Let’s Offer Housing to Men With Monkeypox
It will help fight the stigma and loneliness. It will make finding treatment easier. And it might slow the epidemic.
After a month’s delay, we have finally scrapped the fantasy that ring vaccination will work and are offering vaccine to all men at high risk of monkeypox.
We don’t have enough of the safe Jynneos vaccine, and the C.D.C. isn’t yet ready to whole-heartedly endorse the abundant and safe-ish (if used with precautions) ACAM2000 vaccine.
But there is another tactic we could employ: Let’s offer men with the disease someplace to live until they recover.
Why? One, because it’s a humanitarian gesture. Two, because it’s also good public health.
Right now, men who have monkeypox are being asked to isolate themselves at home for a month while they suffer through the symptoms. Which is fine if you’re well-to-do and have your own apartment or house and supportive friends and family and a relationship with a doctor.
But let’s not assume that everybody with monkeypox earns what the MD’s and and PhD’s who are making these recommendations earn, or that they live similar lives.
Having monkeypox is stigmatizing. It’s lonely, because you have to quarantine away from your friends. It’s scary, because you don’t know how bad the pustules will get. It can be humiliating if they crop up on your face. It can be excruciating if they’re in your rectum. And in some cases, it can lead to hospitalization.
Also, most American doctors know next-to-nothing about monkeypox, have never seen or treated a patient with it. Most pharmacies don’t have tecovirimat (Tpoxx) in stock and probably wouldn’t know how to get it.
Remember how isolating the first months of the Covid lockdown were? Now imagine how that would feel if it was just you by yourself — and you have to tell your friends that you’re missing in action because you have a disease that everyone considers icky. Even if they love you, they’re afraid of you.
How’s that work out if you live in an expensive city like New York or San Francisco and can only afford a room in a place with three roommates?
Also, I know from my own reporting about H.I.V. that some gay men — particularly those from conservative areas (and most of this country is conservative) and those who are black and Hispanic — are often estranged from their families and have little support. Some couch-surf or share beds just to have someplace to sleep. Some sell sex in order to be able to eat.
Some gay men have issues with self-loathing. Having stoned sex with multiple strangers is sometimes a way to paper over a void in your life.
Some men transitioning to womanhood are lost and friendless and scared.
For whatever reason, some men facing this disease need someplace to live and food to eat for a month while their symptoms resolve. Someplace where they can be comforted by being among others with the same problem. Someplace in contact with doctors and nurses who know what to look for. Someplace where the unlucky ones who need medicine or hospital admission can get it.
It doesn’t have to be fancy.
In Wuhan in January to April 2020, people with confirmed coronavirus that was not serious were given cots in gymnasiums (renamed “fangcang shelter hospitals”) for 21 days. (Yes, I know, they were forced to go there. I’m not suggesting that. This disease isn’t as transmissible as Covid.)
They were fed. They were watched over by nurses. If they developed pneumonia, they got oxygen and transport to a real hospital.
It not only protected them as individuals, it kept them from infecting their families and friends. That strategy actually ended Wuhan’s epidemic; by early April, new infections had fallen to zero.
We should adopt a similar policy.
Why? Because we’re still below 1,000 confirmed cases in the U.S., and most of them are concentrated in a few cities like New York, Washington, San Francisco and Los Angeles. The real caseload may be between three and 10 times that high, but even 10,000 cases is containable — if we act fast and intelligently.
The Jynneos vaccine is a good start — but there’s not enough to meet the need.
Even more worrying: news photos suggest that almost all the men in line for the shots— even at a clinic in Harlem — are white. (And the fact that they’re there suggests that they’re well-connected to news media, which not everyone is.) So the word is clearly not getting out to all those who need protection.
But sex crosses network lines, and monkeypox is already jumping between gay networks. In San Francisco, both the Electroluxx Pride Party and the Afterglow Blacklight Discotheque have been flagged as likely superspreader events. Both are more racially inclusive than the leather fetish parties where the epidemic was first spotted; even with rainbows and glow lights thrown in, some fetish gear screams “neo-Nazi.”
But that doesn’t matter — no matter what sexual network you’re in, monkeypox will eventually worm its way in. So public health officers have a hard task ahead of them.
First, testing needs to get much better. Inept testing from January to March 2020 utterly destroyed our Covid response. Inept testing now is crippling our monkeypox response. We have no clear idea of how many are infected; in interviews, men with confirmed cases often say that they have friends who are worried they too have it but can’t get tested.
After testing, we need to offer shelter, food and medical care to all men who come up positive, and to any sexual contacts they can name. We need to let gay men in those networks know that they are neither forgotten nor despised. We should create shelters where men can stay with members of their own networks, among whom they will feel understood and not discriminated against.
It’s only for a few weeks — until they get better and can’t pass the virus on. It will make them feel cared for — which is in itself a reason to get tested.
Why is that important? Think back to the years between 1981 and 1996 in the AIDS epidemic: There was no treatment, so if you tested positive, all you got in return was a death sentence — and the guilty sense that you were infecting other men you liked and consigning them to die. How did many gay men respond to that horrible dilemma? They chose to not get tested.
Do we want to go through that again? No, we don’t. We have a vaccine, we have treatment, we could have support. Offering nothing but loneliness and hopelessness is how an epidemic spreads from a few men to tens of thousands — and ultimately from them to other men and women…and even possibly to fetuses and children. As a public health strategy, that’s rotten.
Plus, offering shelter, food and psychological support would be a kind and affordable thing to do. Why hold back?