UPDATE: Monday 25th July 2022
Good news, vaccine access in the UK is now much wider than when we wrote this blog on 4th July.
Our advice to in-person sex workers of all genders is to phone up your local sexual health clinic now and ask for an appointment to get the Imvanex vaccine for protection against monkeypox. Don’t wait for them to call you. If your local clinic says they don’t have it, push them to find out and tell you where you can get it. If you manage to get an appointment, spread the word among other sex workers you know.
Should I be worried?
There’s no reason to panic. The best thing to do is stay calm and well informed.
At the moment [4th July 2022] the number of confirmed cases in the UK is relatively low, but they are rising. The sex worker community will probably start seeing increasing cases over the next few weeks.
Most people who get monkeypox will have relatively mild symptoms and recover within 2-4 weeks. It’s good to be aware of the virus so you can minimise your risk exposure and seek treatment if you need it.
Who can get monkeypox?
It is possible for anyone to get it. Sex workers who see in person clients are more likely to encounter it than the general non-sex working population because it is transmitted via close physical contact.
Most diagnosed cases so far have been in London.
Most people with diagnosed cases so far have been gay or bisexual men. This is because there have been outbreaks in spaces where some gay and bi men come into close contact, like saunas and sex parties, and the virus then spread to the people they have sex with.
There is nothing inherent to gay sex that results in higher transmission, and it’s very likely that sex workers who aren’t gay or bi men will start seeing more cases of the virus as cases rise. So while male sex workers need to be particularly aware of the higher risks of transmission in their community at this present moment, other sex workers also need to be alert.
It is absolutely vital that we reject stigma and homophobia when talking about monkeypox.
What symptoms should I look out for?
Look out for new spots, ulcers or blisters anywhere on the body, particularly the face and genital area. Other symptoms are fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion.
You can find pictures online in news reports of what monkeypox rash typically looks like, but it can vary so do still get it checked out if you have a rash that looks different.
The incubation period for monkeypox is usually between 6 and 13 days. This is the time between catching the virus and starting to show symptoms.
How is it transmitted?
Monkeypox is usually transmitted by close, skin-to-skin contact. This means that sex is a common way it is transmitted, but it is not a sexually transmitted infection in the way chlamydia or gonnorhea are.
Rashes, bodily fluids such as pus or blood, lesions and scabs are particularly infectious. If an infected person has lesions or sores in their mouth, it can also be transmitted through saliva.
Transmission can also take place through contact with clothing, bedding, towels, cutlery or other objects used by someone with monkeypox, provided their bodily fluids have been transferred to that item. The risk of surface transmission from other types of surfaces that people may have briefly touched with their hands (e.g. cash money or a door handle) seems to be very low or maybe non-existent.
There has been no reported airborne transmission of the virus. There have been several cases where people with monkeypox have been on international flights and nobody has been infected around them.
This means that monkeypox is less easily transmitted from person to person than COVID-19.
We don’t know yet whether it’s possible for people to transmit monkeypox if they are infected but have no symptoms.
Managing stress and anxiety
Because of the stigma surrounding infections associated with sexual transmission, a lot of people feel much more anxiety and fear of this virus than they would of other types of illness.
Scaremongering media stories aren’t helping.
And we know that for sex workers, any health situation that could mean you can’t work for a few weeks while you recover is an additional stress.
As a sex worker community, we can help counter the stigma by talking openly and non-judgmentally about this virus, and being caring and supportive to each other. We can also build confidence in advocating for our rights to healthcare. There’s a long history of sex workers having to push very hard to access the healthcare services we need.
How can I protect myself?
Depending on your situation, some sex workers will be better able to minimise risk than others. If you’re able to do any of the following, these steps can help reduce the risk of transmission:
● Examine your clients for any unusual lesions, rashes or blisters - particularly on the face or genitals.
● Try to get the Imvanex vaccine if you might be eligible - see below for more info.
● Put down a towel or new top sheet on the bed and change this between clients.
● Wash bedding and towels on a high heat.
● Avoid brushing your teeth immediately before or after seeing clients, as this can cause small cuts on your gums, increasing risk of transmission.
● Make a plan for how you might manage taking time to isolate / stop in person work if you get monkeypox. Could you start putting some extra income aside in savings? Could you look into offering more online services? If making this kind of plan is starting to really stress you out, take a break and come back to it when you’re in a calm headspace.
Is there a vaccine?
Yes, there is a vaccine called Imvanex but the NHS is currently only offering it to people considered to be at highest risk. At the moment, supply is very restricted but we are hopeful that will soon change and access will get easier. The government’s guidelines say that eligibility will be assessed on criteria similar to those for PreP - so that should include all in person sex workers.
However, vaccine supplies are currently being mostly restricted to men who are having sex with multiple male partners. If you’re a sex worker and you would be classed in healthcare terminology as being in the category ‘MSM’ (men who have sex with men), you should be able to access the vaccine now. Availability varies from clinic to clinic but if you get turned away, keep trying. If you come up against gatekeeping or get turned away at first, be prepared to be politely pushy.
Cis women are less likely to be prioritised for the vaccine right now, but if you’re a sex worker seeing multiple in-person clients you should be able to make a case for being prioritised over the next few weeks as vaccine supplies increase. Keep asking your local sexual health clinic when you will be able to get access.
For trans sex workers, we don’t know yet how healthcare services will assess eligibility. If your clients are in the ‘MSM’ group, you should be able to make a very strong case for getting the vaccine now. If not, do still advocate with your local clinic for access to the vaccine as soon as possible.
The vaccine is effective in reducing the risk and seriousness of a future infection but won’t reduce symptoms of people who are already infected. If you think you are already infected, then you should phone NHS 111 and ask about immediate treatment options.
What should I do if I think I have been exposed to Monkeypox?
Stay calm, and contact your local sexual health clinic and/or one of these helplines below.
The official advice is to isolate for 21 days if you are infected. This is not legally binding.
If you have a confirmed case, the health service will do contact tracing and they may offer you a post-exposure vaccine (PEP).
NHS 111 - this is a free, 24/7 NHS-run phone service which can connect you directly to NHS services.
Terrence Higgins helpline: 0808 802 1221.
THT also run a live chat service: https://www.tht.org.uk/our-services/support-services/tht-direct-helpline
Where can I get more information?
Terrence Higgins Trust:
UK Government information:
Guidance for isolating with monkeypox symptoms:
https://www.gov.uk/guidance/guidance-for-people-with-monkeypox-infection-who-are-isolating-at-home
UK vaccine strategy:
https://www.gov.uk/guidance/monkeypox-outbreak-vaccination-strategy
World Health Organisation factsheet:
https://www.who.int/news-room/fact-sheets/detail/monkeypox