Gay men need specific warning about Monkeypox


A disproportionate number of cases in the recent monkeypox outbreak occurred in gay and bisexual men. And as public health authorities investigate possible links to sexual contact or other close physical contact at a Pride event in the Canary Islands, a sauna in Madrid and other gay venues in Europe, government officials are trying hard not to isolate a group that endured terrible stigma during the height of the AIDS crisis in the United States.

“Experience shows that stigmatizing rhetoric can quickly disable an evidence-based response by fueling cycles of fear, driving people away from health services, hampering case identification efforts and encouraging ineffective punitive measures. “, Matthew Kavanagh, Deputy Executive Director of the Joint United Nations Program on HIV/AIDS, said recently. For many years, following the HIV epidemic, the fear of being judged or humiliated deterred some homosexuals from getting tested.

But as a gay man who studies the history of infectious diseases, I worry that public health officials aren’t doing enough to directly alert men who have sex with men to monkeypox. Gay men aren’t the only people at risk, but they should know that right now the disease seems to be spreading most actively within their community. In recent days, CDC officials have bluntly acknowledged this. Director Rochelle Walensky noted on Thursday that of the nine monkeypox cases identified in the United States as of midweek, most were in men who have sex with men.

Yet many other well-meaning officials seem afraid to say anything homophobic, and news outlets have run stories emphasizing that monkeypox is “not a homosexual disease.” Their caution is warranted, but health agencies put gay men at risk unless they prioritize them for interventions such as public awareness campaigns, vaccines and testing.

Monkeypox, which is related to smallpox and causes symptoms that include a rash, was not previously considered a sexually transmitted infection, but many people who have recently contracted the disease have experienced symptoms, such as sores around the genitals or anus, consistent with sexual transmission. Public health officials should work with gay community health centers and other LGBTQ organizations to provide information about monkeypox symptoms to doctors and their patients.

Although gay activist groups and clinics are carefully monitoring the outbreak, I am concerned about gay men in areas where doctors may be unaware of the pathophysiology of the virus. Therefore, public health agencies should also pressure gay social media apps and other online platforms to inform their users that men who have sex with men have been disproportionately infected with the virus. These outreach efforts should pay particular attention to the most marginalized people who may be at risk. In the past, HIV prevention and treatment efforts reached white men, but not the large numbers of colored, working class, and poor men who became infected with this virus.

For now, the media and public authorities continue to classify monkeypox as rare. I understand the instinct not to overreact. Yet, although the number of documented cases remains low, the presumption that the epidemic is an anomaly is precisely what misled medical authorities, journalists and even gay people themselves 40 years ago, when HIV first made headlines for the first time. AIDS was regularly described as an unusual disorder among a small group of gay men in San Francisco and New York, but the pathogen that caused it had already circulated much more widely. I fear that we are making the same mistakes as when HIV started to surface.

The United States is still grappling with the baggage of the HIV/AIDS crisis. In the 1980s and early 1990s, confusion reigned and some Americans worried needlessly about having accidental contact or even being in the same room as someone with AIDS. Public health campaigns have tried to ease anxiety by creating subway ads that showed gay and straight couples kissing to emphasize that HIV isn’t spread that way or talk about condoms to promote relationships safer sex. These efforts have been useful; The dissemination of reliable information on how a virus is transmitted and how to avoid it is essential to protect public health.

However, for fear of stoking animosity against gay men, officials today may underestimate the role of sexual transmission in recent cases of monkeypox.

Viruses spread as a direct result of physical and social conditions. COVID-19 is more likely to spread in a crowded indoor environment than along a hiking trail. Similarly, monkeypox does not require sexual contact, but is likely to spread in situations where people with exposed skin are nearby. Like HIV, monkeypox does not check your sex odometer; the virus doesn’t count the number of partners each has, then clings to those with the most. It looks for opportunities to spread — and some queer spaces, especially where people meet for sex, have created the conditions for that to happen.

The premises where homosexuals congregate closely have helped define the community. When public health authorities closed bathhouses at the onset of HIV, many gay men saw these closures as a violation of their growing liberation. (By contrast, in March 2020, when public health officials shut down movie theaters and stadiums, many Americans were sad to see these places temporarily close, but they weren’t essential to anyone’s core identity.) While I’m not suggesting that governments impose restrictions on gay spaces, health agencies should tell gay men that monkeypox can indeed be sexually spread.

Authorities must be able to send this message without moralizing customer behavior. Historically, when public health is threatened, the urge to judge and shame has been strong, as both the HIV/AIDS crisis and COVID-19 have shown. Especially before coronavirus vaccines were available, people were highly critical of each other on social media or in person, even for harmless behaviors, like going to the beach or jogging outside without a mask. .

But health officials and the public must be able to differentiate between using a virus to pathologize an entire community and recognizing that certain physical and social conditions genuinely pose a higher risk of infection. Giving homosexuals carefully tailored warnings about the risk of monkeypox can be a form of education, not a form of stigma.

Rather than treating bathhouses, clubs, and dance parties exclusively as vectors of infectious disease, they should be recognized as potential promoters of sexual health. For decades it was common to find a bucket of condoms at the entrance to many bars, next to posters and leaflets with information about safer sex. LGBTQ organizers have a long history of educating their communities about a possible health threat and advocating for safer sex practices.

Public health officials should activate these resources rather than tiptoe around the problem. If homosexuals are threatened by the monkeypox epidemic, we should be told so explicitly, instead of being told that the disease is rare and occurs mainly in other parts of the world.


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