The monkey goat dilemma: How to warn gays of risk without inciting hatred

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Monkeypox has arrived in Salt Lake County, with two men testing positive after returning from Europe, the epicenter of a global outbreak concentrated in gay and bisexual men.

Officials in the Utah district have faced a dilemma. They wanted to warn men who have sex with men that they are at a higher risk for exposure to the virus. But they feared unintended consequences: heterosexuals who assume they are not sensitive, locked up men in a very Mormon community avoiding care so that they are not seen as gay, and critics exploit the infections to sow bigotry.

It’s not just Utah officials struggling to find the right message. As the United States faces its largest ever epidemic of monkeypox, with nearly 50 probable cases, public health authorities are navigating a delicate but well-known balancing act. In the 17 U.S. cases in which the patient’s sexual behavior is known, all but one involve men who have sex with men, mirroring trends in Europe. It is something never before recognized in outbreaks of the virus.

In Salt Lake County, health officials consulted with activists and decided to get the message across to gay and bisexual men without making the message about them. At a booth at the Utah Pride Festival in Salt Lake City this month, Department of Health staff distributed monkeypox warnings in the size of a business card, urging people to avoid close or sexual contact with anyone experiencing a rash or flu-like symptoms. The warning said nothing about the gay community.

“We don’t need to put rainbows everywhere and explain that it’s only for [men who have sex with men] because it’s not,” said Nicholas Rupp, who oversees public access for the Salt Lake County Health Department. “The virus, of course, does not see a sexual orientation.”

Officials nationally want gay and bisexual men to be alert to symptoms, especially rashes and lesions on or near the genitals, as they travel, celebrate and gather in June for LGBT Pride Month, which celebrates the 1969 Stonewall Uprising in New York City. which marked a pioneering. moment in the fight for LGBT rights. But they also want to avoid creating a false impression that monkeypox is a homosexual disease.

The early days of the AIDS epidemic weighed on public health and LGBT advertisers responding to monkeypox. Activists say public health officials did not act urgently because HIV decimated gay communities in the 1980s and gay men were blamed for the epidemic.

The strain of monkeypox leading to the current outbreak is rarely fatal and causes a disease that lasts for several weeks, unlike AIDS, which is incurable and was often fatal before effective therapies appeared in the 1990s. But even if monkeypox does not pose a deadly threat similar to HIV, health officials do not want to ignore any emerging threat of disease disproportionately affecting gay men.

“It’s really important from a public health perspective for us to make sure that populations that are potentially more dangerous because of how it started are aware of the risk, and also how to keep themselves healthy,” said Demetre Daskalakis, who leads. the division of the Centers for Disease Control and Prevention of HIV / AIDS Prevention and is involved in ape smallpox outreach.

LGBT organizations are mobilizing to deliver the message themselves.

Staff members of a clinic serving gay men in Chicago added prevention of monkeypox to their usual public health at the International Festival of Mr. Leather in May. The Grindr linking program has released two warnings about monkeypox in recent weeks. A LGBT community center in South Florida has scheduled a town hall meeting on monkeypox ahead of next weekend’s Stonewall Pride Parade and Street Festival after local authorities identified several cases.

The organizations are careful not to create panic. Monkeypox is easier to contain than highly contagious strains of the circulating coronavirus because it is relatively difficult to spread. Many of the cases identified in humans in the United States have been linked to a trip to Europe, where most infections have been detected, although the CDC warns that the virus also appears to be spreading locally.

Monkeypox was never associated with men having sex with men until the latest outbreak, when Canada, Spain, Britain and disease trackers in other nations noted that infections were heavy but not exclusively concentrated in that group.

Experts say they believe it reflects the virus spreading first through gay social networks and at places frequented by men who have sex with men, including European saunas and festivals. They also cite two factors that may increase the number of cases detected in the gay community: regular testing for sexually transmitted diseases and health care providers.

“In a sense, we may be the victims of our own success as people come forward and our sexual health is taking over,” said Andrew Lee, a professor of public health at the University of Sheffield in the United Kingdom.

The virus usually spreads through close contact with someone with rashes or injuries, which includes sex, but may also include hugging, skin-to-skin contact while dancing, or sharing contaminated clothing and bedding, or drips for a long period of time, such as between people. . living in the same house. Federal officials said the virus is unlikely to spread through past interactions in a store or bar.

Officials see a parallel to the outbreak of the infection caused by methicillin-resistant Staphylococcus aureus – known as MRSA – about a decade ago. It was first reported among men who had sex with men before being detected in locker rooms and health clubs; the bacteria are spread by common equipment and skin-to-skin contact.

“There are so many infections that once supposedly existed in only one population, and it ends up being quite misleading,” Daskalakis of the CDC said, highlighting the stigma thrown at Asian people early in the coronavirus pandemic.

