Whether it’s abstinence, avoiding nightclubs, limiting sexual partners or pushing for a swift vaccine rollout, Spain’s gay community is on the front line of the monkeypox virus and is taking action. 

“With this monkey thing, I prefer to be careful. … I don’t have sex anymore, I don’t go to parties anymore, and that’s until I’m vaccinated and have some immunity,” said Antonio, a 35-year-old from Madrid who declined to give his last name. 

Antonio, who often went to nightclubs and sometimes to sex parties, decided to act as cases continued to increase. 

Spain on Saturday reported its second monkeypox-related death. 

Outside of Africa, the only other such death has been in Brazil. 

More than 18,000 cases have been detected throughout the world outside of Africa since the beginning of May, according to the World Health Organization (WHO). 

Spain is one of the world’s worst-hit countries. The health ministry’s emergency and alert coordination center put the number of infected people at 4,298. 

As cases increase globally, the WHO has called on the group currently most affected by the virus, men who have sex with men, to limit their sexual partners. 

Lack of vaccines 

“This is not like Covid, the vaccine already exists, there’s no need to invent it. If it wasn’t a queer disease, we would have acted more — and faster,” said Antonio. 

Like other members of the gay community, he believes the authorities have not done enough. 

NGOs have denounced a lack of prevention, a shortage of vaccines and stigmatization linked to the virus.  

This is despite the WHO declaring the monkeypox outbreak a global health emergency. 

Early signs of the disease include a high fever, swollen lymph glands and a chickenpox-like rash. 

The disease usually heals by itself after two to three weeks, sometimes taking a month. 

A smallpox vaccine from Danish drug maker Bavarian Nordic, marketed under the name Jynneos in the United States and Imvanex in Europe, has been found to protect against monkeypox. 

It took Antonio three weeks to get an appointment to be vaccinated, after logging on to the official website every day at midnight. 

Appointments “are going as fast as tickets to the next Beyonce concert,” another said. 

So far, Spain has only received 5,300 doses, which arrived in late June. 

The Spanish health ministry declined to comment when contacted by AFP. 

‘Anyone can catch it’ 

Nahum Cabrera of the FELGTBI+ NGO, an umbrella group of more than 50 LGBTQ organizations from all over Spain, insists there is an urgent need to vaccinate those most at risk. 

That means not just gay men, but anyone who has “regular sex with multiple partners, as well as those who frequent swingers’ clubs, LGTBI saunas, etc.,” he said. 

“It risks creating a false sense of security among the general population, and they relax into thinking that they are safe and that it only happens to men who have sex with men,” he said. 

The target age group for vaccination is those ages 18 and 46, he added. 

Older people are vaccinated against smallpox which was eradicated in Europe in the early 1970s. 

“We are facing a health emergency… that affects the LGBTI community, so people think it is insignificant, that it is not serious,” said Ivan Zaro, of the Imagina MAS (Imagine More) NGO. “This is exactly what happened 40 years ago with HIV.” 

Image director Javier spent three days in hospital in early July after becoming infected.   

The 32-year-old, who is in a monogamous relationship, said he still did not know how he had caught it. 

“I warn everyone,” he said. “It’s an infectious disease, anyone can catch it.” 
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New York has declared a public health emergency due to a monkeypox outbreak.  Mayor Eric Adams and Department of Health and Mental Hygiene Commissioner Dr. Ashwin Vasan made the announcement Saturday.

The two officials said in a joint statement that “New York City is currently the epicenter of the outbreak, and we estimate that approximately 150,000 New Yorkers may currently be at risk for monkeypox exposure.”

“Over the past few weeks, we have moved as quickly as possible to expand outreach and access to vaccines and treatment to keep people safe,” the officials said.  “We will continue to work with our federal partners to secure more doses as soon as they become available. This outbreak must be met with urgency, action, and resources, both nationally and globally, and this declaration of a public health emergency reflects the seriousness of the moment.”

On Friday, New York state Governor Kathy Hochul issued an executive order declaring a state disaster emergency because of the monkeypox outbreak. In her executive order, Hochul said that “More than one in four monkeypox cases in this country are in New York State.”  Her declaration also expanded the number of health care individuals who can administer the monkeypox vaccines.

The World Health Organization has declared the global monkeypox outbreak a public health emergency of international concern.

WHO chief Dr. Tedros Adhanom Ghebreyesus said recently that while 98% of global monkeypox cases “are among men who have sex with men, anyone exposed can get monkeypox, which is why WHO recommends that countries take action to reduce the risk of transmission to other vulnerable groups, including children, pregnant women and those who are immunosuppressed.”

Tedros said, “In addition to transmission through sexual contact, monkeypox can be spread in households through close contact between people, such as hugging and kissing, and on contaminated towels or bedding.” 
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The bedsheets are big. Some are light pink, others hot pink or purple, connected and stretched taut by people holding wooden poles. Together, the sheets form a barrier across the parking lot. The activists, who are supporting a woman’s right to an abortion, wear bright pink vests with PRO-CHOICE in black emblazoned on the front.

