A Community United Against mpox

Lessons learned from the AIDS epidemic and the COVID-19 pandemic fostered a swift, successful end to the local 2022 outbreak

Words by Trey Burnette • Photo by Zach Ivey

 

Larry Kramer said, “You don’t get anything unless you fight for it, united and with visible numbers.” It was the lesson he learned during the AIDS epidemic — one he wanted the LQBTQ+ community to learn. It was a lesson the professionals at DAP Health understood when the mpox outbreak started in May 2022. 

The disease is caused by the mpox virus, similar to the variola virus (smallpox) and related viruses. It often causes a painful rash of blisters on the hands, feet, chest, face, and mouth — as well as near the anus, and penis and testicles, or labia and vagina —before scabbing and healing. It was a rare ailment until 2022, with the CDC reporting only two cases in the United States in 2021. 

Then, on May 7, 2022, the United Kingdom reported its first incidence. On May 17, the first U.S. case was confirmed in Boston by the Massachusetts Department of Health. On May 23, a Sacramento patient was the earliest to be verified in California, and DAP Health saw its first local occurrence on July 8. 

Fortunately, DAP Health was ready. The agency had formalized a task force devoted to mpox by the end of May in view of a potential outbreak hitting the Coachella Valley. 

“We wanted to be proactive on where the clinical services would best be served, knowing we had to maintain operations in all other clinics,” says DAP Health Director of Community Health and Sexual Wellness C.J. Tobe.

The nonprofit already had a waiting list for primary care, and its sexual health clinic was seeing increased numbers of patients. Tobe and his team started by getting emergency authorization from the California Department of Public Health (CDPH) to use DAP Health’s “library” meeting room at the main campus in Palm Springs as clinic space. Also, taking cues from their recent experience with the COVID-19 pandemic, the powers that be knew they’d overburdened an already stressed staff, so they made arrangements for temporary workers to support the mpox response.

At that point, the vast majority of cases reported were in men who have sex with men. DAP Health needed to alert the community. It partnered with county and state health departments, attending weekly town halls. The agency’s mpox response team had triweekly internal meetings. Printed mpox fact and resource material was distributed to more than 80 businesses across the Coachella Valley, and information was also disseminated via local print, broadcast, and internet media outlets. Educational ads were placed on social apps like Scruff, Grindr, and Rent Men. Micro-messaging was done on Facebook and Instagram Live sessions. DAP Health even created a landing page dedicated to mpox on
its website. 

Furthermore, knowing that health crises historically impact people of color most, DAP Health collaborated with Brothers of the Desert for targeted messaging. 

Because mpox had been almost dormant in this country, vaccines were in short supply. Once JYNNEOS — a two-dose vaccine whose shots are administered 30 days apart — became available, its insufficient supply was quickly gobbled up. Los Angeles and other large cities received it first, directly from the federal government, while other federal allocations went to the states to disperse. The CDPH then distributed inoculations to counties pursuant to total population and actual mpox and syphilis case numbers, not infection rates per capita.

Unfortunately, this formula left Riverside County and DAP Health with just a handful of vaccines. What placed Palm Springs — a popular LGBTQ+ tourist destination where people often partake in sexual activity — at a disadvantage is that it was not where transmission occurred that was considered, but the location where the case was reported.

By July 9, DAP Health had received its first batch of 169 vials of JYNNEOS from Riverside University Health Systems (RUHS) and started vaccinating the most high-risk: people who were symptomatic for mpox and those who’d been exposed to a person who tested positive. Soon, guidelines were expanded to include sex workers, people who participated in group sex, and those who’d recently had an STI. 

DAP Health continued its outreach by using social media influencers popular in the queer community. Well-known adult film performer Trenton Ducati reached out to local sex workers to raise awareness about mpox, encouraging them to receive the shots available to them. He also recorded PSAs that spoke directly to those most at risk. 

The vaccines ultimately became (and still are) available to everyone. In addition to protecting people via its sexual wellness clinics in Palm Springs and Indio, DAP Health, in partnership RUHS, was able to set up more than 10 pop-up clinics, including some at sex-themed businesses such as Palm Springs’ All Worlds Resort and Cathedral City’s CCBC Resort Hotel. To date, DAP Health has vaccinated more than 6,000 people. 

As of January 4, 2023, reported mpox cases in the U.S. were 29,913, and 84,417 globally. This country has had a total of 20 deaths from mpox. DAP Health confirmed 109 positive cases after PCR-testing 245 people, and 16 mpox- positive patients were treated with TPOXX (tecovirimat).

Unfortunately, the ramifications of mpox weren’t limited to physical complications. Many people suffered mental, social, and financial costs from the outbreak. Tobe says he spent countless hours after work speaking with many long-term HIV survivors upset that they were initially ineligible for vaccines. The situation seemed too close to the initial federal and social response to the AIDS epidemic in the early 1980s, triggering numerous painful memories. Furthermore, some patients suffered financially or were fired for missing too much work while recovering. Some patients who had informal rental arrangements lost their homes. 

To help remedy these problems, DAP Health utilized its work-reentry program to help patients find new employment. The agency also partnered with the Musicland Hotel to house people until they found permanent residences. Desert Healthcare District funded the hotel cost, along with food delivery and TracFones. Mental health services were available at DAP Health for those in need of counseling. 

Tobe credits the relatively swift, successful end of the local outbreak to DAP Health’s proactive, holistic approach, at the forefront of which was an eagerness to join forces with community, county, state, and federal entities.