In Focus: MMWR Severe Monkeypox (MPX) Study
This information was originally distributed via HUD.gov. HUD Exchange is redistributing the information for awareness.
The first Monkeypox (MPX) case in the United States was confirmed on May 17, 2022, and after a significant rise in cases, MPX was declared a public health emergency in the United States on August 4, 2022. New data is showing that the current MPX outbreak is disproportionately affecting people living with HIV and those experiencing homelessness. This is the same population that meets eligibility requirements for assistance through HUD’s Housing Opportunities for Persons With AIDS (HOPWA) and Homeless Assistance programs.
The latest publication of the Morbidity and Mortality Weekly Report (MMWR) by the Centers for Disease Control and Prevention (CDC) on October 26, 2022 provides evidence through a study that people with HIV and people experiencing homelessness are highly impacted with the most severe cases of MPX. Of the sample of people with severe MPX disease, 82 percent were people with HIV and 23 percent were people experiencing homelessness. Further, 72 percent of the severe MPX cases among people with HIV had <50 CD4 cells/mm3. A person with HIV is considered to have progressed to AIDS when their CD4 cells drop below 200 CD4 cells/mm3. A CD4 cell count of <50 CD4 cells/mm3 indicates a badly damaged immune system and is a likely sign that a person with HIV is not maintaining an HIV medication regimen. In this study, just 9 percent of these patients were taking antiretrovirals at the time of their MPX diagnosis. View the full study.
To prevent and mitigate cases of severe MPX, we need to get people housed, linked to HIV care and treatment, protected through MPX vaccination, and connected to needed supportive services including mental health and substance use services. Housing can and should be used as a platform to get individuals who have disengaged from HIV care to reconnect, and to ensure an HIV medication regimen can be maintained. Both HOPWA and the Homeless Assistance programs, such as the Continuum of Care (CoC) and Emergency Solutions Grants (ESG) Programs, can fund housing and supportive services for individuals most vulnerable to MPX infection and severe health outcomes. Individuals and families who have HIV and who experience homelessness are eligible for assistance under the CoC and ESG programs. HOPWA funding can be used to provide assistance for individuals or families experiencing homelessness or at risk for homelessness with the only eligibility requirements being that the family is low-income and has at least one member who is living with HIV. We encourage communities to learn which HUD funding sources are currently available to reach those most vulnerable to MPX infection and severe health outcomes. In addition to traditional HOPWA and Homeless Assistance programs funding, both annual ESG Coronavirus Aid, Relief, and Economic Security (CARES) Act (ESG-CV) and HOPWA CARES Act (HOPWA-CV) funds designated to prevent, prepare for, respond to, and mitigate the impacts of COVID-19 can be used to pay for several MPX-related costs.
We can get people housed, linked to HIV care and treatment, protected through MPX vaccines, and connected to needed supportive services including mental health and substance use services by using all the resources we have available. This includes resources from HUD and partners at the Health Resources and Services Administration’s (HRSA’s) Ryan White HIV/AIDS Program, Substance Abuse and Mental Health Service Administration (SAMHSA), or CDC for needed medical, mental health, and substance use services for people living with HIV. Following are examples of how to use HOPWA and Homeless Assistance programs to serve those most vulnerable to MPX infection and severe health outcomes.
- Immediate link to housing through hotel or motel vouchers
- HOPWA: HOPWA funds (formula, competitive, and CARES Act) can be used to pay for a hotel or motel voucher for HOPWA-eligible individual or family who is homeless or in immediate need of housing support to stabilize the individual and get them connected to HIV care, MPX vaccination, supportive services, and stable housing. Generally, HUD recommends that grantees and project sponsors limit hotel/motel stays under HOPWA to no more than 60 days in a six-month period.
- ESG: Annual ESG funds not used to prevent, prepare for, respond to, and mitigate the impacts of COVID-19 can be used to pay for a hotel or motel voucher for a family or individual with a contagious disease if no appropriate emergency shelter is available. See Notice CPD-21-08 for additional ways that ESG-CV can be used to support MPX response efforts, including funding for isolation in non-congregate shelter spaces.
- Eligible activities to prepare for and respond to infectious diseases including MPX
- Related Resources for MPX
- Infectious Disease Prevention and Response page on the HUD Exchange
- Infectious Disease Toolkit for CoCs provides guidance for planning and responding to infectious diseases
We join CDC and our federal colleagues in a call to action: We need to continue an aggressive and comprehensive approach to address MPX, HIV, sexually transmitted infection (STI), homelessness, and mental health together. HIV prevention and care mitigates the impact of MPX on the health of individuals living with or at-risk for both infections. And linkage to HIV care and treatment is critical to protect individuals from a variety of health threats, including MPX.
If your community needs assistance navigating a response to a current MPX outbreak, technical assistance (TA) is available to support planning, program development, and problem-solving. Grantees and other stakeholders in need of TA may submit an online request through the HUD Exchange. Grantees, sub-recipients, and project sponsors may also ask program, policy and other questions through the Ask A Question (AAQ) portal.
Jemine Bryon (she/her)
Acting General Deputy Assistant Secretary for Community Planning and Development
Rita Harcrow (she/her)
Director, Office of HIV/AIDS Housing
Norm Suchar (he/him)
Director, Office of Special Needs Assistance Programs
HOPWA Mailing List Subscription
HOPWA uses two different listservs to communicate competition and program updates:
- Subscribe to the HUD.gov listserv for information developed by HUD/Office of HIV/AIDS Housing.
- Subscribe to the HUD Exchange listserv for information and guidance produced by HUD technical assistance providers regarding the HOPWA program.
HOPWA grantees and interested stakeholders should consider subscribing both to the HUD.gov mailing list and HUD Exchange mailing list.