Over 100k American children were diagnosed with COVID last week because so many remain unvaccinated, yet the national health headline this week is that gay and bisexual men are spreading the rare virus akin to smallpox, monkeypox. For those who survived the AIDS pandemic, it’s an uncomfortable reminder of how stigmatization starts.
The COVID spread among children, who are also susceptible to the perils of Long COVID as well as a rare illness, Multisystem Inflammatory Syndrome in Children (MIS-C), associated with COVID-19, is a very real danger imperiling millions of those age-eligible for vaccination. Yet no headlines or TV news alerts. Unlike monkeypox.
About a dozen confirmed or suspected cases of monkeypox in the U.S. triggered warnings from the Centers for Disease Control and Prevention (CDC) about transmission. But the emphasis was not on an overall likelihood of spread, but rather zeroed in on gay and bisexual men, as well as men who have sex with other men (MSM), but do not identify as gay or bisexual.
CNBC, a major news outlet, presented the disease as a sexually transmitted gay illness: “CDC officials sound alarm for gay and bisexual men as monkeypox spreads in community.” The story quotes Dr. John Brooks, Medical Epidemiologist, Division of HIV/AIDS Prevention for CDC, who emphasized that anyone can contract monkeypox through close personal contact regardless of sexual orientation. However, Brooks said many of the people affected globally so far are men who identify as gay or bisexual. Though some groups have greater chance of exposure to monkeypox right now, the risk isn’t limited only to the gay and bisexual community, Brooks said.
Some headlines seem stunningly inflammatory and reminiscent of the tone in mainstream U.S. news reporting in the 1980s and 1990s that often depicted HIV/AIDS as a disease gay men were spreading intentionally to “innocent” people. One such May 24 headline in both the Boston Globe and CBS News reads “Massachusetts Monkeypox patient had contact with 200 people, CDC says.” It requires deeper reading to discover “Most of those close contacts are health care workers who encountered the man, who is a patient at Massachusetts General Hospital.”
Yet the headline implies the contacts are of a sexual nature, given the CDC warnings.
PGN spoke with Dr. Jennifer Aldrich, professor of Clinical Medicine
at the Lewis Katz School of Medicine, Temple University. Speaking on behalf of the Mazzoni Center, Aldrich said, “Monkeypox is not a new virus – but it traditionally has only been seen rarely outside of Africa, and in the context of travel or animal exposure. What we are seeing now is sporadic cases popping up all over, which indicates community transmission.”
The Massachusetts monkeypox patient had recently traveled to Canada, which is among four countries with a couple dozen confirmed cases. In central and western Africa, where the monkeypox virus is endemic, people are mainly infected by animals like wild rodents and primates; outbreaks have not crossed borders, as with the current spate of cases.
Aldrich stressed the difference between monkeypox virus and the coronavirus pandemic, noting, “Unlike Covid, monkeypox virus is not terribly contagious – the major route of transmission is through direct contact, with inefficient respiratory spread.”
But she did explain that “Many of the recent cases have been associated with men who have sex with men” and further delineated the distinction by saying that “this is likely both a function of the virus becoming more prevalent in a social network, and the skin-to-skin contact associated with sexual activities. It is not, however, considered a sexually transmitted infection any more than is scabies, another contagion transmitted through direct skin contact.”
Aldrich said, “Monkeypox can thus infect anyone, and is not limited to the LGBTQ+ community – it is very important to separate risk of exposure from stigma.”
The U.S. response is decidedly different from that of the U.K., long known for having a stellar approach to HIV/AIDS that decries stigmatizing language. Even the British tabloid The Daily Mail tweeted a May 24 story, noting, “Grindr sends out monkeypox alert and urges gay and bisexual men to be aware of rashes,” that is far from inflammatory and includes a graphic from the European CDC with the signs clearly depicted.
On May 25, the San Francisco Chronicle queried a more calm approach than other U.S. mainstream media, tweeting, “With a likely monkeypox case detected near Sacramento, it’s time to ask what we need to know about the virus. Is it deadly? Should we change our behavior? Why should gay and bixexual men be careful?”
Tom Chivers, a British health reporter who has written extensively about HIV/AIDS, published a story headlined, “Monkeypox is not a ‘gay plague’ but tracing people at risk is key to stopping spread.”
Dr. Joseph Heskin, Sexual Health & HIV Doctor for the U.K. Health Security Agency tweeted that it was essential to shift the narrative from blaming gay and bisexual men to applauding them for being pro-active in revealing that the disease could have community spread.
Heskin wrote, “New narrative: Men who have sex with men have always engaged well with sexual health services allowing us to spot patterns of odd symptoms we couldn’t explain and flag this to see if others had seen similar. This led us to discovering a #Monkeypox outbreak. Well done them.”
Liz Highleyman, a U.S. medical journalist and science editor for POZ magazine, replied to Heskin, noting, “Exactly. Trying to hide the fact that the current outbreak is predominantly affecting gay & bi men so far isn’t doing anyone any favors.”
Yet Monkeypox is not a sexually transmitted infection, and anyone can become infected regardless of sexual orientation. “Anyone — anyone can develop and spread monkeypox infection,” Brooks said.
But the CDC is warning to watch out for “a distinctive rash in the genital region, which could be confused with an STI.” Monkeypox is spread through close contact with another person, including hugging, touching or prolonged face-to-face contact. It is thought that two large gay raves in Belgium and Spain precipitated the current spread of cases.
Not all cases are among gay and bisexual men. The first monkeypox cases in London were detected in a family who lived together in the same household. But ABC News reports that “early clusters in Europe and Canada happened among groups of men who have sex with men, with some ongoing transmission reported in this community.”
The U.N. has denounced what it terms “homophobic and racist” reporting on monkeypox spread, noting that media portrayals of cases among African and LGBTI people are fueling blame, as infections ar reported in Europe, US and Australia.
UNAIDS, the United Nations’ AIDS agency, warned of “exacerbating stigma and undermining the response to the growing outbreak.”
UNAIDS said “a significant proportion” of recent monkeypox cases have been identified among gay, bisexual and other men who have sex with men, but also said “transmission was most likely via close physical contact with a monkeypox sufferer and could affect anyone.”
UNAIDS deputy executive director, Matthew Kavanagh said, “Stigma and blame undermine trust and capacity to respond effectively during outbreaks like this one.”
Kavanagh added, “Experience shows that stigmatising rhetoric can quickly disable evidence-based response by stoking cycles of fear, driving people away from health services, impeding efforts to identify cases and encouraging ineffective, punitive measures.”
WHO also emphasized that “monkeypox is not a gay disease.”
In a media briefing on May 23, Andy Seale, an advisor with the HIV, Hepatitis and Sexually Transmitted Infections program at WHO, said: “While, for example, we’re seeing some cases amongst men who have sex with men [MSM], this is not a gay disease as some people on social media have attempted to label it. That’s just not the case. Anybody can contract monkeypox through close contact.”
Seale said, “One of the things we’ve recognized with this outbreak is it’s not typical. We’re seeing cases among men who identify as gay, bisexual, or from other groups of MSM in several countries, often linked to travel or recent travel, and it seems clear that this is linked to close contact. So this could be through social contact, possibly through sexual contact which of course is close contact. We’re still in the early days of this outbreak so there’s a lot we’re still learning.”