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When the World Health Organization declared monkey disease a public health concern over the weekend, it warned of another threat to society:
“Stigma and discrimination can be as dangerous as any virus,” said WHO director-general Tedros Adhanom Ghebreyesus.
In fact, a special WHO committee that previously considered whether to issue such a declaration failed to reach a consensus, partly due to concerns about the risk of stigma, marginalization and discrimination against communities most affected by the virus.
The global epidemic of monkeypox most commonly affects men who have sex with other men. A study published in the journal New England Journal of Medicine In more than a dozen countries, 98% of people diagnosed with the virus between April and June were gay or bisexual men, and the WHO says 99% of cases in the US are related to male-to-male sex.
This means that public health systems can target their messages and interventions to specific communities at risk. But it also risks stigmatizing those populations, while instilling prejudice in others who may still be vulnerable.
Public health experts stress that monkeypox is a concern for everyone because it can be spread from skin to skin and through contaminated items such as clothing or towels. Viruses can infect anyone. For example, the US has already documented two cases of monkeypox in children.
“We may see clusters primarily in certain groups of people, but viruses don’t discriminate based on race, religion or sexual orientation,” said Dr. Boguma Titanji told NPR.
How can leaders accurately identify those at risk of monkeypox without stigmatizing them?
before the Briefing on Tuesday, White House adviser Dr. Ashish Jha urged people “not to use this opportunity to spread homophobic or transphobic messages” but instead to stick to evidence and facts and to do so respectfully.
Stephen Thrasher, an author and professor at Northwestern’s Medill School of Journalism, says part of the solution is having enough resources to test, vaccinate and support people when they’re diagnosed (the U.S. has been criticized for its lack of vaccines, but more are expected to become available in the coming weeks). Another part is fighting homophobia.
“Because when there’s a homophobic society and people are afraid of what it means to come out, that can make people think they’re gay, so they don’t want to come out,” Thrasher said. NPR last month. “It’s not an easy fix. It’s a long-term problem, and it takes long-term thinking to undo it and do it differently.”
How to think about risks and be proactive
The monkeypox virus is similar to smallpox and is endemic to Africa – almost all cases previously found outside the continent have been linked to international travel and imported animals. What’s different now is how well it spreads through intimate contact, says Jason Cianciotto, vice president gay men’s health crisis.
“But it doesn’t necessarily have to be sexual: cuddling, massaging, sharing sheets or towels that come into contact with pustules,” she told NPR. Weekend Edition. “Even if you’re fully clothed, if you’re on the dance floor or dancing next to someone, there’s a chance you can get infected.”
Dr. Ali Khan, a former official at the Centers for Disease Control and Prevention, has worked on previous monkey outbreaks. In Indiana and the Democratic Republic of the Congo, 95% of infections are reported to be sexually transmitted.
He says morning edition The fact that the epidemic is mostly concentrated among men who have sex with men makes it a good opportunity to carry out prevention activities within this group, who have been active in getting information and getting on the waiting list for vaccination.
“But let’s be reminded that people who are not in this group are at risk, and we need to be concerned — not panicked, but concerned — and we need to do enough to prevent the spread of this infection,” he says. Khan added that public health data play a critical role in identifying disease, treating people, vaccinating close contacts and slowing the spread.
As of Monday, there were 3,487 confirmed cases in the United States. And as Cianciotto points out, the increase in cases doesn’t mean more people are at risk, it’s just that more vulnerable people may be at risk.
“If monkeypox is not brought under control, I am concerned that HIV and COVID-19 may also become concentrated in low-income communities of color, where immigrants, especially undocumented people, fear access to health care,” he said. – And it would be a tragedy.
Why stigma is dangerous and how to fight it
According to Titanji, a clinical researcher, false claims that monkeypox is of no concern to anyone except men who have sex with men are dangerous to public health.
This is partly because it creates a stigma that prevents infected people from coming forward, seeking care and warning their close contacts.
“While we’re trying to prevent an outbreak, we want … people to seek medical attention when they see suspicious lesions, so that they can be examined and receive the necessary treatment,” he says.
He adds that most people are not hospitalized for treatment because most recover with support, hydration and isolation. (The CDC believes that more than 99% of patients survive, but some researchers worry that monkeypox could mutate and become dangerous).
Not addressing the stigma early can create a sense of complacency in other segments of the population, who may not be aware of the public health emergency, Titanji adds.
He said public health officials need to act early and offer messages that are not only overt, but that earn the public’s trust and reciprocation. For him personally, this includes sticking to the facts, acknowledging the unknown, and making it clear that information can change as science progresses.
Cianciotto says there are three key pieces of information he wants to share with men who have sex with men.
“First, be aware, but don’t panic,” he says. “The second is if they have flu-like symptoms or start to develop a rash, they should seek medical attention and stay home, right? The third is just taking care of each other, right? The second is about that. — knowing and understanding that we’re dealing with COVID- Like we did for 19. If we’re not feeling well, don’t go out, get us the help we need, and care for and educate each other.
What the fight against HIV/AIDS can teach us
Public health experts and advocates look to the HIV/AIDS crisis of the 1980s and 1990s as an example of what not to do.
Titanji explains that some of the first cases of HIV were identified in gay men, which quickly and inaccurately became known as the “gay disease.”
Stigma and condemnation have caused many people to feel shame and suffering in the LGBTQ community. It also meant that public health officials did not devote adequate resources to dealing with the outbreak when it first started.
“Looking back, we know that the impact of this stigma from the early days of the HIV response has persisted years later, and we’ve been working to destigmatize HIV ever since,” says Titanji. He added that he sees parallels with the monkey epidemic today.
Cianciotto of the Gay Men’s Health Crisis says one of the most important outcomes of the HIV/AIDS crisis is the value of a sex-positive approach to education. He points to New York City, where thousands of appointments for monkeypox vaccines are filled within hours, suggesting that people in vulnerable groups will take appropriate action if given the right information.
“We’re not going to eliminate HIV, and we’re not going to reduce the epidemic of monkeypox by making people not have sex or by shaming only certain types of sex with certain people,” he adds. “When you equip people with the information they need to make the right choices for themselves and their community, and help them make those decisions with self-love and acceptance, it’s amazing what a community can achieve.”