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August 14, 2022 3:46 pm

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‘It’s Scary’: Gay Men Confront a Health Crisis With Echoes of the Past

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Monkeypox has sparked frustration and anxiety among gay and bisexual men in New York, who remember mistakes and discrimination during the early years of the AIDS crisis.

Kelvin Ehigie, right, a bartender at 4West in Harlem, worries about the monkeypox outbreak and the confusion it’s creating in the gay community.

Kelvin Ehigie, right, a bartender at 4West in Harlem, worries about the monkeypox outbreak and the confusion it’s creating in the gay community.Credit…Sara Naomi Lewkowicz for The New York Times

Liam Stack

It was happy hour at a gay bar in Harlem, 4West Lounge, and the after-work crowd had come to drink rum punch and watch “RuPaul’s Drag Race.”

But instead, perched on stools, the men talked about the rapidly spreading monkeypox virus: their efforts to snag a coveted vaccine appointment, in a city where demand for the shots far outstrips supply; the slow government rollout of vaccines and treatment; and their confusion about how the disease spreads and how to stay safe.

“It feels like survival of the fittest, with all the pandemic waves and now monkeypox and all these vaccine problems,” said James Ogden, 31, who secured a vaccine appointment after weeks spent navigating the city’s glitchy online sign-up process.

Kelvin Ehigie, 32, the bartender, agreed. When asked about the future, he said: “I do not feel confident.”

For gay and bisexual men in New York, the summer has been consumed with similar conversations as monkeypox cases spike among men who have sex with men.

There is widespread fear of the virus, which primarily spreads through close physical contact and causes excruciating lesions and other symptoms that can lead to hospitalization. There is fear of the isolation and potential stigma of an infection, since those who contract monkeypox must stay home for weeks. And some fear the vaccine itself, in an echo of the hesitancy and mistrust that hindered the coronavirus response.

Many are also furious at the lags and fumbles in the government’s effort to contain the disease, including delayed vaccines and mixed messaging about how the virus spreads and how people should protect themselves.

And some are anxious that monkeypox could be twisted into a political weapon to be used against gay and transgender people, whose rights have come under increasing fire from Republicans in recent months.

Last week, the World Health Organization declared monkeypox a global health emergency, after it spread from parts of Africa where it is endemic to dozens of countries and infected tens of thousands of people around the world over the course of three months. As of Thursday, there were more than 3,000 confirmed cases in the United States, and 1,148 in New York, but experts suggest cases are being undercounted.

Mr. Ehigie received the first shot of the two-dose vaccine regimen after a referral from his therapist, but worried the city might never give him a second.

And, while he said everyone understands how H.I.V. spreads, monkeypox still felt like a mystery to him and many others. “Especially being in New York,” he said, “where everyone is in close contact with everyone else all the time, it’s scary.”

Many gay and bisexual men signed up for monkeypox vaccinations offered by the city through a glitchy online process.Credit…Mary Altaffer/Associated Press

Nearly all of the cases outside of Africa have been in men who have sex with men. In New York, only 1.4 percent of monkeypox patients self-identified as straight, with the rest describing themselves as gay, bisexual or declining to say, according to city data.

The disease is rarely fatal, and no deaths have been reported outside of Africa.

But the combination of government failure and a virus that has so far primarily affected gay and bisexual men has drawn frequent comparisons to the early years of the H.I.V./AIDS epidemic.

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What is monkeypox? Monkeypox is a virus similar to smallpox, but symptoms are less severe. It was discovered in 1958, after outbreaks occurred in monkeys kept for research. The virus was primarily found in parts of Central and West Africa, but in recent weeks it has spread to dozens of countries and infected tens of thousands of people, overwhelmingly men who have sex with men. On July 23, the World Health Organization declared monkeypox a global health emergency.

I fear I might have monkeypox. What should I do? There is no way to test for monkeypox if you have only flulike symptoms. But if you start to notice red lesions, you should contact an urgent care center or your primary care physician, who can order a monkeypox test. Isolate at home as soon as you develop symptoms, and wear high-quality masks if you must come in contact with others for medical care.

What is the treatment for monkeypox? If you get sick, the treatment for monkeypox generally involves symptom management. Tecovirimat, an antiviral drug also known as TPOXX, occasionally can be used for severe cases. The Jynneos vaccine, which protects against smallpox and monkeypox, can also help reduce symptoms, even if taken after exposure.

