A disproportionate number of cases in the recent outbreak of monkeypox appeared among gay and bisexual men. And as public health officials investigate possible links to sexual 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 taking pains not to single out a group that suffered terrible stigma at the height of the AIDS crisis in the United States.
“Experience shows that stigmatizing rhetoric can quickly disable the evidence-based response, fueling cycles of fear, driving people away from health care, impeding efforts to identify cases and encouraging ineffective punitive measures,” Matthew Kavanagh, Deputy Executive Director of the Joint United Nations Program on HIV/AIDS, said recently. For many years after the HIV outbreak, fear of being judged or shamed dissuaded some gay men from getting tested.
But as a gay man who studies the history of infectious diseases, I worry that public health leaders aren’t doing enough to directly warn men who have sex with men about smallpox. Gays aren’t the only people at risk, but they need to know that, at this time, the condition appears to be spreading more actively within their community. In recent days, CDC officials have openly acknowledged this. Director Rochelle Walensky noted Thursday that of the nine monkeypox cases identified in the United States as of midweek, most were among men who have sex with men.
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However, many other well-meaning officials seem wary of saying something homophobic, and the media ran articles emphasizing that smallpox “is not a gay disease.” Their caution is warranted, but health agencies are putting gay people at risk unless they prioritize them for interventions like public awareness campaigns, vaccines and testing.
Smallpox, which is related to smallpox and causes symptoms that include a rash, was not previously seen as a sexually transmitted infection, but many people who have recently contracted the disease have exhibited symptoms, such as lesions around the genitals or anus, consistent with transmission. sexual. Public health officials need to work with gay community health centers and other LGBTQ organizations to provide information about smallpox symptoms to doctors and their patients.
While gay activist groups and clinics may be 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 must pay special attention to the most marginalized people who may be at risk. In the past, HIV prevention and treatment efforts have targeted white men, but not the large numbers of working-class and colored men and poor men who have been infected with this virus.
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For now, both the media and public officials continue to regard monkeypox as a rare disease. I understand the instinct not to overdo it. However, while the number of documented cases remains small, the presumption that the outbreak is an anomaly is precisely what misled medical officials, journalists and even gay men themselves 40 years ago when HIV made the headlines. AIDS was routinely framed as an uncommon disorder among a small group of gay men in San Francisco and New York, but the pathogen that caused it was already circulating much more widely. I worry that we are making the same mistakes we made when HIV started to emerge.
The United States is still dealing with the baggage of the HIV/AIDS crisis. In the 1980s and early 1990s, confusion reigned, and some Americans were unnecessarily concerned about having incidental contact or even being in the same room with a person with AIDS. Public health campaigns tried to alleviate the anxiety by creating subway ads that showed gay and straight couples kissing to emphasize that HIV is not spread that way or talking about condoms to promote safer sex. These efforts were helpful; spreading reliable information about how a virus is transmitted and how it can be prevented is essential to protecting public health.
However, for fear of provoking animosity toward gay men, authorities today may be downplaying the role of sexual transmission in recent smallpox cases.
Viruses spread as a direct result of physical and social conditions. COVID-19 has a greater chance of spreading in a crowded indoor environment than on a hiking trail. Similarly, monkeypox does not require sexual contact, but is prone to spread in situations where people with exposed skin are together in close quarters. Like HIV, monkeypox does not check the sexual odometer; the virus doesn’t count the number of partners everyone has and then latch onto the ones with the most. It looks for opportunities to spread out – and some queer spaces, particularly where people meet to have sex, have created the conditions that allow that to happen.
The facilities where gays gather closely helped define the community. When public health officials closed toilets during the early days of HIV, many gay men saw the closure as a violation of their growing liberation. (On the other hand, in March 2020, when public health officials closed movie theaters and stadiums, many Americans were saddened to see these venues temporarily closed, but they weren’t essential to anyone’s fundamental identity.) While I’m not suggesting that governments impose restrictions on queer spaces, health agencies should tell gay men that monkeypox may actually be spreading sexually.
Authorities need to be able to send this message without moralizing about customer behavior. Historically, when public health is under threat, the urge to judge and shame has been strong – as the HIV/AIDS crisis and COVID-19 have shown. Especially before coronavirus vaccines were available, people heavily criticized each other on social media or in person, even for harmless behavior like going to the beach or running outdoors without a mask.
But both health officials and the public need to be able to differentiate between using a virus to pathologize an entire community and recognizing that certain physical and social conditions actually pose a greater risk of infection. Giving gay men carefully tailored warnings about the risk of smallpox can be a form of education, not a form of stigma.
Instead of treating bathhouses, clubs and dance parties exclusively as disseminators of infectious diseases, they should be recognized as potential promoters of sexual health. For decades, it was common to find a bucket of condoms at the entrance of many bars, next to posters and leaflets with information about safe sex. LGBTQ organizers have extensive practice in informing their communities of a potential health threat and advocating safer sex practices.
Public health officials should activate these features rather than tiptoeing around the issue. If gay men are at risk of the smallpox outbreak, we need to be told this explicitly – rather than being told that the condition is rare and mostly occurs in other parts of the world.