Join Our Capitol Hill Champions Reception for World AIDS Day

America does not feel safe. The radical right has weaponized my existence so there is a bounty on my head, and that of everyone who is different. Club Q was another on a long list of mass shootings. Nothing makes sense and everyone is afraid. The Right hates the Left, the Left hates the Right, and people are being killed. Thursday is World AIDS Day and there are events across the world. I pray for our safety because we cannot hide and must fight. Join us in person or online. RSVP for the briefing and/or the free reception at

Congress of the United States
Washington, D.C. 20515
November 21, 2022

Minority AIDS Initiative Briefing
Thursday, December 1, 2022, 9:30 a.m. – 10:15 a.m.
Followed by a reception, 10:30 a.m. – 11:30 a.m.
2359 Rayburn House Office Building

Dear Colleague:

By now, you should have received an invitation to NMAC’s World AIDS Day briefing on the Minority AIDS Initiative (MAI). The briefing will be held on Thursday, December 1, 2022, from 9:30 a.m. – 10:15 a.m. in 2359 RHOB. Immediately following the briefing, NMAC will host a reception honoring Members of Congress for their contribution towards ending the HIV epidemic. The reception will take place from 10:30 a.m. – 11:30 a.m. in the same room.

Racial and ethnic minorities continue to be severely and disproportionately impacted by HIV/AIDS in the United States. People of color represent the majority of new HIV diagnoses, people living with HIV/AIDS, and deaths among people with HIV/AIDS. African Americans account for 43 percent and Latinos account for 26 percent of new HIV diagnoses. Asian Americans, Native Americans, and persons of multiple races account for an additional 5 percent combined. Tragically, the rate of new diagnoses among African Americans and Latinos is about eight and three times that of whites respectively.

The Minority AIDS Initiative is an indispensable tool in the effort to combat these unacceptable disparities. This critical initiative targets funds for HIV/AIDS prevention, screening, treatment, education, and outreach to minority communities heavily impacted by HIV/AIDS. The funds are intended to provide community-based organizations that serve minority communities with the help they need to develop capacity and deliver culturally and linguistically appropriate care and services. Consequently, the initiative seeks to fill gaps where the needs are the greatest and strengthen efforts to fight the epidemic nationwide.

Presenting at the World AIDS Day briefing will be MAI expert Dr. Maya Rockeymoore Cummings; Harold Phillips, White House Director of the Office of National AIDS Policy; and Joe Huang-Racalto, Director of Public Policy and Strategic Partnerships at NMAC.

We hope you will consider attending NMAC’s World AIDS Day briefing and the reception that follows. To RSVP for the briefing and/or the reception, please email


Maxine Waters                        Barbara Lee
Member of Congress              Member of Congress

This year NMAC honors House Majority Whip James E. Clyburn (SC), the Honorable Sheila Jackson Lee (TX), and the Honorable Jenniffer González Colón (PR). Thank you, Merck, the presenting sponsor for the reception and Kelley Drye for their support. Our movement is dependent on federal funding to care for people living with HIV and to end the epidemics. Our job is to keep HIV, STDs, and Hepatitis on the agenda of Congress and the Administration. On this World AIDS Day, thank you for staying strong during these difficult times.

Yours in the Struggle,

Paul Kawata

Paul Kawata

Remembering Urvashi Vaid

I went to the memorial for Urvashi Vaid. While I did not know her well, I was a fanboy for this powerful out South Asian Lesbian who opened doors. During these difficult times, the service was exactly what was needed. It helps to remember that our work stands on the shoulders of greats. The gathering was so New York and fabulous without trying. Watching Tony Kushner hold back tears as he tried to explain how Urvashi and Kate Clinton gave him a social life to the icon and GOAT Gloria Steinem who connected Urvashi’s work in the larger struggle for justice and equity. It was exactly what she deserved and our movement needed.

I am worried. I don’t know what’s happening to our country. I’m watching in disbelief and sadness. The world does not feel safe for people who are different. We are fighting for our right to exist, to love and be loved. This was not how it should be. Yet here we are, again. The war has started, and we are not ready. Last week the Supreme Court heard arguments to abolish affirmative based on race. Where is the outrage? In Texas there is a case that uses the Religious Freedom Act to allow employers to stop paying for HIV PrEP because it offends their religious beliefs. They are trying to dismantle the entire Affordable Care Act.

