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Monkeypox Safeguarding Conversation Guide for Homeless and Inclusion Health Populations

The following guide and resources is intended for frontline workers, primary care workers, community health and outreach teams who work with people experiencing, or at risk of, homelessness. 

The impact of monkeypox for homeless and inclusion health populations:

People experiencing homelessness often have poor underlying health and high levels of undiagnosed and untreated chronic disease. This means they could be particularly vulnerable to monkeypox and may find it harder to self-isolate. They also often experience challenges when accessing healthcare and many individuals experiencing homelessness are not GP-registered, making it difficult to identify those who are clinically vulnerable.

Monkeypox stigma:

There is potential ongoing stigma associated with monkeypox due to disproportionate prevalence of the disease among men who have sex with men (MSM), including gay and bisexual men as well as transgender women who have sex with MSM. These individuals face discrimination and violence because of this and may need additional safeguarding support to protect them.

It is important to identify whether an individual who has, or is at risk of having, monkey pox is at risk of being persecuted due to contracting monkeypox. Individuals subjected to homophobia may not always be gay or bisexual.

Having a monkeypox safeguarding conversation:

Due to this potential stigma and homophobic discrimination faced by someone in a shared accommodation setting, it’s important to identify whether the individual is returning to a safe place to stay. The conversation guide below has been developed to help with these potentially sensitive conversations.

 Conversation objectives:

  1. To establish whether there are potential safeguarding risks for an individual related to a confirmed or suspected case of monkeypox
  2. In suspected cases, to understand previous contacts and type of contact of an individual to determine risk of developing monkeypox in near future (e.g., sexual activity or other close contact)
TopicGuidance
Having the conversation
Find a comfortable environmentFind a place to talk that’s private and allows the person to be at ease. Acknowledge that the topic isn’t easy to talk about but explain why it’s important to talk about it, including:
1. To allow you to protect against safeguarding concerns
2. To help you understand their particular needs and to better inform appropriate discharge settings
3. To provide appropriate public health information and advice to help to reduce the spread of monkeypox infection.
Give the facts about monkeypoxGive the individual some background on monkeypox and how it is typically passed between people, i.e., through close contact with others including shared bedding and/or towels. Refer to the latest UKSHA guidance, found on gov.uk: Monkeypox: background information.

Make them aware of where they can go to access medical support for monkeypox if they haven’t done so already:

• Contact NHS 111 or call a sexual health clinic immediately. Their call will be treated sensitively and confidentially
• Avoid close personal or sexual contact with others until they know that this is not monkeypox. Individuals should contact sexual health clinics ahead of visits and avoid close contact with others until they have been seen by a clinician

Cases and suspected contacts will be followed up with by Health Protection Teams, who will provide advice on self-isolation and work with cases to identify any contacts.
ListenBe person centred and have an open conversation, making sure the person feels heard and listened to and understands that you are interested in their safety.
Be non-judgemental Try to avoid showing strong emotions such as shock or embarrassment in response to something someone says. This might discourage people from sharing their experiences with you.

Remember, sex work is work. Be mindful of stigma around sex work and avoid raising conversations around ‘exiting’ sex work when people are seeking healthcare advice.
Be open and honest Encourage them to ask questions. Answer them as honestly as possible. If you don’t have an answer for something, refer to UKHSA guidance.

Any medical concerns should be handled by a clinician, and individuals should follow the advice above if they have any questions or concerns.
Use simple and appropriate languageUse simple terminology that can be easily understood. Avoid using jargon or acronyms that are not obvious. You can use find language in UKHSA guidelines and on the Healthy London Partnership (HLP) website.

Try to mirror the language people use to describe their sexuality and gender identity if discussed.
Confidentiality It’s important that people feel able to share their experiences with you. However, if their safety may be at risk, don’t promise to keep things a secret and explain that you have a responsibility to tell people who can help you. Concerns about someone's wellbeing, should be reported through your standard safeguarding pathways.
Taking action
Referral Contact 111 or local sexual health service to access assessment and testing for monkeypox (highlight if you think they are clinically vulnerable and/or immunocompromised).

You can also contact UKHSA for additional health guidance, contact via LCRC (LCRC@phe.gov.uk), or phone: 0300 303 0450.
Housing contacts For local housing authority and related housing contacts in your area, please consult the London Hospital Discharge Housing Options Directory, found on the Future NHS website.

If you do not have a Future NHS account, you can apply for one on the site.
Additional monkeypox resources Additional information on monkeypox:
• Details on all confirmed cases: https://www.gov.uk/government/news/monkeypox-cases-confirmed-in-england-latest-updates
• UKHSA Monkeypox guidance: https://www.gov.uk/guidance/monkeypox
• NHS monkeypox page: https://www.nhs.uk/conditions/monkeypox/
• Terrence Higgins Trust monkeypox information: https://www.tht.org.uk/news/monkeypox-uk
• Queer Health from the Love Tank monkeypox page: https://www.queerhealth.info/monkeypox
• WHO global perspective and information: https://www.who.int/news-room/fact-sheets/detail/monkeypox
• Follow @UKHSA and @UKHSA_London on Twitter for the latest Monkeypox updates
• Campaign Resource Centre communications assets: https://campaignresources.phe.gov.uk/resources/campaigns/145-monkeypox/resources
LGBTIQ+ and sex worker specific sexual health resources and hate crime reporting servicesLGBTIQ+ Homelessness services:
• The Outside Project LGBTIQ+ Centre: https://lgbtiqoutside.org/
• Stonewall Housing: https://stonewallhousing.org/
• AKT (under 25's): https://www.akt.org.uk/

LGBTIQ+ Hate Crime:
• Galop: https://galop.org.uk/types-of-abuse/hate-crime/
• LGBTIQ+ Sexual Health Clinic, Dean Street: https://www.dean.st/

Trans Specific Sexual Health Clinic:
• 56T: https://www.dean.st/trans-non-binary/
• CliniQ: https://cliniq.org.uk/

LGBTIQ+ Sex Workers Sexual Health:
• SASH: https://londonfriend.org.uk/sash/

Sex Workers Sexual Health:
• CLASH and SHOC: https://www.sexualhealth.cnwl.nhs.uk/clash-and-shoc/

Sex Worker Support:
• SWARM: https://www.swarmcollective.org/
• United Sex Workers: https://www.uvwunion.org.uk/en/sectors/united-sex-workers/
Further reading on safeguarding and stigmaAdult safeguarding and homelessness: Experience-informed practice (LGA and ADASS): A briefing report detailing some practical guidance on managing safeguarding issues with people experiencing homelessness. Useful to see lived-experience feedback on safeguarding and as a reminder of the six safeguarding principles outlined in statutory guidance

Breaking the Cycle of Stigma in Academic Writing (Stephen Parkin, 2022): A guide to language including a dictionary of words that can be harmful for vulnerable groups, including why they may be harmful and alternative words that can be used

Communication practices in conversations about sexual health in medical healthcare settings: A systematic review (Kedler et al., 2021): A report that highlights some common pitfalls and successes of conversation about sexual health

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