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

A recent CNN investigation found that amid the rising number of cases, some phlebotomists in the US have refused to draw blood from patients with suspected monkeypox, preventing these patients from undergoing medically necessary, doctor-ordered tests.
Still, the definition of “suspected monkeypox” and the other details surrounding these cases remain obscure at best. As CNN noted in its coverage, it’s unclear whether the phlebotomists refused to perform blood draws, or whether company policy forbade it. Are these encounters in which gay men are denied blood tests simply because they are gay and monkey pox is now associated with this demographic? Or are these situations where patients with visible and infectious pustules present at diagnostic testing sites where phlebotomists are concerned about good safety policies and procedures?
At the first meeting, homophobia is the driving factor; in the second case, any reasonable health care professional would similarly have reservations about endangering themselves. (Although the U.S. Centers for Disease Control and Prevention suggest that virus levels in the blood of infected people are low, routes of transmission that are not transmitted through the blood, such as directly touching lesions, may increase a health professional’s potential risk of becoming infected. without adequate PPE.)
We are gay men, and seeing those in our community denied medical care echoes the early days of the HIV/AIDS epidemic. Originally dubbed GRID (gay-related immunodeficiency), the outbreak resulted in discrimination and stigmatization of LGBTQ+ individuals across society, regardless of their infectious status.
It is discriminatory to assume that identity itself is a risk factor for disease and that avoiding entire sections of society is an appropriate safety mechanism. Yet these erroneous assumptions remain the cornerstone of homophobia in modern medicine and explain much of the distrust LGBTQ+ people have of the health care system.

But as medical professionals, we also understand the fear associated with encountering patients with highly contagious diseases. Eric has been a primary care physician since the first day of the Covid-19 pandemic and is now a physician working with monkey pox patients. Tom has worked with patients in intensive care during the Delta Covid-19 wave. We understand the real fear of catching viruses at work, and – as a married couple – we recognize the concern of bringing illness into the home of loved ones.

With the Covid-19 pandemic, we saw how PPE guidelines changed out of convenience rather than scientific data and we saw our colleagues – fellow doctors, nurses, phlebotomists, radiology technicians, concierge staff, security – catch the virus from their patients.

No one goes into medicine to hurt patients — everyone in healthcare has decided to work in an industry that seeks to improve the lives of others. Still, it would be unscrupulous to expect everyone in healthcare to risk their own health to help their patients. And as a result of the Covid-19 experience, there is justifiable distrust and lingering fear among many healthcare workers.

The way to improve the situation in general – both to strengthen the health and safety of health professionals and to tackle the stigmas associated with monkey pox – is twofold: education and good safety policies, including the provision of personal protective equipment.

Healthcare providers at all levels should be included in training about what monkeypox is, how it is spread (and how it isn’t) and mechanisms to protect themselves while caring for all patients – both those with monkeypox and those without. We need to make clear what safety procedures are needed and ensure that all providers have access to materials such as PPE at all times.

Opinion: The problem with the distribution of monkeypox vaccines

We must give every health professional the opportunity to ask questions about the impact of monkeypox on their work. As a medical community, we will most likely identify shortcomings in our policies and ways to improve them.

Feeling protected is an important motivator for behavioral change. We’ve seen the evolution in the way we treat, treat and manage HIV with the emergence of universal precautions designed to protect 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; wearing gloves, goggles and jackets; and specific precautions based on transmission routes.
When followed properly, 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 have further reduced the fear of HIV infection among healthcare providers.
In addition, vaccines to prevent monkey pox, such as Jynneos, are hard to come by and must first go to patients at highest risk of disease. The CDC advises people exposed to monkeypox through their work, such as clinical lab personnel performing diagnostic tests, to receive the vaccine as pre-exposure prophylaxis, and some health professionals exposed to patients with monkeypox have been given the vaccine as post-exposure prophylaxis. to prevent disease or relieve 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 health professionals, from nurses to hospital staff to technicians — all of whom may encounter patients with monkeypox.
Labcorp Director Dr. Brian Caveney told CNN last week that some of their phlebotomists were “afraid” of monkey pox. Without specific information about what exactly drives these phlebotomists to refuse blood draws, it feels a bit short-sighted to shame health professionals for fearing (despite possibly missing PPE and updated information on monkey pox) or assuming it stems solely from homophobia. . As the number of cases is expected to rise and the future of the monkeypox outbreak remains uncertain, careful reporting, knowledge sharing and destigmatization must be our collective priority.
Healthcare workers need to feel heard and protected, like many of us exhausted, anxious and burned out from working non-stop for more than two years of the Covid-19 pandemic. But that can’t mean we’re overlooking the needs of our gay, bisexual, queer and transgender patients — an already stigmatized group jaded by decades of minority stress. Institutional and public health strategies must ensure that everyone – patients and caregivers alike – feels safe and welcome.

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