Everything seems upside down and backwards. Regardless of how the elections work out, the struggle is not going away. I am not going to stop being Gay because it offends you or your God. My skin is the color of my skin. These are things I would not change even if I could, and I can’t. How do we live in the same country when my very existence is an affront to your God?

It’s time to build institutions and movements that can work across purposes. We need a NATO for social justice. If they go after one of us, we all stand together in solidarity. Supportive donors need to give like never before. The funding needs to be unrestricted and multiyear. Support should prioritize real political power so we can fight back and not be helpless as they decimate our worlds. The radical right has spent the last 50 years working to overturn Roe and reshape America. We must catch up before it is all gone.

This is how I will remember Urvashi. In 1990 she interrupted a speech by then President George H.W. Bush. I was in the room. It was thrilling and scary. Part of an inside/outside strategy about the Ryan White CARE Act.

Like so many in HIV, I’ve attended too many memorials. We are a generation of walking wounded who saw too much and hurt too long. We buried lovers and friends in numbers that are still incomprehensible. I am tired and crushed to see our work going backwards. Make no mistake, this is a fight about our existence on the planet.

Yours in the Struggle,

Paul Kawata

Paul Kawata

Do The Right Thing!


The letter below was sent to HHS Secretary Xavier Becerra from the following members of Congress: Maxine Waters, Bill Pascrell, Jr., Joaquin Castro, Barbara Lee, Raúl M. Grijalva, and Nanette Diaz Barragán. The Black AIDS Institute, Latino Commission on AIDS, NMAC, and the SF Community Health Center are working with key members to bring the Minority AIDS Initiative back to its original intent.

Congress of the United States
Washington, D.C. 20515September 1, 2022

The Honorable Xavier Becerra Secretary of Health and Human Services
Department of Health and Human Services
200 Independence Avenue S.W.
Washington, DC 20201Dear Secretary Becerra:

We write to urge you to return the Minority AIDS Initiative (MAI) to its originally intended purpose of directing strategic HIV resources to minority-led organizations in order to close the racial and ethnic gap in the HIV epidemic. Minority-led organizations have the cultural competence and proximity to the affected communities that make them ideal partners for helping to end the epidemic.

Earlier this year, we requested that the House Appropriations Committee include language in the report to accompany the FY 2023 Labor, Health and Human Services, and Education Appropriations Bill, recommending that the Secretary of Health and Human Services direct MAI resources to minority-led organizations. In response to our request, the Committee included the following language under the subheading, “Minority HIV/AIDS Fund:” “The Committee […] encourages the Secretary to prioritize MHAF grants to HIV-based agencies that are minority led with preference given to organizations led by women, men, and transgender persons who identify as African American/Black, Latino, American Indian/Alaskan Native, Asian American, and/or Native Hawaiian/Pacific Islander.”

It has come to our attention that this language, and its inclusion under the aforementioned subheading, could be interpreted as applying solely to the $60,000,000 that the Committee provided specifically for the Minority HIV/AIDS Fund, which is managed by your office within HHS. We are writing, therefore, to clarify that it is our intent that this language be applied to all MAI funds controlled by all four of the HHS agencies involved in the administration of the MAI. These agencies include the Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Office of the Secretary.

Of course, we realize that the guidance included in the FY 2023 report will not have standing until Congress has enacted a final Omnibus Appropriations Bill for FY 2023. Nevertheless, we urge you to use your discretion to begin immediately to direct MAI resources to minority-led organizations that have the cultural competence and proximity that enables them to serve minority communities effectively, and to do so across all four of the aforementioned HHS agencies.

We are grateful for your attention to our concerns, and we respectfully request a response from you prior to November 15, 2022. Furthermore, once an Omnibus Appropriations Bill for FY 2023 has been enacted, we would appreciate confirmation from the directors of each of the relevant agencies of their intent to comply with the guidance in the FY 2023 report.


Secretary Becerra and Assistant Secretary Rachel Levine, it’s your move. CDC, HRSA, SAMHSA, and the Secretary’s Office need guidance to quickly address this inequity. As we continue to see with HIV, COVID and now Monkeypox, people of color shoulder a disproportionate burden of disease. When the Congressional Black Caucus works with leaders from the Congressional Hispanic and other Caucuses provide this guidance, it’s time to do the right thing!

