BARCELONA — Roc, a sex worker and adult film actor, was relieved when he was one of the first Spaniards to receive the monkeypox vaccine. He was aware of several cases of infection between men who have sex with men—the main form of transmission—and thought he might be next.
“I came home and thought, ‘Oh my God, I’m saved,’” said the 29-year-old.
However, the vaccine came too late. Roc, who uses that name at his work, had been infected by a client a few days earlier. He thus joined the list of those infected in the European country with the worst outbreak of simian pox, more widespread in Africa and which recently began to spread in other parts of the world.
He began to have symptoms: ulcers, fever, conjunctivitis and fatigue. He was even hospitalized, but has already been discharged.
Health authorities and community groups are scrambling to contain an outbreak that has already killed two young people. It is said that they died of encephalitis, as an inflammation of the brain that can respond to some viruses is called. Most monkeypox infections, however, have mild symptoms.
Spain has 4,577 confirmed cases since the start of the outbreak three months ago. Experts believe that the outbreaks are the product of two parties in Europe in which there was sexual contact.
The only country with more infections than Spain is the United States, a much larger nation, with 7,100 infections.
In total, more than 26,000 cases have been registered in almost 90 countries since May. There are believed to have been 103 deaths in Africa, mostly in Nigeria and the Congo, where there is a variant of the virus deadlier than that in the West.
Health experts say this is not a disease that spreads exclusively through sexual contact, although it has mostly affected gay and bisexual men who have caught it that way. That community accounts for 98% of reported infections outside of Africa.
Anyone who comes into close physical contact with an infected person, their clothing, or their bedding can become infected.
Part of the challenge ahead is to combat the virus without stigmatizing men who have relationships with other men, making sure that the most affected sectors receive adequate information and vaccinations.
Spain has distributed 5,000 doses of the vaccine, which requires two doses to work, and expects another 7,000 from the European Union in the coming days, according to the health ministry.
Different organizations work to ensure that vaccines are distributed among gay, bisexual and transgender women.
In Barcelona, BCN Checkpoint, a group that works to prevent AIDS and HIV in the gay and trans communities, is contacting people at risk and offering them one of the prized vaccines.
Pep Coll, medical director of BCN Checkpoint, said that priority is given to people who are at risk of contracting HIV and are receiving preventive treatment, men who have relationships with many people and those who participate in “chemsex” encounters (which combine relationships and drug use), as well as in people with weak or absent immune responses.
There are a lot more people who fit into those categories.
“If we talk about people who are doing PrEP (against HIV), plus people with HIV, we are talking about more than 15,000 people” in Barcelona alone, said Coll.
The shortage of vaccines increases the importance of preventive health policies, according to experts.
As with the coronavirus pandemic, contact tracing to identify people who might be infected is vital. But unlike covid-19, which is transmitted to anyone through the air, the fact that monkeypox is transmitted through sexual contact makes many people reluctant to share information.
“We are having a crescendo trickle of cases and we may have another deceased. Why? Because the tracing of case contacts is very complicated and because of the sensitivity profiles of those affected, who sometimes find it difficult to say who their sexual partner has been,” said Amós García, epidemiologist and president of the Spanish Association of Vaccinology .
Spain says that most of its infections involve men who have had sex with other men and that only 5% are women. But García said that this can change and encompass the entire population, regardless of gender or sexual orientation, if they are not aware that having relationships with several people increases the risks.
“It’s the same thing that happened with AIDS and HIV. There comes a time when the largest number of those affected are men who have relationships with men, and that may be a bit of the path to follow for this pathology if we are not aware of conveying the rigorous message to the citizenry, “said García.
In the face of vaccine shortages and problems with screening, more emphasis is being placed on prevention.
From the beginning, the government relied on community groups.
Sebastián Meyer, president of the STOP SIDA group, which assists the LGBTQ+ community in Barcelona, said it was logical that his organization and others like it were chosen to spread the message about prevention.
While the media has been bombarded with information, Meyer says there is still a lot to be done. Doctors recommend those infected to isolate themselves until they are fully recovered, which can take up to three weeks. And Meyer argued that people are tired of taking care of themselves after the covid-19 pandemic.
“When people read that you have to isolate yourself, they close the page and forget what they have read,” Meyer said. “We come from COVID and again you have to stay isolated for three or four weeks. People hate that and stick their heads in the sand.”
Meyer said her organization is looking for ways to improve its message.
He expressed that the answer is not to wait for the vaccine, but to “be more careful. That is much better than the vaccine.”