This is the front line of protection for pregnant women who drive to this women’s center for an abortion. The sheeting forms a tunnel for them to leave their cars and enter the center, unseen by anti-abortion protesters trying to stop them.

‘There’s very little conversation’

This is the daily scene at the Bristol Regional Women’s Center.   The abortion-rights activists stay inside the center parking lot; the anti-abortion protesters stand on the sidewalk. They walk next to a busy street with posters reading “Love Your Baby and Yourself” or “Babies are Murdered Here” next to competing pink signs that read, “Honk Twice for Choice.”

A local church organizes the anti-abortion protesters. Natalie, who asked to use only her first name for safety reasons, is 24. She has been coming here weekly for seven years, saying, “This is what the Lord has called us to do.” She says  no patient has ever approached her for help.

Another young protester, Haven, says he’s handed out a few pamphlets but it is difficult to approach the women because of the sheeting. He has not spoken to the doctors or the abortion-rights protesters, adding, “There’s very little conversation that can happen.”

The abortion-rights protesters chose not to speak to VOA about their views and asked us to leave. One shone a flashlight into the lens of our video camera.

Inside the clinic, women are given an ultrasound on the first visit. If no fetal heartbeat is detected, they return for a second ultrasound in 48 hours. Again, if no cardiac activity is heard, they are given counseling before a medical abortion.

That is not the case in the adjacent state.

Legal and illegal separated by a street

Bristol, Tennessee, is a border town.

The state line is marked by numerous 20-centimeter-long brass plaques that run down the center of State Street, separating Tennessee from Virginia and its different laws.

As soon as the U.S. Supreme Court in June struck down abortion as a constitutional right, some states instituted “trigger laws” outlawing some or all abortions.

Tennessee’s trigger law outlawed surgical abortions and allowed medical abortions, which use medication to end a pregnancy, during the first six weeks of a pregnancy or until a heartbeat can be recognized, which typically occurs near that time limit.

That means abortions remain legal in Virginia but across State Street, they are restricted in Tennessee.

Olivia, who prefers to use only her first name for safety reasons, is a medical assistant at a women’s clinic in Bristol, Tennessee. She says in the past month, her clinic has had to turn away women in tears, some who had driven many hours to reach the clinic, because an ultrasound found fetal heart activity. The office refers them to Virginia offices if they live nearby. But some drive from eastern Tennessee, and a delay of an extra day to reach another state that’s closer than Virginia can affect the legality of an abortion.

“It becomes a bigger issue,” Olivia says, giving as an example, “North Carolina, [where] you have two separate visits with a 72-hour waiting period.”

Star Eans is a makeup artist on TikTok. The U.S. Supreme Court decision motivated her to become a abortion-rights activist. Eans had a medical abortion less than a year ago when she lived in Tennessee, and complications required a surgical abortion.

“It just makes me angry thinking that, like, if that had happened this year, I would have just died,” Eans says. “If I was still living in Tennessee, and I had to have this baby that I didn’t want, I was very much on the verge of ending myself.”

Doctor looks to move across the border

On Aug. 25, another Tennessee law will prohibit all abortions, surgical and medical.

Because of that, the doctor who runs the Bristol women’s center is considering a satellite office less than a mile away where abortions are legal in Bristol, Virginia.  A GoFundMe page has raised more than $100,000 for the new clinic, and an update on July 29 said it had opened.

But anti-abortion protesters held a rally earlier in July at the Virginia clinic and alerted residents, including Emmitt Russell, whose house is next door. He objects to the anti-abortion protesters and the clinic and says a Virginia ban would motivate him to the polls.

“I didn’t vote in the last two presidential elections … but I would vote against abortions in Virginia, yes,” he said.

No trigger laws exist in Virginia. But Republican Governor Glenn Youngkin is supporting making abortions illegal after 15 weeks. Republicans hold a majority in the state House and could support a ban, but experts think it would be defeated in the Democrat-controlled Senate.  
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Two of the hardest-hit U.S. regions have raised the alert level over the monkeypox outbreak.

San Francisco declared a public health emergency Thursday. The city accounts for 281 of California’s nearly 800 cases. The declaration gives health officials access to additional resources to deal with the outbreak.

New York, with nearly 1,400 cases statewide, made a similar declaration Thursday.

Worldwide, more than 21,000 cases have been reported in 78 countries, nearly all of them outside West and Central Africa, where the virus is endemic. The World Health Organization (WHO) raised the threat level to its highest ranking last weekend.

The U.S. case count is nearing 5,000, according to the U.S. Centers for Disease Control and Prevention (CDC).

The federal government has not declared an emergency but announced plans Thursday to distribute nearly 800,000 additional doses of monkeypox vaccine.

U.S. health officials said they had already distributed 340,000 doses, but many jurisdictions have reported that they have had to turn away patients because of short supplies.

Here are some answers to frequently asked questions.

Who gets monkeypox, and how?

The outbreak has been concentrated among men who have sex with men, though anyone can get monkeypox.

The virus spreads through contact with the rash that infected patients develop. It can also pass through bodily fluids, respiratory droplets after prolonged face-to-face contact or contaminated clothing, bedding or towels.

