Black Men Bear the Brunt of Monkeypox Cases in North Carolina, but Only a Fraction Receive Vaccines

Lucy Hicks

August 15, 2022

Monkeypox is disproportionally affecting Black men in North Carolina, new data show, yet this group has received less than one quarter of the vaccinations.

Seventy percent of reported monkeypox cases were in Black men, and 19% of cases were in White men, according to a recent report by the North Carolina Department of Health and Human Services (NCDHHS). But White men have received 67% of all monkeypox vaccinations in the state, while Black men have received just 24% of the available doses.

The new data show "what many predicted — stark racial inequities," tweeted Oni Blackstock, MD, a primary care and HIV physician in New York City.

These numbers reflect similar trends in other US cities. For example, while 82% of monkeypox cases in Georgia are in Black men, White people have received at least 54% of monkeypox vaccines in Atlanta, according to data collected by Bloomberg. In Chicago and Washington, DC, more than half of all vaccines have gone to White people, Bloomberg reported.

Of the 111 total cases reported in North Carolina, no cases were reported in women, and "nearly all" cases have been in men who have sex with men, the report states. Sixty-five cases (59%) were in men aged 30–49, and 41 cases (37%) were in men aged 18–29. Seventy-eight cases were in Black men, and 21 cases were in White men. Of 3048 monkeypox vaccine recipients, 2039 were White (66.9%), and 719 (23.6%) were Black.

"Viruses are equal opportunity pathogens, so it's not the case that a virus would necessarily have an affinity to any particular group," said Vincent Guilamo-Ramos, PhD, MPH, RN, dean of the School of Nursing at Duke University, Durham, North Carolina, whose research focuses on preventing HIV and other sexually transmitted infections in underserved communities. "So, the fact that we're seeing this in Black men — in particular, Black men who have sex with men — in North Carolina should raise some questions," he told Medscape Medical News.

The NCDHHS did not provide specifics as to what factors may be driving this disparity in monkeypox vaccine distribution, but Guilamo-Ramos noted that stigmatizing language used in healthcare settings could dissuade people from seeking care, he said.

The webpage describing monkeypox vaccine eligibility, for example, explains that the vaccine is available to men who have sex with men who in the past 90 days

  • have had anonymous sex;

  • have been diagnosed with an STI;

  • and have received medication to prevent HIV.

"As a nurse practitioner, when I work with young people, including young people who happen to identify as men who have sex with men, that's not the kind of language that I use," Guilamo-Ramos said. Instead, he may ask questions such as, "Have you met someone for sex that you didn't know that well," or, "Have you been concerned about having an STI?"

For these interventions to be successful, public health personnel should use "language that can help us to prioritize [access], but also doesn't require people to have to come to terms directly with something that may be difficult for them to admit," he said, "in order to get really what is a vaccine that will not only protect them but will really hold forward transmission."

Guilamo-Ramos also emphasized that to be successful, outreach initiatives need to bring care to the communities that need them most, rather than operate exclusively in traditional care settings.

In an email to Medscape, the NCDHHS noted that they are working with nonprofit organizations, healthcare providers, local health clinics, and HIV/STI clinics to reach those at higher risk for monkeypox. The department will soon be launching a digital campaign to increase awareness of monkeypox testing and vaccines, an NCDHHS spokesperson wrote in an email. The "ads will run on social media, dating apps, and other digital platforms that LGBTQ+ men are likely to visit."

The department will be also publishing demographic data every week to track who is getting monkeypox and who is receiving vaccines.

Collecting and sharing these demographic data are a "foundational step in building an equitable monkeypox response," the report states; "With health equity data, we draw attention to health disparities, we mobilize action to inform and protect North Carolinians currently most at risk, and we create ongoing accountability."

NCDHHS. Monkeypox Response Update. Published online August 10, 2022. Full text

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