People in the St. Louis region can be eligible for limited doses of the monkeypox vaccine in two ways: by confirming they’ve been exposed to someone with the virus, or by stating that they're at high risk of catching the virus through an online screening form.
The eligibility requirements are to make sure the vaccine gets to those who need it the most. But some LGBTQ advocates worry Missouri health officials could discourage people from getting vaccinated by asking them about their sexual behavior and identity.
“Gay men, trans men, bisexual men, trans women who have been marginalized and mistreated by the government historically aren't going to be all of a sudden trustful of a government that asks you to disclose your vulnerabilities and your identity to sign up for this vaccine,” said Shira Berkowitz, the advocacy and policy director at the LGBTQ rights nonprofit PROMO Missouri.
Monkeypox causes fever, sores and fatigue and is spread through close physical contact with the lesions of an infected person. It can also be spread through respiratory secretions during prolonged face-to-face contact or during physical contact. That includes kissing, cuddling or sex. Transmission is most likely in places where people are minimally clothed and packed close together.
Monkeypox can infect anyone, but right now, it’s mainly spreading in people who have sex with men who have sex with men. That includes other gay men, trans and bisexual people and those with other queer identities.
There have been 84 confirmed cases of monkeypox in Missouri, but vaccine supply is still limited. As of last week, the state has received more than 6,000 vials of the vaccine, according to the Centers for Disease Control and Prevention. A vial can contain up to five doses of the vaccine.
Because the state hasn’t yet received enough vaccine to meet demand, it’s used the eligibility screening survey, which patients can access through portals on the St. Louis and St. Louis County health department websites, to figure out who gets the shots.
Among other questions, the form asks respondents if they identify as gay, bisexual or transgender and if they’ve engaged in commercial, public or group sex in the last two weeks. The state offers that information to local health departments, which then distribute the vaccine based on the responses.
Submitting sexual histories to state officials may discourage people who are worried about being outed or otherwise discriminated against because of their identity, especially in Missouri, Berkowitz said.
“It would be lovely if we lived in a state that included sexual orientation and gender identity and expression in our human rights statute, but we just don't yet,” they said.
The information in the forms is not shared with anyone beyond health officials, said Christopher Ave, spokesman for the St. Louis County Department of Public Health. State and local health agencies are bound by health privacy laws and won’t share the information.
Still, Ave understands that some may be hesitant.
“No one is going to know how an individual responds to that survey other than the public health experts and the county and jurisdiction that you live in,” Ave said. “Does that mean no one is ever going to worry about it? Of course people are going to worry, and I certainly sympathize with anyone who wants to keep their information private.”
Local health departments are limited by state and federal guidelines when it comes to determining eligibility for the limited doses, he said.
“In a perfect world we would have plentiful vaccines instantly available to anyone who has wanted it,” Ave said.
St. Louis and St. Louis County health officials also plan to attend Tower Grove Pride events this weekend to talk to people about monkeypox vaccinations, he said, though he couldn’t confirm whether vaccines would be available at those events.
Meeting people and determining eligibility in person could be a more effective strategy than using online forms, Berkowitz said.
“They should go to where the people are,” they said. “Whether that's gay bars, or nightclubs, or Pride this weekend, and make sure that there’s an accessibility to the vaccine without having to disclose if you've slept with anyone recently that has been in contact with the virus.”
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