You might be wondering, “What does monkeypox have to do with trans survivors?” Possibly a lot! In addition to Monkeypox being a public health crisis, some trans community members might be at higher risk for contracting the disease. Trans survivors may have additional risk factors, too. We’ll explain!
Monkeypox is a virus similar to smallpox, and causes a rash on the skin, along with other symptoms like fever, headache, and muscle aches. In 2022, health institutions like the Centers for Disease Control and Prevention (CDC) began tracking an outbreak of monkeypox in the United States. Although monkeypox is currently more prevalent among men who have sex with men (MSM)* in larger cities, transmission can happen to anyone.
*Note: The CDC has a long history of describing sexual behaviors vs. ascribing a sexual orientation identity label. They have also had limited recognition of trans people, including often including trans women who have sex with men under the MSM category.
Despite common misconceptions, monkeypox is not a sexually-transmitted infection. Although monkeypox can be transmitted during sexual contact, it is primarily spread through any skin-to-skin contact with an infected person. This includes non-sexual contact, like bumping against someone in a crowded bar, hugging, or cuddling. It can also be transmitted when someone comes into contact with respiratory droplets from someone with the virus, including respiratory secretions on objects, surfaces like doorknobs and countertops, or materials like bed sheets or clothing. There is also evidence that monkeypox may be spread through respiratory droplets in the air.
Because of the rampant misinformation about monkeypox, it’s difficult to know what steps we can take to protect ourselves and our communities. Knowing the facts can help you and the trans community reduce risks of transmission.
What are the symptoms of monkeypox? The first step toward prevention is knowing the symptoms of monkeypox and monitoring yourself, especially if you may have had a potential exposure. Keep an eye out for the following:
- Muscle aches and backache
- Swollen lymph nodes
- Respiratory symptoms (e.g. sore throat, nasal congestion, or cough)
- A rash that may be located on or near the genitals, but could also be on other areas like the hands, feet, chest, face, or mouth.
- The rash will go through several stages, including scabs, before healing.
- The rash can look like pimples or blisters and may be painful or itchy.
Although most people with monkeypox get a rash, it’s possible to have some but not all of the symptoms. Some people may get a rash with no other symptoms.
According to the CDC: “Monkeypox symptoms usually start within 3 weeks of exposure to the virus. If someone has flu-like symptoms, they will usually develop a rash 1-4 days later.
Monkeypox can be spread from the time symptoms start until the rash has healed, all scabs have fallen off, and a fresh layer of skin has formed. The illness typically lasts 2-4 weeks.
It’s important to get tested at the first sign of monkeypox symptoms to mitigate the spread. If you start to notice new bumps or lesions on your skin, contact your primary care provider, or call an urgent care or sexual health clinic. Testing involves swabbing a lesion. Unfortunately, there are no at-home tests for monkeypox at this time.
Treatment for monkeypox mostly involves managing symptoms. Physicians may prescribe painkillers for people experiencing a lot of pain from lesions, and antibiotics may be prescribed for secondary bacterial infections, if they develop.
Antivirals are also available (tecovirimat or TPOXX), but these are usually only recommended for people who develop a body-wide rash or are at high risk for complications from monkeypox. At the moment, it’s difficult for most people to access antiviral treatment.
The CDC makes several recommendations for mitigating the spread of monkeypox. These include:
- Avoiding skin-to-skin contact with people who have lesions from monkeypox or know that they have the virus (this includes not kissing, hugging, or having sex with someone with monkeypox)
- Avoiding contact with objects and materials that a person with monkeypox has used (such as utensils, dishes, bedding, towels, or clothing)
- Washing your hands often with soap and water or use an alcohol-based hand sanitizer, especially before eating or touching your face and after you use the bathroom.
Although the CDC removed guidance from their website about aerosol transmission of monkeypox, wearing a mask can help to reduce the risk of contracting the virus from someone you have extended face-to-face contact with. Wearing a mask also has the added benefit of preventing the spread of COVID-19!
These steps are a helpful starting point for taking actions to protect yourself and your community. However, there are cases in which these recommendations might be impossible, particularly for sex workers and survivors of violence.
Sex workers may rely on having in-person sexual contact with clients for their income, and it’s not always possible to know if someone is infected with monkeypox. Sex workers are disproportionately Black or Latinx trans women, and we also know that these intersecting identities are often associated with less access to comprehensive and affordable health care. It’s even more important that folks who are at increased risk know how to protect themselves against monkeypox.
During the current monkeypox outbreak, sex workers have been on the frontlines, “demanding resources and creating safety protocols to combat diseases that can be transmitted through sexual contact.”
