It's OK to Acknowledge That Monkeypox Is Primarily Affecting Queer Men Right Now-UrbanUpdate

It's OK to Acknowledge That Monkeypox Is Primarily Affecting Queer Men Right Now

2025-02-05 18:56:59 Source：h Classification：Fashion

Last weekend, the World Health Organization declared monkeypox a global public health emergency. Bizarrely, the immediate reaction from a segment of Twitter users was anger and scorn.

See for yourself: the WHO’s tweet got ratioed, with many people accusing the organization of homophobia, calling back to the HIV/AIDS crisis of the 1980s and 1990s. This narrative has recently come to the fore: That focusing on LGBTQ+ people more broadly, and gay men more specifically, in how we talk about monkeypox is tantamount to homophobia, and that it shows we learned nothing from the HIV/AIDS crisis.

But while the US government still has not declared the situation a public health emergency (thus allowing state health departments to withhold their data from the CDC if they so choose), a UK government report showed that 97 percent of cases were in gay, bisexual, and other men who have sex with men—"GBMSM" in public health terminology. Similarly, a recently published study in the New England Journal of Medicine showed that 98 percent of affected persons were GBMSM. So how did we end up here, where efforts to focus on the people currently most impacted by monkeypox are cast as homophobic?

As a queer writer and a queer infectious disease doctor (who has patiently responded to every one of the writer’s questions about monkeypox), we wanted to offer some information for anyone still confused about what’s going on—and explain why the campaign to focus on queer men in responding to monkeypox is actually the opposite of homophobia. But first, some background.

Monkeypox isn’t new, even though it might seem like it.

First reported in humans in 1970, monkeypox has been endemic in central and west Africa for decades, with periodic outbreaks occurring within these regions and rare, limited outbreaks reported outside, mainly with direct links to travel.

With respect to the current global monkeypox outbreak, the UK first reported a cluster of 2 cases with no previous history of travel to endemic regions on May 14, 2022. Since then, it has begun popping up all across the globe. As of this week, there have been over 20,000 reported cases in 77 countries. While initial cases were at times linked to travel history to endemic areas, now most cases are not, indicating widespread community transmission.

One thing that makes monkeypox challenging to contain is that it has a relatively long incubation period—symptoms can take a couple of weeks to begin appearing—meaning it’s possible that this was circulating in communities at lower levels earlier than we knew but went undetected.

The virus is largely not deadly—but it is extremely painful and unpleasant.

Historically, monkeypox infections have had a 3-10% case fatality rate. It’s reassuring that in the current outbreak, which can be traced back to the milder of the two endemic strains, only 5 deaths have been reported as of this week.

But a low fatality rate doesn’t mean there’s no cause for concern, as monkeypox infections are characterized by a wide range of symptoms. Ninety-five percent of patients have reported skin lesions—frequently on the genitals and anus, as well as the face and torso—and nearly half have had ulcerative lesions in the mouth or rectum. Most patients have also had accompanying fever, fatigue, night sweats, and swollen lymph nodes. Although some have reported milder symptoms, for a large number of patients, lesions are extremely painful, particularly internal ones that have made swallowing, urinating, or defecating very challenging. Most patients hospitalized due to monkeypox have been seeking pain relief.

Many of those with more extreme symptoms have taken to social media to share their experiences.

Because people with monkeypox are contagious until all lesions heal, quarantine can last weeks. Those who have been among the earliest to contract Monkeypox in this pandemic have described feelings of isolation, loneliness, and abandonment that can be as hard to deal with as the physical symptoms themselves.

Queer men and the people in their sexual networks are currently most at risk.

The epidemiological information collected over the first two months of the pandemic shows that most cases have occurred among queer men. Despite extensive speculation, this appears to not be due to bias in sampling. There have been isolated reports of cases involving women and children, but the risk at this time is thought to be considerably lower. Of course, more cases might eventually be seen in these communities the longer the outbreak is left uncontrolled.

The New England Journal of Medicine study suggests that intimate physical contact during sexual activity is likely an important method of transmission. According to the latest CDC update, of the nearly 3600 cases in the US as of July 25, all but 5 were attributed to sex between men. While researchers are still looking into whether monkeypox can be transmitted through sexual activity directly (as opposed to just the prolonged skin contact associated with sex), the link between close and prolonged physical contact and infection is clear.

