By DR. JOY MARTINEZ, Staff Writer
Disease has a way of shining a light on the darker parts and responses of any society. SARS-COV-2 has certainly exposed our vulnerabilities and biases with COVID-19, and the monkeypox virus is doing it again.
Monkeypox isn’t new. The first known human case was recorded more than half a century ago in the Democratic Republic of Congo (DRC). Since then, it has been primarily associated with a number of countries in west and central Africa, although there was a small outbreak in the U.S. in 2003. But, when dealing with illness, sickness and disease, it’s important to reach any disproportionately affected community with non-alarmist, fact-based messaging that provides people with tools they can use to protect themselves and others.
With 6,326 confirmed cases, the United States now has more monkeypox cases than any other country in the world, and the Centers for Disease Control and Prevention (CDC) expects cases to continue to climb. Mecklenburg County health leaders said Monday that transmission of monkeypox is accelerating locally for the first time. Total infections for the virus is trending upward, said Mecklenburg County Health Director Dr. Raynard Washington. As of Aug. 1, the county confirmed 33 cases of monkeypox in Mecklenburg — up from 12 cases on July 20. That’s an increase of 175 percent. “The trend we’re seeing right now is for new cases to double every three to four days roughly,” Washington said.
Many—though not all—of the reported cases have been among gay and bisexual men. Given this, the CDC is focusing on identifying and using specific channels of communication and messaging that will directly reach gay and bisexual men across racial, ethnic, socioeconomic, and geographic backgrounds.
Current messaging left many confused and believing monkeypox is a sexually transmitted infection, and it isn’t known if the virus is transmitted through semen or vaginal fluid. Though monkeypox may not be transmitted through sexual activity, it has been able to take hold in social and sexual networks in which people have close skin-to-skin contact. Language conflating monkeypox and sexuality, however, stigmatizes the community of men who have sex with men, and carries the risk of “driving people away from health services, impeding efforts to identify cases, and encouraging ineffective, punitive measures,” as Matthew Kavanagh, UNAIDS Deputy Executive Director, said.
Now, the world is seemingly falling into a historical script of perpetuating stigma and structural inequity that has shown up in responses to other outbreaks. HIV, for example, is portrayed as a disease of gay men and Africans again and again, and COVID-19 focused on Asians and is still outrageously coined the “China Virus.” Since the Ebola epidemic of 2013-2016, monkeypox has been pushed aside from its status as an important international priority, despite the fact that outbreaks continue to appear.
Spreading through skin-to-skin contact, the disease is most often transmitted through sexual activity, and the World Health Organization (WHO) continues to urge gay and bisexual men to limit their sexual partners. But this came at a high social cost, as critics lambasted the organization charging that fixating on how the virus impacts different populations is unproductive and unhelpful.
Not everyone agrees. “At the end of the day, it’s not homophobic to say that certain groups are disproportionately impacted by the monkeypox outbreak,” said Grant Roth, who is part of a network that collects information about the disease. Dr. Don Weiss, a New York City Department of Health senior epidemiologist was reassigned within the department after speaking out about the city’s politically correct messaging on the monkeypox outbreak doubled down on his criticisms and also took aim at the city’s coronavirus response.
The Department of Health issued a statement saying, “For decades, the L.G.B.T.Q.+ community has had their sex lives dissected, prescribed, and proscribed in myriad ways, mostly by heterosexual and cis people.” The department argued that “abstinence-only guidance” has historically “poorly” performed and that it crafted its guidance “with this disgraceful legacy in mind,” according to a statement.
According to Weiss, a 22-year veteran of the department and its most senior communicable disease epidemiologist, “Too often public health policy has cared more about optics than data.” Weiss wrote a letter to New York City Health Commissioner Ashwin Vasan in July arguing that department leadership “is more concerned with stigma avoidance” for gay men rather than “giving people the risk information they need to protect themselves and others. People are suffering.”
The way leadership communicates about the virus is a delicate balance. On one end, it tends to make people who are disproportionately impacted feel fatalistic and less likely to seek help. On the other end, it makes those who have been less impacted inaccurately believe they are less vulnerable. Both allow the virus to continue to spread more rapidly. Overemphasis on one demographic can lead to assumptions about why the disparity in infection rates in social networks exist, and activates harmful stereotypes.
Dr. Joseph Lee, a professor of health education and promotion at East Carolina University who has studied public health messaging says, “We need to make sure we’re getting the right people involved in reaching the right communities and saying things in a way that resonates, because the harm of getting it wrong is real and hard to repair.”
“You can recognize that there are differences and that’s important to do, but it doesn’t mean it has to be the emphasis or message of the campaign. It just tells you who the messaging needs to go to,” Lee said.
Joaquín Carcaño, the director of community organizing at the Latino Commission on AIDS, said “When you say no sex, you’re mischaracterizing that MPV, also known as monkeypox, is a sex-associated transmission, which it can be, but it’s not the end all be all.”
Since June, the CDC has said it has made a concerted effort to do extensive education and outreach to the LGBTQ community. The agency says it has worked with umbrella organizations for local Pride committees, released educational videos, engaged with groups that work with health disparities and industries whose workers may be exposed to monkeypox. There are agency generated awareness campaigns on Instagram and on dating apps popular with the gay community like Scruff, Adam4Adam and Grindr. The CDC is also planning to participate in listening sessions with LGBTQ community groups.
But those efforts have not shortened the lines for vaccines or eliminated the extensive paperwork necessary to get access to treatments.
Following the WHO, and in an effort to elevate their public health response and open access to emergency resources, California, Illinois and New York state have declared public health emergencies. San Francisco became the first major US city to declare a local health emergency last week, and New York City did so Saturday.
President Joe Biden announced that FEMA’s Robert Fenton will serve as the White House National Monkeypox Response Coordinator and Dr. Demetre Daskalakis, the current director of the CDC Division of HIV Prevention, will serve as the White House National Monkeypox Response Deputy Coordinator. The White House said Fenton and Daskalakis will lead the administration’s strategy and operations to combat the current monkeypox outbreak, including equitably increasing the availability of tests, vaccinations and treatments.
Monkeypox is spread through direct contact with an infectious rash, scabs, or body fluids. It’s found in respiratory secretions and is transmitted during prolonged, face-to-face contact, or during intimate physical contact, such as kissing, cuddling, or sex. You may become infected by touching objects, fabrics (such as clothing or linens) that previously touched the rash or body fluids of someone with monkeypox or being scratched or bitten by an infected animal. It’s important to remember, the virus can be acquired by all people, regardless of gender identity or sexual orientation.
Monkeypox can spread from the time symptoms start until the rash or any lesions have fully healed and a fresh layer of skin has formed, which can take several weeks.