How to effectively talk about monkey pox without stigmatizing gay men

NPR’s Ari Shapiro talks with Gregg Gonsalves of the Yale School of Public Health about the public messaging challenges surrounding monkeypox, which primarily affects men who have sex with men.

When the White House declared monkeypox a public health emergency, Health and Human Services Secretary Xavier Becerra said it should concern everyone.


XAVIER BECERRA: We urge every American to take monkeypox seriously and to take responsibility to help us tackle this virus.

SHAPIRO: But the reality is that this disease doesn’t affect everyone equally. According to the latest data from the World Health Organization, 99% of people diagnosed with monkeypox are men, and 98% of those who report their sexual orientation are men who have sex with men — people like Kyle Planck, a 26- year-old student in New York City studying infectious diseases.

KYLE PLANCK: I haven’t had a ton of super painful experiences to compare it to, but it’s definitely, for me personally, the worst I’ve been through. And especially because it was an internal kind of pain, it was really hard to deal with.

SHAPIRO: He told our colleague Pien Huang that he spent several days in bed with monkeypox.

PLANCK: I had had a really high fever and I took hot baths, e.g. five or six times a day because it was one of the only things that made me feel better. So if I had to rate it, I guess my pain was about a seven or eight out of the worst pain I could ever imagine. And it came and went throughout the day.

SHAPIRO: As someone who studies infectious diseases, Planck was quite familiar with the risks.

PLANCK: Those things, combined with being a gay man in New York City – I think I had more awareness than the average person. So even though I knew about it, I didn’t think I would get it. So when I actually did, I was very shocked.

SHAPIRO: He got better after he started a medication called TPOXX. So how can we talk about this disease in an accurate and specific way to help those most at risk without creating stigma or homophobia? Gregg Gonsalves at the Yale School of Public Health has wrestled with this question. He has spent decades working on HIV and other infectious diseases. Welcome to ALL CONSIDERED.

GREGG GONSALVES: Thank you very much.

SHAPIRO: What comes to mind when you hear Secretary Becerra say that every American should take monkeypox seriously?

GONSALVES: Well, every American should take it seriously, but there are two kinds of taking it seriously. One is when you think you’re at personal risk, and that would be men who have sex with men — gay men in the United States, especially those who are sexually active. Other Americans, you know, should have some empathy and some solidarity and help their gay and lesbian neighbors through this. Many straight Americans rallied to our side during the HIV epidemic, but the federal government really needs to get its act together, because right now we’re failing to respond.

SHAPIRO: There is a long history of politicians and homophobes portraying gay men as carriers of the disease. And so if public officials get specific about how this disease spreads and how to prevent it, do they risk playing into the harmful tropes?

GONSALVES: Well, one thing is that we have to figure out how to hold two thoughts in our heads at once. One is that it is not a homosexual disease, but it occurs among men who have sex with men. And what the federal government has actually been pretty good at is they’ve been very, very vocal about the need not to stigmatize the LGBT community, gay men — not to discriminate against them. Having said that, you know, we’ve already heard from certain politicians – particularly in the other party – who have tried to make this a way to scapegoat people in a moment of crisis. And you know, we have to be fact-based in our prevention messages. And we just have to be very, very clear about the fact that discrimination and stigmatization are bad in a moral sense, but they also drive people away from care and prevention.

SHAPIRO: This disease is not only spread through sex, but it is often spread through sex. And after the head of the World Health Organization, Tedros Adhanom Ghebreyesus, declared monkeypox a global public health emergency, he spoke much more specifically than Secretary Becerra.


TEDROS ADHANOM GHEBREYESUS: It means making safe choices for yourself and others. For men who have sex with men, this currently includes reducing your number of sexual partners.

SHAPIRO: Some gay men were outraged to be told who they had to sleep with. And others, like sex columnist Dan Savage, tweeted it’s not discrimination. It’s not homophobia. It is treating grown gay men as adults. In your opinion, was that the right message?

GONSALVES: Well, Dr. Tedros did something brave when he announced a public health emergency. He overruled his advisory board and said, indeed, it is. It affects gay men all over the world. So I think he spoke about this from an attitude of care and solidarity – not of moral criticism or moral condemnation. And so yes, I think it’s fair to say that it’s fair to change the places you seek out sexual contact. And we should be talking about it explicitly, especially among the gay community – talking to ourselves, peers. That said, watch out for stigma and discrimination. But that’s – that’s what I think people are responding to – that talking about gay sex among themselves – among gay men, among the LGBT community – is one thing, but certain politicians will always take advantage of it.

SHAPIRO: You’ve spent so much of your career working on HIV. Although monkeypox is not fatal – there is a vaccine. There are treatments. Yet there are parallels between that disease and this one. What lessons from your experience with HIV and AIDS are you applying at this moment?

GONSALVES: Well, the most important thing we need to do is support people who are suffering from this disease – the gay men who are in desperate pain that your interviewee was talking about. People must be supported. Remember; 21 day quarantine may be OK for some. But if you don’t have a job that allows you to stay at home, or you don’t have sick pay, how are you supposed to do it? If you go into the hospital for pain medication, what will happen if you are underinsured or uninsured when you get that hospital bill? So my main point is that in the 1980s the gay community had to build its own systems of care for itself. We shouldn’t do that 40 years later. We should figure out a way to make sure that everyone who has a case of the monkeypox doesn’t fall between the racks.

SHAPIRO: I know that treatment, vaccines, access to care is its own whole issue. But on this issue of messaging and how to balance specificity with not wanting to incite homophobia and stigmatization, how would you rate the government’s performance so far?

GONSALVES: I mean, I don’t know if I have enough data to do that. But just remember – public health plays a role at state and local level. CDC’s role in public health is to provide technical guidance. How is it transmitted and how is it prevented? – you know, all kinds of facts. And state and local health departments make public health messages, and so some are better than others, right? Again, you know, the best message is going to be the most honest – as Dan Savage said – and treat us like adults.

This is not a gay disease. There should be no stigma and discrimination, but it is affecting gay men right now and we will have to change our behavior – not from some kind of moral admonition about our sex lives, but about protecting ourselves and caring for each second and to show solidarity with our gay men – to say that it will be a tough few months until we can get vaccination up to a level where we have broad protection against the virus. And you know, this happened in the mid-1980s. Gay men started to change their behavior and we start to decrease HIV rates in the mid-80s, before the big kind of community-based campaigns started. So we can do this.

SHAPIRO: Gregg Gonsalves is an associate professor of epidemiology at the Yale School of Public Health. Thank you.


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