Yours in the Struggle,
Paul Kawata
Paul Kawata

Live Monkeypox Town Hall Oct. 10



Monkeypox Town Hall

Monday, October 10, 6:30 PM ET
San Juan, PR
Livestreamed on Facebook

Five of the nation’s leading organizations focused on ending the HIV, STD, and hepatitis epidemics – AIDS United, NASTAD, the National Coalition of STD Directors, NMAC, and The AIDS Institute – will host a Town Hall on Monkeypox at the 2022 United States Conference on HIV/AIDS. This event will be livestreamed on Facebook.

This Town Hall will invite federal, state, and local leaders to come together with USCHA attendees to have an important but difficult conversation on roles and responsibilities with MPV. Unfortunately, this is another virus that disproportionately impacts gay and bisexual men, particularly Black and Latinx gay men.

Vaccinating all sexually active communities that are impacted by MPV will not be easy or cheap. Our agencies are very concerned that HIV or STD funding does not get reprogrammed for MPV. There is also so much misinformation. We are inviting federal leaders to update and clarify what is known and the next steps.

The Town Hall will be facilitated by:

Daniel Driffin
Damián Cabrera

All USCHA attendees and people on Facebook are invited to listen, ask questions, or make statements. Due to time constraints, comments will be limited to three minutes per person. A report will be produced from the proceeds to help inform next steps.

Yours in the Struggle,
Paul Kawata
Paul Kawata

CDC Admits Problems

My world is literally out of focus (cataracts), and I am mad and concerned. If the last two years were not enough, now we must fight Monkeypox (MPV). How much more must we endure? There is too much pain and loss. I am exhausted by the suffering, overwhelmed by the fighting, and worried about SCOTUS. Below is Aug. 18th data from Philadelphia:

Leaders are not supposed to say these things publicly. We are supposed to be the paragon of virtue and hard work. These unrealistic pictures are why so many fail or quit. I’m speaking my truth so you don’t have to feel alone. Life is hard and there is no clear end. The only thing we have is each other.

Centers for Disease Control and PreventionLast week the Centers for Disease Control and Prevention publicly admitted what we all knew: their response to COVID was less than ideal. This announcement was unprecedented and hopeful. They’ve made a commitment to be ready for the next pandemic. I hope they understand that Monkeypox is here. Their ability to stop MPV before it becomes endemic will demonstrate their real-world capacity. I want CDC to succeed but can’t turn a blind eye to the challenges.

This week Daniel Driffin and Damián Cabrera have two meetings with the White House to talk about Monkeypox. Surgery makes it impossible for me to attend. I’ve asked them to do four things:

  • Fight for more vaccine
  • Ensure Vaccine Equity
  • Work to overcome Vaccine Hesitancy
  • Remember SCOTUS

At their meeting with Mr. Fenton and Dr. Daskalakis, they will be joined by people who got Monkeypox. There is too much fear and discrimination. These community leaders will ask the White House to fight the stigma associated with this virus. To understand that it is rooted in homophobia and racism. During these difficult political times it may be used as a weapon to discriminate against the LGBTQI community.

We’ve also invited David Garcia, the executive director of Affirmations in Michigan. Recently, he shared the frustration of getting MPV vaccines to his community. NMAC asked him to share his story. In some regions it is the “Hunger Games” to get shots.

I know the White House and CDC are committed to these values, but can they deliver? As we saw with COVID, CDC’s ability to communicate basic messages often got lost in their efforts to be scientifically accurate. They feel the responsibility to be the CDC, but that happens at the expense of clear messages that community can understand. The world has changed and their position as the ultimate authority is irrelevant in the age of TikTok. The old paradigm of doctors in white coats must give way to the reality that America is diverse and complex. We want to see our faces in the leadership and programs. Communications from old White cisgender men does not cut it in the new world.

To be clear, Dr. Walensky just got to the CDC and these challenges go back decades. COVID showed what the HIV community already knew: our movement needs a CDC who understands how to reach the communities highly impacted by HIV and now Monkeypox and who understands that leadership is collaborative, and their responsibility is to build a bigger table. The days of telling us what or how to do it are over. We wasted too much time on DEBBIs and EBBIs.

