(NEW YORK) — For the past decade, Kaitlin Preble of Tucson, Arizona, said she has gone to her local pharmacy each month to pick up her daughter’s prescription for methotrexate, a drug that is used to treat rheumatoid arthritis, among other things.

Preble’s daughter, Emma Thompson, was diagnosed at age 3 with juvenile idiopathic arthritis, an autoimmune disease that can cause joint pain and inflammation in body parts including the hands, knees and ankles, according to the Centers for Disease Control and Prevention.

Now 14, Emma relies on methotrexate and a combination of other medications to be able to do basic functions like walking, brushing her hair and attending school in-person, according to Preble.

Preble told ABC News’ Good Morning America that in the 10 years Emma has been prescribed methotrexate, she had not encountered any difficulties accessing the drug — until last month.

In late September, just days after a near-total ban on abortion went into effect in Arizona, Preble said she was denied the medication by a pharmacist at her local Walgreens.

“I went into Walgreens because I’m like, this is my baby, I need to see why they’re not going to give it to her,” said Preble. “The pharmacist said, ‘I denied it because she’s 14 years old.'”

Methotrexate, while prescribed to treat conditions like Crohn’s disease, psoriasis and cancer, in addition to arthritis, can also be used at higher dosages to medically terminate pregnancies.

Preble said she believes Emma’s prescription for the medication was initially denied because of confusion under Arizona’s abortion restrictions that were put in place after the U.S. Supreme Court overturned Roe v. Wade in June.

On Sept. 24, a 15-week abortion ban that was signed into law in March 2022 by Arizona Gov. Doug Ducey went into effect in the state.

Separately, on Sept. 23, a state judge granted Arizona Attorney General Mark Brnovich’s request to lift an injunction on a near-total ban on abortion, passed in 1901, only allowing exceptions to save the life of the mother.

Preble said the month prior, she had been questioned when picking up Emma’s prescription for methotrexate about how much she took and why she took it, but was given the medication.

She described being in tears upon learning that this time, the medication was denied, saying, “I was scared for my daughter. It’s the unknown.”

Preble said she interacted with a pharmacy tech at Walgreens, who conferred with the pharmacist on duty and ultimately gave her the medication.

“I did end up leaving with the medication that day, but I don’t know if it’s going to be filled next month,” she said. “I don’t know what the future holds right now, and not only for my daughter, but for every little girl that that needs this medication, whether it’s for arthritis, whether it’s for Crohn’s disease, and not just girls, women in general.”

A Walgreens spokesperson told GMA the company cannot comment on individual patients, but said it is working to help pharmacists “understand the latest requirements” in different states.

“Our focus is meeting the needs of our patients and making sure they have access to the medications they need, in compliance with applicable pharmacy laws and regulations,” the spokesperson said in a statement. “New laws in various states require additional steps for dispensing certain prescriptions and apply to all pharmacies, including Walgreens. In these states, our pharmacists work closely with prescribers as needed, to fill lawful, clinically appropriate prescriptions. We provide ongoing training and information to help our pharmacists understand the latest requirements in their area, and with these supports, the expectation is they are empowered to fill these prescriptions.”

Preble’s story went viral after Emma’s doctor, Deborah Jane Power, a Tucson-based pediatric rheumatologist, shared it on Twitter, writing, in part, “Welcome to AZ. Today a pharmacist denied the MTX refill for my adolescent patient. She’s on 5 mg/wk to prevent AHCA Ab production. MTX denied purely because she’s a female, barely a teenager. Livid!”

Power told GMA that Emma was her first adolescent patient to face a denial of a methotrexate prescription.

She said she shared it on Twitter as a wake-up call to people that non-abortion related health care was being impacted in a state like Arizona with abortion restrictions.

“I wanted folks to think about the ramifications beyond the obvious, banning abortion, how it affected women’s health in a broader aspect,” said Power. “This is health care for women, period. It’s not just reproductive health, but it’s their health in terms of rheumatologic problems and so many other conditions.”

Power said she contacted state and federal legislators and the state pharmacy board about the incident, and plans to keep speaking out.

“We are part of the noise of getting the word out and I think that’s how you start to affect change,” said Power. “None of my male patients have had methotrexate denied. There’s been no issue about getting their refills.”

This week, the Arizona Medical Association and a physician filed a lawsuit, asking a court to provide clarity amid what they say is “significant confusion” over the state’s abortion laws.

In July, the American College of Rheumatology issued a statement addressed to policymakers, calling on them to continue to make methotrexate “accessible.”

“Methotrexate remains the standard of care for a variety of autoimmune diseases. Therefore, methotrexate must remain accessible to people with rheumatic diseases, and legal safeguards must protect rheumatology professionals, pharmacists, and patients from potential legal penalties,” the college said.

Preble said she will continue to speak out and fight for Emma’s access to methotrexate because she has seen what a difference the medication has made in Emma’s life.

Since being diagnosed at age 3, Emma has faced countless hospitalizations and years of being barely able to leave the house due to pain, according to Preble.

This year, Emma’s freshman year of high school, is the first in many years that she’s been able to attend fully in person.

Both Preble and Power said it took several years to get the right dosage of methotrexate with other medications to allow Emma to live her life.

“She’s able to walk to her classes. She’s staying healthy and getting good grades. She’s able to shower on her own, able to stand up and go out to eat if she wants,” said Preble. “She’s feeling good enough to do those things, where before it was just, ‘I want to stay home. I don’t feel very good.'”

“It fills me with so much happiness to see where she is right now, and I couldn’t imagine her not being able to continue where she wants to go in life,” she added.

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(NEW YORK) — Since the early days of the monkeypox outbreak in the United States, Hispanic and Latino men may have been disproportionately affected.