Men who have sex with men should have fewer sex partners in order to curb the spread, WHO chief Tedros Adhanom Ghebreyesus said Wednesday.

“This is an outbreak that can be stopped,” Tedros said. “The best way to do that is to reduce the risk of exposure.”

However, he added, intolerance of homosexuality would not help.

“Stigma and discrimination can be as dangerous as any virus, and can fuel the outbreak,” Tedros said.

What are the symptoms? Is it fatal?

The disease causes fever, headache, muscle pain, fatigue and swollen lymph nodes, followed by a rash, usually on the face, palms and soles of the feet. About a third of cases also develop a rash on the genitals.

The strain of monkeypox responsible for the global outbreak is rarely fatal but can be extremely painful, according to the CDC. About 10% of cases have been hospitalized “to manage the pain caused by the disease,” Tedros said.

Five deaths have been reported — three in Nigeria and two in the Central African Republic.

What about vaccines and treatments?

About 16 million doses of vaccine are available worldwide, but most will take several months to be packaged and distributed, according to the WHO, which is recommending vaccination only for people at high risk, including people exposed to an infected person, health workers and people with multiple sex partners.

People vaccinated against smallpox likely have some protection against monkeypox, which is a related virus. Smallpox vaccination ended after the disease was declared eradicated in 1980.

Several antiviral medications have been approved.

How unusual is this outbreak?

The current outbreak is the first time this many cases have occurred in such widely dispersed areas outside the endemic countries in West and Central Africa.

Europe accounts for two-thirds of the cases. Nearly one-fifth are in the United States.

WHO’s advisory committee did not agree on the magnitude of the threat at its meeting last Saturday, but Tedros made the decision to declare a “public health emergency of international concern,” the agency’s highest threat assessment.
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U.S. regulators said Friday they are no longer considering authorizing a second COVID-19 booster shot for all adults under 50 this summer, focusing instead on revamped vaccines for the fall that will target the newest viral subvariants.

Pfizer and Moderna expect to have updated versions of their shots available as early as September, the Food and Drug Administration said in a statement. That would set the stage for a fall booster campaign to strengthen protection against the latest versions of omicron.

The announcement means the U.S. won’t pursue a summer round of boosters using the current vaccines for adults under 50, as some Biden administration officials and outside experts previously suggested. They had argued that another round of shots now could help head off rising cases and hospitalizations caused by the highly transmissible omicron strains.

Currently, all Americans ages 5 and over are eligible for a booster shot five months after their initial primary series. Fourth doses of the Pfizer or Moderna shots — a second booster — are recommended for Americans 50 and older and for younger people with serious health issues that make them more vulnerable to COVID-19.

The FDA urged eligible adults who haven’t been boosted to get their extra shot now: “You can still benefit from existing booster options and leave time to receive an updated booster in the fall,” the agency said in a statement.

The White House has also emphasized that getting a fourth dose now won’t impact anyone’s ability to get omicron-targeted shots once they’re made available — although how long it’s been since their last dose will play a role in how soon they’re eligible.

Two omicron subvariants, BA.4 and BA.5, are even more contagious than their predecessors and have pushed new daily cases above 125,000 and hospitalizations to 6,300. Those are the highest levels since February, though deaths have remained low at about 360 per day, thanks to widespread immunity and improved treatments against the virus.

The subvariants are offshoots of the strain responsible for nearly all of the virus spread in the U.S. this year.

All the COVID-19 vaccines given in the U.S. until now have been based on the original version of the virus that began spreading across the country in early 2020.

In June, the FDA told the vaccine makers that any boosters for the fall would have to combine protection against omicron BA.4 and BA.5 and the original coronavirus strain. Both manufacturers have been speeding their production and data gathering to have those so-called bivalent vaccines ready for the fall.

The FDA and the Centers for Disease Control and Prevention would have to sign off on revamped shots before their launch.

The U.S. has a contract to buy 105 million doses of the Pfizer combination shots once they’re ready, and 66 million of Moderna’s version. But how soon large amounts would become available isn’t clear. The government contracts include options to purchase 300 million doses each but reaching that total will require more funding from Congress, the Biden administration said.

As for timing, getting a booster too soon after the previous dose means missing out on its full benefit — something policymakers will have to take into consideration when rolling out revamped shots.

The White House has at times been frustrated by the pace of decision-making at the FDA and CDC, most notably last summer, when the regulators took weeks to decide whether to authorize the first booster dose for U.S. adults. Privately, West Wing officials believe the delay cost lives, preventing optimum protection amid the delta and omicron surges, and also fed into doubts about vaccine and booster effectiveness that affected their uptake.

In recent weeks, some of those frustrations have bubbled up again, as regulators considered whether to recommend a fourth shot for all adults, not just those at highest risk from the virus. Some in the White House believe that the additional dose would have helped somewhat with the rapidly spreading BA.5 subvariant, and also lift the confidence of anyone worried that their protection had waned.

Still, officials across the government have acknowledged the risks of vaccine fatigue among Americans, including tens of millions who still haven’t received their first booster. Government figures show less than half of those eligible for a booster have gotten that third shot.
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