If I seem bitter, please know it’s not because of the CDC. My bitterness comes from a world that feels unrelenting and out of control. Just as I was getting ready to exhale, there is another virus that some people will use to make political points. I can feel the judgements oozing from their pores. Gay and bisexual men are getting what we deserve. They see and judge us as scum. With a bible in one hand, they believe we are going to hell. Don’t let your urban bubbles fool you. We are in a fight for the soul of America and we could lose.

Our fight against Monkeypox, like our fight against HIV, must address the racism and homophobia that these viruses engender. Whether we like it or not, these political hot buttons are inextricably intertwined with our efforts to end the HIV epidemic and our work to stop monkeypox from becoming endemic. I worry about the government’s ability to fight what might be inherent in its systems. For too long government systems were built on values that did not reflect community with systems that reward compliance at the cost of innovation. The search for scientifically proven solutions assumes a static community when the opposite is true. COVID/HIV/Monkeypox solutions need flexibility and innovation. That is not usually a strength of government. I wonder if change is even possible.

I know the leaders at CDC are good competent people who want to do the right thing. The challenge is they live and work in a system that was built decades ago by alpha White male doctors who were taught to be gods and not collaborators. To them weakness was a problem and not a virtue. They were going to save us from ourselves rather than take the time to understand and celebrate who we were. Thank you, CDC, for admitting there was a problem. The proof will be in your ability to change. Next up is Monkeypox. Can you put together systems that are more than just getting out vaccines? Monkeypox, like COVID, requires targeted outreach to communities that might not trust the government. As we’ve learned with HIV, it’s not enough to just provide the medication; we must build systems that reach people where they live. Systems that understand and celebrate the communities needed to be reached.

Yours in the Struggle,
Paul Kawata
Paul Kawata

Welcome to Our New MPV Newsletter

This is the first of what will be a weekly NMAC newsletter on the latest developments in the monkeypox (MPV) epidemic. Production of this newsletter is supported by a grant from Gilead Sciences to NMAC to serve as the coordinating center for the policy response to MPV.

These newsletters are intended for service providers, people living with or at risk of MPV, and policymakers at the federal, state and local levels. Each newsletter will provide updates on the latest data pertaining to MPV, especially as it relates to public policy. These newsletters will center the individuals and organizations most heavily affected by MPV, profiling people living with or at risk of MPV as well as the organizations that are contributing to the fight against this national health emergency.

Why NMAC is helping lead the fight against MPV
NMAC leads with race in the effort to end the HIV epidemic in the U.S. This focus demands that NMAC become engaged in the fight against MPV. Gay/bisexual men – the population most heavily affected by HIV – account for at least 94% of people with MPV. People living with HIV make up 41% of people diagnosed with MPV.

As in the case of HIV, the communities of color for which NMAC advocates are disproportionately affected by MPV. Black and Latinx people account for about one-third of the U.S. population but for 54% of people with MPV. In Georgia, Black people account for 33% of the state’s population but for 82% of the state’s confirmed MPV cases.

Just as people of color are markedly less likely than white people to obtain PrEP or to achieve HIV viral suppression, Black and Latinx gay/bisexual men are being left behind in early efforts to roll out MPV vaccines. In the case of MPV, leading with race means immediate action to ensure equitable access to the prevention of MPV, timely treatment of MPV, and MPV vaccination.

MPV: The latest developments
MPV is spreading rapidly

The federal government has been slow to respond

  • There are shortages of every key tool needed to fight MPV (prevention, testing and treatment) – in large measure because of the federal government’s failure to plan and respond aggressively to protect the health of gay/bisexual men. TPOXX, the only drug available for the treatment of MPV, is in short supply, and doctors who have MPV patients must complete a 27-page application and obtain federal approval before they can administer the drug for their patients who are experiencing severe MPV-related pain.
  • The country has an acute shortage of MPV vaccines because the federal government, even though it owned millions of doses of the vaccine, failed to ask the manufacturer to bottle it for distribution. The federal government is now racing to close this gap, but current estimates indicate that the vaccine shortage won’t be resolved before 2023.
  • To make the limited supply of vaccines go as far as possible, the federal government has approved administration of a smaller dose between the layers of the skin rather than a full dose under the skin. CDC also recommends that people exposed to monkeypox receive post-exposure vaccination (ideally within four days of exposure).

