Monkeypox education without stigmatization

Monkeypox Virus graphic
Monkeypox Virus graphic

LGBTQ Health

Conversations about monkeypox continue to circulate around the country as the illness rapidly spreads. Now officially declared a public health emergency, monkeypox is quickly becoming a hot-topic of discussion and a worldwide worry. 

Back in July, the World Health Organization (WHO) reported a 77 percent weekly increase in the number of lab-confirmed monkeypox cases. As of Aug. 12, there have been 35,058 confirmed cases of monkeypox worldwide, 10,726 confirmed cases in the U.S. and 305 in New Jersey. That number continues to rise daily. 

Amongst the many conversations health professionals, activists, and the public are having in regards to monkeypox is the correlation between the sickness and the LGBTQ community, specifically, self-identified men who have sex with men. According to the WHO, this population makes up about 93 percent of the confirmed cases globally. However, with the noticeable relation between monkeypox and the HIV/AIDS outbreak stigmatization of the 1980s, the WHO, LGBTQ activists and medical professionals are desperately trying to communicate to the public that sexual orientation does not change one’s susceptibility to monkeypox. 

“This is not a gay disease,” Dr. Ken Mayer, the medical research director of the Fenway Institute said in an interview with The Boston Globe. “It’s the social network phenomenon. It’s who you’re having contact with, not anything about the specific behavior.”

Monkeypox is not a sexually transmitted disease (STD). According to the WHO, monkeypox is a part of the orthopox family of viruses and a viral zoonosis, meaning a virus transmitted to humans from animals. Human-to-human transmission can result from close contact with respiratory secretions, skin lesions of an infected person, or recently contaminated objects such as clothing, bedding, towels, or surfaces that have been exposed to someone with the virus. 

The virus can cause symptoms similar to those seen in flu patients or patients in the past who had smallpox, although, according to the WHO, it is clinically less severe. Symptoms include swollen lymph nodes and a rash that often begins on the face and spreads to other parts of the body. Although many of the current cases have been found in individuals who self-identify as men who have sex with men, monkeypox can spread from direct contact with any infected individual to any other individual.

In a May statement to the United Nations (UN), Matthew Kavanagh, the Deputy Executive Director of UNAIDS, an organization leading the global effort to end AIDS as a public health threat by 2030, urged governments, media outlets and communities to respond with a rights-based, evidence-based approach that avoids stigma. 

“Stigma and blame undermine trust and capacity to respond effectively during outbreaks like this one,” Kavanagh said. “Experience shows that stigmatizing 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.”

During a White House briefing in July, adviser Dr. Ashish Jha urged people to “not use this moment to propagate homophobic or transphobic messaging,” and instead encouraged the public to stick to fact-based evidence in a respectful manner. 

In a conversation with NPR, Steven Thrasher, a writer and professor at Northwestern’s Medill School of Journalism, said that part of the solution to changing the stigmatized narrative of the monkeypox outbreak is “having adequate resources in place for testing, vaccinating and supporting people when they’re diagnosed.” In New Jersey, access to these resources are in the works.   

According to the New Jersey Department of Health (NJDOH), N.J. is “working in conjunction with the CDC and local health departments to quickly identify monkeypox cases and close contacts, provide treatment and vaccine and further prevent the spread of disease.” 

On July 17, Governor Phil Murphy and NJDOH Commissioner Judith Persichill announced expanded eligibility for the monkeypox vaccine and a statewide distribution plan for additional 2,700 available doses. Previously, the vaccine was available to residents only with known exposure to a monkeypox case. Now, the vaccine is also available to New Jerseyans who are at high risk of having been exposed to the virus in the past 14 days. 

The difference in vaccine eligibility is the notion of known exposure versus unknown exposure. In New Jersey, anyone with a known exposure within the past 14 days should contact their health care provider or local health department regarding testing and vaccine eligibility. Local health departments will also conduct contact tracing and offer the vaccine to anyone identified as a close contact.

A resident without confirmed exposure who believes they may have been exposed or are at high risk for having been exposed to monkeypox in the past 14 days can contact one of the  nine different locations statewide now offering the vaccine. 

To receive the vaccination, an appointment must be made to discuss the situation regarding the possible exposure. And because there is a very limited supply, the state essentially narrows monkeypox eligibility down to three groups — People who have known contact with someone who tested positive for orthopoxvirus or monkeypox virus within the past 14 days, people who attended an event where known monkeypox exposure occurred within the past 14 days, and people who had multiple sexual partners in the past 14 days in areas where monkeypox has been reported. 

“As cases of monkeypox continue to rise and our state receives additional doses from the federal government, we are taking these critical steps to increase availability of the vaccine to protect the health of residents,” Governor Murphy said . “As my administration works to raise awareness about monkeypox, we encourage our health care and community partners to help spread the word about symptoms, risks, and availability of both testing and vaccines. We will continue to prioritize the health of our communities and take steps to assist and reach residents at highest risk for this virus.” 

In the same interview with NPR, Thrasher said, in addition to resource access, there is one other important step in educating people about monkeypox without stigmatizing members of the LGBTQ community: tackling homophobia itself. 

“Because as long as there is a homophobic society and people are afraid of what it means to come forward, that this thing will make people think that they’re gay, then they’re not going to want to come forward,” Thrasher said. “And there’s no easy fix for that. That’s a long-term problem that needs long-term thinking to undo and make different.”