A section of skin tissue taken from a monkey infected with monkeypox virus, seen at 50x magnification on day four of the rash developing in 1968. Photo: US CDC
- When news broke that monkeypox appears to disproportionately affect gay and bisexual men, Jih-Fei Cheng, an associate professor at Scripps College, thought, “Here we go again.
- This association recalled the beginnings of the HIV/AIDS epidemic, when what we knew about the disease was limited to its impact on the queer community.
- As of May 27, about 300 cases have been reported in the United States and Europe, and many countries have reported that almost all of these cases are in gay and bisexual men.
- There is absolutely no evidence to suggest monkeypox is spread specifically through sex, or gay sex in particular. It is transmitted by skin-to-skin contact.
- Although the possibility of sexual transmission cannot yet be ruled out, skin-to-skin contact can easily explain infection patterns, infectious disease expert Kartik Cherabuddi said.
When news broke that monkey pox appears to disproportionately affect gay and bisexual men, Jih-Fei Cheng, associate professor of feminist, gender and sexuality studies at Scripps College, thought, “Here we go again. . For Cheng and many others, the association of an emerging infectious disease with gay and bisexual men was starkly reminiscent of the early days of the HIV/AIDS epidemic, when little was known about the disease in the first place. beyond its impact on the queer community – an observation that led to it being called “gay cancer” for some time.
As of May 27, around 300 cases have been reported in the United States and Europe, and many countries have reported that all or nearly all of these cases are in gay and bisexual men. Many of the men affected appear to have contracted monkeypox at events initially reported as ‘raves’ but which were actually a 10-day gay pride event in the Canary Islands and a five-day fetish festival in Belgium. A gay sauna in Madrid may also have been a major transmission site.
When this link became clear, health officials reacted quickly. On May 23, John Brooks, head of the epidemiology research team in the Division of HIV/AIDS Prevention at the United States Centers for Disease Control and Prevention, made an explicit appeal to gay and bisexual men at a a press briefing. On May 24, gay dating app Grindr, in partnership with local health agencies, posted a monkeypox warning to users across Europe; Brooks suggested at the press conference that similar warnings may soon be issued to US users.
There is an obvious meaning to this approach: if an infectious disease is disproportionately present in a particular community, then reaching out directly to that community may be the most effective way to contain its spread. But some experts worry that linking monkeypox to gay and bisexual men risks repeating the mistakes of the early days of the HIV/AIDS epidemic.
First, the facts: there is absolutely no evidence to suggest that monkeypox is spread specifically through sex, or gay sex in particular. This is spread through skin-to-skin contact, and sex — gay, straight, or otherwise — tends to involve quite a bit of skin-to-skin contact. Although the possibility of sexual transmission cannot yet be definitively ruled out, there is no valid reason to believe that it occurs when skin-to-skin contact can easily explain infection patterns, says Kartik Cherabuddi, associate professor of infectious and global diseases. medicine at the University of Florida.
As far as experts can tell, monkeypox disproportionately affects gay and bisexual men as a direct result of events in which large numbers of men have repeatedly come into close contact – sexual or otherwise – over the course of of several days. “All it takes is one person with the potential to have monkeypox” to cause an outbreak in such an environment, says Ronald Valdiserri, professor of epidemiology at Emory University’s Rollins School of Public Health.
And once the virus circulates within a particular community, members of that community become more susceptible to contracting it – after all, gay and bisexual men are most likely to be in close physical contact with others. gay and bisexual men. That, according to Valdiserri, is reason enough for public health organizations to work to educate gay and bisexual men about monkeypox. “The choices they make are their own choices, but you like to make sure people have the right information up front,” he says.
But Tonia Poteat, an associate professor of social medicine at the University of North Carolina, isn’t convinced there’s a strong public health imperative to reach gay and bisexual men specifically, at least at this point. Monkeypox is much, much less transmissible than SARS-CoV 2, and as of May 26, the United States has reported only nine cases. She also notes that the preponderance of gay and bisexual men among known case does not necessarily result in a similar bias among everything case. Because of HIV/AIDS, she says, gay and bisexual men are more likely to have contact with the health care system, and they’re likely more likely to seek immediate medical attention for a new, unexplained rash.
Given these facts, says Poteat, the message could have been very different. “What we know is how monkeypox is transmitted,” she says. “That’s what people really need to know. They do not necessarily need to know the sexual behavior or sexual orientation of the people who might have been identified. After all, scientists believe that monkeypox can be spread through any type of close contact – hugging, contact sports, touching someone’s sheets or towels – not just sex.
But the statistical association between monkeypox and gay and bisexual men has become a priority – and now that it is, Valdiserri says he worries about the risk of worsening stigma. Infectious diseases and sex, and sexually transmitted diseases in particular, are already heavily stigmatized. Even though monkeypox does not appear to be sexually transmitted in the traditional sense (through semen and vaginal secretions), sex is a likely cause of its spread, and it has now been publicly linked to events and places, like a fetish festival and a gay sauna, which might push the margins of acceptability for some people. And the discomfort and fear that people may feel about the onset of a new disease, and about certain types of sexual relationships, may then embrace gay and bisexual men as a group.
“It kind of feeds into this message that men who have sex with men are somehow more contagious than other people, and that’s a dangerous subtext,” Poteat says.
Another is that sexual behaviors could become the focal point of assigning blame for monkeypox. This blame can be dangerous when directed at a marginalized group – as has been the case for Asian Americans during the COVID-19 pandemic – and it can hide other roots of the disease’s spread. , such as global inequality. “We have to be very careful not to stigmatize sexual behavior precisely because it prevents us from understanding that structural violence is at play,” Cheng says. He notes that activists in the early days of the HIV/AIDS epidemic called for structural remedies like universal health care and housing, and that the persistent lack of these remedies today has played a major role in spread of COVID-19 in the United States.
There’s another connection Cheng sees between monkeypox today and HIV/AIDS activism: solidarity with women fighting for reproductive rights. He and Poteat noted that this monkeypox epidemic is partially attributed to individual sexual behavior at a time when bodily autonomy is being steadily eroded in the United States. Roe vs. Wade seems on the verge of falling, and a growing number of states are criminalizing the right of transgender children to gender-affirming care. The past few months have also seen an increase in rhetorical attacks on gay and bisexual men, from Florida’s so-called “Don’t Say Gay” bill to the increasingly widespread use of the term. groomer to suggest that gay men are a danger to young boys.
It is true that there are major differences between 2022 and 1981, when HIV/AIDS cases were first reported. For now, same-sex marriage is still legal in the United States, and some gay and bisexual men — although usually white, wealthy men — are extremely visible in public life. But it would be wrong to conclude on this basis that gay and bisexual men, especially men of color and poor men, are not vulnerable to discrimination. “Homophobia has not evaporated,” says Valdiserri. “It’s better in some areas than in others. But it hasn’t gone away. »
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