As queer men, the connection between infection and sex brings back memories of the HIV/AIDS crisis, including apprehension about monkeypox being labeled a “gay disease” in a time when homophobia and hate crimes are on the rise. We’ll explain why in greater detail later, but while concerns around how to carefully message the link between sexual activity and risk are valid, we still need to deal with the reality of the link.

Right now, it’s primarily spreading through prolonged physical contact—so no, you probably won’t pick it up at the gym or movie theater.

Monkeypox seems to be most frequently transmitted through direct skin-to-skin contact with lesions. While it is possible to get it via indirect contact through “fomites” in contaminated bedding or towels, or perhaps even close proximity over a prolonged period of time through respiratory droplets, the currently available epidemiological data suggests that we should be most concerned about spread through close contact, e.g. associated with sexual activity. This may be because intimate contact could allow for exposure to a higher dose of the virus than, say, using shared equipment at the gym.

This doesn’t mean it isn’t possible to contract monkeypox in ways other than sex. But it seems far less likely. While in theory anyone can get monkeypox, not everyone is at the same risk right now. Similarly, though monkeypox can theoretically be spread by different methods, each method does not carry with it the same risk.

In short: you should exercise standard hygienic practices (for example, wiping down gym equipment before usage), but there’s no real reason to suspect that going to the gym or shaking a stranger’s hand will put you at same degree of risk as sexual activity.

We have a vaccine, but not enough of it.

There are two licensed vaccines at our disposal in the fight against monkeypox, ACAM2000 and Jynneos. The latter is a non-replicating virus vaccine, and is being used widely—it’s much easier to administer and is safer for use in immunocompromised patients and those with skin conditions such as eczema. Both vaccines were primarily developed against smallpox, but are expected to confer a degree of protection against monkeypox.

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But even in the LGBTQ+ community, there has been some pushback to the idea that simply telling people to stop having sex is a bad strategy.

Here, a historical context is essential. It didn’t work in the AIDS crisis, so why would it work now? In fact, studies repeatedly show that calling for abstinence is not effective. It’s also, we would argue, not moral to tell queer people, who have been told time and again by the world not to fulfill what is a basic human need, to simply do so again.

Not only does abstinence place the impetus (and blame) on gay and bisexual men, it also allows those truly responsible to skirt blame. We are not to blame for the outbreak—we are victims of it, affected by the illness and then doubly failed by a government that spent pride month speaking in platitudes when real action would have demonstrated an actual commitment to the community. Which is probably why some of the messaging from the CDC and others suggesting gays people simply have less—or distanced—sex has been met with eye rolls by many in the community.

That doesn’t mean you can’t personally reevaluate your sexual practices in light of monkeypox and make whatever adjustments will make you comfortable and potentially reduce risk. You might decide to consider “safer” sexual practices, such as being open about your recent sexual history and asking for the same with potential partners, using condoms, avoiding places like bathhouses at least until vaccination is more widely available, or establishing close contact “pods” similar to strategies used to mitigate COVID. But suggesting queer people abstain from sex or simply have less of it without offering material support via vaccines or financial support during isolation just feels hollow.

It’s not homophobic to focus on the communities most affected

The HIV/AIDS crisis was an instance of the government failing to intervene because the people being primarily impacted initially were queer men and their networks. It’s natural this situation would bring that history to mind for people, but if there’s homophobia to be found in the government’s response to monkeypox, it’s that they haven’t moved faster and more comprehensively. Activists during the HIV/AIDS crisis chastised the government’s inaction, and pointed to the role of homophobia in relegating gay men’s health as less important. Likewise, many of us in the LGBTQ+ community feel this outbreak would be getting a very different response if it was impacting heterosexual people more than men who have sex with men.

With a government response that has been largely reactive rather than proactive, and at times bordering on willful neglect, an emerging outbreak that might have been nipped in the bud has now spread to affect nearly 4700 people in 46 states and DC and continues to grow. As people are left to fend for themselves, large numbers turn to social media as their primary source of information. And in an era where misinformation is rampant, even well-intentioned people can miss the mark.

It's OK to Acknowledge That Monkeypox Is Primarily Affecting Queer Men Right Now

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