Barcelona, Spain — As a sex worker and actor in adult films, Roc was relieved when he was among the first Spaniards to be vaccinated against monkeypox. He was aware of several cases among men who have sex with men, who are the primary demographic for the disease, and feared he was next.
“I came home and thought, ‘Whew, my God, I’m saved,'” the 29-year-old told The Associated Press.
But he was already too late. Roc, the name he uses for work, had been infected by a client a few days earlier. He joined the growing number of monkeypox infections in Spain, which has become the highest in Europe since the disease spread beyond Africa where it has been endemic for years.
He began to show symptoms: pustules, fever, conjunctivitis and fatigue. Roc was hospitalized for treatment before recovering enough to be released.
Spanish health authorities and community groups are struggling to control an outbreak that has already claimed the lives of two young men. They are said to have died of encephalitis, or swelling of the brain, which can be caused by certain viruses. Most cases of monkeypox cause only mild symptoms.
Spain has recorded 4,942 confirmed cases in the three months since the start of the outbreak, which has been linked to two raves in Europe, where experts say the virus was likely spread sexually.
The only country with more infections than Spain is the much larger United States, which has reported 7,100 cases.
In total, the global monkeypox outbreak has seen more than 26,000 cases in nearly 90 countries since May. There have been 103 suspected deaths in Africa, mostly in Nigeria and Congo, where a deadlier form of monkeypox is spreading than in the West.
Health experts point out that it is not technically a sexually transmitted disease, even though it has mainly spread sexually among gay and bisexual men, who account for 98% of cases beyond Africa. The virus can spread to anyone who has close physical contact with an infected person, their clothes, or their bedding.
So part of the complexity of the fight against monkeypox is finding a balance between not stigmatizing men who have sex with men, while ensuring that vaccines and calls for greater caution reach those currently most at risk.
Spain has distributed 5,000 injections of the two-shot vaccine to health clinics and expects to receive another 7,000 from the European Union in the coming days, its health ministry said. The EU has purchased 160,000 doses and donates them to member states as needed. The bloc expects another 70,000 snaps to be available next week.
To ensure that these vaccines are administered wisely, community groups and sexual health associations targeting gay men, bisexuals and transgender women are taking the lead.
In Barcelona, BCN Checkpoint, which focuses on AIDS/HIV prevention in gay and trans communities, is now contacting those at risk to offer one of the valuable vaccines.
Pep Coll, medical director of BCN Checkpoint, said the vaccine rollout is focused on people who are already at risk of contracting HIV and who are on preventive treatment, men with a high number of sexual partners and those taking part in “ chemsex” (sex with drug use), as well as people with weakened immune responses.
But there are many more people who fit these categories than doses.
“If we just consider the number of people (on HIV prophylaxis) plus the number of people living with HIV, we are talking about around 15,000 people (only in Barcelona),” Coll said.
The lack of vaccines, which is much more serious in Africa than in Europe and the United States, makes public health social policies essential, experts say.
As with the coronavirus pandemic, contact tracing to identify people who may have been infected is essential. But, while COVID-19 could spread to anyone simply through the air, the close body contact that serves as the primary vector for monkeypox makes some people reluctant to share information.
“We have a constant flow of new cases, and it is possible that we have more deaths. Why? Because contact tracing is very complicated because it can be a very sensitive issue for someone to identify their sexual partners,” said Amós García, epidemiologist and president of the Spanish Association of Vaccinology.
Spain says 80% of its cases involve men who have sex with men and only 1.5% are women. But García insisted it will balance out unless the entire public, regardless of gender or sexual orientation, understands that having multiple sexual partners creates greater risk.
“The same thing happened with AIDS/HIV, when at one point the group of men who had sex with men was the most affected (before it spread to other groups), and that can become the path it takes if we are not able to send a strong message to society,” García said.
With vaccine shortages and contact tracing issues, there is increased pressure to encourage prevention.
From the start, government officials ceded the lead role in spreading the word to community groups.
Sebastian Meyer, president of the STOP SIDA association dedicated to the care of AIDS/HIV in the LGBTQ community in Barcelona, said the logic was that his group and others like him would carry the message of trust with individual knowledge of how to conduct health warning at home.
Community groups that represent gay and bisexual men have bombarded social media, websites and blogs with monkeypox safety information. Officials in Catalonia, the region including Barcelona which has more than 1,500 cases, are pushing public service announcements on dating apps Tinder and Grindr warning of the disease.
But Meyer, who sits on the monkeypox advisory boards for Spain’s national government and for Catalonia, says there’s still a lot to be done.
Meyer believes fatigue from the COVID-19 pandemic played a role. Doctors advise people with monkeypox lesions to self-isolate until they are fully healed, which can take up to three weeks.
“When people read that they have to self-isolate, they close the webpage and forget what they read,” Meyer said. “We’re just coming out of COVID, when you couldn’t do this or that, and now it’s on again…People are hating it and sticking their heads in the sand.”
Meyer said his group is currently thinking of ways to revamp and reinvigorate their message.
“If you haven’t been selected for a vaccine, the answer is not to desperately hope that you will get one,” he said. “The answer is to be more careful. It’s much better than any vaccine.
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AP writer Raf Casert contributed from Brussels.