October 5, 2022

BARCELONA, Spain (AP) — As a sex worker and adult film actor, Rock was relieved to be among the first Spaniards to get a monkeypox vaccine. He knew of several cases among men who have sex with men, the prime demographic for the disease, and feared he could be next.

“I went home and thought, ‘Whoa, my God, I’m saved,'” the 29-year-old told The Associated Press.

But it was already too late. Roc, the name he uses for work, was infected by a client a few days before. It joined the steadily increasing number of monkeypox infections in Spain that has become the highest in Europe since the disease spread beyond Africa, where it has been endemic for years.

He started showing symptoms: blisters, fever, conjunctivitis and fatigue. Rock was hospitalized for treatment before he was well enough to be released.

Spanish health authorities and community groups are struggling to control an outbreak that has already claimed the lives of two young men. They reportedly died of encephalitis, or swelling of the brain, which can be caused by certain viruses. Most cases of monkeypox cause only mild symptoms.

Spain has had 4,577 confirmed cases in the three months since the start of the outbreak, which has been linked to two raves in Europe, where experts say the virus was likely transmitted through sex.

The only country with more infections than Spain is the much larger United States, which has reported 7,100 cases.

Overall, the global monkeypox outbreak has seen more than 26,000 cases in nearly 90 countries since May. There have been 103 suspected deaths in Africa, mostly in Nigeria and Congo, where a more deadly form of monkeypox is spreading than in the West.

Health experts stress that this is not technically a sexually transmitted disease, although it has spread mainly through sex between gay and bisexual men, who account for 98% of cases outside of Africa. The virus can be spread to anyone who has close, physical contact with an infected person, their clothing or bed linen.

So part of the complexity of fighting monkeypox is the balancing act between not stigmatizing men who have sex with men while ensuring that both vaccines and calls for greater caution reach those most at risk.

Spain has distributed 5,000 shots of the two-shot vaccine to health clinics and expects to receive another 7,000 from the EU in the coming days, its health ministry said.

To ensure these shots are administered judiciously, community groups and sexual health associations targeting gay men, bisexual and transgender women are leading the way.

In Barcelona, ​​BCN Checkpoint, which focuses on AIDS/HIV prevention in gay and transgender communities, is now reaching out to people at risk to offer them one of the precious vaccines.

Pep Coll, medical director of BCN Checkpoint, said the vaccine’s launch is focused on people who are already at risk of HIV infection and are on preventive treatment, men with a large number of sexual partners and those who engage in ‘chemsex’ ( sex with the use of drugs), as well as people with suppressed immune responses.

But there are many more people who fit these categories than doses.

“If we consider the number of people (on HIV prophylactic treatment) plus the number of people with HIV, we’re talking about 15,000 people (in Barcelona alone),” Coll said.

The vaccine shortage, which is much more severe in Africa than in Europe and the USmakes social public health policies essential, experts say.

As with the coronavirus pandemic, contact tracing to identify people who could be infected is critical. But while COVID-19 could spread to anyone simply through the air, the close physical contact that serves as the primary vehicle for monkeypox makes some people reluctant to share information.

“We have a steady stream of new cases and it is likely that we will have more deaths. Why; Because contact tracing is very complicated because it can be a very sensitive issue for someone to identify their sexual partners,” said Amós García, epidemiologist and president of the Spanish Vaccination Association.

Spain says most cases involve men who have sex with men and only 5% are women. But Garcia insisted that this would be equalized unless the entire public, regardless of gender or sexual orientation, perceived that having multiple sexual partners posed a greater risk.

“The same thing happened with AIDS/HIV, where at one point the group of men who have sex with men was the most affected (before it spread to other groups) and that may be the way to go if we are not able to send a strong message to society,” Garcia said.

Given the lack of vaccines and the problem of contact tracing, there is more pressure to encourage prevention.

From the beginning, government officials gave the lead role in the “get the word out” campaign to community groups.

Sebastian Meyer, president of the STOP SIDA association dedicated to AIDS/HIV care in Barcelona’s LGBTQ community, said the rationale was that his group and others like it would be trusted message carriers with person-to-person knowledge of how to promote health. warning home.

While community associations representing gay and bisexual men have bombarded social media, websites and blogs with information on the safety of monkeypox, Meyer says there is still work to be done.

Meyer, who sits on monkeypox advisory boards for both Spain’s national government and regional authorities covering Barcelona, ​​believes fatigue from the COVID-19 pandemic has played a role. Doctors advise people with monkeypox lesions to isolate themselves until they are fully healed, which can take up to three weeks.

“When people read that they should isolate, they close the website and forget what they’ve read,” Meyer said. “We’re just coming out of COVID, when you couldn’t do this or that, and now, here we go again… People just hate it and put their heads in the sand.”

Meyer said his team is currently looking at ways to refresh and bring back its message.

“If you haven’t been selected for a vaccine, the answer is not to get desperate to get one,” he said. “The answer is to be more careful. This is much better than any vaccine.”

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