Monkeypox Cases Are High in Gay, Bisexual Community. How Can We Prevent Stigma?

Until a few months ago, the monkeypox virus was rarely reported in humans outside of Africa. But as of July 23, the World Health Organization (WHO) has declared it a public health emergency of international concern.

According to current research, 98% of positive cases have been in gay or bisexual men, and transmission has largely been thought to occur during sexual activity.

These facts have lead to the spread of misinformation that monkeypox is a sexually transmitted infection, and that its transmission is strictly limited to the LGBTQIA+ community.

Both of these claims are inaccurate, and their spread could endanger not only LGBTQIA+ folks, but the population at large.

Monkeypox and Public Health Response

Monkeypox is a milder cousin of smallpox that was first detected in humans in 1970. It often appears as an itchy or painful rash and can be accompanied by flu-like symptoms of fever, muscle aches, chills, and swollen lymph nodes.

Typically, monkeypox is spread through prolonged skin-to-skin contact and large respiratory droplets from coughs or sneezes.

Epidemiologist Mackenzie Weise, MPH, CIC, notes that anyone can be at risk of contracting the virus, and failing to make that point clear can instill a false sense of security among the larger population.

Gay and bisexual men have been identified as the demographic with the highest risk based on data thus far, but "highest risk" is often the grayest area, she says.

"It's often preliminary, still evolving, and/or bound to change," Weise says.

Fortunately, the virus has a low fatality rate, and a vaccine that's 85% effective in preventing monkeypox is already available.

Licensed therapist Randy Smith, LMFT, facilitates a therapy group for gay men in Los Angeles, where a state of emergency has been declared over the monkeypox outbreak.

He has noted the concern in his patients, and while the men he treats have been supportive of each other and several have received the monkeypox vaccine with little to no side effects, Smith finds himself disappointed in the public health response to the outbreak.

"We should have received more pertinent information about the virus sooner and access to more vaccines at more locations in the L.A. area," Smith says.

"At this point, it is still challenging to get localized, convenient vaccine appointments."

Preventing Stigma

Weise points out that the link between the current outbreak of monkeypox and gay and bisexual men cannot be ignored but must be investigated carefully. Whether it's agreed upon or not, there's still social sensitivity around sexual behaviors and plenty of room for stigma.

"Public health officials are faced with a unique challenge here: a common need to warn those identified as vulnerable while the outbreak unfolds, paired with a unique need to ensure messaging isn't used to fuel already existing fears, discrimination, and discredit," Weise says.

"Any public health messaging around the current monkeypox outbreak which leverages broad, generalized statements and leaves room for public assumptions is greatly missing the mark and probably doing more damage than good."

Caroline Dorsen, PhD, whose research has focused on the role of stigma, bias, and discrimination in LGBTQIA+ health disparities, notes how the public health response is slower than is needed to contain an infectious disease that is "disproportionately impacting sexual and gender minority persons."

Preventing the stigma will be crucial in order to avoid a repeat scenario of the irreparable harm done to the LGBTQIA+ community during the HIV/AIDS crisis of the 1980s.

However, as Dorsen notes, we are now living in much different times, and decreasing stigma around monkeypox has been on the public health agenda from the start.

"Public health providers are aware of the mistakes of the past, especially of the role that stigma had in the tragic delayed response to HIV and the disastrous results that individual and structural level discrimination had in the unnecessary loss of life from AIDS," Dorsen says.

It is possible, though, that the current monkeypox outbreak could potentially trigger past trauma from the AIDS crisis among those who lived through it, those who cared for sick patients, and those who have lost loved ones, Dorsen says.

This could also be triggering for individuals who've worked on the front lines of the COVID-19 pandemic.

"Some people are absolutely going to need extra support due to the social isolation, anxiety, depression, and PTSD that monkeypox might trigger," she says.

"However, it is also my hope that our collective experience of trauma during the past two years will allow us to better empathize, protect, and care for each other without judgment or stigma."