Stigma hurts Black residents’ monkeypox vaccination rate
Kimberly Thomas had to lie to receive the monkeypox vaccine — and she is not the only one.
When a meager supply of doses became available at the Houston Health Department in July, the narrow eligibility criteria targeted men who have sex with men, or MSM, specifically those with a confirmed exposure or multiple anonymous sex partners. When Thomas called to schedule an appointment, she was turned away.
Then, her friends told her how to answer the screening questions.
“I had to tell them that I was a sex worker,” she said. “I had to tell them that I just had sex with someone who’s an MSM. I’m a lesbian woman, and I had to tell them that I was bisexual.”
The barriers Thomas confronted have a disproportionate effect on Black people like herself, experts say, worsening the systemic inequities that already prevent people of color from seeking health care.
The problem is especially apparent with monkeypox, the latest virus to inflict an unequal toll on racial minorities and illustrate the ongoing struggle to protect them. Similar to national trends, non-Hispanic Black people in Houston account for 33 percent of all monkeypox cases — the most of any racial
group — and only 15 percent of vaccinations, according to the Houston Health Department. The reverse is true for white people, who account for 17 percent of cases but 29 percent of vaccinations.
Early access issues, as well as persistent stigma and misinformation, all play a role in that disparity, experts say.
“There’s still of a lack of trust of the medical community, and there’s still a fear of being identified as gay or bisexual — and how that knowledge will be perceived even by people we don’t know,” said Jeffrey Campbell, chief health officer at AIDS Foundation Houston. “They’re going to assume that I’m gay ... because I’m attempting to get this vaccination.”
While most monkeypox cases have been reported among men who have sex with men, anyone can become infected through close contact, such as hugging, kissing and touching fabrics used by someone with the virus. So far, a Los Angeles County resident is the only person confirmed to have died from monkeypox in the U.S. The cause of death is still pending for one Harris County resident who died three weeks ago with multiple severe illnesses, including the virus.
More commonly, infections cause fever, headache and painful rashes that look like pimples or blisters. There have been 794 total cases in Houston and Harris County as of Thursday.
The rate of new cases is slowing, with a similar decline in vaccine uptake. In early August, more than 150 people per day received their first dose through Harris County Public Health. That number has not cracked 50 since Sept. 6, with the vast majority of vaccinations now among people receiving a second dose, according to data on the Harris County Public Health website.
Now with ample vaccine supply and wider eligibility, health care activists like Thomas drive to predominantly Black and low-income neighborhoods in Houston to break through the reluctance. Thomas is a research coordinator with the Normal Anomaly Initiative, a Houston nonprofit that addresses inequities in the Black LGBTQ community. She distributes educational flyers in areas like Third Ward and southwest Houston and addresses common misconceptions about monkeypox.
Thomas has spoken to women who believe the virus only infects gay Black men. Some people believe it only threatens people who have “a massive amount of sex,” she said. Others believe the vaccine causes monkeypox, even though it contains a weakened version of the virus that does not lead to an infection.
Early on, the specific and at times demeaning questions during the registration process fed a false narrative of that “ideal client” that may have discouraged vaccinations in the Black community, said Ian Haddock, Normal Anomaly’s executive director.
Those factors complicated efforts to recruit people for a popup vaccination event Thursday at the group’s headquarters in southwest Houston, Haddock said.
“We knew it was going to be hard to get people … but it was absolutely more difficult than we thought,” he said.
Studies show that young gay Black men are especially vulnerable to the stigmatization, in part because of gendered social norms and the historical exclusion from the white gay community.
The Houston and Harris County health departments have tried to address this by expanding the vaccine eligibility criteria to include “all people, of any sexual orientation or gender, who recently had multiple sex partners.” Anyone living with HIV and those taking PrEP also qualify.
Dr. Ericka Brown, Harris County’s deputy local health authority, said the challenge at first was stretching the limited vaccine supply to immediately protect the most vulnerable. She acknowledged other vulnerable populations “probably should have” received the vaccine during the rollout, but the health department simply did not have enough to meet the demand. She hopes more inclusive criteria will chip away at the stigma.
Outreach efforts have improved in recent weeks. Harris County is sending a mobile vaccine clinic to Cypress Station, which has the highest rate of new HIV diagnoses in the county, Brown said. City health workers also stayed up into the early-morning hours on a recent Sunday in Montrose, offering vaccines at two pop-up sites where bars and clubs held a “hip-hop night.” More than 100 people, mostly people of color, were vaccinated, said Kaylan Henderson, who helps manage community outreach for the health department.
The city health department also partnered with Normal Anomaly for Thursday’s vaccine event in southwest Houston. About 67 people had received a dose by midafternoon, including Houston resident Jamaal Clue.
Clue received his first dose in Dallas last month, after he was turned down in Houston. He was prepared to fly back to Dallas for the second dose until he saw Normal Anomaly’s event.
As someone raised in a family that emphasized the importance of preventative health care, Clue feels like an outlier in the Black community. Most young Black people are not taught to seek help “until the house is burning,” he said. On top of that, the monkeypox vaccine is viewed as a kind of “scarlet letter,” he said.
“It’s an uphill battle,” he said. “But I think the partnerships with organizations like (Normal Anomaly) are critical.”