This info sheet was created by and for sex workers, and covers the symptoms of monkeypox, how it’s transmitted, cleaning protocols, and client screening questions. Included in the info sheet is this chart, displaying levels of risk associated with certain sexual and non-sexual activities.
What steps can you take to make these activities less risky? Here are some things you might consider for reducing potential risks of monkeypox transmission:
- Monitor yourself for the symptoms of monkeypox. If you or your partner have recently been sick, currently feel sick, or have a new or an unexplained rash, try to avoid having sex and see a healthcare provider.
- Consider using screening questions for clients in order to gauge if they might have been exposed to monkeypox.
- Check yourself and your partner or clients’ skin for bumps or lesions.
- Avoid sharing things like towels, fetish gear, sex toys, and toothbrushes with someone who has monkeypox.
- Reduce skin-to-skin contact as much as possible by wearing clothes, especially covering areas if a rash is present. (If the rash is confined to the genitals or anus, condoms may help; however, condoms alone are likely not enough to prevent monkeypox).
- Washing your hands, fetish gear, sex toys and any fabrics (bedding, towels, clothing) after sexual contact. Follow these suggested protocols for cleaning up afterward.
- Avoiding touching any rash, even on your own body, as it can spread to other areas.
If possible, consider other ways of engaging in sexual interactions with people that involve less direct contact. For example, the CDC suggests having virtual sex/phone sex without in-person contact, or masturbating together at a distance of at least 6 feet, without touching each other.
This LGBTQ+ specific tip sheet suggests:
- Temporarily avoiding high-risk environments like sex parties and saunas until monkeypox vaccines become more available.
- Forming “sex pods,” similar to social pods to mitigate the spread of COVID-19, to reduce your number of sex partners.
- Having open and honest communication with your partners and clients about potential exposure.
- Staying home and isolating if you test positive for monkeypox.
While these precautions won’t eliminate all risks, and they may not all be possible, taking some steps to protect yourself can reduce the potential for transmitting or getting infected with monkeypox.
For sexual assault survivors and/or those who are currently in abusive relationships, it may be very difficult to navigate risk reduction with your partner or the person who is engaging in abusive behaviors. Assessing your emotional and physical safety will play a large part in determining if talking about risks and behavioral changes will escalate violence or not. Some of the same strategies listed above can be useful to consider for risk reduction. Possibly one of the best risk-reducing options for survivors in actively abusive dynamics is to get vaccinated, since this does not rely on another person’s behaviors.
For survivors of any type of violence, having regular social contact (including physical contact) with others can be crucial to reducing the mental health impacts of isolation. The COVID-19 pandemic has made it difficult for many people to get the in-person connection and support they need. It is stressful to consider that monkeypox might worsen isolation and loneliness.
As we’ve learned during COVID-19, it’s almost impossible to eliminate all risks. However, we’ve often had to take calculated risks, such as traveling to visit family, or spending time in close contact with a social group, to meet our needs. Similarly, there are steps we can take to make our social gatherings and sexual interactions safer when it comes to monkeypox.
These steps are similar to those above, like monitoring yourself for symptoms of monkeypox, seeing a healthcare provider if you have symptoms, reducing skin-to-skin contact with others (for example: wearing long sleeves or a jacket while hugging someone), and frequently washing your hands.
There is currently a limited supply of vaccines for Monkeypox in the US. You may qualify for a monkeypox vaccine if you have been in contact with someone who has monkeypox, if you live in an area with a high rate of infections and had multiple sex partners in the past 2 weeks, or if you work in a field that puts you at increased risk.
If you believe you meet these criteria, consider asking your healthcare provider about getting vaccinated against monkeypox! (Don’t have a healthcare provider? More and more community health clinics are offering vaccines and treatment options.)
In addition to the health toll that monkeypox takes on trans and LGBQ+ communities, there’s also a mental health impact on marginalized groups:
“[Monkeypox] may not be as serious as HIV, or the coronavirus still causing covid-19, but monkeypox has come along at a time when gay people in America are already feeling stressed and vulnerable.”
Some members of the LGBTQ+ community fear that because of the initial transmission among gay men, Monkeypox will be used to justify further anti-LGBT attitudes and legislation: “There’s the stigma foisted on the community that’s first impacted.”
However, increased dialogue about monkeypox among trans and LGBQ+ community members can lead to greater community care and mutual aid: “The community is sharing knowledge, pushing for government action and promoting harm reduction.” We can all take steps to care for ourselves and our communities by knowing the facts about monkeypox, having open communication with our partners, taking precautionary measures, and staying informed.