It was the Friday of Pride weekend in Chicago. Nirmalpal Sachdev was driving to Michigan for the day since he’d have to work Saturday and Sunday. His cell phone signal was spotty, so he was surprised when he received a text message saying that the Chicago Department of Public Health (CDPH) wanted his help to set up an mpox vaccination clinic that weekend at Steamworks, the longtime bathhouse where Sachdev is general manager. He turned around and headed back to the city.
The message had come from Stockton Mayer, DO, an assistant professor with the Division of Infectious Diseases at the University of Illinois Chicago (UIC), who was among others from local medical institutions helping to organize the city’s vaccination efforts against mpox (previously known as “monkey pox”).
During the COVID-19 pandemic, UIC and Rush University Medical Center had worked with CDPH and community organizations, establishing teams that handled outbreak response and COVID testing. The hospitals and public health officials turned to these groups again, to serve as locations for mpox vaccinations.
Mpox first appeared in Chicago in early June 2022, not long after it had reached the U.S. in a global outbreak. Early epidemiological data from CDPH indicated that some of the cases could be connected to Steamworks, Dr. Mayer said. So, the initial plan was to vaccinate Steamworks’ customers. Working with Steamworks CEO Larry Hickey, Sachdev came up with a plan.
“We told them, ‘we think it’d be better if we vaccinated the community, and that became our counteroffer,” said Sachdev. (From 2009–2019, Sachdev was a board member of TPAN which publishes Positively Aware.) “We said, ‘look, we can reach sex workers, we can reach the people who are most vulnerable probably quicker than you can, and we have methods of reaching them faster or more expeditiously than you could.’”
Bars often play a central role in LGBTQ+ communities. To fight a viral outbreak driven by close physical contact, he saw bars as essential, especially bar employees. “They are the frontline workers,” he said. In addition to being protected from acquiring or transmitting mpox, vaccinated bar employees could give patrons information and share their experiences, addressing any questions or concerns they might have. “They are your ambassadors,” he said.
CDPH told Sachdev that he would need to identify the most vulnerable working in and patronizing the bars of Chicago’s iconic Northalsted LGBTQ+ neighborhood, determine if they met the city’s qualifications for vaccination, get them to the bathhouse, provide information and answer questions, secure informed consent and then get them quietly vaccinated. The third floor of the bathhouse was shut down and turned into a pop-up vaccination clinic. Because word would get out quickly once they started, Sachdev and his crew had only 48 hours after Pride weekend to start getting people vaccinated.
“I was like, you’ve got to be kidding me,” Sachdev said.
In the first three days of its popup clinic, Steamworks vaccinated 225 bar staff and sex workers. Over the popular Market Days weekend, which rivals Pride, another 535 got their shots. From June 28 to October 25, over 2,500 were vaccinated.
In addition to mpox information and vaccine dissemination, Sachdev worked with UIC and CDPH to create a survey that was given to vaccine recipients and shared with Steamworks’ email list and social media to get community feedback on the vaccination process. The survey yielded hundreds of responses, and the findings will be part of a presentation at the STI & HIV World Congress, to be held July 24–27 in Chicago.
A matter of messaging
Recalling HIV, UIC’s Dr. Mayer said there was an awareness of the potential for stigma. “We didn’t want people to see this as a gay disease,” he said. “We can’t walk away from the fact that this is affecting predominantly men who have sex with men in the majority of cases, but at the same time, you can’t broadly paint a population with the same brush. Our message was, this is a disease of intimate contact. This is something that can spread within a family or within a community just by being close to folks.”
The response to the mpox outbreak was far from perfect, and whatever lessons learned from the COVID pandemic, utilizing community partners was key to the city’s efforts.
“I was proud of how quickly we were able to access community members,” said Dr. Mayer. “A lot of that is because of the work that the Chicago community has done to establish a network for supporting folks living with HIV. We were able to use that to respond to mpox. There was a feeling about mpox that they didn’t want it to become like another HIV-type thing. People rallied around that. It was just really emotional to see that.”
Mpox info at a glance
CDC research reports that about 40% of people diagnosed with mpox in the U.S. also are living with HIV. Limited data suggest that people living with HIV, particularly those with low CD4 counts (below 350 cells/mL) or who are not virally suppressed, are more likely to be hospitalized if they get mpox than people without HIV.
Based on what the CDC knows, mpox treatments have few interactions with HIV medications. If you’re living with HIV, let your health care provider know before starting mpox treatment.
Only the JYNNEOS vaccine (also known as Imvamune or Imvanex) is considered safe by the CDC for people living with HIV. The CDC does not recommend the ACAM2000 vaccine for people with HIV because of the increased risk of serious side effects.
If you’re taking pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP), those medications are still effective for preventing HIV even if you have received the mpox vaccine, have mpox, or are taking mpox treatment. If you have been prescribed HIV PrEP or HIV PEP by your health care provider, the CDC recommends you continue taking your medicine as prescribed.
Find more information, including some material in Spanish, at the CDC’s mpox and HIV page: cdc.gov/poxvirus/monkeypox/prevention/hiv.html. HIV.gov has a listing of resources from various federal agencies): hiv.gov/hiv-basics/staying-in-hiv-care/other-related-health-issues/federal-resources-about-mpox.