As monkeypox continues to spread throughout the US, activists and experts say stigmatizing gay and bisexual men could curtail the efforts to contain the outbreak. In addition, the failure of public health systems to ensure access to vaccines and treatment could cause a potential backlash against disproportionately affected groups.
When California and Illinois declared health emergencies to bolster their response to the monkeypox outbreak, governors of both states warned against the stigmatization of LGBTQ communities disproportionately affected by the disease.
“We’ll continue to work with the federal government to secure more vaccines, raise awareness about reducing risk, and stand with the LGBTQ community fighting stigmatization,” Governor of California Gavin Newsom said.
It echoed Dr. Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, remarks that “stigma and discrimination can be as dangerous as any virus” while declaring the monkeypox outbreak an international public health emergency in July.
To date, there are 7,102 confirmed cases of monkeypox in the US, and men who have sex with men (MSM) account for most of them. However, activists urge not to frame monkeypox as a “gay” disease and make the vaccines and treatment more accessible.
Describing the risk clearly
Dr. Dolores Albarracín, a professor at the University of Illinois whose research focuses on health communication, says that any disease prevalent in a particular social group can stigmatize the group. However, not describing the risk in that particular group will harm its health.
“If the disease is primarily among gay and bisexual men who have multiple partners concurrently, that needs to be said loud and clear, and funds need to go into those communities. If this is not communicated clearly, then we have serious misrepresentation, and MSM at risk are being done a disservice,” she said.
The Human Rights Campaign (HRC), the American LGBTQ advocacy group, says on their website that the HIV epidemic showed that framing it as a “gay” disease is misleading and hinders from properly stopping the outbreak.
The CNN report that many technicians at two of the largest commercial labs in the US have been refusing to draw blood from patients who might have monkeypox is another example of how dangerous stigmatization can be.
The stigma around monkeypox will not be relegated to men who have sex with men, predicts Stella Safo, MD, MPH, a board-certified HIV primary care physician in New York. Instead, as more people of color get infected, they will be viewed as “dirty,” she wrote on Twitter.
“Women with it will be considered promiscuous. Kids with it may be viewed as victims of abuse. None of this is true, obviously, and getting rid of stigma now benefits us all.”
Dr. Albarracín says that we may see women who have many partners or whose partners are at risk contract monkeypox first, and “what happens from there is an open question.”
She thinks that not declaring monkeypox “sexually transmitted infection” is not without criticism, given that most infections have so far been associated with sex.
“Of course, one may have sex without skin contact, and the current CDC recommendations are to reduce the number of partners, perform mutual masturbation from a distance, and have virtual sex. But in most cases, people who have sex have “close contact,” she said.
Better access to vaccines
Jason Cianciotto, the vice president of the Gay Men’s Health Crisis organization (GMHC) in New York, says that public health systems in the US have done a good job in providing scientifically accurate information about the spread of the infection, the most affected groups, and ways to protect yourself.
However, Cianciotto says the challenge comes from the LGBTQ community being under attack. And that plays a role in how people view monkeypox, who is affected, and their relative risk.
According to Ciancotto, the potential backlash against gay, bisexual and transgender people might be caused by the failure of public health systems to provide the vaccine necessary to contain the outbreak.
Having been criticized for the lack of response to the outbreak, the Biden administration declared monkeypox a public health emergency on Thursday. The declaration could accelerate vaccine distribution and make it easier for doctors to prescribe treatment.
The Department of Health & Human Services (HSS) said that 602,000 doses of the JYNNEOS vaccine against monkeypox were shipped to states and jurisdictions. An additional 150,000 doses will arrive at the US Strategic National Stockpile in September.
Cianciotto, the vice president of GMHC, calls the authorities to authorize a drug TPOXX (tecovirimat), which helps mitigate the symptoms, for emergency use in monkeypox patients.
The Food and Drugs Administration (FDA) approved TPOXX in 2018 to treat smallpox in adults and children. However, in monkeypox treatment, it is classed as an investigational new drug. It means a lot of paperwork for providers who want to prescribe TPOXX for their patients.
A false sense of security
In July, the CDC issued guidelines for messaging to general audiences encouraging partners to emphasize that anyone can get monkeypox and promote it as a public health concern for all.
“Focusing on cases among gay and bisexual men may inadvertently stigmatize this population and create a false sense of safety among those who are not gay and bisexual men,” the CDC website says.
Warnings of a false sense of security were fueled by the story, which went viral on Twitter and was extensively covered in Spanish and international media. A user who identifies himself as a doctor shared a picture of a man whose body was allegedly covered in monkeypox lesions.
Arturo, a user who later restricted access to his tweets, claimed he approached the infected man and asked a woman close by if she was worried about getting infected. She reportedly said she wasn’t because she wasn’t gay.
However, the allegedly infected man later contacted the media and said he suffers from neurofibromatosis, which causes tumors to grow along nerves and is not infectious. He denied that any doctor approached him.
A few days later, the British Association of Dermatologists (BAD) issued a statement urging not to share pictures of people with rashes online, speculating it is monkeypox.
“It adds to the stigma around the disease, which is enormously unhelpful; it is also the sort of thing that adds to the psychological burden of people living with a visible skin condition,” said Dr. Mabs Chowdhury, President of the BAD.