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We Need to Bring Sexual Health Care to Places Where People Have Sex

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On Saturday, June 29, 2019, a group of over 200 queer and trans folks were gathered in New York City, celebrating the city’s big World Pride weekend. They had all come to a party called NYC Inferno known for sexual activity. At around midnight, they were gathered in the front of the venue, rapt as an artist led them in an interactive performance. Within moments, everyone was singing the refrain: “We’ve got to keep each other alive, because no one else is gonna do it.”

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

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When NYC Inferno relaunched on Sept.17, 2022, attendees were able to first make a stop at 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 executive leadership 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 Jynneos vaccine doses on site at commercial sex venues in NYC. Over this summer, MPV vaccination was severely limited by supply as cases rapidly rose. In New York, the Health Department partnered with community organizations and set up mass vaccination sites, even as demand remained consistently higher than supply through the fall. The success in lowering the MPV epidemiological curve, and the continued low and declining case counts even as sexual behaviors are returning to normal, highlight the power of bringing sexual healthcare directly to impacted 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 high number of sexual partners. Providing preventative care to this group can help prevent infectious disease—from HIV and STIs to MPV—not only in people who attend sex parties, but all the other people in their sexual networks. By getting vaccinated to help prevent MPV, this community has shown that queer pleasure and community care can go hand-in-hand.

After initially closing on July 14, 2022, spaces where queer people meet for sex in NYC reopened on Sept. 3. Community members wanted to ensure people could safely be vaccinated on site. NYC Health + Hospitals—in collaboration with the sexual health team at NYC’s Department of Health and Mental Hygiene, community experts, event hosts and participants—worked rapidly to meet this need. To date, NYC has administered over 3,000 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 model of collaboration at NYC Inferno and other sex parties prompted a rapid uptake of vaccines at safe, accessible sites. On Sept. 17 in Brooklyn, after NYC Inferno reopened, and NYC allowed access to second Jynneos doses on site, 60% of those attending the party received an MPV vaccine dose at a mobile unit.

At GBU, a weekly sex party for queer men, mobile vaccine delivery was proving to be efficient, but we needed to adjust our model to meet community need. When the party re-opened on Sept. 3 and only first Jynneos doses were available, only 13 vaccinations were administered. When we spoke to the event attendees, most reported having received one vaccination already—and because of NYC’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 participants recognized the risk they faced and wanted full protection.

The community advocated for and successfully persuaded NYC health officials to allow a second subcutaneous Jynneos dose to be administered at commercial sex venues. The next week at GBU, healthcare workers administered 82 vaccinations, mostly second doses, to 40% of those in attendance. The following week, healthcare workers provided another 57 doses, reaching 43% of attendees that night. NYC Inferno had the highest vaccine uptake of any MPV mobile vaccine event in the city, with 90 shots given in one night.

To address the racial disparities in MPV vaccine access and cases, we partnered with hosts of nightlife events for queer people of color, like Papi Juice and Trappy Hour, providing dozens of doses on site. The NYC Health Department also provided outreach teams on site to educate community members about both MPV and the vaccine.

NYC Health + Hospitals’ mobile fleet clearly met a need—73% of the doses administered by mobile units at high risk events like sex parties were second doses. Low-risk events promoted broad uptake of first doses, and high-risk events proved essential to providing high immunity for those at most risk of MPV infection. Both increasing first doses in the queer community at large, and ensuring full protection of those with the most sexual partners, has helped keep daily MPV cases in N.Y. in single digits through the fall.

Research on MPV shows that preventing infection in the most-connected people in a sexual network is essential to protecting the community at large. While our work cannot directly determine the Jynneos vaccine’s efficacy, which is currently not known, high vaccine uptake in NYC among those most at risk, including second doses, has resulted in ongoing low transmission of MPV, even as sex parties resume.

Read More: TIME 100 Next: Joe Osmundson

On Nov. 5, one of us staffed a GBU party and asked if people needed an MPV dose as they streamed in. 20 minutes after walking someone down to the mobile van, a freshly vaccinated man returned to the party, a wide 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 joyful thing. 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 healthcare units meet community needs by bringing people into care that they need and are actually excited about.

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

Sex parties attract people with many sexual connections. Providing care directly at these locations is an opportunity to lower the frustratingly high rates of infectious and sexually-transmitted diseases and HIV in NYC.

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