I live in New York. Can I get the vaccine? Adult men who have sex with men and who have had multiple sexual partners in the past 14 days are eligible for a vaccine in New York City, as well as close contacts of infected people. Eligible people who have conditions that weaken the immune system or who have a history of dermatitis or eczema are also strongly encouraged to get vaccinated. People can book an appointment through this website.

Those years were marked by acts of homophobia that remain seared in the minds of many gay Americans. The White House press secretary made jokes about AIDS at a 1982 press briefing. Churches refused to provide funerals for the dead. And President Ronald Reagan did not deliver a public speech on the epidemic until 1987, by which point roughly 23,000 Americans had died of the disease.

Disagreements within the New York City Department of Health about how to communicate the risks of the disease spilled into public view last week. Some epidemiologists have argued that officials should more explicitly advise men who have sex with men to reduce their number of partners, or even consider short-term abstinence. (The director general of the W.H.O. made a similar recommendation this week, including that men should reconsider having “sex with new partners,” according to STAT News.)

A department spokeswoman has said messages advising men to abstain from sex in particular could stigmatize gay and bisexual men and repeat the mistakes of the past.

That history was on many people’s minds (and many people’s banners) at a protest last week in Manhattan that was organized by activist groups including ACT UP, which formed in 1987 in response to government inaction on H.I.V./AIDS.

“I am sad that we have to be here,” said Erik Bottcher, a city councilman whose district includes Chelsea and Hell’s Kitchen, neighborhoods that have been hit hard by the outbreak.

“We have been forced to do this for so long, we have been forced to fight for our own health care when we got let down by the government,” he said. “Shame on the government for letting us down again.”

Nearby, protesters carried signs comparing President Biden to Mr. Reagan.

Jon Catlin, 29, a graduate student, said he knew several people with monkeypox in New York and many more in Berlin, where he lives part time to do research. He said he studies the evolution of the idea of catastrophe in German thought, and “whose suffering counts as a crisis.”

“Because it is happening to queer people,” Mr. Catlin said, the government has been slow to treat monkeypox as a true crisis, waiting to deploy vaccine doses until cases had grown exponentially.

“AIDS wasn’t treated as a crisis at first either,” he added, before citing a homophobic saying from that time. “The quip about the ’80s is ‘the right people were dying.’”

But as much as the protesters wanted to combat what they described as indifference, many were also concerned that increased attention could bring with it hostility from heterosexual people.

Speaking at the rally in Manhattan, Mordechai Levovitz, the clinical director at Jewish Queer Youth, warned the crowd of about 100 people that the L.G.B.T.Q. community could become a scapegoat in the event of a larger and more widespread monkeypox outbreak.

“You know what will happen,” he shouted into a microphone. “A few months from now, on the cover of every magazine, there will be children with monkeypox on their face, and they will come after us.”

That was a concern shared by some of the men at 4West Lounge.

Chavis Aaron, 33, the bar manager, said the public focus on gay and bisexual men made him uneasy. He knew two gay people with the disease, and understood the statistics on who the outbreak was impacting most, but still thought “this is really everybody’s problem,” he said.

“The situation is still all foggy and crazy,” he added. “We are getting information from Instagram and the news and each one is saying something different.”

Gay and bisexual men and activist groups have protested the government’s slow response to monkeypox.Credit…Andrew Seng for The New York Times

Some people are improvising different ways to protect themselves against an illness that can last for a month, but their methods can be dangerous and deeply unscientific.

“Most of my friends are not having sex or they are just being really selective,” said Mr. Ehigie, the bartender. He also knows men who are opposed to vaccines in general “because they think the vaccines have a political agenda or will cause bad side effects.”

Others, he said, had embraced a potentially dangerous approach — in which they waited a few days after having sex to see if a rash broke out before resuming sexual activity — that he thought they may have adopted after reading the wrong things online.

Two years of pandemic isolation have made people eager for human connection. There has so far been little appetite in the L.G.B.T.Q. community to cancel events.

Some events have made minor concessions to monkeypox, including Pines Party, a large annual gathering on Fire Island in July, which asked partygoers to get vaccinated and not attend if they feel unwell.

But the outbreak has caused the cancellation of other events in the city, including several regular sex parties that are less high profile but more high risk than dance parties.

At smaller bars like 4West Lounge, things have been quieter lately. Some of that probably had to do with the hot weather, or with a clientele that partied too hard during Pride Month in June, its staff said.

But some of it was also the result of the outbreak, they said. Mr. Aaron said he could think of a few regular customers who stopped coming in as much after the monkeypox case numbers began to climb in July.

“After Covid, a lot of people have PTSD,” he said. “They’d rather not go out than take the risk.”