Bring sexual health to the places where people have sex

OOn Saturday, June 29, 2019, a group of over 200 queer and trans people gathered in New York to celebrate the city’s big World Pride weekend. They had all come to a party called the NYC Inferno, known for its sexual activity. Around midnight, they gathered at the front of the hall, engrossed as an artist leading them in an interactive performance. After a moment, everyone was singing the refrain: “We have to keep each other alive because no one else will.”

With this care-based ethos in mind, NYC Inferno and all other queer sex-based venues in New York quickly closed in July 2022 when cases of Monkeypox (MPV) increased in the United States. The horror of the MPV was almost unfathomable to many, including the queer community: excruciating pain, terrible wounds and treatment that few doctors could prescribe.

When the NYC Inferno restarts on September 17, 2022, attendees were able to first stop in a white van parked near the venue, a mobile clinic offering Jynneos — the MPV vaccine. Jynneos, safe and effective, requires two doses for full immunity.

As an executive at NYC Health + Hospitals, a community organizer and queer scientist, and the creator and host of NYC Inferno, we are part of a team that provided free, subcutaneous doses of the Jynneos vaccine on site at commercial sex sites in New York City. This summer, MPV vaccination was severely limited in supply as cases rapidly increased. In New York City, the Department of Health has partnered with community organizations and set up mass vaccination sites, even though demand remains consistently higher than supply in the fall. Success in lowering the epidemiological curve of MPVand the continued low and declining number of cases, even as sexual behavior returns to normal, underscore the power of providing sexual health care directly to affected communities and the places where they congregate.

Read more: How the monkeypox virus does and doesn’t spread

People who participate in group sex tend to have a large number of sexual partners. Providing preventive care to this group can help prevent infectious diseases – from HIV and STIs to MPV – not only in people who attend sex parties, but all other people in their sexual networks. By getting vaccinated to help prevent MPV, this community has shown that queer enjoyment and community care can go hand in hand.

After originally closing on July 14th, 2022, the places where queer people meet for sex in New York reopened on September 3rd. Community members wanted to ensure that people could safely be vaccinated on site. NYC Health + Hospitals—in collaboration with the New York City Department of Health and Mental Hygiene’s Sexual Health Team, community experts, event hosts, and participants—worked quickly to meet this need. To date, New York administers over 3000 doses of the MPV vaccine at nearly 60 mobile sites across the city—from queer health clinics and community pride centers to sex parties and raves.

Our collaborative model at the NYC Inferno and other sex parties has spurred the rapid entry of vaccines into safe and accessible locations. On September 17th in Brooklyn, after the NYC Inferno reopened and NYC allowed access to second doses of Jynneos on site, 60% of party attendees received a dose of MPV vaccine in a mobile unit.

At GBU, a weekly sex party for queer men, mobile vaccine delivery has proven effective, but we’ve had to adjust our model to meet the needs of the community. When the lot reopened on September 3 and only the first doses of Jynneos were available, only 13 vaccinations had been administered. When we spoke to those attending the event, most reported that they had already received one vaccination – and because of New York’s vaccine criteria, they were not eligible to receive a second dose. It was clear that demand for second doses was high. It was also clear that participants were aware of the risk they faced and wanted full protection.

The community advocated for and successfully convinced New York City health officials to allow a second subcutaneous dose of Jynneos to be administered at commercial sex sites. The following week at GBU, health workers administered 82 vaccinations, mostly second doses, to 40% of those present. The following week, health workers administered another 57 doses, reaching 43% of those present that night. The NYC Inferno had the highest vaccine uptake of any MPV mobile vaccine event in the city, with 90 vaccinations done in one night.

To address racial disparities in Access to MPV vaccine and cases, we’ve partnered with queer night event hosts like Papi Juice and Trappy Hour, providing dozens of on-site shots. The New York City Department of Health also provided field outreach teams to educate community members about both MPV and the vaccine.

NYC Health + Hospitals’ mobile fleet is clearly meeting the need—73% of doses administered by mobile units at high-risk events like sex parties are second doses. Low-risk events promote widespread uptake of the first doses, and high-risk events appear essential to provide high immunity to those most at risk of MPV infection. Both the increase in first doses in the queer community as a whole and the provision of full protection to those with the most sexual partners helped New York City’s daily MPV cases to single digits in the fall.

MPV study shows that preventing infection in the most closely related people in a sexual network is essential to protect the community as a whole. While our work cannot directly determine the efficacy of the Jynneos vaccine, which is currently unknownNew York’s high vaccine uptake among those most at risk, including second doses, has led to ongoing MPV low transmissioneven when sex parties resume.

Read more: TIME 100 Next: Joe Osmondson

On November 5th one of us was working a GBU party and asked if people needed a dose of MPV while they were streaming. 20 minutes after sending someone to the mobile van, a newly vaccinated man returned to the party with a big smile on his face.

“Thank you so much for helping to keep our community safe,” he said

Healthcare, when it’s so seamlessly integrated into your life, can be a joy. Based on our experience with MPV vaccines and with parties like GBU and NYC Inferno, queer people want to protect themselves. Queer people want to enjoy parties and have sex with as little risk of disease as possible. Mobile health units respond to community needs by bringing people in care that they need and that they actually care about.

While NYC Health + Hospitals’ mobile units only administer MPV vaccines in commercial sex settings, we envision a pop-up sexual health model that could provide resources for routine HIV prevention vaccination for COVID-19, influenza, and even prevention of sexually transmitted bacterial infections.

Sex parties attract people with many sexual relationships. Bringing care directly to these locations is an opportunity to reduce the disappointingly high rates of infectious and sexually transmitted diseases and HIV in New York City.

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