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Monkeypox in Pima County likely to increase, local group combats stigma of virus

Monkeypox cases in Pima County are expected to increase, with the residents most at risk being people who have multiple intimate partners, Health Director Dr. Theresa Cullen said.

Cullen’s message comes as the county has avoided the sharp increase of infections seen nationwide, but not the stigma around the virus. While the case count is low, local groups such as the Southern Arizona AIDS Foundation are working to stem misinformation around the illness. There's false but widespread perception that the painful viral infection only affects gay men.

Three weeks after the county's first reported case, known infections in the area have remained steady with a few suspected cases awaiting test results, Cullen told the Tucson Sentinel in an interview.

“We do expect that the number will increase, but we have been at three for a couple days,” she said on Monday. The number of “probable/confirmed” cases was up to four at the beginning of the week.

The county's early success at fending off the disease may be due to communication, Cullen said, citing information provided to the community and health providers, as well as the availability of testing. Plans for webinars on the illness and public service announcements are also in the works, she said.

The trend nationwide is much different as more than 5,800 cases of monkeypox have been confirmed in the United States, with 56 in Arizona, according to the Centers for Disease Control and Prevention. Worldwide, there have been more than 23,600 confirmed cases.

The virus was declared a public health emergency on Thursday by the federal Department of Health and Human Services.

The disease, which the World Health Organization now considers a “public health emergency of international concern,” is endemic in portions of west and central Africa, usually near rainforests, according to the WHO. Now confirmed in 80 countries, the illness is only normal in seven of them, according to the CDC. Most cases have been seen in Europe and the Americas.

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Most individuals with monkeypox get a rash that can be painful and resemble blisters or pimples, according to the CDC. Some people also exhibit other symptoms including chills, fever and congestion. Symptoms normally develop within three weeks.

Death is rare, with only about 10 percent of people being hospitalized from the illness due to pain, and five deaths reported worldwide, WHO Director-General Dr. Tedros Adhanom Ghebreyesus said at a press conference last week.

The lack of serious infections is similar to what Cullen has seen.

“As far as we know right now, we have not had anyone with monkeypox admitted to the hospital,” Cullen said.

Different infections, same stigma

Some Tucson area health leaders, such as Monique Vallery, have noticed a stigma emerging around monkeypox, with a perception that the disease only affects men who have sex with men.

The notion was given further life after many of the early cases in the United States appeared in marginalized groups, said Vallery, director of development at the Southern Arizona AIDS Foundation.

“And then people decided this is going to be the second wave of HIV and AIDS,” she said. “And that’s not the case whatsoever.” Similar to in the 1980s, other people are getting the infection despite the hyperfocus on certain populations, Vallery told the Sentinel.

Misperceptions surrounding monkeypox may be causing some people to not get treatment because they do not want people to think they are a member of the LGBTQ community or a man having sex with other men, said Alethea Đỗ, the organization’s associate director of testing and prevention services. Another reason cases may be going unreported is the cost for healthcare and medical services, she said.

SAAF is combating the stigma with pushing for education on the disease and accurate communication with officials like Đỗ, who sits on the county’s Public Health Ethics Committee.

In a meeting last week she gave feedback on a proposed flier about monkeypox, which she said should focus more on the disease and preventing it rather than a population of people. Younger people may not even identify with the populations mentioned, she said.

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“I shared in that meeting that though a lot of the people who are contracting it are men who have sex with men, but the younger population now don’t even necessarily identify as a particular way when they’re having sex with people,” she said.

In a July 28 report, the CDC said anyone can be infected but also emphasized the prevalence of cases among gay and bisexual men.

“While anyone can catch monkeypox if they have close contact with someone who has monkeypox, regardless of gender identity or sexual orientation, many of those affected in the current global outbreaks are gay, bisexual, or other men who have sex with men,” the report said.

The CDC is doing its “due diligence” by providing such information, Vallery said, but the conversation must not end there.

“But again, this is where we know that it’s important to also just try to educate the greater community that yes this is a high population that are currently contracting monkeypox, but it isn’t only limited to only MSM,” Vallery said.

The CDC’s information on the virus does not single out populations of people but rather does a good job of focusing on the facts and how the virus spreads, Đỗ said.  

The virus is spread through intimate contact like sex and kissing, but it can also spread through clothes and sheets that have come into contact with the infected person’s sores. Scratches or bites from an infected animal or eating the infected animal’s meat. The disease’s source is unknown, but African rodents and primates are suspected of possibly carrying it and infecting people, according to the CDC.

The agency’s focus on behaviors and not groups of people is similar to Cullen’s message. What puts people most at risk is not their identity or sexual orientation but their activitIes, Cullen said.

“Because say you identify as gay, right? But you have one sexual partner, you’re not at risk to get monkeypox,” she said. “It’s your activity that puts you at risk.”

In need of vaccines

Pima County only has 225 full doses of vaccines for monkeypox, Cullen said. More doses are expected after the Department of Health and Human Services announced the addition of nearly 800,000 doses of the JYNNEOS Vaccine. Pima County will be receiving 600 more doses this week, Anthony Gimino, a health department spokesman, said via email.

Residents who have been exposed to the infection or are at “high risk” can fill out a vaccine interest form. The county’s form asks questions such as, “In the past 14 days, have you had sexual contact, or close physical contact, with more than one man or person assigned male at birth?”                         

If someone experiences monkeypox symptoms they should contact their provider and isolate at home, according to the health department. Individuals should also cover their rashes, wear a mask if around others and avoid intimate contact with others. More county guidance on the infection is available online.

The county is offering free testing at its clinic at the Health Department's North Office: 3550 N. 1st Ave.

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CDC/ Cynthia S. Goldsmith

Monkeypox virus particles from a human skin sample, related to a 2003 prairie dog Monkeypox outbreak.