The Biden Administration has declared MPV a national emergency

  • The President named Robert Fenton, an emergency response expert, and Dr. Demetre Daskalakis, of the CDC, to lead efforts to coordinate a national MPX response. It is hoped that the emergency declaration will open new funding for the MPX response and light a fire under the federal bureaucracy to overcome its early fumbles.

Building on the leadership of Black and Latinx gay/bisexual men to fight MPV
Given the disproportionate impact of MPV in communities of color, efforts to address this national emergency must elevate the voices of Black and Latinx gay/bisexual men. To help NMAC serve as the coordinating center for the national MPV policy response, Daniel Driffin has agreed to spearhead advocacy with the White House and other arms of the federal government. A Black gay man living with HIV in Atlanta, Daniel co-founded THRIVE Support Services, an innovative community-centered support and service program that aims to promote the health and well-being of Black gay men.

“Regardless of whether it is cancer, HIV, STIs, housing or other social determinants of health, Black gay men are often the last group for whom solutions are provided,” Daniel says. He has seen this with MPV vaccines in his hometown of Atlanta. “Anytime a local health department stands up a vaccine clinic, within minutes all of the available appointments are gone, and the slots aren’t going to the Black and brown men who are most affected.”

Although the challenge of ensuring vaccine equity is considerable, Daniel knows from his own experience that there are solutions to this problem. “COVID-19 has shown that with the right education and the right messengers, Black and brown people have the same uptake of vaccines as other people. Ensuring that Black and brown people are included in the response from the outset – from Day Zero – is critical if we want to ensure equity.”

Yours in the Struggle,

Paul Kawata

Paul Kawata

Dear Mr. Fenton

NMAC logo

Mr. Robert J. Fenton Jr.

National Monkeypox Coordinator
The White House
Washington, DC

Dear Mr. Fenton,

Congratulations on your appointment as the National Monkeypox (MPV) Coordinator. Kudos on the White House announcement on alternative dosing.

There are concerns about implementation. Like you, NMAC will follow the science.

NMAC (formerly National Minority AIDS Council) leads with race to end the HIV epidemic. Thanks to an unrestricted educational grant from Gilead, the agency has put together the moniker This program, like our mission, leads with race to stop MPV. Our work prioritizes MPV vaccine equity and overcoming vaccine hesitancy, particularly for gay men of color, the transgender community, Black women, and sex workers.

Thankfully, Dr. Demetre Daskalakis is on your team. He has our full support. Given the reality that gay and bisexual men, especially Black and Brown gay men, are 98% of people with MPV, there is a critical need to address equity.

Policy Priorities

  1. More MPX Vaccines
  2. Fight for Vaccine Equity
  3. Overcoming Vaccine Hesitancy
  4. Culture Wars

The number one priority is more vaccines. NMAC urges you to quickly overcome any impediments to getting vaccines into arms. While alternative dosing was a good first step, the virus is quickly spreading. Each day, I read the new US case count and worry. Community is watching and losing patience.

Recent data said 63% of people with MPV are people of color. NMAC is concerned that history will repeat itself and this becomes another on a long list of challenges impacting communities that are overwhelmed by too many issues. If COVID taught us anything, there needs to be vaccine equity plans at the start. We cannot be an afterthought.

Given the numbers, will hold-up and tell the stories of Black and Latinx gay and bisexual men. We will also tell stories from the frontlines. Leading our efforts are:

 Daniel Driffin         Damián Cabrera

On Wednesday, our first monkeypox e-newsletter goes out for free to the entire NMAC mailing list. You will get three pieces of email each week which could be annoying, so we ask for your patience. We are still working out the kinks. At some point, we hope MPV will just go away or at least the need for a weekly newsletter will.

Vaccine hesitancy is a challenge when reaching gay men of color, particularly Black and Latinx men. The White House needs to support targeted education and training. General outreach won’t work. While the HIV community has decades reaching these communities, as we’ve seen from PrEP, it has not always been successful. Do not let history repeat itself.

MPV may be used by extremists to say gay men are sick and undeserving. Once again, it all sounds too familiar and impossible. The political, moral, and ethical contradictions abound. Vaccine education programs may require outreach and campaigns that they will find offensive. Let’s not kid ourselves: MPV sits in the middle of the culture wars.

I hope you can visit an LGBTQ clinic. During these times without enough vaccine, your support and work to get them shots is critically needed. As we’ve learned with COVID, we must take care of our heroes on the front lines.

