101: Getting the Monkeypox* Vaccine

A Conversation about the Monkeypox* Virus, Vaccine, and Safer Sex Practices with SJ Stephens

SJ Stephens (they/he, elle/él) is a 22-year-old Wellesley College student born and raised in Los Angeles, CA. They are the co-president of Wellesley College’s Sexual Health Educators organization and works on-campus in the Office of LGBTQ+ Programs and Services as a student worker or “Q Connector.” SJ is a trans, Latine, sex educator majoring in psychology and education and is passionate about non-monogamy and housing justice. You can find him at @theyelle on Instagram.

*Disclaimer: Jems is aware that the World Health Organization (WHO) is in the process of renaming the monkeypox virus amidst valid concerns about stigma and racism. This article will be updated once a new name has been confirmed.

JEMS: There’s a lot of information circulating about the monkeypox virus. What sites/sources are you following for reliable information?

SJ Stephens: Most of my information initially came from firsthand accounts on disability-oriented Twitter, disability-oriented TikTok, and Instagram. 

I was following The Centers for Disease Control and Prevention (CDC) guidelines and updates on monkeypox, but there were three main accounts I specifically utilized:

I liked these resources because they confirmed that monkeypox is not an STI. It can be transmitted through sex, but that’s just one of the ways it can be transmitted – it’s not the only way. My significant other and I also learned a lot from TikToker Dr. Asher Williams

Some major media outlets continue citing that men who have sex with men are more at risk for the monkeypox virus (a factor of eligibility for the vaccine) but where does that leave transgender people, nonbinary folks and other members of the queer community?

It leaves us out in a way that’s dangerous to us, because we’re just as susceptible to monkeypox as cis people are. The CDC is reporting that monkeypox mainly affects cis gay men, cis bisexual men and transgender persons, but I find that its not actually affecting those populations more – many people within the queer community are significantly more vigilant about getting tested than some cis-het populations are in the aftermath of the AIDS crisis.

As a trans non-binary person myself, I do sometimes align myself with manhood and trans maleness – it’s a little bit fluid for me. When getting the monkeypox vaccine, in that specific moment, I did decide to self-identify as a trans man when asked. Part of that is because it did feel right for me in the moment, but also out of fear. I was definitely worried about being denied on account of my biological sex and the gender that I live in. 

Also, as a childcare worker, as somebody who works with children at my school, as somebody focusing on developmental psych and early education in college—Spoonieuniproject says, “queer people are not a danger to you or your children. Narratives that demonize queer people put queer adults, trans adults, and kids in harms way. If you care about your child’s safety, you should teach them about risks, and the precautions to take during a global health crisis without insinuating that any person's identity is to blame for a potential illness.”

Where did you sign up for the vaccine? What was that process like and how quickly did you receive information about next steps?

I live in LA county, so l went to ph.lacounty.gov/monkeypox and signed up on August 1st, the day California declared a state of emergency.

I got a text the following day with a link to the walkup schedule for clinics in my area. When I originally clicked the link, there were only five walkup clinics, but I see now there’s a sixth clinic that’s appointment only, which is nice, because I would’ve loved to make an appointment.

[*See lapublichealth for updates about vaccine availability.]

What was the eligibility criteria?

When I signed up the eligibility criteria said the vaccine was “available to gay or bisexual men and transgender persons who are 18 years of age or older who have had multiple or anonymous sex partners in the last 14 days including engaging in survival and/or transactional sex (e.g., sex in exchange for shelter, food and other goods and needs).

I am a transgender person, and as a polyamorous, non-monogamous person, I do have multiple sexual partners. 

Ultimately, you are the person who determines your eligibility. They didn’t interrogate me personally about how much sex I had in the last 14 days, or what venue I went to if I was going somewhere to have sex with multiple people. 

You brought your significant other who didn’t get a text, but they were able to get vaccinated. What did they need to show in order to meet eligibility requirements for the vaccine?

When I initially got the text – we had maybe been misinformed – we assumed you could only get access to the vaccine if you got this specific text. We got to the clinic about an hour early and were about 55th in line. While waiting, we realized there are a couple of different ways to access the vaccine that we weren’t aware of. We saw a sign that said:

Please have ID ready with one of the following documents:

  1. PrEP Medication
  2. Provider (DPH) Attestation Form
  3. Lab Results
  4. Email/Text from DPH with Name

We had no idea that just having proof of being on PrEP gives you access to the vaccine. We feel very fortunate that we were both able to get vaccinated at the same time, however, it’s definitely stigmatizing people who are on PrEP and people with HIV. 

We would’ve felt more comfortable if the CDC/Department of Public Health (DPH) were focusing on immunocompromised people across the board, because that’s the population of people who should be eligible first, not just people who are on PrEP. Having to specify PrEP and HIV is homophobic.

[As of August 23], LA County Public Health (PH) states that “if you are immunocompromised (including if you have advanced or uncontrolled HIV), you may be at high risk for severe disease and will be prioritized for vaccination,” but there is no information on other conditions that may make you eligible. It does not say if it is self-attested or through documentation. 

I would suggest, if applicable, compiling any diagnoses and prescriptions ahead of time. My significant other has been supporting people by calling doctors to confirm what diagnoses make someone eligible, like atopic dermatitis for example.

The CDC says that “young children (<8 years of age), individuals who are pregnant or  immunocompromised, and individuals with history of atopic dermatitis or eczema may be at especially increased risk for severe outcomes from monkeypox disease.” But this may require self-advocacy due to inconsistent information, and/or stigmatizing information and specifications, depending on the state you live in.

