Reviews | Gay men deserve the straight truth about monkeypox
This broad strokes maxim – that everyone on Earth is susceptible to this troubling viral infection – might be factual on its surface. But it’s so misleading that it amounts to misinformation.
Those who make such statements do not intend to harm. On the contrary, the leaders of the Centers for Disease Control and Prevention, the World Health Organization and elsewhere repeat them because they commendably want to combat the societal stigma faced by gay and bisexual men, who have been disproportionately affected by monkeypox. They know that stigma harms public health, including discouraging testing for infectious diseases. And they don’t want the rest of the public to be complacent about a potential new pandemic.
But as these public health experts well know, epidemiology is less concerned with whether somebody could getting an infection; instead, far more vital questions focus on groups of people most likely being exposed to a pathogen, contracting it and why. In public health statistics, it is the study of relative risk.
By reducing the risk of monkeypox to a simplistic binary equation, public health officials are prioritizing the fight against stigma rather than their duty to directly inform the public about the true contours and drivers of this global epidemic. . In particular, they fail to properly convey the seriousness of this emerging crisis to gay and bisexual men.
Here’s what we can discern from the data collected so far on monkeypox: This viral outbreak is not just occurring primarily among men who have sex with men. Confirmed cases, at least to date, have always occurred almost entirely among this demographic, which accounts for 96% or more of diagnoses for which data is available.
On a per capita basis, the few cases of monkeypox in women and children remain miniscule compared to the rate in gay and bisexual men. Of course, substantial transmission could still occur among these other groups. But researchers at the WHO and elsewhere have speculated that the reproductive rate of monkeypox is likely to remain significantly lower in these demographics – meaning the virus is more likely to reach transmission dead ends among them than among gay and bisexual men.
An uncomfortable truth, documented in peer-reviewed articles, is that the sexual behaviors and networks specific to gay and bisexual men have long made them more susceptible to various sexually transmitted infections compared to heterosexual people. This includes not only HIV, but also syphilis, gonorrhea, chlamydia, hepatitis B and sexually transmitted hepatitis C.
Global Public Health Experts I agree that skin-to-skin contact in the context of male-to-male sexual activity has been the primary driver of the monkeypox epidemic, at least so far.
These experts also claimed that the risk of monkeypox for the general population without multiple sexual partners remains low – same “very slow.” This is hopeful news, and the general public deserves to be reassured accordingly. Allaying fears of contagion will help combat unnecessary hysteria and prevent gay and bisexual men from being subjected to even greater stigma if they are portrayed as guilty of spreading the virus to others.
Such enmity devastated the gay community at the height of the AIDS crisis, when the CDC ran a long, deceptive public service campaign with variations of the slogan “anyone can get HIV/AIDS.” These claims belied the truth about the relative risk of HIV, which in Western countries has traditionally primarily affected gay and bisexual men.
As with the monkeypox epidemic, recently launched vaccination campaigns are appropriately targeting this group, particularly those who report multiple recent sexual partners, which data show is associated with acquiring the monkeypox. Unfortunately, state and local public health departments in the United States do not report vital demographic details about people diagnosed with monkeypox to the CDC. This hampers the country’s ability to respond to the epidemic with impactful interventions, such as targeted vaccines, and to promote health equity.
In contrast, the rich data collection in Britain helps answer the question of whether monkeypox appears to occur primarily only in gay and bisexual men, as the vast majority of tests are carried out among them. As we know from covid-19, differences in test positivity rates help control differences in test rates. And these figures in Britain are striking: the UK health security agency reported that half of men screened for monkeypox tested positive; women, on the other hand, only tested positive 0.6% of the time. No one under the age of 18 has tested positive.
Tragically, the monkeypox outbreak is occurring just as a shocking resurgence of anti-LGBTQ sentiment is gripping the United States. But public health officials cannot be expected to control public reactions to epidemiological facts.
Gay men deserve to hear the unvarnished truth about monkeypox so we can act on it. We are adults. Please be honest with us.