Philly sex workers finally have access to the monkeypox vaccine

Sex workers in Philadelphia are now eligible to receive the monkeypox vaccine, the Philadelphia Department of Public Health said Thursday, a relief for people at high risk of catching the virus.

Philadelphia’s limited supply of vaccine doses had been restricted to people with confirmed exposure to the virus, or men who have sex with men, are over 18 years old, and are considered high-risk for contracting the virus because they either have had multiple recent partners or were treated recently for a sexually transmitted infection. Transgender and nonbinary people are also eligible.

The decision to include anyone who does sex work came amid lobbying from activist groups and sex workers themselves.

“It was so urgent for me,” said a 42-year-old Philadelphia sex worker who calls herself Madeline Layne. “I woke up in the middle of the night having a panic attack because I was so stressed about this. I can’t really work until I get the vaccine.”

Even with restrictions on who is eligible for the vaccine, the city has not been able to meet demand, and has been prioritizing doses for people who have a confirmed exposure to the virus.

Still, health officials decided it was important to add sex workers to the eligibility list because they are at high risk of contracting the virus, said health department spokesperson James Kyle.

“If one of them catches monkeypox, it’s going to go all through the community,” said Jazmyn Henderson, whose organization, ACT UP Philadelphia, an HIV and AIDS activist group, has sought to expand vaccine access. “We need to be thinking about high risk populations differently.”

» READ MORE: Monkeypox vaccine limits cause frustration and fear in Philly

Others at risk, such as people experiencing homelessness who may share clothes, toiletries, and drug paraphernalia, and health care workers who treat people with monkeypox, are not yet eligible.

“At this point, we haven’t seen cases among healthcare workers or unhoused individuals who don’t also have other risk factors,” Kyle said. “However, these are important groups to watch, and we hope to be able to vaccinate these groups as soon as we have enough vaccine.”

In the meantime, staff at Philadelphia FIGHT, an LGBTQ-focused health center, are wearing surgical gowns and gloves as extra protection, in addition to the masks and face shields they were already wearing because of COVID, said Jay Kostman, a doctor there.

On Tuesday, the U.S. Food and Drug Administration permitted health care providers to use smaller doses of the vaccine JYNNEOS to stretch the supply of doses as much as fivefold, federal health officials said. Philadelphia’s health department, though, has questions about the efficacy of the approach, and whether people can choose the amount of vaccine they receive, and has not yet started providing the smaller doses.

Monkeypox continues to spread widely in the United States, with the country cracking more than 10,000 cases as of Wednesday according to the Centers for Disease Control and Prevention. Philadelphia reported 128 cases Monday, the most recent data available.

» READ MORE: Philly’s monkeypox vaccine shortages aren’t solved yet as feds make move to increase access to the shots

Monkeypox spreads primarily through extended physical contact with the rashes and lesions it causes, and while it is not exclusively a sexually transmitted disease, the close contact of sex has proven to be an ideal means of transmission. The virus isn’t fatal but can be extremely painful, with symptoms and the potential to infect others lasting for up to a month.

“Monkeypox is really scary, especially to people for whom our appearance is such an important factor in our ability to make money,” Layne said. “If my face is covered in scars, I’m done. It’s really terrifying, honestly.”

She asked that her legal name not be used to avoid stigma.

Layne has worked as an escort for about two years, she said, and developed a rigorous routine of testing and masking that allowed her to keep seeing clients through the COVID-19 pandemic. She wants to take the same approach to monkeypox, but there is no rapid test she can use, and a mask or condom can’t reliably prevent contact with the rashes and lesions monkeypox causes, which may not be clearly apparent. Layne knows she has had male clients who are sexually active with men.

» READ MORE: Exposed to monkeypox? Here’s how to get a vaccination appointment in Philly.

“This week and last week, I’ve been more cautious because of monkeypox,” said Layne, who has largely paused seeing clients. “I can just kind of wait until I get the vaccine.”

Layne had tweeted at the city health department, urging officials to make sex workers eligible for vaccination.

» READ MORE: Are you at risk of getting monkeypox? Here’s everything you need to know.

Philadelphia Red Umbrella Alliance, an advocacy group for city sex workers, has educated women working on the street about what monkeypox looks like and how it spreads, said Raani Begum, an organizer for the group. She is glad for greater access to the vaccine, but is concerned that women may not get it if they have to identify themselves as sex workers.

“They have to expose themselves, and I think that can really keep them from accessing monkeypox vaccine,” Begum said.

Sex workers have a complicated relationship with health care providers, Begum said, the result of stigma and discrimination they face. Women could fear how information provided to health care workers might be used or shared. It’s something Layne has encountered too.

“There’s always a stereotype of us being disease vectors, but our livelihoods depend on us being in good health,” she said.

Though expanding eligibility to sex workers is a step in the right direction, health experts and activists say the city must do more. Kathleen Brady, a doctor and acting director of the health department’s AIDS Activities Coordinating Office, said the agency relies on grant funds earmarked for specific programs, and cannot quickly redirect many employees to an unfunded crisis like monkeypox.

Last week’s federal public health emergency declaration is expected to send much-needed money to health departments for monkeypox response.

“The response was definitely slow at the national level,” Brady said. “I think it should have been declared a public health emergency earlier without a doubt.”

Health department staff will soon be reaching out to around 100 organizations, bars, venues, churches, and clubs that cater to LGBTQ people with information about the virus. Among them, she said, are two bath houses that cater to gay men, though they haven’t been receptive to other outreach efforts, Brady said. Neither returned a reporter’s calls.

Extended physical contact or even touching objects that touched the lesions on an infected person can spread the virus. The bath houses offer ample opportunity for transmission, Kostman said.

Yet, he said, it’s not necessarily sexual practices that put people in harm’s way.

“Let’s realize the potential risk is out there depending on behavior,” he said, “not just what group you’re in.”