The CDC has appealed to gay and bisexual men to be on the lookout for monkeybox. To some, that sounds like dangerous stigmatization.
AdvertisementWhen this link became clear, health officials responded swiftly. On Monday, John Brooks, head of the Epidemiology Research Team in the CDC’s Division of HIV/AIDS Prevention, made an explicit appeal to gay and bisexual men in a news briefing.
On Tuesday, the gay dating app Grindr, in partnership with local health agencies, displayed a to users across Europe; Brooks suggested in the press briefing that similar warnings may soon be coming to U.S. users.There’s an obvious sense in 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 with 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 through gay sex in particular. Itspread through skin-to-skin contact, and sex—gay, straight, or otherwise—tends to involve quite a bit of skin-to-skin contact. Though the possibility of sexual transmission can’t yet be definitively ruled out, there is no strong reason to think it is taking place when skin-to-skin contact can easily explain infection patterns, says Kartik Cherabuddi, associate professor of infectious diseases and global medicine at the University of Florida.As far as experts can tell, monkeypox is disproportionately affecting gay and bisexual men as a direct result of events where large numbers of men were repeatedly in close contact—sexual or otherwise—over the course of several days. “All it takes is one person who might have monkeypox” to prompt 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 is circulating within a particular community, members of that community become more likely to contract it—after all, gay and bisexual men are most likely to be in close physical contact with other gay and bisexual men. That, in Valdiserri’s view, is enough reason for public health organizations to work to raise awareness of monkeypox among gay and bisexual men. “The choices they make are their own choices, but you like to ensure that people have the appropriate information up front,” he says.But Tonia Poteat, associate professor of social medicine at the University of North Carolina, isn’t convinced that there is a strong public health imperative to reach out to gay and bisexual men in particular, at least at this point. Monkeypox is much, much less transmissible than SARS-CoV 2, and by Thursday the U.S.cases doesn’t necessarily translate into a similar bias amongcases. Because of HIV/AIDS, she says, gay and bisexual men are more likely to have contact with the health care system, and they are probably more likely to seek immediate medical attention for a new, unexplained rash.Given those facts, Poteat says, the messaging could have looked quite different. “What we know is how monkey pox is transmitted,” she says. “That’s what people really need to know. They don’t necessarily need to know the sexual behavior or the sexual orientation of people who might have been identified.” After all, scientists think monkeypox can be spread through any sort of close contact—hugging, contact sports, touching someone’s bed linens or towels—not just sex. But the statistical association between monkeypox and gay and bisexual men has become a focus—and now that it has, Valdiserri says he does does worry about the risk of compounding stigmas. Infectious disease and sex, and sexually transmitted diseases in particular, are already highly stigmatized. Even though monkeypox does not appear to be sexually transmitted in the traditional sense , sex is a likely cause of its spread, and it has now been publicly linked to events and locations, like a fetish festival and a gay sauna, that might push the margins of acceptability for some people. And the discomfort and fear that people may feel about an outbreak of a new disease, and about certain types of sex, may then adhere to gay and bisexual men as a group.“It sort of feeds this message that men who have sex with men are somehow more infectious in some way than other people—and that’s a dangerous subtext,” Poteat says. Another is that sexual behaviors could become the focus in attributing blame for monkeypox. That blame can be dangerous when directed toward a marginalized group—as has been the case for Asian Americans during the COVID pandemic—and it can cover up other roots of disease spread, like global inequality. “We have to be very careful not to to stigmatize sexual behavior precisely because that deters us from understanding that structural violence is at play,” Cheng says. He notes that activists during the early days of the HIV/AIDS epidemic called for structural remedies like universal health care and housing, and that the continued lack of those remedies today played a major role in the spread of COVID in the U.S.
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