The atmosphere at the ballroom event in Berlin is electric and joyful — it’s a place where many lesbian, gay, bisexual, but predominantly people from the trans community come together, free from discrimination. Tonight, around 500 event-goers are celebrating, applauding members of the community as they walk the catwalk and compete in dance-offs.
Amanita Calderón-Cifuentes, one of the ballroom judges, is carried in on the shoulders of 2 dancers. She’s a transwoman who is living with HIV, and in her day job, she’s an HIV Research and Advocacy Officer at Transgender Europe (TGEU), the mission of which is to strengthen the rights and well-being of trans people in Europe and central Asia. She is well-known for providing critical health information and advice for event-goers, and tonight the health topic she will address is mpox — a topic from which the trans community has often been excluded, be that in literature, guidance or services.
The critical work of civil society organizations (CSOs)
In the current mpox outbreak, outside of countries in Africa where the disease has long been endemic, the vast majority, but not all, cases have been among gay, bisexual and other men who have sex with men (GBMSM). However, communities of trans and gender-diverse people have also been impacted. To fight mpox, CSOs that represent affected groups have mobilized to protect themselves and prevent onward transmission. Amanita’s work at ballroom events is just one example of the critical outreach being provided by CSOs who are engaging the most affected groups on protection from mpox, reaching them where they gather.
“If it wasn’t for the LGBTQ+ communities of the world, we would not be able to deal with these mpox infections, because it is us, the ones that are reaching out to those communities that need it the most. It is us reminding the world that, ‘Hey, we're still here. Hey, we are in pain.’ That's the word that comes to my head when I think about mpox. It’s pain; the pain of my community,” says Amanita.
She notes that the first cases of mpox detected in Europe last year were a wakeup call. I've survived 2 pandemics [HIV and COVID-19] and several epidemics,” she adds. “And mpox was clearly going to be one that was going to affect the queer and trans communities just as much as HIV did.”
In her role at TGEU she advocates for the rights and well-being of trans people, an often stigmatized population in the WHO European Region, which covers 53 countries across Europe and central Asia. She believes that health providers may not have learnt important lessons from the HIV/AIDS epidemic because often they have not fully grasped how to address the health needs of key populations that include sex workers, people who use drugs, people in prison and migrants.
“What we know from HIV is which are the key populations that have a high risk of contracting this type of infection. It's not just gay, bisexual, and other men that have sex with men. It's trans people too. Many medical doctors are not prioritizing access to vaccination for trans people because, according to medical guidance, we're not in a high-risk group, unlike MSM,” concludes Amanita.
Learning from communities to eliminate mpox
WHO/Europe has been working with affected communities all through the outbreak, listening and learning and incorporating their valuable insights and ideas into messaging, interventions, guidance and strategies with the goal of eliminating mpox from the Region.
“WHO/Europe has released a campaign called ‘Eliminating mpox: Placing affected populations at the heart of our response’ [...]This campaign makes sure, after working hand-in-hand with TGEU, that the language includes, very explicitly, further marginalized members of the community that were not included before, such as trans people and sex workers,” says Amanita.
Reaching and building trust, particularly with groups left behind or not yet fully integrated in the mpox response, is crucial to stand a chance of eliminating mpox in the Region. WHO/Europe stresses that, even though mpox may no longer be defined as a Public Health Emergency of International Concern (PHEIC), there is no room for complacency, and health authorities and the most-impacted communities alike need to remain vigilant if the disease is to be effectively controlled, let alone eliminated.
At the ballroom, other community members share their thoughts on mpox. Sedami is a photographer who identifies as trans feminine. “Mpox is here; people are still getting it,” says Sedami. “I think it should become common sense to be able to talk about it. I got the 2 vaccines but then I'm more careful with who I'm hooking up with or having sex with, because not everybody has access to a vaccine.”
When Jeffry, a gay man, went for his mpox vaccination, he found registration a relatively easy process, but the questionnaire he filled out did not reference groups such as trans and non-binary. “I did get the vaccine,” he says. “It is a privilege to be with each other again [after COVID-19 measures have eased] but be aware of what's happening with your body, because it can easily affect another person.”
Jade Mugisha is 21 years-old and identifies as a trans woman. To eliminate mpox, she says health services must be inclusive and provide stigma-free advice. “We need to be protected because the world doesn’t often work for us, but mostly against us. Perhaps a reason why people might not be willing to engage is that they don’t feel invited. It’s important to come together and fight this disease as a community, as one,” stresses Jade.
Although cases of mpox across the Region remain low, mpox has not gone away. It is uncertain what will happen in the coming months and indeed years; people continue to travel to and from places with higher levels of mpox or less vaccination, and large and mass gathering events start again this summer.
When Amanita takes to the stage, to whoops and cheers, her message is a call to action. “We don’t want a resurgence of mpox happening this spring and summer,” she says. “So, for all of you present, go and get tested, get vaccinated, get treated. Protect each other, have conversations with each other, with your friends, with your partners, with your lovers, with your families.”
WHO/Europe’s campaign to eliminate mpox
Launched in May 2023, WHO/Europe’s mpox campaign calls on affected communities, health authorities and providers to remain vigilant this summer. It urges countries to reach all affected communities with mpox health information and advice, testing and vaccination and shines a light on people’s mpox-related experiences, needs and hopes this year. Through the updated Risk Communication Community Engagement and Infodemic Management (RCCE-IM) Toolkit, WHO/Europe is also offering a comprehensive resource for health authorities, CSOs and event organizers to eliminate mpox, including a new section with tips to ensure the inclusion of groups, such as the trans community, sex workers and organizers of sex-on-premises venues. A new compendium of 12 case studies produced by WHO/Europe details the central role of community-based initiatives in bringing down mpox numbers, offering inspiration and best practice examples for health authorities and CSOs.