Earlier in the Covid-19 pandemic, members of the gay and bisexual men’s social group Prime Timers St Louis, were “very, very worried” about Covid-19 because of underlying health conditions, said Bob Brinkman, 69, president of the group. That includes HIV, among other issues that compromised their immune systems.
But the group’s 141 members got vaccinated against Covid, he said, and in June, Prime Timers held its monthly potluck for the first time in more than two years.
Now the gay community in St Louis and elsewhere in the US have another health threat to worry about: monkeypox, a viral disease that has primarily affected men who have sex with men – but can infect anyone – and caused New York, California and Illinois to declare a public health emergency.
Other cities and states across the US are bracing and preparing for its impact also, both within the LGBTQ community and more broadly. On Thursday the White House declared monkeypox a national public health emergency, triggering more resources especially around vaccines.
“It will have a continual impact on my intimate side of life,” said Brinkman, who lives in a St Louis suburb and is retired after working in information technology. “I don’t have anybody in my life right now, and to try to meet somebody on that level, it raises a big concern, and I think a lot of people are thinking about that too.”
But while infectious disease experts urge men who have sex with men in cities, like St Louis, not yet hit hard by monkeypox to educate themselves on the disease, they also warn against panic, an understandable reaction for a demographic that was torn apart by the Aids epidemic.
“I think it would be safe to say that this could be stressful for individuals, on top of two and a half years of incredible stress,” said Dr Preeti Malani, an infectious disease specialist at the University of Michigan. “People should be worried but not to the point where they are not able to move forward with their lives.”
The virus can cause fever, headaches and a painful rash, among other symptoms, but is rarely fatal. It’s primarily spread through prolonged skin-to-skin contact, such as during sex, according to the Centers for Disease Control and Prevention (CDC).
The United States had recorded more than 6,300 cases of monkeypox by Wednesday, almost half of which have occurred in New York, California and Illinois, according to the CDC.
But most states have reported fewer than 100 cases. Missouri has reported 10.
Cities such as St Louis “should be prepared to see infections transmitted among men who have sex with men and then eventually spilling over into other social networks as well”, Jay Varma, the director of the Cornell Center for Pandemic Prevention and Response, said. “It’s very hard to say whether or not this will be large outbreaks or whether it might be just a few cases.”
That will depend on the availability of vaccines and the effectiveness of testing and contact tracing efforts, Varma said. There is only enough vaccine supply in the United States to cover about a third of the estimated 1.6 million gay and bisexual men whom officials consider at highest risk, and the shortage could last for months, the Washington Post reported.
To promote vaccination and information on the virus, Malani said, public health agencies should collaborate with trusted community organizations such as the University of Michigan’s Spectrum Center, which in 1971 became the first office for queer students at a US university. The group now works with the school’s public health department and the county health agency and is preparing messaging for when students return later this month, Malani said.
“That’s an example of going to the organizations, the grassroots, the community centers, the individuals who have clout and are visible and are good partners,” said Malani. Public health officials should also use “non-traditional locations” such as bars, restaurants and bathhouses to provide information about the virus.
On Monday afternoon, a steady stream of customers entered Club St Louis, which is part of a chain of private men’s saunas. On its website homepage, the company offers advisories regarding Covid and monkeypox.
“The first step in controlling MONKEYPOX is to seek out as many cases as possible, learn how the disease is transmitted, and what the symptoms are,” the alert states. “It’s important to get treatment for those infected and to vaccinate those who are potentially exposed, and to ensure that our at-risk community knows what is happening.”
David Williams, a 49-year-old hairdresser, and a friend visiting from out of town came to the pool.
“Apparently gay men are the only ones having sex any more in America,” Williams joked of the virus’s primary spread.
Williams, who is HIV positive but protected from transmitting the virus because of medication, had already received a monkeypox vaccine from a county health department in Illinois.
Still, when asked whether the threat of monkeypox had caused him to change his lifestyle, Williams, who is divorced and single, said, “absolutely”.
“No sex,” he said. “Until more people get vaccinated.”
But the message from public health officials to gay men should not be, “Just don’t have sex,” Varma said.
“Whenever we talk about sex, we as healthcare providers always need to recognize that sex has health benefits, and it brings joy to people’s lives,” said Varma. “That said, you also need to be realistic and honest about where risk is right now. And at the moment … the highest risk is from either anonymous sex partners and/or sex-related events where people are having sex with multiple partners, so it is wise for men who have sex with men to be thinking about what their risk tolerance is.”
AJ Pupillo, a 45-year-old St Louis county resident who acts as a caretaker for his parents, had not yet given much thought to monkeypox. Pupillo, who is HIV positive but also cannot transmit the virus, said he trusted Vivent Health, an HIV treatment organization with an office in St Louis, to provide information and care he could need regarding monkeypox.
“I know I’m in good hands,” said Pupillo.
Brinkman, the president of Prime Timers, said the organization would probably continue gathering because monkeypox is much less contagious and is spread differently than Covid.
“It might have some affect,” he said. “But I don’t think it’s going to force us back to Zoom.”