How long did you have to wait in line?

The whole thing took about three hours. We stood in line for about two to three hours. I’m glad I brought headphones! 

I get heat exhaustion pretty easily, so I wasn’t as covered up as I would’ve liked to be. if I wasn’t so susceptible to heat exhaustion, I would’ve worn closed-toe shoes, pants and covered up as much as possible since you are standing in line with people who might have monkeypox – you just don’t know, and you’re not necessarily going to ask people around you why they’re eligible for the vaccine. 

I also wish I had brought a blanket or a chair because standing was quite hard and there wasn’t a lot of shade. Wear SPF, and please bring water because you’re going to be there for a while! Bring your documentation and make sure your phone is fully charged. 

What sort of questions were you asked while waiting in line?

Somebody came around and checked if we had gotten the text and whether the name on your government ID matched the text, after which you got a little red sticker. I got a sticker immediately, but because my significant other didn’t get a text, a nurse came around to check that the prescription that ze had gotten for PrEP matched zir name on zir government ID. 

Then, at the front of the line we had to fill out some demographic information. I can’t remember exactly all of the questions and possible responses. They do ask for your gender and I believe the options were:

  • Cis man
  • Cis woman
  • Trans man
  • Trans woman
  • Non-binary, gender non-conforming, and other
  • Prefer not to say

They also ask for your biological sex and I think the options were:

  • Male
  • Female
  • Intersex
  • Other
  • Prefer not to say

I chose prefer not to say for the assigned sex, but in hindsight, I wish I put female because that is my assigned sex at birth, and there is so little reporting on people who check female for their sex when getting the monkeypox vaccine.

What was the process like of receiving the vaccine?

Two workers who were very kind asked me to verify my information and then I got my vaccine in the very back of my arm, not exactly in the muscle or outer part of my arm where I got my Covid vaccine.

Afterwards, they sat me in a waiting area for 15 minutes to monitor me and make sure I didn’t experience any reactions to the vaccine, which I didn’t. It’s now been a little over 24 hours since I got my vaccine, and the arm pain was a little worse than it was with the Covid vaccine and boosters, but I’ve had no symptoms other than arm pain and it definitely subsided over the course of one day.

What are the next steps after receiving your first dose?

They’re still very unsure how they’re going to roll out the second dose of the vaccine. The earliest I can get my second dose is August 31st (a little less than one month after my first dose) and since I’m going back to school, I asked them if I can receive my second dose in another state. 

They were nice enough to ask their supervisor, but we’re still in such early stages of this, they weren’t even sure how the second dose is going to roll out, even if I were to stay in California. 

What advice do you have for anyone concerned about the monkeypox virus?

I urge anybody who is eligible to jump on getting the vaccine as quickly as they can. The eligibility does vary by state, but I would say get on it – and don’t get on it just because you’re gay. Everyone should get on it if they can and if they’re eligible.

The fear-mongering that’s happening is harmful and dangerous and it's centered in homophobia and transphobia. However, I do think the government should be making a bigger deal about it in other ways. I don’t fault individual people for being misinformed about this virus, because the government has been doing a poor job of talking about it in a way that is real and not based in fear and homophobia. 

Experts agree that monkeypox is not an STI, it’s a contact-based virus which is not transmitted through sexual contact alone. That being said, where do you think barrier methods and safer sex practices play a role in protecting yourself from the monkeypox virus?

I think of monkeypox being an STI in the same way that strep throat is an STI. They’re not STIs, but they can be transmitted during sex. The flu can be sexually transmitted as well! So yes, it’s not an STI, but it is a contact-based virus. 

If anything, my concern has been less about sex and more about who I’m being physically intimate with in terms of clothing and sheets. Maybe you’re not having sex with somebody, but maybe there’s someone you’re sharing a bed with – if that person has monkeypox, it’s also a risk. Of course there are levels to it, and we have to be realistic about the fact that you’re not as likely to get monkeypox from shaking somebody’s hand. However, it is highly possible to get monkeypox if you’re spending extended amounts of time touching or sharing sheets with someone who has it.

I think we use the term safer sex practices because it’s about being safer, and safety means a lot of different things to a lot of different people. Emotional safety is also important, but we don’t always talk about emotional safety in the context of generic safer sex practices like STI testing, barrier methods, pregancy testing, etc. Safer sex practices can also look like:

  • Having clean towels for post-sex aftercare
  • Cleaning your sheets as a form of aftercare
  • Peeing after sex
  • Communicating what your physical intimacy boundaries are

Concerns about monkeypox do fit within the umbrella of safer sex practices, but lots of things do too – I think we just need to be more expansive in how we think about physical intimacy and safer sex practices overall.

You mentioned that you’re polyamorous with multiple partners, do you have any advice for folks in polyam dynamics who want to talk openly with partners about fears, boundaries and concerns around the monkeypox virus?

I think transparency is important and also being firm in your boundaries. I’ve still been going on dates with people this month, but for my own personal preference, I’ve been limiting the dates I go on in LA. It’s definitely impacting the ways that I am dating, entering relationships and thinking about safer sex practices, but I don’t think anybody needs to be doing it the way I’m doing it. 

What I would suggest to other people in polyamorous and non-monogamous dynamics is just be upfront with all of the people that you’re currently interacting with, and maybe even the people that you’re not currently physically interacting with. It’s a part of emotionally safer sex practices to be transparent about it.

Transparency is the main tip I would recommend to people in polyamorous dynamics – just like with Covid – so that people can make informed decisions about what boundaries they want to set.