While data from the CDC is limited and fewer than 50% of cases include information about race/ethnicity, it indicates that there may be disparities for Hispanic and Latino Americans affected by monkeypox.

Additionally, 47% of first doses of the JYNNEOS vaccine — a two-dose vaccine approved by the U.S. Food and Drug Administration to prevent smallpox and monkeypox — have been given to white Americans, despite accounting for less than 30% of weekly cases with reported demographics, according to the CDC. Meanwhile, Hispanic Americans have received just 20%.

Data on a city-level shows similar trends.

In New York City, Hispanic residents make up a plurality — 34% — of infections, as of Oct. 1, according to data from the city’s Department of Health and Mental Hygiene. In Los Angeles, Hispanic residents account for 45% of cases, as of Oct. 4, according to the Los Angeles County Department of Public Health. Around 10% of race/ethnicity data was unknown for each city.

Public health experts told ABC News a lack of access to healthcare and insurance, language barriers and the stigma around the disease has led to such large disparities.

“I’ve lived through the HIV epidemic, I’ve lived through the COVID pandemic and now through monkeypox, and it is frightening to see the similarities in the sense that it’s always the same populations that really are at a disadvantage,” Dr. Judith Flores, executive board member of the National Hispanic Medical Association, told ABC News. “Don’t have the equity in access to care, equity in getting the care in the way they needed, and in the manner that’s most appropriate to them, culturally and linguistically. So, I’m not surprised that we’re seeing this.”

Lack of information

Public health experts told ABC News one reason Hispanic and Latino men may have been disproportionately affected by the outbreak is because getting information to the community about the disease was difficult.

David Cuevas, disease intervention specialist and supervisor at the Multnomah County Health Department in Portland, Oregon, told ABC News there was limited information being released by the CDC in Spanish.

“At the beginning, when there was an emerging communicable disease coming out, there was limited information in other languages,” he said. “At the beginning in our team, we were looking at information from other websites in the U.K. or in Europe that have translations in different languages.”

Dr. Sean Cahill, director of health policy research at the Fenway Institute, a healthcare organization that focuses on sexual and gender minorities, in Boston, also said there weren’t many televised briefings about monkeypox like there were with COVID-19, meaning most people received public health information via internet, as well as booking vaccine appointments.

According to a Pew Research Center poll, only 65% of Hispanic adults said they had a broadband connection at home, as of February 2021, compared to 80% of white adults.

“In the early weeks of the monkeypox outbreak, vaccine was made available in many locations in New York and Washington, D.C. and elsewhere online,” he told ABC News. “And you had to have a computer and an internet connection or data, or Wi-Fi access or a smartphone in order to be basically book an appointment to get a vaccine.”

He continued, “And there are racial/ethnic disparities that affect groups in terms of socioeconomic status and whether or not people have smartphones and computers and internet access. And so, I think that played a role.”

Cahill added getting access to the treatment TPOXX required doctors and patients to fill out a great deal of paperwork from the CDC, which was not available in Spanish until August.

Fear of stigma

Aside from lack of information, stigma associated with the disease may also be affecting vaccine distribution.

The outbreak has primarily been concentrated in men who have sex with men, a group that includes people who identify as gay, bisexual, transgender and nonbinary, although health officials have said anyone — regardless of sexual orientation — is at risk if they have direct contact with an infected patient.

“We started mass distribution, so you’re expecting people to go online to basically out themselves,” Flores said. “If you are especially from Hispanic communities and communities of color, it is not something perhaps you’re most comfortable doing and you don’t want to make it public.’

Cuevas, a gay Hispanic man himself, said because the disease was mischaracterized as a disease only affecting LGBTQ populations, Hispanic Americans may have been fearful of being outed.

“A lot of individuals in the Latinx community may not be feel comfortable with their sexuality, with their identity,” Cuevas said. “Myself included, when I went to get my vaccine, I’ve even thought about that. “I was like, ‘Wow, if I was me, like my younger years when I was more in the closet and wasn’t out with my sexuality, this will be very stressful.'”

Cuevas said when Multnomah County was scheduling vaccine appointments, one way of trying to remove the stigma was to try to make the process as anonymous as possible.

“We would give this list of the people that are eligible [and say], ‘You just have to say yes or no, you don’t have to specify which part of the eligibility you fall into,'” he said. “So, people don’t feel like they’ve been put on the spot.”

How to reduce racial/ethnic disparities

Public health experts say to prevent to reduce the racial/ethnic gap, public health leaders and community leaders need to knock down barriers that prevent access to care among minority populations.

“That means going to where they are, having vaccine clinics at flexible times, on the weekends and late at night, and going to the places where, like those individuals, maybe hanging out,” Cuevas said.

He added, “Specific to our county, we were working hard and putting information on social media, on dating apps, information that somebody that speaks Spanish can actually read and make sense of. You want to have individuals talking to you in your own language, when you call and make the appointment for your vaccine.”

The effort appears to be working. In the latest CDC report, as of Sept. 18, Hispanics made up 19% of weekly monkeypox cases nationally with reported race/ethnicity data. which is down from 31% a month prior.

Cahill added that the bigger systemic issue that will help is expanding Medicaid eligibility.

“In order to qualify for Medicaid, you have to be categorically eligible. You either have to be disabled, or be a parent with dependent children, and you also have to be really, really poor,” he said. “That’s another big systemic reason why we see these ethnic disparities in HIV, in COVID, and now in monkeypox affecting Hispanic and Latino populations, because people don’t have health insurance and they’re not in routine care.”

“So, when a new threat emerges, they don’t have someone they can just call and talk to about it or get an appointment, or you know they’re not familiar with a medical office where they have gone on a regular basis and, therefore, they’re losing out on information,” Cahill continued.

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