NPR Story
1:43 pm
Thu July 4, 2013

Meningitis Vaccination Effort Aimed At Gay Men

Originally published on Thu July 4, 2013 6:02 pm

There have been 22 cases in the past three years of a deadly new strain of meningitis that has spread in New York’s gay, bisexual and MSM (men who have sex with men) communities.

Seven of the men who contracted the illness died.

The judgment of whether they are having anonymous sex is less important than the fact that we’ve protected such a large number of them from this infection.
–Dr. Demetre Daskalakis

Meningitis can be spread by sneezing, coughing, sharing utensils or kissing. Often, there are reports of meningitis outbreaks in college dorms or army barracks.

But this particular strain has circulated exclusively among men who have sex with men.

Dr. Demetre Daskalakis, an HIV specialist who is administering meningitis shots through the community health organization Gay Men’s Health Crisis (GMHC), said the community of “men who have sex with men are effectively a dorm or an army barracks without walls.”

New York’s health department has partnered with gay community organizations to launch an aggressive campaign to get men who have sex with men access to meningitis vaccinations. The health department has advised “men who have regular and intimate contact with men” — whether through websites, gay bars and clubs, or hook up apps like Grindr — to get the vaccination.

When reports of the first deaths from meningitis began, comparisons to the early years of the AIDS epidemic were made in the mainstream press and within the gay community.

Like the AIDS epidemic of the 1980s, a moral color became attached to the behaviors of men who engaged in anonymous, sexual activity with multiple partners, even though meningitis is not a sexually transmitted disease.

“When you uncouple judgment of behavior and just look at bare cold science and fact, if you vaccinate people at risk, you will prevent infection,” Daskalakis said. “The judgment of whether they are having anonymous sex is less important than the fact that we’ve protected such a large number of them from this infection.”

The most susceptible men are those who are highly social in the gay community but don’t want to be identified as gay or bisexual. They are disconnected from community news, and are the hardest to reach through public service announcements.

For this reason, Daskalakis goes to gay bars and after hours clubs to administer shots, where men often go to have some degree of anonymity.

“Meningitis has made a big splash in the gay press, but if you’re not looking at the gay press because you’re afraid someone is going to look over your shoulder … putting [the vaccinations] in an environment you feel safe is the right thing to do,” he said.

Guest:

  • Dr. Demetre Daskalakis, an HIV specialist who is administering meningitis shots through the community health organization Gay Men’s Health Crisis (GMHC). He tweets @DrDemetre.
Copyright 2013 WBUR-FM. To see more, visit http://www.wbur.org.

Transcript

ROBIN YOUNG, HOST:

It's HERE AND NOW. And we have a conversation, now, that may not be for young ears. It's about a deadly strain of meningitis that's been causing concern in New York's community of gay and bisexual men since 2010. Twenty-two men have contracted the virulent strain of meningitis, and seven have died. Now, meningitis is spread by droplets, like when you sneeze or cough or kiss. It's exchanged between people in close contact but not by sex. So why has the infection just stayed within this particular community of men?

Demetre Daskalakis is an HIV and infectious disease specialist at the NYU School of Medicine and the Bellevue Hospital in Manhattan. But late at night, he gives out meningitis shots at gay bars and clubs on behalf of the Gay Men's Health Crisis, a community organization that was founded during the AIDS crisis. So, Dr. Daskalakis, is this particular strain of meningitis targeting anyone else in New York? Is it just gay men?

DR. DEMETRE DASKALAKIS: This outbreak, very specifically, is focused on men who have sex with men in the city. The reason for that has to do with the fact that it's an enclosed social network in some ways. So the population of men who have sex with men in New York are, in effect, a dorm or an Army barrack without walls. So I likened it to the idea of there being a measles outbreak in a Hasidic community. The measles don't know that they're infecting a Hasid, it just knows that this is an efficient way to spread.

YOUNG: So you're saying that it's more about a group of people that tends to hang together because these organisms love to spread within a close-knit group of people. How do you know you have it?

DASKALAKIS: The classic symptoms of meningitis are headaches, neck stiffness, fevers, rashes and what's called photophobia, which means that bright light is uncomfortable to look at. Those constellations of symptoms together should really trigger an evaluation by a physician. So the time from onset of illness to collapse of someone's cardiovascular system because of overwhelming infection and death, can be very, very quick. It's pretty critical to get to care because antibiotics in that setting can be lifesaving.

YOUNG: Yeah. And you talk about wanting to create a herd immunity. By what, vaccinating not everybody but enough people that the meningitis realizes that it's not as cozy a community anymore?

DASKALAKIS: Exactly. This bacterium likes to spread in a social network. If you create immunologic roadblocks by making people resistant to getting the infection because they have an immune response against vaccine, you can really isolate the outbreak, and ultimately, it will then peter out.

