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Sexual health clinics at the forefront response to monkeypox already struggling financially, leaving the United States and the UK ill-prepared for the first major global health test since the COVID-19 pandemic.
Infectious disease experts say sexual health clinics, which offer confidential diagnosis and treatment without an appointment, are best placed to identify and treat cases of monkeypox, which mostly affects men who have sex with men.
However, such programs are carried out largely without additional funding, despite years of financial neglect. There is little data on funding for sexual health services worldwide, but experts agree that the sector is under-resourced.
This hinders the response to monkeypox and diverts scarce resources needed to contain the rise in other sexually transmitted diseases (STDs), sexual health experts in the UK and the US told Reuters.
Lack of resources can lead to further spread of monkeypox, They said. According to the World Health Organization (WHO), the outbreak has affected 63 countries.
“This is a gap and a weakness in our public health system that monkeypox has exposed,” the doctor said. Meg Doherty, director of the WHO Global Program on HIV, Hepatitis and STIs, announced this in an email.
“Even among high-income countries, funding for sexual health worldwide is declining or unfunded,” she said.
Although monkeypox is sexually transmitted, the virus can infect anyone who comes into contact with festering sores, bodily fluids, respiratory droplets, or soiled linens.
Clinic staff have to spend extra time cleaning examination rooms and purchasing additional protective gear. On top of a chronic staffing shortage, a problem exacerbated by the COVID pandemic, it can be difficult to find appointments. Test equipment in the United States is also in short supply.
Monkeypox has been endemic in parts of Africa for many years, but since early May the virus has been spreading rapidly in other countries, mostly among gay and bisexual men, who often develop genital and anal rashes that doctors may confuse with herpes or syphilis. Of the 11,500 confirmed cases worldwide, Reuters estimates that 1,469 are in the US and 1,856 are in the UK.
In Spain, with 2,447 cases – the most in the world – patients are seen in hospitals and clinics. Local health authorities said they added additional testing capacity early in the outbreak and the health system was not under pressure.
Data from the UK-based charity Health Foundation shows that England’s sexual health services budget was cut by 14% in the six-year period ending in fiscal year 2022. UK clinics have yet to secure any new funding to meet the additional demand for monkeypox.
In the United States, funding for sexual health and research has also dwindled, said David Harvey, executive director of the National Coalition of STD Directors (NCSD).
“Monkeypox shed a bright light on this fact. Generally speaking, the field of STDs has been grossly underfunded for 20 to 30 years,” said Harvey, whose group has requested $100 million in funding to fight the monkeypox outbreak.
According to the NCSD, federal funding for STD programs has remained relatively flat over the past two decades — $168.5 million in 2003 versus $152.5 million in 2022 — a 40% drop when adjusted for inflation. According to a 2021 report from the National Academy of Sciences, Engineering and Medicine, state and local investment has also declined, even as STD rates have reached an all-time high.
A survey of NCSD members released on June 12 found that 42.7% of sexual health clinics in the US have access to appropriate swabs for testing, and less than 20% have appropriate tubes to collect monkeypox specimens for transport to clinical laboratories.
Due to a limited number of providers and appointments, clinics must triage patients in favor of patients with pain, a rash, or suspected monkeypox. This has left asymptomatic patients and those in need of other services without care.
Harun Tulunai, 35, sexual health advocate, HIV-positive and recently hospitalized with monkeypox in London, knows friends whose sexual health appointments have been delayed or unavailable ‘because they (the clinics) are too busy treating monkeypox’ .
He is not surprised, as he experienced the painstaking decontamination effort when he was diagnosed.
“We see it overwhelming clinics,” he said. “If we suddenly have 5,000 cases, what will happen?”
Last week, a coalition of sexual health/HIV organizations in the UK called for urgent financial support, asking for £51m ($60m) in sexual health services to ‘contain and eliminate monkeypox’ as some clinics reported drastic cuts in essential services .
Part of the problem is that funding for HIV and other sexually transmitted infections is largely separate, especially in the United States.
“A lot of money was invested in the fight against HIV, and rightly so, but STIs were poor,” said the doctor. Matt Golden, director of an HIV/STI clinic serving Seattle and King County, Washington. His clinic diagnosed half of the monkeypox cases in the area and provided vaccines and treatment recommendations.
Experts from both countries agreed that monkeypox was a wake-up call for additional investment in sexual health. “It’s time to do something,” NCSD’s Harvey said.