“The fact that the parade is returning is a sign that we have survived,” says Rikki Redd, a New Orleans resident and the first Black trans woman to grand marshall the festival’s main parade. “We’re dedicating this parade to the people of New Orleans for their resilience—and now the community is trying to come back.” But the global spread of monkeypox this summer has presented a new challenge. The virus has sickened more than 16,000 Americans so far, and the outbreak is still growing in Louisiana. A monkeypox infection typically causes painful blister-like sores, which harbor infectious particles and can pass the disease on. Although the pathogen can spread by touch—and in rare cases, through spit or dirty sheets—a multinational study from July found that 95 percent of examined cases were acquired during sex. So far, most cases have showed up among men who have sex with other men, although anyone could be infected. That means the risks of catching monkeypox at a big celebration can vary based on the activities and environments. “The heart and soul of Decadence is the parade,” says Redd. “And the events that we sponsor have absolutely nothing to do with sex. We hosted a drag brunch; we hosted a pool party.” The bigger concern is that over the course of the weekend, festival goers are going to hook up, as they would at other big parties, and many of them will be members of high-risk groups. The other worry is that sweaty, packed crowds could be a potential vector. In one exceptional case, a man in California was likely infected at an outdoor music festival in the UK—he reported no sexual history for the previous three months—and the Centers for Disease Control and Prevention (CDC) reports that many other monkeypox patients had recently visited festivals. The packed nature of the event could also expose not just attendees, but bouncers, bartenders, and even hotel workers changing sheets. Those risks were front of mind for Chuck Robinson, the owner of Napoleon’s Itch, a gay bar in the French Quarter, and the organizer of Bourbon Street Extravaganza, a free street concert that headlines the weekend. When he first began hosting the event two decades ago, it was in response to efforts by the archbishop of New Orleans to end the festival, which is now in its 50th year. The narrative at the time was that “it was vulgar and nasty,” he says. “That was a challenge to me.” But this year, he wondered whether it was a good idea to go on with the concert almost as soon as he saw the first news of US monkeypox cases. “The estimated 20,000 that line up in front of our nightclub for the concert—sweating, having a good time, shirts off—and with all the people coming in from all over the world, there’s no way that they’re going to be immune to this.” Monkeypox isn’t COVID—it spreads less easily, and in contexts that are easier to identify—but festival leaders and local health experts are trying to figure out how to manage the risks at such a sprawling event. Two weeks ago, Robinson announced that he was canceling the extravaganza to protect both concertgoers and his staff. He says that by and large, people have been supportive of his decision—but other elements of the celebration are still going forward. “At the end of the day, educating yourself is the key to safety, and the LGBTQ community has been doing that for years,” says Redd. Indeed, a CDC survey published on August 26 found that half of respondants, all men who have sex with men, had recently reduced their number of sex partners because of monkeypox. City officials are also trying to be proactive in vaccinating against the virus, building on lessons learned during COVID, which led them to cancel Mardi Gras in 2021. “We had been working really really hard to put [Southern Decadence] on the CDC’s radar for months now,” says Jennifer Avegno, the director of the New Orleans Health Department. The national agency can provide the hard medical resources the city needs to fight monkeypox—but without grassroots outreach that speaks to the unique event and its audience, that will only go part way in protecting the most vulnerable.
Getting monkeypox vaccines to at-risk residents
In mid-August, the CDC announced that it would provide 50,000 extra doses of monkeypox vaccines to cities holding major LGBTQ celebrations, including 6,000 for New Orleans. At a press conference about the Southern Decadence response today, the White House also noted that it was planning shipments to Oakland, California, and other cities with upcoming Pride events. But even with thousands of additional vaccines, “the timing for Southern Decadence is really difficult,” says Joe Hui, the communications director of Crescent Care, a New Orleans health clinic that was founded to care for AIDS patients, and has been administering monkeypox vaccines independently. Doses have been prioritized for cities that saw the first monkeypox outbreaks, like New York and Los Angeles. (The entire state of Louisiana only has 150 confirmed cases.) What’s more, it takes six weeks to get the two-shot sequence, so few people are likely to have finished their vaccine series by the time Southern Decadence begins—and that’s not counting the thousands of tourists. Those are now being distributed in a series of pop-up events at bars in nightlife hotspots. The first, held in early August at a bar called the Phoenix, administered 300 doses to a crowd. On August 24, the New Orleans Health Department (NOHD) held an event called Vaxxtravaganza in the French Quarter, advertised by stilt-walkers and loudspeakers. Attendees who spoke to Popular Science said that while they’d been thinking about getting the vaccine ahead of Southern Decadence anyway, they showed up to the event because it was convenient. “I read in other places that you’d have to sign up and get on the waitlist,” one said. “And it seems like New Orleans has more than enough vaccines.” But Avegno says that assembling staff to run vaccine clinics is a challenge. “There’s no funding to do this for monkeypox, like there was for COVID, so everybody’s kind of scraping it together.” The department is offering