arc of the moral universe is long, but it bends towards justice.”

I loved the rainbow flowers under the portrait of President Lincoln in the State Dining room. What would Lincoln think about this reception? The Civil War was a fight for the soul of America. The South lost, but the memories lingered. Unfortunately, there are too many who want to go backwards. The country couldn’t even unite behind the fight against COVID! As the world continues to slug it out, homosexuals will be used to create unfounded fear and anxiety.

In this mess, how do we end the HIV epidemic? How do we provide care and prevention services to communities who are regularly vilified by too many elected officials? HIV programs must accommodate and speak to the pain that our communities endure on a regular basis. This impossible balance is what makes the work so hard. Right now, there are states with governors who want us silenced. They are searching textbooks and bathrooms. It is only a matter of time until they get to HIV. Are we ready to be part of the culture wars? In the past, our work had bipartisan support. Who knows in this America?

My concern is some government officials might think appeasement and water down HIV programs. PrEP campaigns must be sex positive and speak to the realities of the communities hardest hit by HIV. We can’t go backwards. Technology and TikTok have changed the game. If we are serious about reaching the communities needed to be reached, then the work must be real and fearless. But that is easier said than done.

While the food was wonderful, the reception was more than a party. It was a public declaration of the administration’s support. Since we have a friendly President, now is the time to take risks with HIV initiatives that speak to the communities we’ve missed. Everything could change after 2024.

In his remarks, President Biden said that “we are in a fight for the soul of America. And that we will win.” I needed his words in ways I hadn’t understood. The lies and misrepresentations of my communities seem never ending. To have the most powerful man on the planet use his bully pulpit to stand with us is critical, especially at this divisive moment in history. As we’ve seen from Sweden and Finland, you can no longer be neutral. People, countries, and the world must take a side. It’s a fight for the soul of America, and I am hopeful.

How does the HIV community educate about monkeypox and not stigmatize gay men? As we know, HIV is not a gay disease and gay men are the majority of people living with HIV. Our work must thread the needle between the need to educate gay men about monkeypox while not adding to the disease burden of a community traumatized by HIV, STDs, and Hepatitis.

The world has lots of judgements about people who are different. Between monkeypox, “don’t say Gay,” and the anti-transgender bathroom, sports, and school bills, it’s a tough time to be LGBTQ in America. The radical right feels emboldened to lie and label us as groomers in a not too veiled attempt to equate gay men to pedophiles. Have they no shame?

HIVphobia, homophobia, transphobia, racism, sexism, and ageism create the trauma that I believe are major contributors to why 49% of people living with HIV fall out of care and why overall enrollment for PrEP is so low. It’s not enough to offer services, even if they are free. There needs to be active and ongoing outreach to community that provides trauma informed care and prevention services. The CDC has developed six guiding principles to a trauma-informed approach:

The communities we need to reach are the same people who are traumatized because they live in America. COVID, Black Lives Matter, Jan 6, climate change, inflation, immigration, war in Ukraine, fires, baby formula shortages, elementary school shootings, crime, Asian violence, racist mass shootings, abortion, Supreme Court, monkeypox, and the upcoming midterm elections are the trauma impacting our family, clients, staff, donors, and government officials.

We’re trained to wait for the “other shoe to drop.”  Monkeypox is just another on a long list of “what fresh hell is this?” Two years after the initial outbreak of COVID, we are still trying to figure out how to live in a world that has gone upside down. Too many Americans are suffering from some form of trauma, and many do not know how to cope. The trauma is coming from multiple sources/directions and feels never ending.

Not only do we need to support family, clients, staff, donors, and government officials, we also need to take care of ourselves. Do not minimize the stress and trauma of leadership while flying blind. The control queen in me is having a particularly difficult time. I’m learning to lean into the reality that I don’t have the answers. We are making the best decisions we can and there are too many unknowns to be definitive.

After my signature there is a resource list prepared by the White House on monkeypox. Given everything that is happening, it is comforting to know that the President stands with the LGBTQ community. We see it in his words and deeds. By the end of June, the Supreme Court will issue their much-anticipated ruling on abortion. Reproductive health and HIV are connected in our commitment to the sexual health and wellbeing of all Americans. Their fight is our fight.