Monkeypox, like HIV, is more than numbers. There already is too much stigma. Sometimes with social media it feels like the early days on steroids. Please come out of the gate fighting MPV stigma. Like HIV stigma, it comes from a place of homophobia and racism. In this political climate, it is particularly dangerous.

Yours in the Struggle,

Paul Kawata

Paul Kawata

USCHA Almost Sold Out

Thank you to everyone who registered early for the 2022 United States Conference on AIDS. The meeting had the largest number of early bird registrations. Close to 3,000 folks are on the list to attend. As a result, NMAC made the difficult decision to keep registration open for only 500 more delegates. It is first come first served and we will close when we reach capacity.

The conference made this difficult decision because it is unfair to take people’s money when there are so few reasonably priced hotel rooms still available in San Juan. USCHA has sold out of the group rate at five hotels. Hotel rooms are still available in San Juan, just not at the lower negotiated USCHA group rates. Now the gathering must refer people to Airbnb or more expensive hotels. While USCHA gets no support, most of Airbnb’s rental fees go to locals who can use the money. We will only provide buses between official conference hotels and the Puerto Rico Conference Center. Please make sure your Airbnb is close to an official hotel so you can catch the free USCHA bus.

Hotel rooms have been set aside for scholarship recipients. They do not need to worry. Thanks to our major sponsors Gilead, ViiV Healthcare, Janssen, and Merck, USCHA is giving away a record number of scholarships. However, we still turned down many very qualified applicants. Moises Agosto, NMAC’s Treatment Director, put together an article about the scholarship process for Thursday’s e-newsletter.

There is very limited exhibit space. Around 90% of the exhibit hall has been reserved. It will be sold out soon. Exhibitors get passes to attend the conference. Click here to reserve a booth. Given the challenges of shipping to Puerto Rico, we encourage them to use San Juan based companies for printing, booths, receptions, and give aways. Not only does this bring much needed resources to the local community, but it also lets you bypass shipping headaches. Many partners host private receptions, so please consider working with the local community to identify locations and businesses that support the HIV community. USCHA is the first large conference in PR to happen since COVID and locals are excited for our meeting.

As an example of working with regional providers, USCHA contracted with Connecting Paths to sew all the conference bags. Connecting Paths is a local nonprofit that fosters community entrepreneurship in Puerto Rico. Since hurricane Maria (2018) they have trained 87 women and 20 of these women are sewing the conference bags. Please watch their Spanish language YouTube video to learn more. USCHA is an opportunity to bring much needed economic development to Puerto Rico. Please support the businesses that support the local HIV community.

While space is very limited, we want to encourage our federal partners to send key staff to meet with attendees. The community desperately needs your leadership and partnership to complete our mission to end the HIV epidemic by 2030. Show up to show your support for the leaders on the frontlines. There may be budgetary issues since the meeting happens in the new fiscal year and NMAC is willing to work to make any needed accommodations. Please contact Tara Barnes-Darby for assistance.

NMAC wants to thank the local host committee co-chairs:

I’ve put hyperlinks to their emails so that you can contact them about restaurants, bars, and companies that support the HIV community in San Juan and Puerto Rico. NMAC also has staff who live in San Juan. Damian can answer questions about local agencies, culture, and community. Please email Damian with any questions.

It’s only July and the meeting is almost sold out. Most people will think it’s because we are going to PR. I want to believe our movement is committed to language justice, reaching the Latinx community, and learning in an environment when English is the second language. Building a movement is key to our ability to end the epidemic. USCHA is the place where we come together to check-in, learn, and nurture our family. The world is going crazy, and we need each other more than ever.

Damian Cabrera-Candelaria
Program Manger Treatment

Yours in the Struggle,

Paul Kawata

Paul Kawata

A Call to Plan

This is not a joke. In the middle of a world out of control, it’s time for the CDC to review the science on monkeypox (MPX) and recommend that all sexually active gay and bisexual men, regardless of their HIV status, get the MPX vaccine. NMAC makes this request to trigger the development of national, state, and local plans. Between the World Health Organization’s (WHO) declaration and the data in the New England Journal of Medicine (NEJM), where 41% of the people who got MPX are also living with HIV, it’s time to move from monitoring to planning.