The World Health Organization has repeatedly emphasized that monkeypox is not a homosexual disease, and has encouraged Pride celebrations. Activist groups have condemned news organizations that emphasize gay and bisexual men in their headlines and coverage.

“One of the most glaringly wrong things about the initial message about AIDS is that it was homosexual immunity or not transmitted asexually or from mother to child,” said Daniel R. Lucey, a fellow at the Infectious Diseases of America, which began. his medical career treating AIDS patients in San Francisco. “It’s clear that everyone wants to draw attention to avoid the trap of blaming a certain population, in this case, men who have sex with men.”

But some cultural observers are concerned about over-correction, which leaves gay and bisexual men in the dark about the virus threat.

“Early in the AIDS crisis, public health officials and news reporters were not alerted to a new disease because they didn’t care about gay or bi men, they didn’t care if we lived or died,” sex columnist Dan. Savage recently said in his podcast. “Now they fail to sound the alarm because they care too much about us, so they don’t want to hurt our feelings or accidentally give ammunition to anti-gay mustaches.”

Jim Downs, a gay historian who has written about the history of infectious diseases including HIV / AIDS, said that fixing stigma avoidance could undermine efforts to raise awareness.

“Worry about allocating the resources to the gay community so they can spread the word,” Downs said. “We have a history where the community has been an effective force in the promotion of public health.”

The legacy of AIDS has created a strong network of public health organizations in the gay community, reflecting how the community has often stood alone in condom advertising and in pressuring drug companies to develop AIDS treatments.

Bowls of condoms and STD literature are fixtures at gay clubs, and there are also HIV outreach teams at gay spaces known for sexual activity. At Grindr, it is routine for users in their profiles to list their HIV status and whether they are using preventative pills to reduce the risk of transmission.

Mr. Leather’s International Convention – known as IML – in Chicago over Memorial Day weekend presented one of the first trials for organizations adapting to monkeypox.

The LGBT-oriented Howard Brown Health Center routinely sends workers to the annual event to distribute condoms and offer rapid HIV testing. In response to monkeypox, extraordinary workers urged people at the festival to examine themselves for lumps, bumps and redness around the genitals and to consider examining partners before having sex in the dark.

“Telling people to avoid IML? That’s ridiculous, and it will never work, “said Anu Hazra, Howard Brown’s co-medical director.” People are already at IML, so all we can do is alert them. “

The White House has made a call this month with activists and nonprofits that work with gay men to discuss messaging and outreach.

“What a painful contrast to 1981 and HIV,” said Peter Staley, a longtime AIDS activist who called. “If the White House had contacted the gay community like that with the first reported cases in June and July 1981, we would certainly have had a chance to make it an epidemic, which is a fraction of the size it was in. The United States.”

Some organizations say the small number of monkeypox cases so far does not guarantee a full response while HIV and the coronavirus are more prevalent.

“The interventions that work for both covid and HIV will go a long way in preventing the spread of monkeypox,” said Alexis Sanchez, director of advocacy and training at the Sacramento Community Center LGBT.

Five cases have been detected in Sacramento County, including close contacts of an international traveler. These cases come against the background of the CDC indicating the district as having high coronavirus levels, which has triggered mass command in some schools.

“Especially in Sacramento with an increase in covid, people are more likely to hire covid. What doesn’t mean [monkeypox] is not within our radar, but it’s not our top priority,” Sanchez said.

Some activists want HIV prevention and LGBT organizations to do more to spread warnings about monkeypox symptoms and help extinguish the outbreak.

“This is a burgeoning crisis, and we may contain a virus that is now spreading in its early days in the United States in our community. There is no reason to sit aside,” said Gregg Gonsalves, an epidemiologist at the Yale School of Public Health and a longtime activist. AIDS.

Some have used the monkeypox epidemic to condemn Pride and other aspects of gay life.

In the UK, an organization called the LGB Alliance has called for a ban on saunas and leather bars during Pride Month to curb the spread of monkeypox, sparking protests from major LGBT groups who have often criticized the alliance for supporting anti-transgender views.

David Bath, a 43-year-old health economist in London who contracted monkeypox in May, was among those who rejected the view, saying it would only feed stigma and reduce people from reporting symptoms.

He said his experience with monkeypox testifies to the value of a free public health system that does not abandon gay men.

Bath sought care at a clinic where he is routinely screened for infections after he noticed symptoms that included fever and spots on his body and after hearing about monkeypox from a doctor friend and reading an article that noted cases were concentrated among men who have sex. with men.

When health authorities investigating the spread of the virus contacted him, Bath had no qualms about filling out a spreadsheet with information about 28 contacts, including friends he hugged, his therapist and sexual partner. Some have been offered vaccines that can prevent the virus from causing disease. He fears that this would not be possible in an anti-gay society.

“Reluctance to talk about sex and stigmatizing communities and their practices that are part of life is not only wrong and unethical, but counterproductive,” Bath said.