Monkeypox cases up 180% in Sonoma County, raising alarm as health officials hone public message

However, they said the local public health agency has communicated to health care providers that “high risk” individuals can be vaccinated prior to exposure, technically known as pre-exposure prophylaxis, or PrEP

When asked which high risk groups are being targeted for monkeypox PrEP, Baldwin explained gay, bisexual or other men who are having sex with men; those who have recently had a sexually transmitted infection in the past three months; those who have engaged in group sex, anonymous partners or visited locations where there may be close skin-to-skin contact.

At the same time, Baldwin says she does not want to focus on behavior, as that could “lead to stigma and that’s not what we’re trying to say here.”

“No, I don't want it to be focused on behavior and making that the point,” she said. “I think it should really be about knowing your risk and knowing how it's transmitted … and what the higher risk exposure is, if you’re skin-to-skin with somebody or you're in close contact and you're going to be … you could touch lesions or a rash and I think that's really the main thing, not the behavior.”

Caught in a dilemma

Dr. John Swartzberg, a UC Berkeley infectious disease expert, said public health officials are currently caught in a dilemma. He said about 98% of confirmed or suspected cases of monkeypox are occurring among men who have sex with men, a fact that can’t be ignored in crafting any public health response.

“But on the other hand, it's the stigmatization of a particular group that in the long run comes back to bite you,” said Swartzberg, who recalls public health missteps in the early years of the AIDS crisis.

Stigmatization, he said, “means you're going to have a lot of friction with that particular group … and that group is going to be right off less responsive to public health advice. It’s a difficult needle to thread.”

The official number of confirmed or suspected monkeypox cases stands at 826 in California and 7,510 nationally, according to the latest data. But experts believe those official monkeypox figures are an undercount because of a lack of testing and surveillance.

Mitcho Thompson, of Sebastopol, said he believes he contracted monkeypox in late June while attending San Francisco’s Pride festival, where he helped set up an art installation in close proximity with other people. He said he simultaneously contracted COVID-19.

But Thompson said he never tested for monkeypox, though he had all the symptoms, including the rash of pimple-like pustules that started on his leg but soon spread to his back, neck and arms. He said his outbreak was similar to chickenpox, which he’s had numerous times because “my adrenal glands don’t work and I have no immunity to chickenpox.”

Thompson said he believes it was “respiratory transmission” that gave him monkeypox, not sexual or intimate contact. According to the Centers for Disease Control and Prevention, transmission may be possible through contact with respiratory secretions.

Left in the dark

For some, the effort to avoid open discussion about those who are most affected by monkeypox risks creating more confusion and frustration.

As a young, gay man living in Santa Rosa, Stevan said he’s grown tired of being left in the dark about the monkeypox outbreak. His frustration also includes his inability to get vaccinated. On Monday, he went to the Guerneville vaccine clinic after work but by that time it was too late — the clinic was offering only 250 doses for the event.

Stevan, who asked that only his first name be used to maintain his privacy, said he’s called the public health department numerous times and left voicemails but he dohadn’t heard back.

“It just seems like they don't care, unfortunately, which has led to more stress and feeling frustrated/helpless,” he said in an email. “If California had a sign-up system like they do in DC and New York, it would help tremendously because then you would know when you would be safe and could at least see the light at the end of the tunnel.”

Stevan said he wants the county to be more “transparent with the LGBTQ community” about its public health campaign against the virus. He said he appreciates that local health officials do not want to create stigma, but he added that the current public health approach is not the answer.

“They’re leaving people in the dark by doing that,” he said. “We're all adults, we all understand … how it's spreading. So I just don't understand why they can't just be open about it and explain it.”

Mindful of stigma

Dr. Jessica August, a Kaiser Permanente infectious disease expert and consultant, said a public health strategy that ignores or downplays the current dynamics of monkeypox transmission can be dangerous.

August said she thinks local public health officials are trying to be mindful of stigma when saying that anyone can contract the virus, which she said was a scientific fact.

“However, it is also scientific fact, by the numbers, that this is heavily burdening the population of people who identify as gay bisexual men who have sex with men,” she said. “And not calling that out, I actually think it's harmful, because the way that we need to protect the members of our community is through education in a thoughtful way.”

On Monday, August was among the physicians giving subcutaneous monkeypox shots to the hundreds of men who had waited hours for their turn. Up until Monday’s vaccine clinic, the very limited doses that had been obtained through state Department of Public Health were reserved for those who had close, prolonged skin to skin contact, “mainly intimate sexual contact with someone who has been confirmed to have monkeypox.”

August said Lazy Bear Week is the “perfect way to get the word out there and to do this in a supportive way where we are meeting people where they are.” A message tied to abstinence and telling people, regardless of sexual orientation, not to have sex or intimate contact won’t work, she said.

“We're not saying to avoid these types of things, we're just saying, let's do it in the safest way possible,” August said. “We want to support all of these things, we want to support healthy sexual health by getting people the tools that they need as soon as we can. Just like we want to support this population with things like PrEP.”

August pointed to a page on the CDC’s website, titled “Safer Sex, Social Gatherings, and Monkeypox.” The webpage offers numerous suggestions aimed at reducing the chance of exposure.

“It's things such as promoting virtual sex with no in-person contact right now,” she said. “It goes as far as saying have sex with clothes on when you're at these places where you're engaging with multiple partners.”

At the vaccine clinic Monday, Tamale Ringwald, 52, came all the way from Mexico to attend Lazy Bear Week. Ringwald, a former San Francisco resident who now lives in Puerto Vallarta, said the vaccine is not available in Mexico and extremely difficult to get in San Francisco. He praised Monday’s vaccine clinic.

“We are at the forefront of this outbreak,” he said. “It’s almost like queer people are getting a little bit of priority — that usually doesn’t happen.”

Ringwald said members of the LGBTQ+ community are eager to be active partners in the public health campaign against monkeypox. “We’re really good about spreading information like this,” he said. “Everyone I know is really on top of this. Everyone I know is coming to Lazy Bear early so they can get a shot.”

Swartzberg, the UC Berkeley infectious disease expert, agreed that a stronger public health partnership with the LGBTQ+ community is crucial in slowing the spread of the virus. But for that, he said, more vaccine and therapeutic treatments are needed.

He said the failure to ramp up vaccine production for monkeypox, especially going through a 2½-year COVID-19 pandemic, is a painful reminder of the lack of investment in public health systems.

The Biden administration’s declaration Thursday that the growing monkeypox outbreak is a national health emergency triggers more robust measures aimed at containing further spread of the virus.

The declaration comes more than a week after the World Health Organization declared monkeypox a “public health emergency of international concern.” Paul Kawata, director of NMAC, formerly known as the National Minority AIDS Council, welcomed Biden’s declaration, calling it a “good first step.”

NMAC said federal, state, and local officials will need to conduct aggressive outreach in at-risk communities and not rely on “a passive approach to vaccine distribution.” The organization said that nationally, too many health departments are currently using distribution methods that require internet access.

“We need direct community outreach for this effort to work,” said Kawata in an email. “For example, in Montreal, they have tents set up in the gay neighborhood and are approaching passersby about the vaccine. That's the kind of outreach we need.”

NMAC said members of communities most affected must be included in public health planning and outreach.

“Gay, bisexual, and other men who have sex with men, particularly in communities of color, will have their walls up due to stigma and distrust of the medical community and vaccines,” he said. “Being approached by someone who intimately understands those issues and can address them will be vital in getting through those walls.”

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @pressreno.