Last weekend the WHO declared monkeypox a public health emergency of international concern. There are over 16,500 cases in 74 countries. In the US, there are 2,800 cases in 44 states, DC, and Puerto Rico. A recent article quoted the NEJM that said 95% of MPX cases were transmitted through sexual activity. Ninety-eight percent of the people who got MPX were gay or bisexual men. Forty-one percent were living with HIV. The declaration and science cannot be ignored. There needs to be a new standard of care that recommends and implements initiatives so all sexually active gay and bisexual men get the MPX vaccine.

While the recommendation prioritizes sexually active gay and bisexual men, vaccination targets may need to be expanded if we are unable to control MPX. Plans should include the transgender community, sex workers, and staff who work where there is sexual activity (bathhouses, saunas, and sex clubs). Due to shortages, there is not enough vaccine. This failure will not be forgotten. Hopefully, the system will be fully stocked in September. The next 45 days should prioritize planning. Vaccine equity and overcoming vaccine hesitancy are key. NMAC is particularly concerned about reaching people of color. The COVID vaccine roll-out showed it’s not enough to just make the vaccine available. There are too many who are unaware of MPX and/or who do not trust the system. Plans must prioritize hard to reach communities.

The WHO declaration validates the need for leadership and funding from the White House. Since the White House’s MPX response is coordinated by the National Security Agency (NSA), it’s time to bring everyone together to plan how to plan. Vaccine equity and overcoming vaccine hesitancy may create new pathways to educate about PrEP and/or U=U. While MPX and HIV impact the same communities, we don’t know much about the specific impact the virus that causes HIV has on MPX. Does viral load impact MPX outcomes? Since there are different versions of the MPX vaccine, is there a need to recommend a specific vaccine for people who are immune compromised? While there is a shortage, should we prioritize getting at least one MVA vaccine?

Why is HIV getting involved in MPX? These viruses impact the same communities and HIV has the infrastructure to support this huge lift. However, it is too big a task and requires coordination across multiple movements. Vaccine experts may not understand how to reach the target communities. The data and experience of vaccinating all sexually active gay men could support efforts to end the HIV epidemic. While many health departments have already started, there needs to be a coordinated national response. The sooner we vaccinate, the better our chances of stopping MPX from becoming another epidemic. It starts with an emergency transfer of $100 million to be drawn broadly from HHS. Federal guidance to health departments to reprogram HIV and COVID funds. Support for the National Coalition of STD Directors request for $100 million in new federal funding. But we can’t wait for Congress.

This is too much and our plates are already full. I really hoped to avoid this burden, but the virus had other plans.  The thought of vaccinating all sexually active gay and bisexual men is overwhelming. This is a very heavy lift that is going to take money, planning, and coordination across multiple sectors.

I got the monkeypox vaccine (MPXV)! Normally I would not share this information, but there is too much slut shaming, particularly from other gay men! I’m shocked I tell you. It’s a vaccine, not a lifestyle. Getting it says I care about my health. It’s the same smallpox vaccine that has been around for decades. Many older Americans got the shot; however, routine vaccinations stopped in 1972. If you don’t recall getting the vaccine, it is OK to get another dose. Talk to your doctor.

There are multiple versions. I got the MVA vaccine which is built around a weaker version of the virus and is much safer. The ACAM2000 vaccine contains active virus and is not recommended for immune compromised individuals. Are PLHIV considered immune compromised if they have an undetectable viral load? Once again, the role of treatment education is critical to our field.

Like the COVID vaccine, MPX vaccines needs to be free. Given the large percentage of PLHIV who might also get MPX, HRSA needs a MPX strategy for Ryan White clients. Can their infrastructure be used to vaccinate sexually active PLHIV? What about gay men who are HIV negative? While the data is clear, more science is needed. Hopefully, answers and strategies will be shared at the International AIDS Conference and/or the National Ryan White Conference. NMAC’s Treatment Division will have MPX updates at the 2022 United States Conference on HIV/AIDS. We will also try to get vaccines onsite at the meeting.

I got my MVA vaccine in Canada. It’s free, even for tourists. Why does Canada have enough MVA vaccines, even for tourists, but we have to wait until September in the US? You’ve got to love the Canadian healthcare system. Mobile vaccine clinics are set-up in the Gay Village of Montreal. A handsome young man in scrubs asked me to talk about monkeypox (MPX). I said, “I’m a tourist”, he said “it didn’t matter.” For folks going to the International AIDS Conference in Montreal, schedule an appointment and visit the mobile clinics in the Village. The site is in French, so click on the FR language icon in the upper right corner and it will change to English. When putting together plans, think outside the box. Set-up clinics in the places where gay and bisexual men gather.



