With nearly one million shots in arms, the monkeypox (MPV) outbreak remains concentrated in communities of color, specifically among Black gay and bisexual men. Although Black and Latinos continue to be underrepresented according to vaccine distribution data, the threat of a continued MPV outbreak (paired with a decrease in national media attention) appears to be subsiding as the FDA-approved JYNNEOS vaccine becomes more widely available. But for many gay and bisexual men, the discoloration and scarring at the injection site is a visible and often traumatic reminder of the stigma attached to MPV and sex between men, despite declining cases across the United States.
Approved by the FDA for emergency use in August, the first dose, typically administered into the fatty tissue over the triceps, and the second dose, an intradermal injection typically administered into the inner forearm, can result in long-term skin discoloration and scarring in some vaccinated people. In updated guidelines, the Centers for Disease Control and Prevention (CDC) has authorized an alternative regimen to include intradermal administration to the deltoid and upper back, two areas where scars would be less visible and covered by clothing.
“Among the advantages of intradermal vaccination is that it can generate immune responses equivalent to those achieved with subcutaneously or intramuscularly administered vaccines. But with as little as one-fifth to one-tenth the dose, while avoiding the rare risk of nerve, blood-vessel, or joint-space injury,” according to a report in The New England Journal of Medicine by CDC Director Rochelle P. Walensky and other medical professionals.
“The smaller dose needed for intradermal administration will translate into greater available supply and opportunity for vaccination. Ideally, such availability will avert inequities like those seen when JYNNEOS first became available, when access to the vaccine by all groups, especially marginalized persons, was not equal,” the report further states.
Aaron Thomas, 37, a Columbus, Ohio resident and program manager at Ohio State University, received his MPV vaccine at Columbus Public Health. While he says, he was eager to get vaccinated, the scar from his second dose and the uncertainty of if or when it will go away has been anxiety-inducing.
“It’s just weird to look down and see something on your arm,” Thomas says. “I don’t have a lot of scars on my body, and I wear a lot of polos, so my arms are always exposed.”
Thomas correlates his MPV scar to a similar spot on his mother’s body from the polio vaccine.
“I want it to go away. It’s just a weird reminder of something I haven’t completely sussed out yet,” he adds.
Thomas tells GLAAD that although the scar is an unsightly reminder of the threat of the MPV virus for gay and bisexual men, he has no regrets about being vaccinated.
“Stick me. Give me everything I need to live a long and productive life,” he says. “It’s not a regret by any measure. Two things can be true at the same time. As I begin to leave my youth behind, health equals wealth.”
A Black gay man of size, Thomas says the decision to be vaccinated is more significant than any cosmetic inconvenience from his MPV scar in the aftermath of the devastating impacts of COVID-19, HIV, and now MPV in Black communities.
“Like a lot of people, I may not have had the greatest start to health, but I’m trying my hardest to stay alive, and I consider all of this a part of that,” he says. “All the men that died way before their time, it’s my duty to live out the dreams and freedoms they never got to have.”
The scars of rural limitations
The testimonials of Black gay men across social media diagnosed with MPV who shared their experience with painful symptoms from the virus were more than enough for author Rashid Darden, 43, to get vaccinated. But now, Darden is grappling with the side-effect of a visible scar on his forearm and the challenges he and other gay and bisexual men encounter while accessing the MPV vaccine in rural cities like Conway, North Carolina, where he resides.
“I went in there with my list. I said I would like the bivalent Covid booster and a monkeypox vaccine,” Darden recalls during a visit to his primary physician’s office. “I got the sense that they were scrambling to find information.”
Darden says a nurse then called a nearby health department.
“I just looked at her [the nurse practitioner] and said, tell them I want the vaccination so that I can have sex with men.”
Darden says the nurse turned red at his bluntness.
“I just want the vaccine,” he retorted. Can we make it happen?”
Darden tells GLAAD he had to travel 30 miles to the nearest health department from his home in Conway to receive his MPV vaccine. The side effects of his now visible scar were almost immediately after the first dose.
“It itched and was discolored for about a week,” he says. “The mound didn’t go down until about three weeks later. There’s a scar. So for symmetry, I decided, well, I’ll go and get it in the other arm [for the second dose], so at least I won’t have a huge double scar on one arm.”
But in an unexpected turn of events, Darden says he must return to the health department for an additional dose after medical personnel discovered the previous second dose had decreased efficacy after being exposed during refrigeration beyond the recommended time. For Darden, this incident, paired with his MPV scar, illuminates the limitations of public health, especially for gay and bisexual men in rural areas across the South.
“I do believe that most of them are doing the best they can. But the best you can do with limited resources is not going to be as great as mediocre efforts in cities like D.C. or Atlanta,” he says.
Kirk D. Myers, Founder and President of Dallas-based Abounding Prosperity, Inc., and a GILEAD COMPASS grant partner, say public health professionals need to include community members in all conversations about vaccines before any potential issues arise.
“Working together to find solutions and communicating them to providers and patients will go a long way to building trust and encouraging vaccinations,” Myers says. “We must incorporate this step from the beginning, whether it’s HIV, COVID-19, MPV, or any future virus.”
While their respective scars are an unwanted reminder of their vaccinations, Darden and Thomas say they are grateful for access to the MPV vaccine.
Aesthetically, I don’t regret it,” Darden says. “I trust science.”