Opinion: The two ways to fight monkeypox and end the stigma surrounding it

A recent CNN investigation found that amid a growing number of cases, some phlebotomists in the United States have refused to draw blood from patients suspected of monkeypox, preventing those patients from getting medically necessary and ordered tests. by a doctor.
Still, the definition of “suspected monkeypox” and other details regarding these cases remain hazy at best. As CNN noted in its reporting, it’s unclear whether the phlebotomists refused to perform blood draws or whether company policy prohibited it. Are these encounters where gay people are denied blood tests just because they are gay and monkeypox is now associated with that demographic? Or are these situations in which patients with visible, infectious pustules present themselves to diagnostic testing sites where phlebotomists are concerned about having appropriate safety policies and procedures in place?
During the first meeting, homophobia is the determining factor; in the second case, any reasonable health care provider would also have reservations about putting themselves at risk. (Even though the US Centers for Disease Control and Prevention suggests that virus levels in the blood of infected people are low, non-bloodborne routes of transmission, such as direct contact with lesions, may increase the possible risk of infection to a healthcare worker without adequate PPE.)
We are gay men, and seeing those in our community being denied medical care echoes the early days of the HIV/AIDS epidemic. Originally called GRID (Gay-Related Immunodeficiency), the outbreak has led to discrimination and stigmatization of LGBTQ+ people in society, regardless of their infection status.
It is discriminatory to assume that an identity is itself a risk factor for disease and that the avoidance of entire segments of society is an appropriate safety mechanism. Yet these flawed assumptions remain the cornerstone of homophobia in modern medicine and largely explain LGBTQ+ people’s mistrust of the healthcare system.

But as healthcare professionals, we also understand the fear that comes with encountering patients with highly contagious diseases. Eric has been a front line doctor since day one of the Covid-19 pandemic and is now a doctor working with monkeypox patients. Tom worked with patients in the intensive care unit during the Delta Covid-19 surge. We understand the genuine fear of contracting viruses at work, and as a married couple, we recognize the concern of bringing the disease home to loved ones.

With the Covid-19 pandemic, we have seen PPE guidelines change for convenience rather than scientific data and have seen our colleagues – fellow doctors, nurses, phlebotomists, X-ray technicians, maintenance staff, security – contract the virus from their patients.

No one goes into medicine to hurt patients – everyone in healthcare has decided to work in an industry that tries to make life better for others. Still, it would be unreasonable to expect everyone in healthcare to put their own health at risk to help their patients. And in the wake of the Covid-19 experience, there is justified distrust and lingering fear among many healthcare workers.

The way to improve the overall situation – both to enhance the health and safety of healthcare workers and to address the stigma associated with monkeypox – is two-fold: education and appropriate safety policies, including including the provision of personal protective equipment.

Healthcare providers at all levels should be included in trainings on what monkeypox is, how it spreads (and how it doesn’t), and the mechanisms to protect themselves while taking care of all patients – both those with monkeypox and those without. We must clearly state what safety procedures are necessary and ensure that all suppliers have access to materials such as PPE at all times.

Opinion: The problem with distributing the monkeypox vaccine

We need to empower every healthcare worker to ask questions about the impact of monkeypox on their work. As a medical community, we will more than likely identify gaps in our policies and ways to improve them.

Feeling protected is a key motivation for behavior change. We have seen the evolution of how we have interacted with, treated and dealt with HIV through the rise of universal precautions, aimed at protecting healthcare workers. These precautions were introduced by the CDC in the 1980s in response to the HIV epidemic when much was unknown about the virus, and they include hand hygiene protocols; wear gloves, goggles and gowns; and specific precautions based on the route of transmission.
If followed correctly, they can prevent the transmission of blood-borne pathogens and other infectious materials. The availability of pre-exposure prophylaxis, post-exposure prophylaxis and HIV treatment has further reduced fear of HIV infection among healthcare providers.
Additionally, vaccines to prevent monkeypox, such as Jynneos, are hard to find and must be given to patients most at risk of disease first. The CDC advises people exposed to monkeypox in the course of their work, such as clinical laboratory personnel who perform diagnostic tests, to get vaccinated as pre-exposure prophylaxis, and some health care workers who have been exposed to patients Monkeypox patients received the vaccine as post-exposure prophylaxis to prevent disease or lessen symptoms. But stocks are still low, and once the vaccines become more readily available, they should be offered as pre-exposure prophylaxis to a wider range of healthcare workers, from nurses to hospital staff to technicians – who can all encounter monkeypox patients.
Labcorp director Dr. Brian Caveney told CNN last week that some of their phlebotomists “got scared” of monkeypox. Without specific information about what exactly drives these phlebotomists to refuse blood draws, to shame health care workers for being scared (despite the potential lack of PPE and up-to-date information on monkeypox), or to assume it stems exclusively about homophobia, feels a little myopic. As case numbers are expected to rise and the future of the monkeypox outbreak remains uncertain, cautious messaging, knowledge sharing and de-stigmatization should be our collective priority.
Healthcare workers need to feel heard and protected, because many of us exhausted, fearful and exhausted from working non-stop for more than two years of the Covid-19 pandemic. But that cannot mean we neglect the needs of our gay, bisexual, homosexual and transgender patients – a group already stigmatized and jaded by decades of minority stress. Institutional and public health strategies must make everyone – patients and providers – feel safe and welcome.

About Bradley J. Bridges

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