Spain leads Europe in monkeypox and is struggling to contain the spread

A sex worker and adult film actor, Roc was relieved to be among the first Spaniards to receive a monkeypox vaccine. He knew of multiple cases in men who have sex with men, which is the leading demographic for the disease, and feared he might be next.

“I went home and I was like, ‘Whew, my God, I’m saved,'” the 29-year-old told The Associated Press.

But it was already too late. Roc, the name he uses for work, had contracted it from a client a few days earlier. He joined the steadily rising number of monkeypox infections in Spain, 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 well enough to be discharged.

Spanish health officials and community groups are struggling to contain an outbreak that has killed two young men. They reportedly died from encephalitis, or brain swelling that can be caused by some viruses. Most cases of monkeypox cause only mild symptoms.

Spain has confirmed 4,942 cases in the three months since the outbreak began, which have been linked to two raves in Europe, where experts say the virus was likely spread through sex.

The only country with more infections than Spain is the much larger United States, which has reported 7,100 cases.

Global Count

Overall, 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 stress that this is not technically an STD, although it has been spread primarily through sex among gay and bisexual men, who account for 98% of cases outside of Africa. The virus can be transmitted to anyone who has close physical contact with an infected person, their clothing or bedding.

Part of the complexity of tackling monkeypox is finding a balance between not stigmatizing men who have sex with men, while ensuring that both vaccines and calls for greater caution reach those who are currently most at risk.

Spain has distributed 5,000 shots of the two-shot vaccine to health clinics and expects to receive another 7,000 from the European Union in the coming days, the health ministry said. The EU has bought 160,000 cans and is donating them to member states as needed. The block expects another 70,000 recordings to become available next week.

To ensure these shots are administered wisely, community groups and sexual health associations are targeting gay men, bisexual and transgender women.

In Barcelona, ​​BCN Checkpoint, which focuses on AIDS/HIV prevention in gay and transgender communities, is now contacting vulnerable people to offer them one of the valuable vaccines.

Pep Coll, medical director of BCN Checkpoint, said the vaccine rollout would focus on people who are already at risk of contracting HIV and who are undergoing preventive treatment, men with a high number of sexual partners and those who who engage in sex while under the influence of drugs, and people with suppressed immune responses.

But there are many more people who fit into those categories than cans, about 15,000 people in Barcelona alone, Coll said.

Vaccine shortages, far more severe in Africa than in Europe and the US, make social health policies a key factor, experts say.

Contact tracing difficult

As with the coronavirus pandemic, contact tracing is critical to identifying those who may be infected. But while COVID-19 could simply spread through the air to anyone, the close physical contact that serves as a leading vehicle for monkeypox makes some people reluctant to share information.

“We have a steady stream of new cases and it is possible that we will 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 that will change unless the entire public, regardless of gender or sexual orientation, understands that having different sex partners poses a greater risk.

With vaccine shortages and contact tracing problems, more pressure is being put on promoting prevention.

From the beginning, government officials gave community groups the lead role in the “Speak Out” campaign.

Sebastian Meyer, president of the STOP SIDA association, which is dedicated to AIDS/HIV care in Barcelona’s LGBTQ community, said the logic is that his group and others like them are trusted ambassadors who know how from person to person one promotes health warning home.

Community groups representing gay and bisexual men have bombarded social media, websites and blogs with information about monkeypox safety. Officials in Catalonia, the region including Barcelona, ​​which has over 1,500 cases, are pushing for public service announcements on dating apps Tinder and Grindr warning of the disease.

But Meyer believes fatigue from the COVID-19 pandemic has played a role. Doctors advise people with monkeypox lesions to isolate themselves until they have fully healed, which can take up to three weeks.

“When people read that they need to self-isolate, they close the site and forget what they read,” Meyer said. “We’re just coming out of COVID when you couldn’t do this or that and now we’re going again. …People just hate it and stick their heads in the sand.”