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BARCELONA, Spain (AP) — As a sex worker and adult film actor, Roque was relieved when he was one of the first Spaniards to be vaccinated against monkeypox. He is aware of several cases among men who have sex with men, the main population for the disease, and worries he may be next.

“I came home thinking, ‘Bah, my God, I’m saved,'” the 29-year-old told The Associated Press.

But it’s too late. Roc, the name under which he works, was infected by a client a few days ago. He joins Spain’s growing number of monkeypox infections, which have become the highest in Europe, as the disease spreads beyond Africa and has been endemic for years.

He started showing symptoms: pustules, fever, conjunctivitis, and tiredness. Dapeng was hospitalized for treatment before he recovered and was discharged.

Spanish health authorities and community groups are struggling to contain an outbreak that has claimed the lives of two young men. They reportedly died from encephalitis or swelling of the brain that could be caused by certain viruses. Most monkeypox cases cause only mild symptoms.

Spain has had 4,577 confirmed cases in the three months since the outbreak began, linked to two sprees in Europe, where experts say the virus is likely to be transmitted sexually.

The only country with more infections than Spain is the larger United States, which has reported 7,100 cases.

Overall, the global monkeypox outbreak has seen more than 26,000 cases in nearly 90 countries since May. There are 103 suspected deaths in Africa, mostly in Nigeria and Congo, where monkeypox is more deadly than in the West.

Health experts stress it’s not technically a sexually transmitted disease, although it spreads primarily through sex among gay and bisexual men, who account for 98% of cases outside Africa. The virus can spread to anyone who has had close physical contact with an infected person, their clothing or sheets.

So part of the complexity of fighting monkeypox is balancing not stigmatizing MSM, while ensuring that both vaccines and calls for greater caution reach those who are currently most at risk.

Spain has distributed 5,000 second doses of the vaccine to health clinics and expects to receive another 7,000 doses from the European Union in the coming days, the Spanish Ministry of Health said.

To ensure these injections are managed wisely, community groups and sexual health associations for LGBT women are taking the lead.

In Barcelona, ​​BCN Checkpoint, which focuses on HIV/AIDS prevention in the gay and trans community, is now reaching high-risk groups to provide them with a precious vaccine.

Pep Coll, medical director of BCN Checkpoint, said the vaccine was being rolled out for those who are already at risk of HIV infection and who are receiving preemptive treatment, men with a large number of sexual partners and engaging in “chemical intercourse” (with the use of drugs), ​A person whose immune response is suppressed.

However, far more people fit these categories than doses.

“If we just consider (the number of people on preventive HIV treatment) plus the number of people living with HIV, we’re talking about 15,000 people (in Barcelona alone),” Cole said.

Lack of vaccines, Africa much worse than Europe and the USexperts say, making social public health policy key.

As with the coronavirus pandemic, contact tracing to identify those who may be infected is critical. But while COVID-19 can be simply airborne to anyone, the close physical contact that is the primary vector of monkeypox has made some people reluctant to share information.

“We have a steady stream of new cases, we may have more deaths. Why? Because contact tracing is so complicated, because it can be a very sensitive issue for someone to identify their sexual partner,” Spanish Vaccines said Amos Garcia, president of the Society and an epidemiologist.

Spain says most cases are among men who have sex with men, and only 5% are women. But Garcia insists that will subside unless the entire public, regardless of gender or sexual orientation, understands the greater risks associated with having different sexual partners.

“The same thing happens with AIDS/HIV, and at a certain point, the MSM group is the most affected (before it spreads to other groups), if we don’t send a strong message to society,” Garcia said.

Given the lack of a vaccine and the difficulty of contact tracing, there is growing pressure to encourage prevention.

From the outset, government officials ceded the leading role of advocacy campaigns to community groups.

Sebastian Meyer, president of the STOP SIDA association dedicated to AIDS/HIV care in Barcelona’s LGBTQ community, said the logic was that his group and others like it would be trusted messengers and learn, on a case-by-case basis, how to push health warnings home.

While community associations representing gay and bisexual men have bombarded social media, websites and blogs with messages about monkeypox safety, Meyer said there is still a lot of work to be done.

Meyer, who is a member of the Spanish national government and the Barcelona regional authority’s monkeypox advisory committee, believes fatigue from the COVID-19 pandemic has played a role. Doctors advise people with monkeypox lesions to isolate until they are fully healed, which can take up to three weeks.

“When people read that they have to self-isolate, they close the page and forget what they’ve read,” Meyer said. “We just came out of COVID, when you couldn’t do this or that, and now, here we are again…people just hate it and bury their heads in the sand.”

Meyer said his team is currently brainstorming to improve and republish their message.

“If you haven’t been selected to get vaccinated, the answer is not to desperately hope you get vaccinated,” he said. “The answer is to be more careful. It’s much better than any vaccine.”

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