Monkeypox has disproportionately impacted Hispanic and Latino men in US

Since the early days of the monkeypox outbreak in the United States, Hispanic and Latino men may have been disproportionately affected.

While data from the CDC is limited and fewer than 50% of cases include information about race/ethnicity, it indicates that there may be disparities for Hispanic and Latino Americans affected by monkeypox.

Additionally, 47% of first doses of the JYNNEOS vaccine -- a two-dose vaccine approved by the U.S. Food and Drug Administration to prevent smallpox and monkeypox -- have been given to white Americans, despite accounting for less than 30% of weekly cases with reported demographics, according to the CDC. Meanwhile, Hispanic Americans have received just 20%.

Data on a city-level shows similar trends.

In New York City, Hispanic residents make up a plurality -- 34% -- of infections, as of Oct. 1, according to data from the city's Department of Health and Mental Hygiene. In Los Angeles, Hispanic residents account for 45% of cases, as of Oct. 4, according to the Los Angeles County Department of Public Health. Around 10% of race/ethnicity data was unknown for each city.

Public health experts told ABC News a lack of access to healthcare and insurance, language barriers and the stigma around the disease has led to such large disparities.

"I've lived through the HIV epidemic, I've lived through the COVID pandemic and now through monkeypox, and it is frightening to see the similarities in the sense that it's always the same populations that really are at a disadvantage," Dr. Judith Flores, executive board member of the National Hispanic Medical Association, told ABC News. "Don't have the equity in access to care, equity in getting the care in the way they needed, and in the manner that's most appropriate to them, culturally and linguistically. So, I'm not surprised that we're seeing this."

Lack of information

Public health experts told ABC News one reason Hispanic and Latino men may have been disproportionately affected by the outbreak is because getting information to the community about the disease was difficult.

David Cuevas, disease intervention specialist and supervisor at the Multnomah County Health Department in Portland, Oregon, told ABC News there was limited information being released by the CDC in Spanish.

"At the beginning, when there was an emerging communicable disease coming out, there was limited information in other languages," he said. "At the beginning in our team, we were looking at information from other websites in the U.K. or in Europe that have translations in different languages."

Dr. Sean Cahill, director of health policy research at the Fenway Institute, a healthcare organization that focuses on sexual and gender minorities, in Boston, also said there weren't many televised briefings about monkeypox like there were with COVID-19, meaning most people received public health information via internet, as well as booking vaccine appointments.

According to a Pew Research Center poll, only 65% of Hispanic adults said they had a broadband connection at home, as of February 2021, compared to 80% of white adults.

"In the early weeks of the monkeypox outbreak, vaccine was made available in many locations in New York and Washington, D.C. and elsewhere online," he told ABC News. "And you had to have a computer and an internet connection or data, or Wi-Fi access or a smartphone in order to be basically book an appointment to get a vaccine."

He continued, "And there are racial/ethnic disparities that affect groups in terms of socioeconomic status and whether or not people have smartphones and computers and internet access. And so, I think that played a role."

Cahill added getting access to the treatment TPOXX required doctors and patients to fill out a great deal of paperwork from the CDC, which was not available in Spanish until August.

Fear of stigma

Aside from lack of information, stigma associated with the disease may also be affecting vaccine distribution.

The outbreak has primarily been concentrated in men who have sex with men, a group that includes people who identify as gay, bisexual, transgender and nonbinary, although health officials have said anyone -- regardless of sexual orientation -- is at risk if they have direct contact with an infected patient.

"We started mass distribution, so you're expecting people to go online to basically out themselves," Flores said. "If you are especially from Hispanic communities and communities of color, it is not something perhaps you're most comfortable doing and you don't want to make it public.'

Cuevas, a gay Hispanic man himself, said because the disease was mischaracterized as a disease only affecting LGBTQ populations, Hispanic Americans may have been fearful of being outed.

"A lot of individuals in the Latinx community may not be feel comfortable with their sexuality, with their identity," Cuevas said. "Myself included, when I went to get my vaccine, I've even thought about that. "I was like, 'Wow, if I was me, like my younger years when I was more in the closet and wasn't out with my sexuality, this will be very stressful.'"

Cuevas said when Multnomah County was scheduling vaccine appointments, one way of trying to remove the stigma was to try to make the process as anonymous as possible.

"We would give this list of the people that are eligible [and say], 'You just have to say yes or no, you don't have to specify which part of the eligibility you fall into,'" he said. "So, people don't feel like they've been put on the spot."

How to reduce racial/ethnic disparities

Public health experts say to prevent to reduce the racial/ethnic gap, public health leaders and community leaders need to knock down barriers that prevent access to care among minority populations.

"That means going to where they are, having vaccine clinics at flexible times, on the weekends and late at night, and going to the places where, like those individuals, maybe hanging out," Cuevas said.

He added, "Specific to our county, we were working hard and putting information on social media, on dating apps, information that somebody that speaks Spanish can actually read and make sense of. You want to have individuals talking to you in your own language, when you call and make the appointment for your vaccine."

The effort appears to be working. In the latest CDC report, as of Sept. 18, Hispanics made up 19% of weekly monkeypox cases nationally with reported race/ethnicity data. which is down from 31% a month prior.

Cahill added that the bigger systemic issue that will help is expanding Medicaid eligibility.

"In order to qualify for Medicaid, you have to be categorically eligible. You either have to be disabled, or be a parent with dependent children, and you also have to be really, really poor," he said. "That's another big systemic reason why we see these ethnic disparities in HIV, in COVID, and now in monkeypox affecting Hispanic and Latino populations, because people don't have health insurance and they're not in routine care."

"So, when a new threat emerges, they don't have someone they can just call and talk to about it or get an appointment, or you know they're not familiar with a medical office where they have gone on a regular basis and, therefore, they're losing out on information," Cahill continued.