COVID jabs at monkeypox events to access federal funding, and relying in part on volunteer vaccinators. Louisiana’s vaccine eligibility guidance leaves broad leeway for local public health officials to decide who exactly is at risk. “Most of the outreach has focused on men who have sex with men, so we’re trying to make sure that hotels and venues are educated about the risk,” Avegno says. She notes that another focus of the street event was to catch bartenders and hotel employees on their way to work. Reaching service industry staff presents a special challenge because some don’t speak English as a first language and may not be able to access resources online. The CDC has said that its vaccine allocation to New Orleans is one way of addressing racial inequities in vaccine access. Currently, 30 percent of US monkeypox cases are among white people, 33 percent among Black people, and 32 percent among Hispanic or Latino people. As of August 23, under 10 percent of all the country’s vaccine doses had gone to Black Americans, and around 20 percent to Hispanic or Latinos. All of the Vaxxtravaganza attendees who spoke to PopSci said they’d heard about the event online. The Louisiana Department of Health has promoted ads about monkeypox on Grindr, and information on some pop-ups has been shared on Instagram. But others, like one at a Black-owned gay bar, didn’t show up on state or city health department accounts. Dustin Duncan, an epidemiologist at Columbia University who studies health disparities and geography, says that relying on digital outreach is likely to miss people at risk—an outcome that occurred during COVID vaccine campaigns. “I think it’s great that they’re getting vaccines, but I’m not sure it’s going to reach the population that [the CDC] anticipates and wants.” That concern was echoed by Hui. “I’m really worried that we’re missing a lot of people that may be vaccine hesitant—people who may be undocumented, or trans, or have reasons for not wanting to trust a government agency in administering them.” At the press conference today, federal officials said they’d be providing about 50,000 doses of vaccine to what it calls “smaller equity interventions” across the country. “We need to work closely with local organizations and service providers on the ground to reach deeper in the community, even when there is no big event in town,” said Demetre Daskalakis, the White House’s deputy coordinator for the monkeypox response. Cities will be able to come to the CDC with a plan, like a vaccine pop-up at a ballroom show, to receive doses.
Providing more options than abstinence
Beyond vaccine outreach, CDC officials think major festivals can be an opportunity to share information about the virus. “That’s the spirit in which we’re leaning into the engagement that we’re having here,” said Jennifer McQuiston, deputy director of the agency’s high consequence pathogens division, at today’s event. “Making sure that the educational measures they need to stay safe can be provided along with the vaccine.” The CDC and local health officials plan to distribute guides with information on monkeypox transmission and symptoms, and which rank activities from most risky—sex, contact with rashes—to least—dancing outside, or trying on clothes at a store. But the earliest festival-specific advice has mainly come from local organizations like Crescent Care that focus on harm reduction. The idea is to give people tools to keep themselves safe in any situation. In the case of monkeypox, that means not just telling someone to avoid crowds and sexual contact, but also giving them information about what to do if they are having sex or attending a busy festival. “We know based on decades of research and firsthand knowledge that telling people not to have sex doesn’t mean that people aren’t going to have sex,” Hui says. “It’s up to public health in general to acknowledge that those things are happening and [ask], ‘how can we help people keep themselves as healthy as possible?’” In Crescent Care’s “Harm Reduction Guide to Southern Decadence,” the clinic gives out basic information on the efficacy of the monkeypox vaccine and how to get tested—while suggesting ways to celebrate Decadence outdoors, cover up skin with costumes, and talk to sex partners about symptoms. (It also has recommendations on dehydration, and even testing drugs for fentanyl contamination.) “Having all this stuff in one place encourages people to think of the whole picture, to have conversations with their friends or partners,” says Hui. Redd says that Southern Decadence organizers have also been out in bars talking about vaccinations, and that MCs at events will be “giving out information on what to look for when it comes to monkeypox.” The whole point of harm reduction is to meet people with sound public health advice that serves their specific circumstances. Crescent Care’s guide is based partly on one released by the San Francisco AIDS Foundation for attendees of the Dore Alley kink festival, held earlier in August. In the weeks since, there’s been no obvious rise in cases in the city. Among other things, the guide, narrated by a cartoon douche, playfully suggests people “dress from top to bottom in latex or leather” to minimize skin-to-skin contact—advice that the CDC has also begun to share in its guides. Full-body latex and leather won’t quite work in New Orleans humidity: “You will die,” Hui warns. Instead, the Southern Decadence guide focuses on the fact that “we’re one of the very few places where people can drink in the street,” he says. “We’re encouraging people to go to the outdoor events, because you can see and be seen without having to be in a dark sweaty venue.” But without greater government support, Duncan worries that the same inequities and uncontrolled spread from COVID could be repeated during the current monkeypox outbreak. “Because of these events, there’s going to be a stigma. But there’s also an opportunity for public health intervention,” he says. The question is whether the patchwork of federal vaccines, local distribution, and homegrown harm reduction tips will be enough.