YOUNG: Well - and just a question. You've made clear that you're more likely to get this from a sneeze, you know, than anything else. But still, The New York Times did a piece in which you are in after-hours sex club...

DASKALAKIS: Yeah.

YOUNG: ...and it describes, you know, bare-chested young men and some sort of trapeze. And there you are - your table, you know, giving out shots.

DASKALAKIS: Yup.

YOUNG: Well, how do you counter the thinking that this is a community that has anonymous sex, why should I care?

DASKALAKIS: We've learned what judging people's behavior does from the perspective of spreading disease, so that's how we landed with an overwhelming HIV epidemic in the country and in the world, frankly. So when you uncouple judgment of behavior and just look at bare cold science and facts, if you vaccinate people who are at risk, you'll prevent infection. The judgment of whether they're having anonymous sex is less important than the fact that we protected such a large number of them from this infection that we're averting, potentially, a way bigger outbreak that can spread right outside of the gay community.

So after-hours nightclubs are important because not that you'd be surprised by this, but many people who go to after-hours nightclubs are running to clinics to get vaccines and are often disconnected from care, because they have other issues that may sort of, you know, be barriers. And so, you know, bringing things to the street and being a medical activist is really what HIV and infectious disease medicine is all about.

YOUNG: Well, it also should be noted that a couple of things - not everyone who goes to an after-hours club has perhaps told their friends that they are going to those after-hours clubs so they're going off into other communities. You have tourists coming in from other parts of the country.

DASKALAKIS: Sure.

YOUNG: And the article also showed a very straight-laced, buttoned-up, literally, gay couple who came in to get the shot who were appalled at the after-hours club.

DASKALAKIS: Yup. It's just a way to, sort of, create community outreach that's a bit different. And so, you know, the GMHC model which was the Gay Men's Health Crisis model which was putting vaccines in the setting of an AIDS service organization and making them available for free and an easy signup process to get them without a lot of the, sort of, garbage that you get in a medical environment, is one great model. And then the supplement to that, is you take it to the street.

The after-hours clubs are a great place to go if you also don't want to disclose that you're gay. And very often, those undisclosed folks are disconnected from the news in the communities. That meningitis has made a big splash in the gay press, but if you're not looking at the gay press because you're scared someone's going to look over your shoulder on the Internet or see what newspaper you're reading, putting it sort of in the environment where you feel safe is the right thing.

YOUNG: Staying somewhat on this theme, the Health Department has put out an advisory to men who regularly have intimate contact with other men through websites, digital application apps...

DASKALAKIS: Right.

YOUNG: ...or at a bar or party. And we know about the app, Grindr, where...

DASKALAKIS: Yeah.

YOUNG: ...people can meet anonymously, sort of like a GPS for people...

DASKALAKIS: Yeah.

YOUNG: ...who want to meet anonymously. Is there more of that anonymous contact within the gay community, therefore, making it more of a problem for health care?

DASKALAKIS: I think from the perspective of the meningitis outbreak and other diseases, looking at the apps as being a driver is interesting. I actually think that the apps are more likely a marker for people who are in the social network. They are highly social and are interacting in close proximity to a lot of folks.

YOUNG: It sounds like you're also saying it's not the app. It's, you know, whatever, you know, safe behavior you participate in once you use the app. I mean you can...

DASKALAKIS: Yeah.

YOUNG: ...use the apps safely. So...

DASKALAKIS: Yeah.

YOUNG: But just conversely, how has the AIDS epidemic helped when it comes to the gay community addressing a health issue that springs up?

DASKALAKIS: We've learned lessons from HIV, and I think that HIV has created an infrastructure such as GMHC. It's a great example that has sort of poised to respond to health threat. So medicine is never sexy. It doesn't cause a lot of hearts to race except for maybe mine and a couple of other folks.

(LAUGHTER)

DASKALAKIS: But this has been interesting to see a community of gay men. And men who have sex with men, rise up and say, we want this vaccine. We want to get it in a way that is appropriate for our community. This one's not one that we're going to lose.

YOUNG: Dr. Demetre Daskalakis, an HIV specialist at NYU and Bellevue Hospital with the gay men's health crisis. He's been administering these meningitis vaccinations to gay men in New York. Dr. Daskalakis, thanks so much for speaking with us.

DASKALAKIS: My pleasure. Thanks for having me.

YOUNG: OK. We'll take a break. And when we come back, I tweeted that we were going to meet house jackers in New Jersey. And Lon Seidman tweeted back, are they stealing the houses?

(LAUGHTER)

YOUNG: No. They're raising them up as we hear in one minute.

JEREMY HOBSON, HOST:

And by the way, if you've got anything like that to tell us, you can tweet us at HERE AND NOW at @hereandnowrobin, @jeremyhobson. We are back in a minute, HERE AND NOW. Transcript provided by NPR, Copyright NPR.