Why Are Blacks Disproportionately Being Affected By Monkeypox?

As monkeypox cases continue to spread, a detailed analysis of monkeypox case records published by the US Centers for Disease Control and Prevention offers new insight into the outbreak, which is disproportionately affecting men who have sex with men, especially those who are Black and Hispanic.

It's important that communities of color and those already infected have access to testing, treatment, and vaccines Dr. Jonathan Colasanti, an infectious disease specialist, says.

“A few weeks ago when this was circulating in Europe, this wasn’t even being talked about in our communities of color. And I think there was an initial perception that this was in, largely white communities and white, gay and MSM (men having sex with men) communities,” says Colasanti, who is also the medical director of Grady Memorial Hospital’s Ponce De Leon Center, a comprehensive program dedicated to serving those living with or affected by HIV.

In Georgia, monkeypox is infecting an overwhelming number of Black people compared to other races.

“...I just want our folks here at home to know that that’s absolutely not the case. ... And at this point in Atlanta, (monkeypox is) very heavily concentrated within communities of color, based on the early epidemiologic data we have.”

Confirmed cases in Georgia had climbed to 749 including eight women, according to the Georgia Department of Public Health., although the actual number is likely far higher.

Of the 74% of the cases reported in the data, the racial breakdown shows: 82% were Black people, 14% were white, and under 1% were Asian; multiracial and “other” accounted for a total of about 3%. The total includes 6% Hispanic people.

Across the United States, the numbers aren't much different.

Among the cases with available data, 94% were in men who reported recent sexual or close intimate contact with another man. More than half (54%) of cases were among Black and Hispanic people, a group that represents about a third (34%) of the general US population. The share of cases among Black people has grown in recent weeks, according to the CDC analysis.

Why the disparity?

Blacks have longstanding racial and ethnic disparities in access to care for everything from HIV to COVID-19, according to Dr. Felipe Lobelo, an epidemiologist at Kaiser Permanent of Georgia and an associate professor at the Emory University School of Public Health. He says the racial breakdown is “unacceptable but unfortunately not surprising.”

“But as with COVID, social determinants of health are going to continue to drive racial disparities with every new emerging public health threat,” he says.

A “substantial proportion” of monkeypox cases have been reported among people with HIV, who may be at higher risk of severe illness. HIV is another disease that disproportionately affects Blacks.

How to protect yourself

Nearly all cases to date have been among men who have sex with men, according to the CDC, however, health authorities emphasize that anyone can catch monkeypox. According to health officials, the virus could begin to spread more broadly.

“Public health efforts should prioritize gay, bisexual, and other men who have sex with men, who are currently disproportionately affected, for prevention and testing, while addressing equity, minimizing stigma, and maintaining vigilance for transmission in other populations,” the authors of the report say.

According to the CDC, "monkeypox can spread to anyone through close, personal, often skin-to-skin contact." This includes:

Direct contact with monkeypox rash, scabs, or body fluids from a person with monkeypox.
Touching objects, fabrics (clothing, bedding, or towels), and surfaces that have been used by someone with monkeypox.
Contact with respiratory secretions.

This direct contact can happen during intimate contact, including:
- Oral, anal, and vaginal sex or touching the genitals (penis, testicles, labia, and vagina) or anus (butthole) of a person with monkeypox.
- Hugging, massage, and kissing.
- Prolonged face-to-face contact.
- Touching fabrics and objects during sex that were used by a person with monkeypox and that have not been disinfected, such as bedding, towels, fetish gear, and sex toys.

Early warning signs of illness are less common in the current outbreak compared with “typical” monkeypox. In about 2 in 5 cases, the illness started with the rash – with no reported prodromal symptoms such as chills, headache or malaise. About 2 in 5 cases also did not report fever.

What to do if you experience symptoms

You should take precautions to reduce your exposure to monkeypox until immune protection from vaccines has reached its maximum. However, if you experience symptoms, it is important to get tested.

If you have a rash that is consistent with monkeypox, you should be tested for the virus, regardless of your sexual or gender identity or the presence of other symptoms.

The preferred vaccine to protect against monkeypox is JYNNEOS, which is a two-dose vaccine. It takes 14 days after getting the second dose of JYNNEOS for its immune protection to reach its maximum.

The ACAM2000 vaccine can be used an alternative to JYNNEOS. ACAM2000 is a single-dose vaccine, and it takes four weeks after vaccination for its immune protection to reach its maximum. However, because it has more side effects than JYNNEOS, it is not recommended for people with severely weakened immune systems and several other conditions.

Consult your healthcare provider to see if you should get vaccinated against monkeypox, and if you should receive ACAM2000 instead of JYNNEOS.