Thank you to the National Council of STD Directors for their leadership on this issue. For more information on MPX go to their Command Center. There is also a letter from community to Secretary Becerra that outlines multiple requests. Also check out the O’Neill/amfAR brief on Monkey and Meningococcal Disease Outbreaks that more fully outlines concerns.

The White House needs to lead with community to develop a domestic strategy to stop MPX before it becomes another epidemic. Sexually active gay men, regardless of their HIV status, need to get the MVA vaccine. Because there is a vaccine, MPX might go away quickly, another in a long list of faded viruses, but right now no one knows. Unfortunately, this is not a joke.

Yours in the Struggle,

Paul Kawata

Paul Kawata

The Reckoning Is Here!

I got COVID! What fresh hell is this? Thankfully, I’m double vaxxed and double boosted. It was the perfect ending to an awful couple of weeks. Just when I thought it couldn’t get any worse, two lines on a plastic tray said different. The reckoning is here! It seems like the planet and its inhabitants can’t catch a break. Just when we might get a respite, the world says “ah.” Here’s the assassination of the former Prime Minster of Japan, war, recession, more guns, no abortions, school prayer, new variants, and it’s just July. What do you think the fall is going to bring?

To be honest, I’m pissed I got COVID. Like everyone, I’m doing the best that I can, but it is not possible to live in a bubble and still have a life. I am over it. By “it” I mean all the things that don’t make sense. Why are we having culture wars in the middle of a pandemic? When we most need to be united, we find ourselves divided. Instead of working together, we are fighting of the soul of the country. Maybe the pandemic really was the catalyst for change. The virus brought to the surface what had been badly hiding for too long.

I was on a zoom with Dr. Rachel Levine, the Assistant Secretary for Health. Yes, I’m that Queen, dropping names like I drop bombs. I shared concerns about a certain member of Congress and was Dr. Levine OK? She says she’s fine, but I’m worried. The congresswoman’s dog whistles can lead to real harm. She put Dr. Levine in the crosshairs of hate. The White House and HHS have made sure she is safe. In addition to being a pediatrician and four-star admiral, she is living proof that we are everywhere, and we are not going away.

If the radical right follows their regular formula, they will begin to question the abilities of multiple senior LGBTQ officials, trying to generate fear about the large number of homosexuals working in the administration. Our pride makes another community afraid and angry. Dr. Levine gives me hope, but to the some she is a sign of the end of days.

The problem is there is no compromise or middle ground. We are not going back into the closet. I am a Queen, not a punching bag. I deserve to live a life free from prejudice and discrimination in all my outrageousness. Some people may see me as an exaggeration, but they underestimate me at their peril.

We have decades of experience fighting against a world that wished us dead, literally and figuratively. Our ability to work in coalition with like minded communities serves everyone. It starts with a strategy for survival in a world that hates us, who we love, the color of our skin, our gender, or how we choose to express our gender. If we spend too much time trying to fit into their box of acceptability, we lose everything that makes us special. Don’t be less so somebody can feel more. We deserve to be here and to sit at the table. In the fight to end HIV, our voice is critical.

It may be the fever from COVID, but I can’t believe the Supreme Court and, as a result, our country are again reviewing the legality of abortion, sodomy, school prayer, and affirmative action. Issues that were long ago decided are now at risk. Justices who sold themselves as conservatives are actually very radical. While it may have been a smart short term power play, I don’t think they are prepared for the civil unrest that will follow. This Supreme Court is just starting to reveal its true nature and will set off the reckoning that is coming for all of us.

Since I had to isolate at home, I got to catch up on RuPaul’s Drag Race. I love the show because it celebrates being different. This program showed the world the art of drag. If Mama Ru taught us anything, it’s to tell your unique story in all its beauty and drama. Take the things that caused shame and transform them into your greatest strengths. I can’t imagine living the life my good Japanese parents envisioned for me. Coming out was one of the most courageous acts of treason I’ve ever accomplished. I murdered the man my parents wanted me to be to become the Queen I was supposed to be.

Yours in the Struggle,

Paul Kawata

Paul Kawata